Affective disorders Flashcards
What are mood (affective) disorders?
What other psychiatric disorders are they often associated with?
Disorders of mental status and function where altered mood is the (or a) core feature
This includes states of depression & elevation of mood (mania)
Often associated with anxiety symptoms and anxiety disorders
What causes mood disorders?
Can be primary or as a consequence of other illnesses or disorders - such as cancer, dementia, steroid use, drug misuse
What are the 2 classification systems for mood disorders?
ICD-10
DSM-5
International classification of disease - 10th edition (used in UK clinical practice)
Diagnostic Statistical manual - 5th edition (USA)
What are the 4 aspects of mood disorders that psychiatrists focus on when making a diagnosis?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms & signs
In diagnosing depression - what is meant by:
a) Persistence of symptoms
b) Pervasiveness of symptoms
c) Degree of impairment
d) Presence of specific symptoms/signs
a) Persistence - of symptoms of at least 2 weeks
b) Pervasiveness - symptoms experienced throughout most of the day
c) Impairment - restriction on tasks of everyday life
d) Specific symptoms/signs - psychological, physical, social
What are the 3 groups (spheres) of symptoms of a depressive episode?
Psychological
Physical
Social
What are the psychological symptoms that patients suffering from a depressive episode may experience?
Change in mood:
- depression
- anxiety
- perplexity (esp in puerperal illness) - being overwhelmed
- anhedonia - no pleasure from the things you previously enjoyed doing
Changes in thought content:
- guilt
- hopelessness
- worthlessness
- neurotic symptoms - hypochondriasis, agorophobia etc
- ideas of reference
- psychotic symptoms - hallucinations & delusions
Presence of neurotic symptoms are changes of thought content that can indicate a depressive episode.
What are examples of neurotic symptomatology?
Hypochondriasis - worrying about health
Agorophobia - fear/resentment to leave ones house
Obsessions & compulsions
Panic attacks
What is meant by ideas of reference?
When an individual believes something happening that is unrelated to them in their environment is infact related to them
So if a person is walking down the street and sees random people laughing and believes that they are laughing at him/her without evidence - that would be an idea of reference
What is the difference between hallucinations and delusions?
Hallucinations - sensory experience of something that is not present
Delusions - strong, unshakeable belief about something with no evidence to support it (ie a belief that your organs are rotting)
What are the physical symptoms of depression?
Change in bodily function:
- energy
- appetite
- sleep
- libido
- constipation
- pain
Change in psychomotor function:
- agitation
- retardation & stupor
What are the social symptoms of a depressive episode?
Loss of interests (anhedonia)
Irritability
Apathy
Withdrawel, loss of confidence, indecisive
Loss of concentration, registration, memory
What is stupor?
A state of extreme retardation (slowing of motor responses) in which consciousness is intact
The patient stops moving, speaking, eating or drinking but can recall everything they experienced while stuporose - after they recover
For the diagnosis of depression using ICD-10 - what criteria must be met?
Symptoms >2 weeks
No hypomanic or manic episode in lifetime
Not attributable to psychoactive substance use or organic mental disorder
If a patient has a history suggestive of severe depression with psychotic symptoms - what conditions must be excluded before this diagnosis can be made?
Exclude other psychotic illnesses such as Schizophrenia
Somatic syndrome is a specific type of depression. What are the features that characterise it?
Anhedonia
Waking early (2 hours)
Morning depression
Psychomotor agitation or retardation
Loss of appetite & weight
Loss of libido
What is post-natal depression and how common is it?
Depressive episodes that affect women after they have delivered a child
75% of women get ‘blues’ in the 2 weeks following delivery
10% of women experience MDD* within 3-6 months
1/500 women experience ‘puerperal psychosis’
What are the diffs for depressive episodes?
Normal reaction to life event
Seasonal Affective Disorder
Dysthymia
Cyclothymia
Bipolar
Stroke, tumour, dementia
Hypothyroidism, Addison’s, Hyperparathyroidism
Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
Drugs
Give an overview of the treatments for depression
Antidepressants:
- SSRIs - first line
- TCAs
- Monamine oxidase inhibitors
- Others
Psychological:
- CBT, IPT etc
Physical:
- ECT
- Psychosurgery
- DBS, VNS
What is mania?
State of elevated mood - characterised by:
grandiose ideas
disinhibition
loss of judgement
Similarities to the effects of amphetamines and cocaine
What general symptoms and signs are seen in manic episodes?
Elevation of mood, energy and feeling of wellbeing - with features such as:
- Increased talkativeness, sociability, libido
- Overfamiliarity
- Decreased need for sleep
- May be irritable
- Reduced concentration
- New interests
- Disinhibition - both socially and financially
- may have psychosis
What is hypomania?
Lesser degree of mania - without psychosis:
- Mild elevation of mood for several days on end
- Manic symptoms* - but not to the degree of severe disruption of work or social rejection
* see photo for details of symptoms
What are the features of ICD-10 Mania?
Manic episode lasting >1 week - with or without psychosis:
- severe enough to disrupt work & social life
- Elevated mood & energy, overactivity with decreased sleep
- may be irritable
Specific features:
- grandiosity
- increased pressure of speech
- disinhibition
- alteration of senses
- extravagent spending
What tools are used to measure symptoms of mania?
SCID
SCAN
Young mania rating scale (YMRS)
SCID & SCAN also used for depression
What is Bipolar affective disorder?
BAD consists of repeated (2+) episodes of depression and mania or hypomania
What is the diagnosis if a patient has multiple episodes of depression without mania/hypomania?
What is the diagnosis if a patient has episodes of mania without depression?
No mania/hypomania = Recurrent depression
No depression = hypomania or bipolar disorder*
*A single episode of mania is enough to diagnose bipolar (DSM-5)
Concerning the epidemiology of bipolar disorder, what are the differences between…
a) males and females
b) developing and developed countries
a) males = females
b) developed = developing
What is the typical age of onset of bipolar disorder?
What factors may predispose an individual to developing BAD earlier?
mean age = 21
1/3rd <20
unusual >30
Early onset (teens) usually with positive family history
Concerning the epidemiology of depression, what is the:
a) difference in the prevalence between males and females
b) mean age of onset (and spread of age of onset)
a) Females exceed males 2:1 - but male suicide is much more common
b) mean age 27 - but much more variability than BAD - ie its not unusual for a 70 year old to develop depression
