Affective Disorders Flashcards
What is a mood disorder?
Commonest group of affective disorders, referring to disorders of mental function where altered mood is the core feature. The altered mood can refer to a state of depression or of an elevated mood (mania)
How can disordered mood present?
Disordered mood can present as a primary symptom or as a consequence of other illness such as cancer or dementia
Through what systems can mood disorders be classified?
ICD-10
DMS-5 (american system, used mainly in research)
What are the three spheres of symptoms of depression?
Psychological
Physical
Social
What are the symptoms of depression in the psychological sphere?
- Change in mood- depression, anxiety, perplexity, anhedonia (inability to feel pleasure)
- Change in thought content- guilt, hopelessness, worthlessness, any neurotic symptoms (obsessions, compulsions, anxiety attacks), ideas of reference (paranoia that events refer to you when they don’t), hallucinations/delusions (if severe).
What symptoms of depression are in the physical sphere?
- Change in bodily function- fatigue, sleep disturbance (early waking, difficulty to fall asleep, fractured sleep, excessive sleep), appetite change, libido loss, constipation, pain
- Change in psychomotor function- agitation (severe), retardation (slow speech and movements, stupor is extreme retardation)
What symptoms of depression are in the social sphere?
- Loss of interests
- Irritability
- Apathy
- Withdrawal, loss of confidence, indecisive
- Loss of concentration, registration & memory
How is depression defined in the ICD-10?
- Last for at least 2 weeks
- No hypomanic or manic episodes in lifetime (if these are present, BAD may be more appropriate diagnosis)
- Not attributable to psychoactive substance use or organic mental disorder
- If psychotic symptoms or stupor then severe depression with psychotic symptoms (Need to exclude other psychotic illnesses first like schizophrenia)
What is somatic syndrome?
A type of depression with a specific cluster of symptoms that can occur without low mood
How is somatic syndrome defined in ICD-10?
- 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
How is severity of depression graded?
Based on the presence of the following characteristics:
General criteria:
•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 criteria:
•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
Mild depression = 2 general + 4 total
Moderate depression = 2 general + 6 total
Severe depression = 3 general + 8 total
What is on a differential diagnosis 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?
- Anti-depressants- selective serotonin reuptake inhibitors (SSRIs) (FIRST LINE), tricyclic antidepressants, monamine oxidase inhibitors
- Psychological treatments- cognitive behavioral therapy, interpersonal therapy, individual dynamic psychotherapy, family therapy
- Physical treatments- electroconvulsive therapy, psychosurgery, deep brain stimulation, vagus nerve stimulation
What is mania?
Mania is a term to describe a mood that can range from near-normal experience to severe, life-threatening illness. It is rarely a symptom and is associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs. It is typically thought of as a form of pathological, inappropriate elevated mood
How is hypomania classified in the ICD-10?
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
