Affective Disorders Flashcards
What are affective disorders?
The central feature of these disorders is an abnormality of mood. Mood is best described in terms of a continuum ranging from severe depression at one extreme to severe mania at the other, with the normal, stable mood in the middle. Mood disorders are divided into unipolar and bipolar affective disorders.
What is cyclothymia?
Below threshold version of bipolar
What is dysthymia?
Below threshold version of depression
What are the clinical features of depression?
Mood- Depressed, miserable or irritable
Talk- Impoverished, slow, monotonous
Energy- Reduced, lethargic, lacking motivation
Ideas- Feelings of futility, guilt, self-reproach, unworthiness, hypochondriacal preoccupations, worrying, suicidal thoughts, delusions of guilt, nihilism and persecution
Cognition- Impaired learning, pseudodementia in elderly patients
Physical- Insomnia (especially early waking), poor appetite and weight loss, constipation, loss of libido, erectile dysfunction, bodily pains
Behaviour- Retardation or agitation, poverty of movement and expression
Hallucinations Auditory – often hostile, critical
What four things make depression an illness?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs
What are the psychological symptoms of depression?
CHANGE IN MOOD DEPRESSION May find diurnal variation ANXIETY inability to relax PERPLEXITY particularly in Puerperal illness ANHEDONIA CHANGE IN THOUGHT CONTENT GUILT HOPELESSNESS WORTHLESSNESS ANY NEUROTIC SYMPOMATOLOGY e.g.. Hypochondriasis, agoraphobia, obsessions & compulsions, panic attacks. IDEAS OF REFERENCE DELUSIONS AND HALLUCINATIONS if severe
What are the physical symptoms of depression?
CHANGE IN BODILY FUNCTION ENERGY Fatigue SLEEP APPETITE weight loss LIBIDO CONSTIPATION PAIN CHANGE IN PSYCHOMOTOR FUNCTIONING AGITATION RETARDATION
What are the social symptoms of depression?
LOSS OF INTERESTS
IRRITABILITY
APATHY
WITHDRAWAL, LOSS OF CONFIDENCE, INDECISIVE
LOSS OF CONCENTRATION, REGISTRATION & MEMORY
What is anhedonia?
loss of ability to derive pleasure from experience
What are retardation and stupor in terms of depression?
RETARDATION a slowing of motor responses including speech
STUPOR a state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking. On recovery can describe clearly events which occurred whilst stuporose
How long should depression last to make it an illness in the ICD-10?
2 weeks
What is 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 2 hrs before the normal time
Depression worse in the 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
What symptoms must be had for it to be mild depression?
General criteria
At least two of
Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatigability
Additional from this list to give at least 4
Loss of confidence or self esteem
Unreasonable feelings of guilt or 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 symptoms must be had for it to be moderate depression?
General criteria
At least two of
Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatigability
Additional from this list to give at least 6
Loss of confidence or self esteem
Unreasonable feelings of guilt or 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 symptoms must be had for it to be severe depression?
General criteria
All of
Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatiguability
Additional from this list to give at least 8
Loss of confidence or self esteem
Unreasonable feelings of guilt or 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
If depression also includes psychosis what is it graded as?
Severe
What are maternity blues?
Maternity blues’ describe the brief episodes of emotional lability, irritability and tearfulness that occur in about 50% of women 2–3 days postpartum and resolve spontaneously in a few days.
What is postpartum psychosis?
Onset is usually within the first 2 weeks following delivery. In addition to the classical features of an affective psychosis, disorientation and confusion are often noted. Severely depressed patients may have delusional ideas that the child is deformed, evil or otherwise affected in some way, and such false ideas may lead to either attempts to kill the child or suicide.
What are differential diagnoses for depression?
Normal reaction to life event SAD Dysthymia Cyclothymia Bipolar Stroke, tumour, dementia Hypothyroidism, Addison’s, Hyperparathyroidism Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS Drugs
What treatments are available for depression?
Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs) Tricyclic antidepressants (TCAs) Monamine Oxidase Inhibitors Other antidepressants Psychological Treatments CBT, IPT, Individual dynamic psychotherapy, family therapy Physical Treatments ECT, Psychosurgery, DBS, VNS
What are SSRI’s?
Selective serotonin reuptake inhibitors (SSRIs) selectively inhibit the reuptake of the monoamine serotonin (5-HT) within the synapse
Citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine and sertraline
SSRIs do not usually lead to significant weight gain.
The most common adverse effects of SSRIs resemble a ‘hangover’ and include nausea, vomiting, headache, diarrhoea and dry mouth. Insomnia and paradoxical agitation can occur when first starting the drugs. Adolescents, in particular, may develop suicidal thoughts with SSRIs; for this reason, only fluoxetine is licensed in the UK for adolescents.
Because of their long half-lives, they can also be given just once a day, normally in the morning after breakfast. SSRIs are now first-line treatments for depressive disorders
Risk of bleeding
Prolonged QTc interval
What is serotonin syndrome?
Serotonin syndrome’ is a toxic hyper-serotonergic state, which can be caused by the ingestion of two or more drugs that increase serotonin levels, e.g. an SSRI combined with a monoamine oxidase inhibitor, a dopaminergic drug (e.g. selegiline) or a tricyclic antidepressant. Symptoms include agitation, confusion, tremor, diarrhoea, tachycardia and hypertension; hyperthermia is characteristic. This is a medical emergency
What are tricyclic antidepressants?
Tricyclic antidepressants (TCAs) potentiate the action of the monoamines, noradrenaline (norepinephrine) and serotonin, by inhibiting their reuptake into nerve terminals
nortriptyline, doxepin and clomipramine, lofepramine
Dosulepin, imipramine and amitriptyline are the three most commonly used
Side effects include Dry mouth, Constipation, tremor, Blurred vision, Urinary retention, QT prolongation, Arrhythmias, Postural hypotension, Convulsant activity, Lowered seizure threshold, Weight gain, Sedation,
Mania (rarely)
What are serotonin and noradrenaline reuptake inhibitors, SNRIs)?
Venlafaxine is a potent blocker of both serotonin and noradrenaline (norepinephrine) reuptake. At higher doses, it also affects dopamine transmission
What are tetracyclics?
Trazodone is a tetracyclic compound that acts as a serotonin antagonist (except at 5-HT1A receptors, where it acts as a partial agonist) and reuptake inhibitor. Also used for insomnia due to its sedative effects
What is mirtazapine?
5-HT2 and 5-HT3 receptor antagonist and a potent α2-adrenergic blocker
What are Noradrenaline (norepinephrine) reuptake inhibitors (NRIs)?
Reboxetine
Can also treat panic disorders and attention deficit disorders
What are monoamine oxidase inhibitors?
Monoamine oxidase inhibitors (MAOIs) act by irreversibly inhibiting the intracellular enzymes monoamine oxidase A and B, leading to an increase of noradrenaline (norepinephrine), dopamine and 5-HT in the brain
Only used by psychiatrists
moclobemide, Selegiline, Agomelatine
When is lithium used in depression?
When two trials of antidepressants have failed, lithium can be added in
What is mania?
The clinical features of mania include a marked elevation of mood, characterized by euphoria, over-activity and disinhibition
Almost always occurs as part of bipolar disorder
What is hypomania?
Hypomania lasts a shorter time and is less severe, with no psychotic features and less disability. Hypomania can be distinguished from normal happiness by its persistence, non-reactivity (not provoked by good news and not affected by bad news) and social disability
What are the clinical features of mania
Mood Elevated or irritable
Talk Fast, pressurized, flight of ideas
Energy Excessive
Ideas Grandiose, self-confident, delusions of wealth, power, influence or of religious significance, sometimes persecutory
Cognition Disturbance of registration of memories
Physical Insomnia, mild to moderate weight loss, increased libido
Behaviour Disinhibition, increased sexual activity, excessive drinking or spending
Hallucinations Fleeting auditory
What is the ICD description of hypomania?
Lesser degree of mania, no psychosis,
Mild elevation of mood for several days on end
Increased energy and activity, marked feeling of wellbeing
Increased sociability, talkativeness, overfamiliarity, increased sexual energy, 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
What is the ICD description of mania?
1 Week, severe enough to disrupt ordinary work and social activities more or less completely
Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
Disinhibition
Grandiosity
Alteration of senses
Extravagant spending
Can be irritable rather than elated
What is the treatment for mania?
Anti psychotics- Olanzapine Risperidone Quetiapine Can add valproate or lithium if response isnt enough ECT
What is the ICD description of bipolar disease?
Bipolar Affective Disorder consists of repeated (2+) episodes of depression and mania or hypomania.
If no mania or hypomania then diagnosis is recurrent depression.
If no depression the diagnosis is hypomania or bipolar disorder
(In DSM-5 a single episode of mania is sufficient to diagnose bipolar disorder.)
What is bipolar affective disorder?
Bipolar disorder, previously termed manic depression, is a psychiatric diagnosis characterised by abnormally elevated or irritable mood episode(s) accompanied by disruptive symptoms of distractibility, indiscretions, grandiosity, flight of ideas, hyperactivity, decreased need for sleep, and talkativeness. Manic episodes include a clustering of these symptoms over at least a period of 1 week, and are more disruptive than hypomania (milder symptoms, >4 days’ duration). It is marked by alternating mood elevation (mania or hypomania) and depression
What are the management options for bipolar disorder?
Antipsychotics Mood stabilizers Clonazepam can be added to therapy if it isnt working Clozapine ECT
