Affective Disorders Flashcards
What are mood disorders?
Disorders of mental status and function where altered mood is the core feature.
It is the commonest group of mental disorders.
What are some features of mood disorders?
Can be primary problem or secondary to another disorder e.g. cancer, dementia, drug misuse.
They are often associated with anxiety symptoms and anxiety disorders.
What are some classification methods for mental disorders?
ICD-10 - international Classification of Disease 10th edition by the WHO.
DSM-5 - Diagnostic and Statistical manual of mental disorders 5th edition by the American Psychiatric Association.
When does depression become abnormal?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs.
How do symptoms of depressive illness occur?
3 spheres;
psychological
physical
social
What symptoms are involved in the psychological sphere?
Change in mood: Depression Anxiety Perplexity Anhedonia
Change in thought content: Guilt Hopelessness Worthlessness Any neurotic symptomatology Ideas of reference Delusions and hallucinations
What are the symptoms of the physical sphere?
Change in Bodily function: energy sleep appetite libido constipation pain
Change in pyschomotor functioning:
agitation
retardation
What are the symptoms of the social sphere?
Loss of interests irritability apathy withdrawal Loss of confidence indecisive loss of concentration, registration and memory.
What is agitation?
a state of restless overactivity, aimless or ineffective.
What is anhedonia?
loss of ability to derive pleasure from experience.
What is apathy?
loss of interest in own surroundings.
What is anxiety?
an unpleasant emotion in which thoughts of apprehension or fear predominate.
What is depression?
An unpleasant emotion in which sadness or unhappiness predominates.
What is retardation?
a slowing of motor responses including speech.
What is stupor?
a state of extreme retardation in which consciousness is in tact. The patient stops moving, speaking, eating and drinking. On recovery can describe events clearly.
How does the ICD-10 define depression?
Lasts for 2 weeks
No hypomanic or manic episodes in lifetime.
Not attributable to psychoactive substance use or organic mental disorder.
If there are psychotic symptoms or stupor then it is severe.
How does the ICD-10 classify somatic syndrome?
Marked loss of interest or pleasure in activities that are normally pleasurable.
Lack of emotional reactions to events or activities that normally produce an emotional response.
Waking 2hrs before the normal time.
Depression worse in morning
Objective evidence of psychomotor agitation or retardation.
Marked loss of appetite
Weight loss (5%+ of body weight in a month).
Marked loss of libido.
How does the ICD-10 classify mild depression?
Need at least 2 from general criteria of depressed mood that is abnormal for most of the day, almost everyday for 2 weeks, largely uninfluenced by cirucmstances, loss of interest or pleasure or decreased energy or increased fatiguability.
Additional from this list to give 4; Loss of confidence of self-esteem Unreasonable feelings of guilt, self-reproach or excessive guilt. Recurrent thoughts of death by suicide or any suicidal behaviour. Decreased concentration Agitation or retardation Sleep disturbance of any sort Change in appetite.
How does the ICD-10 classify moderate depression?
At least 2 from general list of depressed mood that is abnormal for most of the day, almost everyday for 2 weeks, largely uninfluenced by cirucmstances, loss of interest or pleasure or decreased energy or increased fatiguability.
And additional 4 from this list to give 6:
Loss of confidence of self-esteem
Unreasonable feelings of guilt, self-reproach or excessive guilt.
Recurrent thoughts of death by suicide or any suicidal behaviour.
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite.
How does ICD-10 classify severe depression?
All of general criteria:
depressed mood that is abnormal for most of the day, almost everyday for 2 weeks, largely uninfluenced by circumstances, loss of interest or pleasure or decreased energy or increased fatiguability.
And an additional 6 to give 8 from this list:
Loss of confidence of self-esteem
Unreasonable feelings of guilt, self-reproach or excessive guilt.
Recurrent thoughts of death by suicide or any suicidal behaviour.
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite.
What are some treatment options for Depression?
Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic antidepressants (TCAs), Monamine Oxidase Inhibitors
Psychological treatments - CBT, IPT, Individual dynamic psychotherapy.
Physical treatments - ECT, Psychosurgery, DBS, VNS
What are some measurement tools used to assess affective disorders?
SCID (Structured Clinical Interview of DSM disorders)
SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
HDRS (Hamilton Depression Rating Scale)
BDI-II (Beck Depression Inventory II)
HADS (Hospital Anxiety and Depression Scale)
PHQ-9 (Patient Health Questionnaire 9)
What is Mania?
A state of feeling or mood that can range from near-normal to life threatening illness. Grandiose ideas, disinhibition, loss of judgement, inappropriate levelled mood with similarities to the mental effects of stimulant drugs.
How does the ICD-10 classify Hypomania?
Lesser degree of mania as there is no psychosis.
Mild elevation of mood for several days on end.
Increased energy and activity, marked feeling of well-being.
Increased sociability, talkativeness, overfamiliarity, increased sexual energy and decreased need for sleep.
May be irritable
Concentration reduced, new interests, mild overspending.
Not to the extent of severe disruption of work or social rejection.
How does the ICD-10 classify Mania?
1 week of symptoms severe enough to disrupt ordinary work and social activities more or less completely.
Elevated mood, increased energy, overactivity, pressure of speech, decreased need fo sleep.
Disinhibition
Grandiosity
Alteration of senses
Extravagant spending
Can be irritable rather than elated.
What measurement tools can be used to assess Mania?
SCID
SCAN
Young Mania Rating Scale (YMRS)
What are the treatment options for Mania?
Antipsychotics - Olanzapine, Risperidone, Quetiapine
Mood stabilisers - Sodium Valproate, Lamotrigine, Carbamazepine
Lithium
ECT
How does the ICD-10 classify Bipolar Affective disorder?
Repeated episodes of depression and mania or hypomania.
If no mania then diagnosis is recurrent depression.
If no depression the diagnosis can be hypomania or bipolar disorder.
What is the clinical course of major depression?
Typical episode last 4-6months. Treatment takes 4-6 weeks to kick in.
What is the clinical course of Mania and Bipolar disorder?
Typical manic episode lasts 1-3 months.
