Affective Disorders

Question 1

What are mood disorders

Answer 1

Disorders of mental status and function where altered mood is the core feature (depression or elevated mood-mania)

Question 2

Classification systems for mood disorders?

Answer 2

ICD-10 International Classification of Disease 10th Edition- WHO
DSM-5 Diagnostic and statistical manual of mental disorder 5th Edition- American Psychiatric Association

Question 3

Symptoms of depressive illness occur in 3 spheres, what are they?

Answer 3

Psychological
Physical
Social

Question 4

Depression symptoms in the psychological sphere?

Answer 4

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

Question 5

Depression symptoms in the physical sphere?

Answer 5

Change in bodily function:
Energy,
Sleep,
Appetite,
Libido,
Constipation, 
Pain 
Change in psychomotor functioning:
Agitation,
Retardation

Question 6

Depression symptoms in the social sphere?

Answer 6

Loss of interests,
Irritability,
Apathy,
Withdrawal, loss of confidence, indecisive,
Loss of concentration, registration and memory

Question 7

Define anhedonia

Answer 7

Loss of ability to derive pleasure from experience

Question 8

Define retardation

Answer 8

A slowing of motor responses including speech

Question 9

Define stupor

Answer 9

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

Question 10

ICD-10 criteria of depression

Answer 10

Lasts for 2 weeks,
No hypomanic or manic episodes in lifetime,
Not attributable to psychoactive substance use or organic mental disorder

Question 11

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?

Answer 11

Other psychotic illnesses like schizophrenia

Question 12

What is depression somatic syndrome?

Answer 12

extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning

Question 13

What is the general criteria for depression?

Answer 13

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

Question 14

What are the additional symptoms experienced in depression?

Answer 14

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

Question 15

Mild depression

Answer 15

At least 4 criteria from list

Question 16

Moderate depression

Answer 16

6 criteria from list

Question 17

Severe depression

Answer 17

At least 8 criteria from list

Question 18

What percentage of woman experience baby blues within 2 weeks postpartum

Answer 18

75%

Question 19

What percentage of woman experience major depressive disorders within 3-6 months postpartum

Answer 19

10%

Question 20

What percentage of woman experience puerperal psychosis

Answer 20

1 in 500 deliveries

Risk of recurrence of 1-3 with subsequent deliveries

Question 21

Differential diagnosis of depression?

Answer 21

Normal reaction to life event,
Seasonal affective disorder,
Dysthymia, 
Cyclothymia, 
Bipolar, 
Stroke, tumour, dementia,
Hypothyroidism, addisons, hyperparathyroidism,
Infections,
Drugs

Question 22

Antidepressants used in depresssion?

Answer 22

Selective serotonin reuptake inhibitors,
Tricyclics antidepressants,
Monamine oxidase inhibitors,
Other antidepressants

Question 23

Psychological treatments of depression?

Answer 23

CBT,
IPT,
Dynamic psychotherapy,
Family therapy

Question 24

Physical treatments of depression?

Answer 24

ECT,
Psychosurgery,
DBS,
VNS

Question 25

Main measurement tools used for depression?

Answer 25

SCID (Structures Clinical Interview for DSM disorders)

SCAN (Schedules for Clinical Assessment in Neuropsychiatry)

Question 26

Define Mania

Answer 26

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

Question 27

Define hypomania

Answer 27

Lesser degree of mania, no psychosis

Symptoms not to the extent of severe disruption of work or social rejection

Question 28

Presentation of hypomania

Answer 28

Mild elevation of mood, 
Increased energy and activity, 
Increased sociability, talkativeness, overfamiliarity, sexual energy,
Decreased need for sleep,
Irritable, 
Reduced concentration,

Question 29

Presentation of mania?

Answer 29

Elevated mood, 
Increased energy, 
Overactivity,
Pressure of speech, 
Decreased need for sleep, 
Disinhibition, 
Grandiosity, 
Alteration of senses, 
Extravagant spending

Question 30

Psychiatric differential diagnosis of mania?

Answer 30

Mixed affective state, 
Schizoaffective disorder, 
Schizophrenia, 
Cyclothymia, 
ADHD, 
Drugs and alcohol

Question 31

Medical differential diagnosis of mania?

Answer 31

Stroke, 
MS, 
Tumour, 
Epilepsy, 
AIDS,
Neurosyphlis, 
Endocrine- cushings, hypothyroidism
SLE`

Question 32

Treatment of mania?

Answer 32

Antipsychotics:
Olanzapine, 
Risperidone, 
Quetiapine
Mood stabilisers:
Sodium valproate,
Lamotrigene, 
Carbamazepine

Lithium
ECT

Question 33

Define bipolar affective disorder?

Answer 33

Repeated episodes (2+) of depression and mania or hypomania

If no depression the diagnosis is hypomania or bipolar

Question 34

Age onset of bipolar disorder?

Answer 34

21
(Unusual >30)
1/3 onset <20

Question 35

Are you likely to have a late or early onset of bipolar disorder if you have a FH of it?

Answer 35

Early (15-19)

Question 36

How long goes a typical episode of major depression last?

Answer 36

4-6 months

Question 37

How long does a typical bipolar disorder/ manic episode last?

Answer 37

1-3 months