Affective disorders: clinical aspects

Question 1

Mental status examination

Answer 1

Appearance and behaviour

Speech

Mood

Thought

Perception

Cognition

Insight

Question 2

The affective episodes

Answer 2

Major depressive episode

Manic episode

Hypomanic episode

Mixed affective episode

Question 3

Symptoms of depression

Answer 3

Depression of mood

Anhedonia

Psychomotor retardation

Agitation/ restlessness

Anxiety/ preoccupation

Diurnal variation of mood

Insomnia

Feelings of guilt

Somatic symptoms

Hypochondrioasis

Weight loss

Suicidal thoughts

Question 4

Major depressive episode DSM V criteria

Answer 4

5 or more during 2 weeks:

1. depressed mood most of the day, nearly everyday
2. diminished interest or pleasure
3. weight loss/ gain or appetite increase/ decrease
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or guilt
8. diminished ability to think/ concentrate/ indecisiveness
9. recurrent suicidal ideation or suicide attempt/ plan

Question 5

Melancholic features

Answer 5

Loss of pleasure in all or most 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 6

Atypical depression

Answer 6

Mood reactivity

And

Significant weight gain or increase in appetite

Hypersomnia

Leaden paralysis

Interpersonal rejection sensitivity

Question 7

Main episode DSM V diagnosis

Answer 7

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 these:
  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. distractibility
  6. increase in goal directed activity
  7. excessive involvement in high risk activities

Question 8

Hypomanic episode DSM V diagnosis

Answer 8

Lasting at least 4 days, nearly all day everyday

• abnormally and persistently elevated, expansive or irritable mood
• abnormally and persistently increased activity or energy
• 3 or more of these:
  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. distractibility
  6. increase in goal directed activity
  7. excessive involvement in high risk activities

Question 9

Features associated with depression and mania

Answer 9

Anxiety

Psychotic symptoms

Catatonia

Question 10

Anxiety

Answer 10

Restlessness

Tension

Worry

Anticipatory anxiety

Fear of losing control

Question 11

Psychotic symptoms

Answer 11

Delusions and hallucinations

Mood congruent or incongruent

Question 12

Mixed affective episodes

Answer 12

Full criteria met for either manic or depressive episode

and

At least 3 symptoms of the opposite polarity are present

Question 13

MDD epidiomology

Answer 13

Age of onset 25-35 years

Females more than males

Variation in 12 months prevalence av 7%

Variable course

1 in 5 lifetime prevalence

8-19% die by suicide

Question 14

Bipolar disorder I

Answer 14

At least one manic episode

Question 15

Bipolar disorder II

Answer 15

At least one hypomanic episode

At least one major depressive episode

Question 16

Bipolar disorder

Answer 16

Peak onset: 15-24 years old

Prevalence: 0.6-2.4%

Delayed diagnosis (10 years)

Familial aggregation (10x higher risk in 1st degree relatives)

Men and women affected equally

Highly recurrent

May have progressive course

Rate of suicide >20x higher than general population