Affective disorders: clinical aspects Flashcards
Psychopathology
abnormal experience, cognition and behaviour
Descriptive psychopathology
- observation of behaviour
- phenomenology: emphathic assesment of subjective experience
DSM 5 and ICD10
Standard sets of criteria used to classify all psychiatric disorders
(Diagnostic and statistical manual for mental disorders
or
international classification of diseases)
Eliciting symptoms of affective illness with the psychiatric examination
Presenting symptoms and their chronology
The psychiatric history
Mental state examination
Diagnosis
The mental status examination
- Appearance and behaviour (clothing, posture, gestures, gaze, attitude, towards examiner, motor retardation, agitation, stooped posture, downcast gaze, catatonic features)
- Speech (decreased rate and volume, delayed response, spontaneity)
- Mood, affect (depression, anhedonia, reactivity of mood, anxiety, panic)
- Expression (Mood congruence)
- Thoughts: Form (thought blocking, slow flow of thought, associations maintained), content (poverty of contents, non delusional ruminations about loss, death, suicide etc); mood congruent delusions (guilt, punishment)
- Perception: mood congruent (biased perception of what is happening to them- focussing on negative information) hallucinations (rare)
- Cognition (oriented to person, place and time, memory and concentration impairment)
- Judgement and insight: excessive INSIGHT (centre of thoughts remains in your distress) or poor
The affective episodes
- Major depressive episode
- Manic episode
- Hypomanic episode
- Mixed affective (KT QUESTION) episode- Mixed affective episode is both manic or hypomanic and depressive eg feeling sad but racing thoughts, hyperactivity, cant sleep but content of thought is depressive focussed on all the negative things with the energy of a manic episode
Symptoms of depression
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
Major depressive episode- DSM V criteria
Five or 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 of excessive inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent suicidal ideation or a suicide attempt/plan
The symptoms must cause clinically significant distress of functional impairment and are not attributable to the physiological effects of a substance (eg alcohol) or to another medical condition (hypothyroidism)
Melancholic features (subtype of depression)
Loss of pleasure in all, or almost all, activities
Lack of reactivity to usually pleasurable stimuli
Profound despondancy, 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
Atypical depression (subtype)
-mood reactivity
and
- significant weight gain or increase in appetite
- hypersomnia
- leaden paralysis (ie heavy, leaden feelings in arms of legs)
- interpersonal rejection sensitivity
The manic episode (DSM V diagnosis)
- 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 following symptoms
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep talking
4. Flight of ideas or racing thoughts
5. Distractability
6. Increase in goal- directed activity or psychomotor agitation
7. 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 (cocaine, amphetamine) or to another medical condition (hyperthyroidism)
Can be associated to psychotic symptoms such as delusions (on a mission on behalf of God) and hallucinations
LACK OF INSIGHT
The HYPOMANIC episode - DSM V diagnosis
The HYPOMANIC episode - DSM V diagnosis
For a period lasting at least 4 days and present most of the day, nearly every day:
– same symptoms as mania–
The episode is not severe enough to cause marked functional impairment or to necessitate hospitalisation.
- 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)
Features may be associated to both depression and mania
- anxiety–> restlessness, tension, worry, anticipatory anxiety, fear of losing control
- psychotic symptoms–> delusions and hallucinations, mood congruent or incongruent
- catatonia
Mixed affective episodes
Full criteria met for either (hypo) manic or depressive episode and
- at least 3 symptoms of the opposite polarity are present
mentioned earlier what could be in KT
Major depressive disorder epidemiology
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
