Affective Disorders COPY Flashcards
Definition of mood disorders
Disorders of the mental status and function where altered mood is (or a) core feature
How can a disordered mood present?
As a primary problem
As a consequence of other disorder/illness e.g. cancer, dementia, drug misuse or medical treatment (steroids)
Two classification systems of affective disorders
ICD-10 (WHO)
DSM-5 (American)
What can depression be seen as?
A STATE OF FEELING OR MOOD, that can range from normal experience to severe, life threatning illness
A SYSTEMIC SYMPTOM (complaint) with similarities to fatigue and pain
A FORM OF SADNESS, not just the absence of happiness
A SYNDROME - constellation of symptoms and signs
A RECURRENT ILLNESS - if had it once then likely to recur again
When does depression become abnormal?
No clear and convenient division
Consensus problematic, often matter of perspective
What does psychiatry place emphasis on?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs
Symptoms of depressive illness occurs in 3 spheres
Social
Physical
Psychosocial
Symptoms of depression
Diurnal variation - worse in the morning Anxiety - inability to relax Perplexity - particularly in puerperal illness. - feeling a bit bewildered/overwhelmed Anhedonia Guilt (not really justified, unduly) Hopelessness/worthlessness Any neurotic symptoms e.g. - hydrochondriasis, agoraphobia, obsessions and compulsions, panic attacks Ideas of reference Delusions and hallucinations if severe Fatigue Sleep - insomnia or early wakening Loss of appetite leading to weight loss Loss of libido Constipation Pain Psychomotor function - agitation (restless sort of anxiety) - retardation (severe = stupor) Loss of interests Irritability Apathy Withdrawal Loss of confidence Indecisive Loss of concentration, registration and memory
Definition of anhedonia
Not being able to experience pleasure in the things that you like doing
Definition of ‘ideas of reference’
Where there is a casual event e.g. group of friends laughing across the street - and you believe that they are laughing at you - so connecting things to negative things about you
Delusion vs Hallucination example
Delusion - actually believe their organs are rotting inside of them
Hallucination - they may smell the rotting flesh (olfactory hallucination)
What is usually wrong with sleep in depression?
Early wakening
Definition of agitation
A state of relentless overactivity, aimless or ineffective
Definition of anheondia
Loss of ability to derive pleasure from experience
Definition of anxiety
An unpleasant emotion in which thoughts of apprehension or fear predominate
Definition of depression
An unpleasant emotion in which sadness or unhappiness predominate
Definition of retardation
A slowing of motor responses including speech
What is stupor?
A state of extreme psychomotor retardation in which consciousness is in tact, but the patient stops moving, speaking, eating and drinking
On recovery of stupor, what can the patient do?
Can clearly describe the events which occurred whilst stuporose
Which gender is more affected by depression?
F > M 2:1
Highest age risk of depression
18-44 (median 25)
Mean age of onset of depression
27
What can the onset of depression (first episode) be associated with?
Excess of adverse life events
‘exit events’ - separations and loses
Depression ICD-10 criteria that needs to be met to be diagnosed with depression
Lasts for at least 2 weeks
No hypomania or manic episodes in lifetime
Not attributable to psychoactive substance use or organic mental disorder
Somatic syndrome
What is somatic syndrome?
Mood disorder which is characterised by physical symptoms more
Presentation of somatic syndrome
Marked loss of interest or pleasure in activities that are normally pleasurable
Lack of emotional reactions to event or activities that normally produce an emotional response
Waking 2 hours before normal time
Depression worse in the morning
Objective evidence of psychomotor agitation or retardation
Marked loss of appetite
Weight loss (5% + of body weight in a month)
Marked loss of lidio
When diagnosing depression and how severe it is, what is the criteria used?
At least a number of
- depressed abnormal mood for most of the day almost everyday for past 2 weeks, largely uninfluenced by circumstances
- loss of interest/pleasure
- decreased energy or increased fatigability
Addition features from this list to give a number
- loss of confidence/self esteem
- unreasonable feelings of guilt or self reproach or excessive guilt
- recurrent thoughts of death by suicide or any suicidal behaviour
- decreased concentration
- agitation or retardation
- sleep disturbance of any sort
- change in appetite
Criteria to diagnose MILD depression
At least 2 from first list AND
Additional from second list to make 4
Criteria to diagnose MODERATE depression
At least 2 from first list AND
additional from second list to make 6
Criteria to diagnose SEVERE depression
ALL from the first list AND
Additional from the second list to give 8
How many days after childbirth is there increased risk of psychiatric admission?
30 days following childbirth
How many women experience ‘blues’ in the first 2 weeks after childbirth?
75%
Differential diagnosis of depression
Normal reaction to life event SAD Dysthymia Cyclothymia Bipolar Stroke, tumour, dementia Hypothyroidism, Addison's, hyperparathyroidism Drugs Infection - flu, hepatitis, HIV/AIDs
Definition of dysthymia
Persistent mild depression
Definition of cyclothymia
Mood swings between short periods of mild depression and hypomania. The low and the high mood swings never reach the severity or duration of major depressive or full mania episodes
Treatment of depression
Antidepressants - SSRIs (selective serotonin reuptake inhibitors) - tricyclic antidepressants (TCAs) - monoamine oxidase inhibitors (MOIs) Psychological treatments - CBT - IPT - Individual dynamic psychotherapy - family therapy Physical treatments - ECT - psychotherapy - DBS - VNS
Measurement tools for depression
SCID SCAN HDRS BDI-II HADS PHQ-9
What measurement tool of depression is associated with ICD-10?
SCID
How long does a typical episode of depression last?
4-6 months
How many depression patients have further episodes?
80%+
How many depressed patients die by suicide?
15%
Definition of mania
Describes a state of feeling, or mood, that can range from near-normal experience to severe, life threatening illness. Considered a form of pathological, inappropriate elevated mood
What is mania associated with?
Granidose ideas
Disinhibition
Loss of judgement
Similarities to mental effects of stimulant drugs (e.g. AMPH, cocaine)
Presentation of hypomania
Lesser degree of mania, no psychosis
Mild elevation of mood several days on end
Increased energy and activity
Marked feeling of wellbeing
Increased sociability, talkativeness, overfamiliarity
increased sexual energy
decreased need for sleep
concentration reduced
new interests
mild overspending
not to the extent of severe disruption of work or social rejections
Presentation of mania
1 week Severe enough to disrupt ordinary work or social activities more or less completely Elevated mood Increased energy and overactivity Pressure of speech Decreased need for sleep Disinhibition Grandiosity Alteration of senses (much more intense) Extravagant spending Can be irritable rather than elated
Differential diagnosis of mania
Psychiatric - mixed affective state - schizoaffective disorder - schizophrenia - cyclothymia - ADHD - drugs and alcohol Medical - stroke - MS - tumour - epilepsy - AIDs - neurosyphilis - endocrine; cushings, hyperthyroidism - SLE
Tools to measure the symptoms of mania
SCID
SCAN
Young mania rating scale (YMRS)
Treatment of mania
Antipsychotics - olanzapine - risperidone - quetiapine Mood stabilisers - sodium valproate - lamotrigine - carbamazepine Lithium ECT
Definition of bipolar disorder
Consists of repeated (2+) episodes of depression and mania or hypomania
Which gender has a higher prevalence for bipolar disorder?
Males = females
Mean age of onset of bipolar disorder
21
Unusual age to have onset of bipolar disorder
> 30
What does early onset bipolar disorder usually suggest?
Positive FH
How long does a typical manic episode last for?
1-3 months
How old is early for onset bipolar disorder?
15-19
How many manic/bipolar patients have further episodes?
90%
How many manic/bipolar patients die by suicide?
10%
What delusions can be seen in depression?
Paranoid
Guilt (late/unduly)
Dying/world ending aspect -> nihilistic
Ideas of reference
Trio of depression cognition
- guilt
- hopelessness
- worthlessness
Common thoughts content in mania?
Thought interference
Grandiosity
Paranoia
Suicidal ideation
Risk of suicidal intention in depressed vs manic patients
High risk in mania
Lower risk in depressed patients
Depressed patients may lack the motivation to do it, however manic people have high energy and do not stop to think
What questions could be asked for insight in the MSE?
Do you think you are ill?
Do you agree with the treatment plan?
Do you think you can get better?
What form of thoughts can depressed patients get?
Incomplete thoughts
What form of thoughts can manic patients get?
Flight of thoughts
Tangenitalality
What is tangenitalality?
Thoughts linked and connected that shouldn’t be connected
Two types of mood
Subjective - self (what there thinking they feel)
Objective - others
Two factors indicative of severe depression
Psychotic symptoms
Acting/planning suicide
Definition of euthymia
Normal mood
What is the condition called when there is depression and mania at the same time?
Mixed Affective Disorder
Absolute contraindication to ECT
Raised ICP
Short term side effects of ECT
Headache Nausea Short term memory impairment Memory loss of events prior to ECT Cardiac arrhythmia
Long term side effects of ECT
Some patients report impaired memory
Can pseudohallucinations be part of the normal grieving process?
Yes
Risk of SSRI use in the 3rd trimester
Persistent pulmonary HTN of the newborn
What is the consistent difference between mania and hypomania?
Presence of psychotic symptoms
What drug should be avoided in patients taking SSRIs and why?
Triptans
Increased risk of serotonin syndrome
What is cotard syndrome?
Rare mental disorder where the patient believes that they are (or in some cases just a part of their body) is either dead or non existent
What is cotard syndrome associated with?
Severe depression
Schizophrenia sometimes
Common blood abnormality as a S/E of SSRIs
Hyponatraemia
Indications for ECT
Treatment resistant severe depression
Manic episodes
An episode of moderate depression known to respond to ECT in the past
Life threatening catatonia
What is the tool used by GPs to characterise severity of depression?
Patient health questionaree-9 (PHQ-9)
