Affective disorders Flashcards
What are mood disorders?
Disorders of mental status and function where mood is a core feature
Most common mental disorder
Often associated with anxiety
Are mood disorders always primary problems?
No
What is the main classification system we use for mood disorders?
ICD-10
International classification of disease
WHO
What are some factors in an affective disorder being classed as abnormal?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs
What are the 3 phases of symptoms of depressive illness?
Psychological
Physical
Social
What are some possible changes in thought content in depression?
Guilt Hopelessness Worthlessness Any neurotic symptoms like hypochondriasis or obsession Delusion Hallucination
How might mood change in depression?
Depression
Anxiety
Perplexity
Anhedonia
How might depression affect bodily function?
Fatigue Sleep Decreased appetite Libido Constipation Pain
How might depression affect psychomotor functioning?
Agitation
Retardation
How can depression affect the social sphere?
Loss of interests Loss of confidence Loss of concentration, registration and memory Indecisive Irritability Apathy Withdrawal
What is agitation?
A state of restless overactivity, aimless or ineffective
What is anhedonia?
Loss of ability to derive pleasure from experience
What is apathy?
Loss of interest in own surroundings
What is anxiety?
An unpleasant emotion in which thoughts of apprehension or fear predominate
Define depression.
An unpleasant emotion in which sadness or unhappiness predominates
Define retardation.
A slowing of motor responses including speech
What is stupor?
A state of extreme retardation in which consciousness is intact
The patient stops moving, speaking, eating and drinking
On recovery can describe clearly events which occurred whilst stuporose
What are some features of somatic syndrome depression?
Waking early Depression worse in morning Loss of appetite or libido Objective evidence of psychomotor agitation or retardation
How is depression classified as mild, moderate or severe?
At least 2 of:
- Abnormally depressed mood for most of day for 2 weeks
- Loss of interest/pleasure
- Decreased energy or or increased fatigability
And more from the folowing, to give a total of 4 (mild), 6 (moderate) or 8 (severe)
- Loss of confidence or self esteem
- Unreasonable/excessive guilt
- Recurrent suicidal thought/behaviour
- Decreased concentration
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
When is the most risk for post-natal depression?
30 days following birth
Risk up to 24 months
Is post-natal depression associated with hormone changes?
No
What is the differential diagnosis for depression?
Normal reaction to life event Seasonal Affective Disorder Dysthymia Cyclothymia Bipolar Stroke, tumour, dementia Hypothyroidism, Addison’s, Hyperparathyroidism Infections
What are some infections associated with differential diagnosis of depression?
Influenza
Infectious mononucleosis
Hepatitis
HIV/AIDS
What are some options for antidepressants?
SSRIs
TCAs
Monoamine
oxidase inhibitors
What are some psychological treatment options for depression?
CBT
IPT
Individual dynamic psychotherapy
Family therapy
What are some physical treatments for affective disorders?
ECT
Psychosurgery
DBS
VNS
What does SCAN mean?
Schedules for Clinical Assessment in Neuropsychiatry
What are some rating scales for depression?
HDRS (Hamilton Depression Rating Scale)
BDI-II (Beck Depression Inventory II)
HADS (Hospital Anxiety and Depression Scale)
PHQ-9 (Patient Health Questionnaire 9)
What is mania?
Often associated with grandiose ideas, disinhibition, loss of judgment
What does F30.0 mean?
Hypomania
Mild degree of elevation for several days on end
What does F30.1 mean?
Mania without psychotic symptoms
What does F30.2 mean?
Mania with psychotic symptoms
What does F30.8 mean?
Manic episodes, unspecified
How might mania present?
Elevated mood Increased sociability and sexual energy Decreased need for sleep Irritable Distracted
What are some psych differential diagnoses with mania?
Mixed affective state Schizoaffective disorder Schizophrenia Cyclothymia ADHD Drugs and Alcohol
What are some medical differential diagnoses with mania?
Stroke MS Tumour Epilepsy AIDS Neurosyphilis Cushing's, SLE, hyperthyroidism
What is a scale used to rate mania?
Young Mania Rating Scale (YMRS)
What are some antipsychotics used for mania?
Olanzapine
Risperidone
Quetiapine
What are some mood stabilisers used for mania?
Sodium Valproate
Lamotrigene
Carbamazepine
Lithium
Can ECT be used for mania?
Yes
What is bipolar affective disorder?
Repeated (2+) episodes of depression AND mania or hypomania
What are some risk factors for bipolar disorder?
Industrialised nations
Males
Mean onset is 21
What are some risk factors for depression?
Highest risk for age 18-44, mean onset at 27
Females
Adverse life events, especially losses
Who is less likely to get MDD?
Employed
Financially independent
Stable marriage
Is lower education attainment associated with MDD?
Yes
What proportion of people with major depression die by suicide?
15%
What proportion of people with major depression?
80+%
What proportion of people with bipolar disorder/mania die by suicide?
10%
What proportion of people with bipolar disorder/mania have further episodes?
90%
What is the difference between grief and depression?
Grief includes longing/yearning for the loved one
Positive emotions can still be experienced
Symptoms worst when thinking about the deceased person
People often want to be with others whereas people with depression tend to want to be alone
What is prolonged grief disorder?
Marked distress and disability caused by the grief reaction
Persistence of this distress and disability more than 6m after a bereavement
