Affective disorders Flashcards
What is an affective disorder? Give some examples.
An affective disorder is one where the mental state or function is affected by mood. The problem can be elevated mood or low mood.
- Depression
- Mania
What are the 3 main classification systems for categorising mood disorders?
- ICD-10 shows a description of the disorder
- DSM-5 gives specific operationalised diagnosis
- ICD-11 will adopt a dimensional approach with specifiers for specific traits
Define Depression
An emotion within the range of normal experience – a state of feeling, or mood, that can range from normal experience to severe, life-threatening illness.
It must last for at least 2 weeks with no hypomanic or manic episodes in lifetime. Not attributable to psychoactive substance use or organic mental disorder.
If the patient has psychotic symptoms or stupor then it is severe depression with psychotic symptoms. Need to exclude other psychotic illnesses first like schizophrenia.
What is Dysthymia?
A lower level of depression that isn’t severe enough in the patient’s eyes to interfere with their life i.e they can still work etc
In Major/ clinical Depression, how long does a typical episode last for?
4-6 months
4 key thinks to look for when diagnosing depression or mania
- Persistence of symptoms – at least 2 weeks
- Pervasiveness of symptoms – lasting symptoms i.e have them for most of the day
- Degree of impairment – unable to carry out tasks of normal, everyday life?
- Presence of specific symptoms or signs – occurs in 3 spheres
- Psychological
- Physical
- Social
What are some psychological symptoms of depression?
- Changes in mood
- Depression - presence of sadness not just absence of happiness. May show diurnal variation i.e worse in the morning or night
- Anxiety - inability to relax
- Perplexity - overwhelmed - common in puerperal illness (post-natal)
- Anhedonia – inability to experience pleasure in the things you would normally enjoy
- Changes in thought content
- Guilt – that isn’t merited/deserved
- Hopelessness
- Worthlessness
- Any neurotic symptomatology – hypochondriasis, agoraphobia, obsessions and compulsions, panic attacks
- Ideas of reference
- Delusions and hallucinations if severe - psychotic symptoms
Physical symptoms of depression (7)
- Lack of energy - fatigue
- Sleep disturbance
- Appetite changes – weight loss
- Libido
- Constipation
- Pain
- Change in psychomotor functioning
- Agitation - restless kind of anxiety
- Retardation – slowing down of things like thoughts, speech or movements
- Stupor – state of extreme retardation in which consciousness is intact. Patient stops moving, eating, speaking, drinking etc but on recovery they can recall clearly the events which occurred whilst they were in this state.
Symptoms of depression relation to social sphere
- Loss of interests (anhedonia)
- Irritability
- Apathy
- Withdrawal, loss of confidence, indecisive
- Loss of concentration, registration and memory
What is somatic syndrome?
A type of depression characterised by specific cluster of symptoms:
- Anhedonia
- Lack of reaction to events/activity
- Sleep disturbance – wakening early morning (2 hrs before normal time) with worse symptoms in the morning
- Loss of libido
- Objective evidence of psychomotor agitation or retardation
- Loss of appetite
- Marked weight loss
ICD-10 diagnostic criteria for Mild depression
at least 2 from general and 2 from additional
ICD-10 diagnostic criteria for Moderate depression
At least 2 from the general criteria and 4 from the additional list (to give 6 or more)
ICD-10 diagnositic criteria for Severe depression
You must have all 3 from the left and at least 5 from the right
What things are involved in the treatment of depression?
- Anti-depressants – selective serotonin reuptake inhibitors
- Psychological treatments – CBT, IPT, family therapy
- Physical treatments
- Electroconvulsive therapy (good for people with severe treatment-resistance depression)
- Psychosurgery (not done frequently)
- Deep brain stimulation / vagus nerve stimulation (both rare)
How can you measure depression symptoms?
- Diagnosis
- SCID – structured clinical interview for DSM disorders
- SCAN – schedules for clinical assessment in neuropsychiatry
- HDRS (Hamilton Depression Rating Scale)
- BDI-II (Beck Depression Inventory II)
- HADS (Hospital Anxiety and Depression Scale)
- PHQ-9 (Patient Health Questionnaire 9)
