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psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

What are the two main classification systems for mental disorders?

A

ICD - 10

DSM - 5

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2
Q

What is depression?

A

A systemic symptom characterized by sadness, but can also cause other symptoms such as fatigue and pain

Often depression is a syndrome, a combination of different symptoms and signs that can differ between different people

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3
Q

What characteristics separate depression from episodes of sadness?

A
  • Persistence of symptoms
  • Pervasiveness (feeling all the time) of symptoms
  • Degree of impairment
  • Presence of symptoms and signs
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4
Q

What is anhedonia?

What is perplexity?

A

Anhedonia is the inability to feel pleasure in normally pleasurable activities

Perplexity refers to the feeling of being overwhelmed, unable to deal with or understand things

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5
Q

What is an idea of reference in psychiatry?

A

When a patient assumed something in their environment is happening to them even though there is no evidence to suggest this is the case

Eg. see a group of people laughring when you’re walking down the road and assume that they laughing at you

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6
Q

What is a delusion?

What is a hallucination?

A

Delusion - when a patient has an unshakeable belief in something which there is no evidence to indicate (eg. their organs are rotting)

Hallucination - having a sensory experience of something that isn’t really there

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7
Q

What are some of the psychological changes that can occur in patients with depression?

A

Changes in mood
- Anxiety, depression, perplexity, anhedonia

Changes in thought content

  • Guilt, hopelessness, worthlessness, other neuroses
  • Delusions, hallucinations, Ideas of reference
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8
Q

What are some of the pysical changes that can occur in patients with depression?

A

Changes in bodily function
- Fatigue, sleep, libido, appetite, constipation, pain

Changes in psychomotor function
- Agitation, retardation

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9
Q

What are some social changes that can occur in patients with depression?

A

Loss of interest
Apathy
Irritability
Withdrawal, loss of confidence, indecisiveness
Loss of concentration, registration and memory

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10
Q

What does apathy refer to in psychiatry?

A

Loss of interest in the patient surroundings

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11
Q

What does retardation refer to?

What does stupor refer to?

A

Retardation - a slowing of motor response including speech

Stupor - a state of extreme retardation in which consciousness is intact. Patient can’t move, speak, eat or drink. Once recovered can clearly recollect the events that occurred whilst under stupor

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12
Q

What are some of the classification guidelines for depression that are set forth by ICD-10?

A
  • Lasts for longer than 2 weeks
  • No hypomanic or manic episodes in lifetime
  • Not attributable to any psychoactive substance or organic mental disorder
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13
Q

If depression is accompanied by psychotic episodes how is it defined?

What is it important to rule out?

A

Classified as SEVERE depression with psychotic episodes

Need to exclude other psychotic illnesses such as schizophrenia first

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14
Q

What is somatic syndrome? What are the symptoms?

A

A syndrome of depressive symptoms that is classified as a depression syndrome in ICD-10

  • Anhedonia
  • Apathy, lack of emotion
  • Waking about 2hrs earlier than normal time
  • Depression is worse in the morning
  • Objective evidence of retardation / psychomotor agitation
  • Marked loss of apetite leading to weight loss
  • Marked loss of libido
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15
Q

What does a patient need to be experiencing in order to get diagnosed with mild depression?

A

At least two of the following:

  • Depressed mood for most of the day for 2+ weeks
  • Anhedonia
  • Decreased energy or increased fatigability

+ additional depressive symptoms to give a total of at least 4 symptoms

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16
Q

What are the additional symptoms that are useful in diagnosing and distringuishing between types of depression?

A
  • Loss of confidence or self esteem
  • Unreasonable feelings of guilt / self reproach
  • Recurrent thoughts of suicide or suicidal behaviour
  • Decreased concentration
  • Agitation or retardation
  • Sleep disturbance
  • Change In appetite
17
Q

What does a patient need to be experiencing in order to be diagnosed with moderate depression?

A

At least two of the following:

  • Depressed mood for most of the day for 2+ weeks
  • Anhedonia
  • Decreased energy or increased fatigability

+ additional depressive symptoms to give a total of at least 6 symptoms

18
Q

How does pregnancy influence likelihood of depression?

A

75% of women experience “baby blues” within 2 weeks of delivery

10% of these will go on to develop a depressive disorder within 3-6 months

19
Q

What are the three classes of therapies available to treat depressive disorders?

A

Antidepressants

Psychological treatments

Physical treatments

20
Q

What are the main classes of antidepressants used to treat depressive syndromes?

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs): 1st choice bc lower profile of side effects
  • Tricyclic Antidepressants (TCAs): more side effects but good alternative
  • Monamine Oxidase antidepressants
  • Others
21
Q

What are some psychological treatments available for the treatment of depressive syndromes?

A

Cognitive behavioural therapy

Interpersonal therapy

Individual dynamic psychotherapy

Family therapy

22
Q

What are some physcial therapies available for the treatment of depressive disorders?

A

ECT - Electroconvulsive therapy. (purposely initiates brief seizures to cause changes in brain chemistry that may help with certain medical disorders such as severe treatment resistant depression)

Psychosurgery

DBS - deep brain stimulation

VNS - vagus nerve stimulation

23
Q

What is mania?

A

A state of being characterized by disinhibition, grandiose feelings and ideas, and loss of judgement

Pathological elevated mood

24
Q

What is hypomania?

A

Lesser degree of mania, no psychosis. Characterized by:

  • Increased energy, libido, feeling of wellbeing, sociability, talkativeness
  • Decreased need for sleep, reduced concentration, new interests, mild overspending

Not to the extent of severe work disruption of social rejection

25
Q

What is mania?

A

1 week of symptoms severe engough to disrupt ordinary work and social life more or less completely.

Characterized by:

  • Elevated mood, energy, overactivity, pressure of speech, decreased need for sleep
  • Disinhibition and grandiosity
  • Alteration of senses
  • Extravagant spending

Can be irritable rather than elated

26
Q

What is grandiosity?

A

Elevated sense of oneself, feeling of superiority

27
Q

What types of drugs are often used to treat manic patients?

A

Antipsychotics
- olanzapine, risperidone, quetiapine

Mood Stabilizers
- sodium valproate, lamotrigene, carbamezapine

Lithium

ECT

28
Q

What are the criteria that are needed to be met for a diagnosis of bipolar affective disorder (BAD)?

A

2+ episodes of depression and mania / hypomania

if no depression the diagnosis is either mania or bipolar disorder

29
Q

Who tends to develop bipolar disorder? (age, gender)

A

Young people, usually under 30 years old. Genders equal

prevalence of bipolar is 0.7-1.6 per 100

Prevalence tends to be increased in those with a 1st degree relative affected, early onset at age 15-19 common if positive family history. Other forms of depression also more common in relatives

30
Q

Who tends to develop depression? (age, gender)

A

2:1 females to males, highest risk is from 18-44 years old

Old age onset is not unusual, mean age of onset is 27

Higher risk in people with affected 1st degree relatives

31
Q

What are some lifestyle factors that have been shown to influence risk of depression?

A

Employment, depression more common in unemployed

Financial dependence

Level of educational attainment

Stability of marriage

Adverse life events

32
Q

Describe the clinical course of major depression?

A

Episodes tend to last 4-6 months

54% recover at 26 weeks

12% fail to recover

80+% have further episodes

33
Q

Describe the clinical course of bipolar disorder / mania?

A

Typical episode lasts 1-3 months

60% recovered at 10 weeks

5% fail to recover

90% have further episodes

34
Q

Which is more common, mania or bipolar disorder?

A

Bipolar disorder

35
Q

What sort of treatment model should be employed in the treatment of most psychiatric pathologies?

A

Biopsychosocial model

Meds - therapy - social factors

psychiatry (19 decks)

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