affective disorders

Question 1

agitation

Answer 1

state of restless, overactivity, aimless or ineffective

Question 2

anhedonia

Answer 2

loss of ability to derive pleasure from experience

Question 3

anxiety

Answer 3

an unpleasant emotion in which thoughts of apprehension or fear predominate

Question 4

depression

Answer 4

an unpleasant emotion in which sadness or unhappiness predominates

Question 5

retardation

Answer 5

a slowing of motor responses incl speech

Question 6

stupor

Answer 6

state of extreme retardation in which consciousness is intact
patient stops moving, speaking, eating and drinking.
on recovery can describe clearly events which occurred whilst stuporose

Question 7

depression ICD-10

Answer 7

last for at least 2wks
no hypomanic or manic episodes of life
not attributable to psychoactive substance use or organic mental disorder
if psychotic symptoms or stupor then severe depression with psychotic symptoms

Question 8

somatic syndrome

Answer 8

marked loss of interest or pleasure in activities that are normally pleasurable
lack of emotional reactions to events/activities that normally produce emotional response
waking 2hrs before normal time
objective evidence of psychomotor agitation or retardation
marked loss of appetite
weight loss (5%+ body weight in month)
marked loss libido

Question 9

mild depression (ICD-10)

general criteria: at least 2 of

Answer 9

• depressed mood that is abnormal for most of day almost everyday for past 2wks, largely uninfluenced by circumstances
• loss of interest or pleasure
• decreased energy or increased fatiguability

Question 10

mild depression (ICD-10)

additional 2 from this list to give 4

Answer 10

• loss confidence or self esteem
• unreasonable feeling of guilt or self reproach
• recurrent thoughts death
• decreased concentration
• agitation or retardation
• sleep disturbance
• change in appetite

Question 11

moderate depression criteria

Answer 11

same two lists as mild

at least 2 core symptoms and 4 from additional list

Question 12

severe depression criteria

Answer 12

all core symtomps

at least 5 symptoms from additional list

Question 13

post natal depression

Answer 13

inc risk of psychiatric admission in 30 days following childbirth

despite intuitive appeal, no assoc with hormonal changes has ever been demonstrated

Question 14

depression differential diagnoses

Answer 14

normal reaction to life event 
seasonal affective disorder
dysthymia
cyclothymia 
bipolar
stroke, tumour, dementia 
hypothyroidism, addison's, hyperparathyroidism 
infections: influenza, HIV/AIDs
drugs

Question 15

depression treatments

Answer 15

antidepressants

• selective serotonin reuptake inhibitors
• tricyclic antidepressants
• monoamine oxidase inhibitors

psychological treatments
-CBT, IPT, individual dynamic psychotherapy

physical treatments
-ECT, psychosurgery, DBD, VNS

Question 16

what is mania

Answer 16

state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness

typically considered as a form of pathological, inapropriate elevated mood

Question 17

classification of mania ICD-10: F30.0 hypomania

Answer 17

lesser degree of mania, no psychosis 
mild elevation of mood for several days 
increased sociability, talkativeness, overfamiliarity, inc sexual energy, decreased need for sleep 
may be irritable 
concentration reduced

Question 18

classification of mania ICD-10: F30.1 mania (with or without psychosis)

Answer 18

1 wk, severe enough to disrupt ordinary work/social activities
elevated mood, inc energy, overactivity 
dishinibition 
grandiosity 
alteration of senses
extravagant spending
can be irritable rather than elated

Question 19

manie differentila diagnosis

Answer 19

psychiatric:
mixed affective state, schizoaffective disorfer, schizophrenia, cyclothymia, ADHD, drugs and alcohol

medical: stroke, MS, tumour, epilepsy, AIDs, neurosyphilis, Cushing’s, hyperthyroidism

Question 20

tools to measure mania symptoms

Answer 20

SCID
SCAN

young mania rating scale

Question 21

mania treatments

Answer 21

antipsychotics: olanzapine, risperidone, quetiapine

mood stabilisers: sodium valoprate, lamotrigene, carbamazepine

lithium
ECT

Question 22

bipolar disorder ICD-10

Answer 22

bipolar affective disorder consists of repeated (2+) episodes of depression and mania or hypomania

if no mania/hypomania then recurrent depression
if no depression then hypomania or bipolar

Question 23

mean age on onset of bipolar disorder

Answer 23

mean age = 21

unusual >30

early onset (15-19) usually with positive FH

Question 24

suicide risks

Answer 24

male
older
mental illness
comorbid physical illness
social isolation 
chronic pain 
drugs, alcohol