Affective disorders: Clinical aspects

Question 1

What is descriptive psychology?

Answer 1

Observation of behaviour

Phenomenology

Question 2

What is psychopathology?

Answer 2

Abnormal experience, cognition and behaviour

Question 3

What is DSM5 and ICD10?

Answer 3

Standard set of criteria used to classify all psychiatric disorders
Diagnostic and statistical manual for mental disorders
International classification of diseases

Question 4

Name some important factors when making a diagnosis

Answer 4

Presenting symptoms and their chronology

The psychiatric history

Mental state examination

Diagnosis

Question 5

What is involved in the mental state examination?

Answer 5

Appearance and behaviour

Speech

Mood

Thought

Perception

Cognition (orientation,
memory and intelligence)

Insight

Question 6

List the affective episodes

Answer 6

Major depressive episodes
Manic episode
Hypomanic episode
Mixed affective episode

Question 7

List some symptoms of depression

Answer 7

Depression of mood
Anhedonia
Psychomotor retardation
Agitation / restlessness
Anxiety / preoccupation
Diurnal variation of mood
Insomnia
Feelings of guilt , self-reproach worthlessness
Somatic symptoms
Hypochondriasis
Weight loss
Suicidal thoughts

Question 8

Define a manic depressive episode

Answer 8

Five of more symptoms during 2 weeks period:

Depressed mood most of the day, nearly every day
Diminished interest or pleasure
Weight loss / weight gain or appetite decrease / increase
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent suicidal ideation or a suicide attempt/plan

Question 9

List some melancholic features

Answer 9

Loss of pleasure in all, or almost all, activities
Lack of reactivity to usually pleasurable stimuli
Profound despondency, despair, empty mood
Depression regularly worse in the morning
Early-morning awakening
Marked psychomotor agitation or retardation
Significant anorexia or weight loss
Excessive or inappropriate guilt

Question 10

What is atypical depression?

Answer 10

Mood reactivity

and

Significant weight gain or increase in appetite

Hypersomnia

Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)

interpersonal rejection sensitivity

Question 11

Describe a manic episode

Answer 11

abnormally and persistently elevated, expansive, or irritable mood
For a period lasting at least one week and present most of the day, nearly every day:
abnormally and persistently increased activity or energy
3 or more of the the following symptoms

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in high risk activities

The mood disturbance is sufficiently severe to cause marked functional impairment or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The episode is not attributable to the physiological effects of a substance or to another medical condition.

Can be associated to psychotic symptoms such as delusions and hallucinations

Question 12

Describe a hypomanic episode

Answer 12

For a period lasting at least 4 days and present most of the day, nearly every day:
abnormally and persistently elevated, expansive, or irritable mood
abnormally and persistently increased activity or energy
3 or more of the the following symptoms

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in high risk activities

The episode is not severe enough to cause marked functional impairment or to necessitate hospitalization

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic

The disturbance in mood and the change in functioning are observable by others.

The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment).

Question 13

List some features that are associated with both depression and mania

Answer 13

Anxiety
Restlessness, tension, worry, anticipatory anxiety, fear of losing control

Psychotic symptoms
Delusions and hallucinations, mood congruent or incongruent

Catatonia

Question 14

What is a mixed affective episode?

Answer 14

Full criteria met for either (hypo)manic or depressive episode, and

at least 3 symptoms of the opposite polarity are present

Question 15

Describe the epidemiology of major depressive disorder

Answer 15

age of onset 25-35 years (but can be at any age)
Females more than males
Variation in 12-months prevalence, av. 7%
Variable course
1 in 5 lifetime prevalence
8 -19% die by suicide

Question 16

What is Bipolar Disorder I?

Answer 16

At least one manic episode

Question 17

What is Bipolar Disorder II?

Answer 17

At least one hypomanic episode

At least one major depressive episode

Question 18

Describe the epidemiology of bipolar disorder

Answer 18

Peak age onset : 15-24 years old
Prevalence: 0.6 – 2.4%
Delayed diagnosis (10 years)
Familial aggregation (10 times higher risk in 1st degree relatives)
Men & women affected equally (BP-I)

Question 19

Describe the prognosis of bipolar disorder

Answer 19

Highly recurrent
May have progressive course
Rate of suicide > 20 times higher than general population
30%-50% of patients attempt suicide
Asymptomatic over half their life