Affective Disorders Flashcards
What are mood disorders?
Disorders of mental state and function where altered mood is a core feature
Name two common mood disorders
Depression and mania
What can cause mood disorders?
- Primary
- Secondary: cancer, dementia, drug misuse, medical treatment etc.
Which disorder is often associated with mood disorders?
Anxiety disorders (and their symptoms
Name the two classification systems for mood disorders
- ICD-10
- DSM-5
What is depression?
- Symptom: a systemic symptom which is typically considered a form of sadness, not just the absence of happiness
- Syndrome: a constellation of signs and symptoms
- Recurrent Illness: recurrent depressive disorder
When does depression become abnormal?
- No clear/convenient division
- Consensus problematic
- Persistence of symptoms
- Pervasiveness of symptoms
- Degree of impairment
- Presence of specific symptoms or signs
List the potential psychological symptoms of depression
- Depression
- Anxiety
- Perplexity
- Anhedonia
- Guilt
- Hopelessness
- Worthlessness
- Neurotic Sympomatology: hypochondriasis, agroraphobia, obsessions and compulsions and panic attacks
List the potential physical symptoms of depression
- Fatigue
- Disturbed sleep pattern (insomnia or sleeping too much)
- Appetite changes
- Libido
- Constipation
- Pain
- Agitation
- Retardation
List the potential social symptoms of depression
- Loss of interests
- Irritability
- Apathy
- Withdrawal, loss of confidence and indecisiveness
- Loss of concentration, registration and memory
According to the ICD-10, which features would be in keeping with a diagnosis of depression (not symptoms)?
- Lasts for at least 2 weeks
- No hypomanic or manic episodes in lifetime
- Not attributable to psychoactive substance use or organic mental disorder
- If psychotic syndromes or stupor then severe depression with psychotic symptoms (other psychotic illnesses need excluded first)
What are the features of depression as a 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 two hours before the normal time
- Depression is worse in the morning
- Objective evidence of psychomotor agitation or retardation
- Marked loss of appetite
- Weight loss
- Marked loss of libido
List the possible differential diagnosis for depression
- Normal reaction to life event
- SAD
- Dysthymia
- Cyclothymia
- Bipolar
- Stroke, tumour or dementia
- Hypothyroidism, Addison’s or hyperparathyroidism
- Infections: influenza, infectious mononucleosis, hepatitis, HIV/AIDs
- Drugs
List the potential treatments for depression
- Antidepressants: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monamine oxidase inhibitors etc.
- Psychological treatments: CBT, IPT, individual dynamic psychotherapy and family therapy
- Physical treatments: ECT, psychosurgery, DBS and VNS
Name the two most commonly used measurement tools for depression
- Structured clinical interview for DSM disorders (SCID)
- Schedules for clinical assessment in neuropsychiatry (SCAN)
What is mania?
- A form of pathological, inappropriate elevated mood
- Often associated with grandiose ideas, disinhibition, loss of judgement with similarities to the mental effects of stimulant drugs (AMPH and cocaine)
What are the features 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 and decreased need for sleep
- May be irritable
- Reduced concentration, new interest and mild overspending
- Not to the extent of severe disruption of work or social rejection
What are the criteria for classifying someone as having mania?
- 1 week
- Severe enough to disrupt ordinary work and social activities more or less completely
- Elevated mood, increased energy, overactivity, pressure of speech and decreased need for sleep
- Disinhibition
- Grandiosity
- Alteration of senses
- Extravagant spending
- Can be irritable rather than elated
List the differential diagnosis for mania
- Psychiatric: mixed affective state, schizoaffective disorder, schizophrenia, cyclothymia, ADHD, drugs and alcohol
- Medical: stroke, MS, tumour, epilepsy, AIDs, neurosyphilis, Cushing’s, hyperthyroidism and SLE
Which tools can be used to measure the symptoms of mania?
- SCID
- SCAN
- Young mania rating scale (YMRS)
List the treatment options for mania
- Antipsychotics: olanzapine, riperidone and quetiapine
- Mood stabilisers: sodium valproate, lamotrigene and carbamazepine
- Lithium
- ECT
What are the criteria for a diagnosis for bipolar affective disorder?
-Repeated (2+) episodes of depression and mania or hypomania
What are the features of depression according to ICD-10?
D-Depressed mood most of the day E-Lack of Energy A-Anhedonia D-Death thoughts S-Sleeplessness W-Worthlessness or excessive guilt A-Changes in appetite M-Decreased mentation P-Psychomotor retardation
What are the features of mania according to ICD-10?
D-Distractibility I-Irritability G-Grandiosity F-Flight of Ideas A-Increased activity S-Reduced sleep and increased speech T-Thoughtlessness (risk taking, impulsivity etc.)
