Affective disorders Flashcards
what is Depression?
symptom (a ‘systemic’ symptom (complaint) with similarities to fatigue and pain typically considered as a form of sadness, not just an absence of happiness), syndrome (constellation of sx, recurrent illness
what does psychiatry place emphasis on when diagnosing and treating sx of affective disorders?
persistence of sx, pervasiveness of sx, degree of impairment, presence of specific sx.
what symptoms are in the psychological sphere?
DEPRESSION, 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 symptoms are in the physical sphere?
CHANGE IN BODILY FUNCTION
ENERGY - Fatigue, SLEEP, APPETITE - weight loss, LIBIDO, CONSTIPATION, PAIN, CHANGE IN PSYCHOMOTOR FUNCTIONING, AGITATION, RETARDATION
what symptoms are in the social sphere?
LOSS OF INTERESTS, IRRITABILITY, APATHY, WITHDRAWAL, LOSS OF CONFIDENCE, INDECISIVE, LOSS OF CONCENTRATION, REGISTRATION & MEMORY
what does icd-10 define depression as?
Last for at least 2 weeks, No hypomanic or manic episodes in lifetime, 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 does icd-10 define somatic syndrome depression as?
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
Post natal depression…
increased risk of psychiatric admission in the 30 days following childbirth (risk for 24m), 75% of women experience ‘blues’ within 2 weeks, 10% of women develop MDD within 3-6 months , ‘puerperal psychosis’ - 1 in 500 deliveries with a risk of recurrence of 1-3 with subsequent deliveries, despite intuitive appeal - no association with hormonal changes has ever been demonstrated
epidemiology of depressoin
losses, separations, adverse life events, Fhx, unemployed, lower education, financially dependant, 18-44yo highest risk.
Measurement tool for depression…
SCID, SCAN, HDRS, BDI-II, HADS, PHQ-9
ddx 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
Tx
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
Mania
typically considered as a form of pathological, inappropriate elevated mood , a term to describe a state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness
rarely a symptom, often associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs (AMPH, cocaine)
In classification of mania - what is 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
mania (without psychosis)
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.
Ddx of Mania
Psychiatric - Mixed affective state, Schizoaffective disorder, Schizophrenia, Cyclothymia, ADHD, Drugs and Alcohol
Medical - Stroke, MS, Tumour, epilepsy, AIDS, Neurosyphilis, Endocrine – Cushing’s, hyperthyroidism, SLE
tools for measurement of sx?
SCID, SCAN, YMRS
Tx
Antipsychotics - Olanzapine, Risperidone, Quetiapine
Mood Stabilisers - Sodium Valproate, Lamotrigene, Carbamazepine
Lithium, ECT
How does ICD-10 define Bipolar Affective Disorder?
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.) Dont need to have depression just more than 1 episode of mania then back to “normal” mood.
epideminology of BAD
rates for males = rates for females, mean age of onset = 21 (unusual >30), some studies - 1/3 onset < 20, Fhx,
mx
mood stabilisers - lithium. Some antipsychotics have mood stabilising properties.
clinical outcome of depression…
Major Depression = typical episode lasts 4-6 months, 54% recovered at 26 weeks, 12% fail to recover, 80+% have further episodes, 15% die by suicide
Bipolar Disorder / Mania = typical manic episode lasts 1-3 months, 60% recovered at 10 weeks, 5% fail to recover, 90% have further episodes, 1/3 have poor outcome, 1/3-1/4 have good outcome, 10% die by suicide
