Affective disorders - clinical aspects Flashcards
MOOD DISORDERS
i) how can mood disorders be diagnosed?
ii) what is the criteria used in the US and Europe?
iii) name four mood disorder episodes that may help to define the disorder
i) look at experience and behaviours - identify symptoms and cluster into syndromes
ii) DSM-5 (america) ICD10 (europe)
iii) manic depressive, manic, hypomanic, mixed affective
CLASSIFIC OF MOOD DISORDERS
i) what is unipolar depression?
ii) what is dysthymia?
iii) what is bipolar depression type I and type II?
i) unipolar is when the individual has episodes of low mood only which can be single, recurrent
ii) dysthymia is persistent low mood that lasts longer than single/recurrent but doesnt reach the threshold for major depressive disorder
iii) bipolar is where you have both depressed and elevated mood
- Bipolar I = at least one manic episode
- Bipolar II = both hypomania and one depressive episide
name disorders A-F
A = unipolar (single episode)
B = unipolar (recurrent)
C = Dysthymia
D = Bipolar I
E = Bipolar II
F = cyclothymia
what does this show?
how is it characterised?
manic depressive disorder
charac by multiple episodes with symptoms free episodes in between
SYMPTOMS OF DEPRESSION
i) what are the two core symptoms for diagnosis of depression?
ii) give five other symptoms
iii) how long do symptoms have to be present for diagnosis of major depressive disorder?
iv) what must these symptoms cause?
i) depression of mood and loss of interest in pleasure (anhedonia)
ii) diurnal variation, guilt, self blame, depersonalisation, worthlessness, agitation
iii) need to be present for the majority of the time for two weeks - most of the day nearly every day
iv) must cause clinically significant distrress/func impairment which is not attributed to physiological effects of a substance or another medical condition
MELANCHOLIA
i) what is this also known as?
ii) how is it characterised? (5)
iii) what type of depression is the opposite of this? how is it characterised?
I) also known as typical depression
ii) characterised by profound anhedonia, depression that is worse in the morning, agitation, weight loss, guilt
iii) atypical depression - charac by opposite symptoms to melancholia eg mood reactivity to pleasure, weigjt gain, hypersomia, leaden paralysis (heavy limbs), rejection sensitivity
EPIDEMIOLOGY OF MAJOR DEPRESSIVE DISORDER
i) what is the average age of onset?
ii) it is the most common mental disorder in primary care - true or false?
iii) how does it affect males and females differently?
iv) how many die by suicide?
i) 25-35yrs
ii) true
iii) affects double the amount of females than males
iv) 8-19% die by suicide
BIPOLAR DISORDER
i) what are the two polarities and what are they called?
ii) what is the normal baseline called?
iii) what happens in mixed state?
iv) what is mania?
v) how are mixed affective episodes characterised? what are these associated with?
i) two polarities are mood elevation (mania and hypomnia) and low mood (major or subthreshold)
ii) normal baseline = euthymia
iii) mixed state = both manic and depressive features
iv) mania = lots of thoughts and ideas
v) full criteria met for hypomania, mania or depression but three from the extra symptoms such as suicide, guilt, weight loss
- associated with a worse prognosis
MANIC EPISODE
I) what does it require? (2)
ii) how long does it last? how frequently is it present?
iii) name the some symptoms you need three or more of
iv) what must the mood disturbance be sufficient to cause?
v) what must the symptoms not be attributable to?
vi) what may it also be associated with?
i) requires abnormal and persistent elevated/expansive/irritable mood anc increased activity/energy
ii) lasts for a period of at least one week and is present most the day nearly every day
iii) three or more of inflated self esteem/grandiosity, decreased need for sleep, talkative, racing thoughts, goal directed activity, high risk activity
iv) symptoms sufficient to cause marked functional impairment or hospitalisation to prevent harm or there are psychotic features
v) symptoms not attributable to physiological effects of a substance (amphetamine) or a medical condition (hyperthyroidsm)
vi) may also be associated with delusions and hallucinations
HYPOMANIA
i) how does this differ from mania?
ii) what is the minimum duration?
iii) does it cause marked functional impairment or hospitalisation?
iv) what may it be associated with (to do with persons normal personality)
i) less severe and impactful
ii) min duration is at least four days
iii) not severe enough to cause marked func impairment or hopsitalisation
iv) associated sith change in function that is uncharacterisitc of the normal personality of the individual
DETECTION AND RECOGNITION OF BIPOLAR
i) what type of symptoms are usually seen early on?
ii) what is the mean age of onset?
iii) give five symptoms that make it more likely to be bipolar rather than unipolar depression?
iv) give five symptoms that make it more likely to be unipolar rather than bipolar depression?
i) early onset symptpms are usually depressive
ii) mean age of onset is 21 years
iii) bipolar > unipolar = hypersomia, hyperphagia, leaden paralysis, retardation, irritable, early onset, family hx, multiple episodes
iv) unipolar > bipolar = initial insomia, weight loss, increased activity level, late onset, negative family history
BIPOLAR PREVALENCE
i) how many x at risk are you if you have an affected first degree relatives?
ii) how affected are men compared to women?
iii) what is the x increase rate of suicide?
iv) does it have a higher or lower prevalence than depression?
v) what is the % concordance in monozygotic twins?
i) 10x increased risk
ii) men and women affected equally
iii) x20 increased risk of suicide
iv) lower prevalence than depression
v) 70-80% concordance of monozygotic twins
name stages 1-5 in the progressive nature of bipolar
i) does loss of performance and cognitive function preceed the onset of illness?
1 = genetic suscep 2 = prodrome (sub threshold) 3 = first episode 4 = multiple episodes 5 = chronicity
i) loss of performance does not preceed onset of illness (like in schizophrenia) - there is normal cognition before onset but then it progressively declines and gets worse with relapses
STAGING MODEL OF BIPOLAR
i) what characterises the latent stage?
ii) what charac stages 1-4
iii) what is the association with dementia? what may be protective here?
i) latent stage = positive family history
ii) 1 = well defined periods of euthymia, 2 = inter episodic periods, 3 = marked impairment of cognition and function, 4 = unable to live autonomously
iii) increased risk of dementia with bipolar and lithium may be neuroprotective
