Affective Disorders

Question 1

What are mood disorders?

Answer 1

Disorders of mental status and function where altered mood is the core feature.
It is the commonest group of mental disorders.

Question 2

What are some features of mood disorders?

Answer 2

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.

Question 3

What are some classification methods for mental disorders?

Answer 3

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.

Question 4

When does depression become abnormal?

Answer 4

Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs.

Question 5

How do symptoms of depressive illness occur?

Answer 5

3 spheres;
psychological
physical
social

Question 6

What symptoms are involved in the psychological sphere?

Answer 6

Change in mood:
Depression
Anxiety
Perplexity
Anhedonia

Change in thought content:
Guilt
Hopelessness
Worthlessness
Any neurotic symptomatology
Ideas of reference
Delusions and hallucinations

Question 7

What are the symptoms of the physical sphere?

Answer 7

Change in Bodily function:
energy
sleep
appetite
libido
constipation
pain

Change in pyschomotor functioning:
agitation
retardation

Question 8

What are the symptoms of the social sphere?

Answer 8

Loss of interests
irritability
apathy
withdrawal
Loss of confidence
indecisive
loss of concentration, registration and memory.

Question 9

What is agitation?

Answer 9

a state of restless overactivity, aimless or ineffective.

Question 10

What is anhedonia?

Answer 10

loss of ability to derive pleasure from experience.

Question 11

What is apathy?

Answer 11

loss of interest in own surroundings.

Question 12

What is anxiety?

Answer 12

an unpleasant emotion in which thoughts of apprehension or fear predominate.

Question 13

What is depression?

Answer 13

An unpleasant emotion in which sadness or unhappiness predominates.

Question 14

What is retardation?

Answer 14

a slowing of motor responses including speech.

Question 15

What is stupor?

Answer 15

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.

Question 16

How does the ICD-10 define depression?

Answer 16

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.

Question 17

How does the ICD-10 classify somatic syndrome?

Answer 17

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.

Question 18

How does the ICD-10 classify mild depression?

Answer 18

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.

Question 19

How does the ICD-10 classify moderate depression?

Answer 19

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.

Question 20

How does ICD-10 classify severe depression?

Answer 20

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.

Question 21

What are some treatment options for Depression?

Answer 21

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

Question 22

What are some measurement tools used to assess affective disorders?

Answer 22

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)

Question 23

What is Mania?

Answer 23

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.

Question 24

How does the ICD-10 classify Hypomania?

Answer 24

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.

Question 25

How does the ICD-10 classify Mania?

Answer 25

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.

Question 26

What measurement tools can be used to assess Mania?

Answer 26

SCID
SCAN
Young Mania Rating Scale (YMRS)

Question 27

What are the treatment options for Mania?

Answer 27

Antipsychotics - Olanzapine, Risperidone, Quetiapine

Mood stabilisers - Sodium Valproate, Lamotrigine, Carbamazepine

Lithium
ECT

Question 28

How does the ICD-10 classify Bipolar Affective disorder?

Answer 28

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.

Question 29

What is the clinical course of major depression?

Answer 29

Typical episode last 4-6months. Treatment takes 4-6 weeks to kick in.

Question 30

What is the clinical course of Mania and Bipolar disorder?

Answer 30

Typical manic episode lasts 1-3 months.