Affective disorders: Clinical aspects

Question 1

Describe the psychopathology of affective disorders

Answer 1

Abnormal experience, cognition and behavior

Descriptive psychopathology can be subdivided into observation of behavior and phenomenology.

Phenomenology is the empathetic assessment of subjective experience, it lacks precision

Question 2

What are DSM-5 and ICD-10

Answer 2

They are standard sets of criteria used to classify all psychiatric disorders

Question 3

What does the psychiatric examination comprise of?

Answer 3

Presenting symptoms and their chronology
The psychiatric history
Mental state examination
Diagnosis

Question 4

Which observations are to be made in a mental state examination?

Answer 4

Appearance and behavior: unkept? hyperactive? lethargic?
Speech- rate, volume, tone
Emotion (mood and affect)
Perception (hallucination and illusion)
Thought
Insight
Cognition

Question 5

What is a mixed affective episode?

Answer 5

A state wherein features unique to both depression and mania (despair, fatigue, morbid/suicidal ideation, racing thoughts, pressure of activity and increased irritability) occur SIMULTANEOUSLY in SHORT succession

Full criteria met for either (hypo)manic or depressive episode and more than 3 symptoms of opposite polarity

Question 6

What does the life chart for bipolar disorder look like?

Answer 6

Periods of mania (large upstroke)
Hypomania (smaller successive upstrokes)
Depression (large downstrokes)

Disorder 1: 1 or more manic episodes
Disorder 2: 1 or more Manic episodes + hypomanic episodes

Question 7

Diagnosis of depression requires:

Answer 7

Depression of mood and Anhedonia (diminished interest/pleasure)

As well as other symptoms in 2 week period:

• Weight change
• Insomnia/hypersomnia
• Psychomotor agitation or retardation
• fatigue
• feelings of worthlessness or excessive/inappropriate guilt
• diminished concentration/indecisiveness
• recurrent suicidal ideation or suicide attempt/plan

** Symptoms must cause clinically significant distress or functional impairment and not attributable to physiological effects of a substance or to another medical condition

Question 8

Give 3 examples of melacholic features

Answer 8

• Loss of pleasure in all/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
• Anorexia/weight loss
• Excessive or inappropriate guilt

Question 9

What is considered as atypical depression?

Answer 9

Mood reactivity and:

• significant weight gain/ increased appetite
• hypersomnia
• leaden paralysis (heavy feeling in limbs)
• interpersonal rejection sensitivity

Question 10

State 3 features which are associated with both depression and mania

Answer 10

Anxiety- restlessness, tension,worry, anticipatory anxiety, fear of losing control

Psychotic symptoms- delusions and hallucinations, mood congruent or incongruent (act in sync with mood)

Catatonia - abnormality of movement and behaviour arising from a disturbed mental state (typically schizophrenia)

Question 11

What does the life chart for major depressive disorder look like?

Answer 11

Large dips separated by “free interval”

Question 12

Explain the epidemiology of MDD

Consider age of onset, sex, course of disease, prevalence and suicide rate

Answer 12

Onset 25-35
Females >men
Variable course
1/5 lifetime prevalence
8-19% die by suicide

Question 13

Explain the epidemiology of Bipolar disorder

Consider age of onset, sex, course of disease, prevalence and associations

Answer 13

Peak onset 15-24
Prevalence: 0.6-2.4% but delayed diagnosis (10 years)
Familial aggregation
Men=Women
Highly recurrent