Affective Disorders Flashcards
What are mood disorders
Disorders of mental status and function where altered mood is the core feature (depression or elevated mood-mania)
Classification systems for mood disorders?
ICD-10 International Classification of Disease 10th Edition- WHO
DSM-5 Diagnostic and statistical manual of mental disorder 5th Edition- American Psychiatric Association
Symptoms of depressive illness occur in 3 spheres, what are they?
Psychological
Physical
Social
Depression symptoms in the psychological sphere?
Change in mood: Depressed Anxiety, Perplexity, Anhedonia Change in thought content: Guilt, Hopelessness, Worthlessness, Neurotic sympomatology eg hypochondriasis, agoraphobia, obsessions and compulsions, panic attacks, Ideas of reference, Delusions and hallucinations
Depression symptoms in the physical sphere?
Change in bodily function: Energy, Sleep, Appetite, Libido, Constipation, Pain Change in psychomotor functioning: Agitation, Retardation
Depression symptoms in the social sphere?
Loss of interests,
Irritability,
Apathy,
Withdrawal, loss of confidence, indecisive,
Loss of concentration, registration and memory
Define anhedonia
Loss of ability to derive pleasure from experience
Define retardation
A slowing of motor responses including speech
Define stupor
A state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking.
When remover the patient can describe events during clearly
ICD-10 criteria of depression
Lasts for 2 weeks,
No hypomanic or manic episodes in lifetime,
Not attributable to psychoactive substance use or organic mental disorder
If a patient presents with psychotic symptoms or stupor with depression symptoms what needs to be ruled out before the final diagnose of depression can be made?
Other psychotic illnesses like schizophrenia
What is depression somatic syndrome?
extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning
What is the general criteria for depression?
At least 2 of:
Depressed mood that is abnormal for most of the day almost everyday for past 2 weeks, largely uninfluenced by circumstances,
Loss of interest or pleasure,
Decreased energy or increased fatigability
What are the additional symptoms experienced in depression?
Loss of confidence or self esteem, Unreasonable feelings of guilt or self reproach or excessive guilt, Suicidal thoughts, Decreased concentration, Agitation or retardation, Sleep disturbance, Change in appetite
Mild depression
At least 4 criteria from list
Moderate depression
6 criteria from list
Severe depression
At least 8 criteria from list
What percentage of woman experience baby blues within 2 weeks postpartum
75%
What percentage of woman experience major depressive disorders within 3-6 months postpartum
10%
What percentage of woman experience puerperal psychosis
1 in 500 deliveries
Risk of recurrence of 1-3 with subsequent deliveries
Differential diagnosis of depression?
Normal reaction to life event, Seasonal affective disorder, Dysthymia, Cyclothymia, Bipolar, Stroke, tumour, dementia, Hypothyroidism, addisons, hyperparathyroidism, Infections, Drugs
Antidepressants used in depresssion?
Selective serotonin reuptake inhibitors,
Tricyclics antidepressants,
Monamine oxidase inhibitors,
Other antidepressants
Psychological treatments of depression?
CBT,
IPT,
Dynamic psychotherapy,
Family therapy
Physical treatments of depression?
ECT,
Psychosurgery,
DBS,
VNS
Main measurement tools used for depression?
SCID (Structures Clinical Interview for DSM disorders)
SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
Define Mania
A state of feeling or mood that is inappropriate
Often associated with grandiose ideas, disinhibition, loss of judgement, with similarities to the mental effects of stimulant drugs
1 week of symptoms severe enough to disrupt normal routine
Define hypomania
Lesser degree of mania, no psychosis
Symptoms not to the extent of severe disruption of work or social rejection
Presentation of hypomania
Mild elevation of mood, Increased energy and activity, Increased sociability, talkativeness, overfamiliarity, sexual energy, Decreased need for sleep, Irritable, Reduced concentration,
Presentation of mania?
Elevated mood, Increased energy, Overactivity, Pressure of speech, Decreased need for sleep, Disinhibition, Grandiosity, Alteration of senses, Extravagant spending
Psychiatric differential diagnosis of mania?
Mixed affective state, Schizoaffective disorder, Schizophrenia, Cyclothymia, ADHD, Drugs and alcohol
Medical differential diagnosis of mania?
Stroke, MS, Tumour, Epilepsy, AIDS, Neurosyphlis, Endocrine- cushings, hypothyroidism SLE`
Treatment of mania?
Antipsychotics: Olanzapine, Risperidone, Quetiapine Mood stabilisers: Sodium valproate, Lamotrigene, Carbamazepine
Lithium
ECT
Define bipolar affective disorder?
Repeated episodes (2+) of depression and mania or hypomania
If no depression the diagnosis is hypomania or bipolar
Age onset of bipolar disorder?
21
(Unusual >30)
1/3 onset <20
Are you likely to have a late or early onset of bipolar disorder if you have a FH of it?
Early (15-19)
How long goes a typical episode of major depression last?
4-6 months
How long does a typical bipolar disorder/ manic episode last?
1-3 months
