Affective Disorders COPY Flashcards

1
Q

Definition of mood disorders

A

Disorders of the mental status and function where altered mood is (or a) core feature

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2
Q

How can a disordered mood present?

A

As a primary problem

As a consequence of other disorder/illness e.g. cancer, dementia, drug misuse or medical treatment (steroids)

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3
Q

Two classification systems of affective disorders

A

ICD-10 (WHO)

DSM-5 (American)

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4
Q

What can depression be seen as?

A

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

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5
Q

When does depression become abnormal?

A

No clear and convenient division

Consensus problematic, often matter of perspective

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6
Q

What does psychiatry place emphasis on?

A

Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs

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7
Q

Symptoms of depressive illness occurs in 3 spheres

A

Social
Physical
Psychosocial

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8
Q

Symptoms of depression

A
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
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9
Q

Definition of anhedonia

A

Not being able to experience pleasure in the things that you like doing

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10
Q

Definition of ‘ideas of reference’

A

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

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11
Q

Delusion vs Hallucination example

A

Delusion - actually believe their organs are rotting inside of them
Hallucination - they may smell the rotting flesh (olfactory hallucination)

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12
Q

What is usually wrong with sleep in depression?

A

Early wakening

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13
Q

Definition of agitation

A

A state of relentless overactivity, aimless or ineffective

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14
Q

Definition of anheondia

A

Loss of ability to derive pleasure from experience

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15
Q

Definition of anxiety

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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16
Q

Definition of depression

A

An unpleasant emotion in which sadness or unhappiness predominate

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17
Q

Definition of retardation

A

A slowing of motor responses including speech

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18
Q

What is stupor?

A

A state of extreme psychomotor retardation in which consciousness is in tact, but the patient stops moving, speaking, eating and drinking

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19
Q

On recovery of stupor, what can the patient do?

A

Can clearly describe the events which occurred whilst stuporose

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20
Q

Which gender is more affected by depression?

A

F > M 2:1

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21
Q

Highest age risk of depression

A

18-44 (median 25)

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22
Q

Mean age of onset of depression

A

27

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23
Q

What can the onset of depression (first episode) be associated with?

A

Excess of adverse life events

‘exit events’ - separations and loses

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24
Q

Depression ICD-10 criteria that needs to be met to be diagnosed with depression

A

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

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25
Q

What is somatic syndrome?

A

Mood disorder which is characterised by physical symptoms more

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26
Q

Presentation of somatic syndrome

A

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

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27
Q

When diagnosing depression and how severe it is, what is the criteria used?

A

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

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28
Q

Criteria to diagnose MILD depression

A

At least 2 from first list AND

Additional from second list to make 4

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29
Q

Criteria to diagnose MODERATE depression

A

At least 2 from first list AND

additional from second list to make 6

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30
Q

Criteria to diagnose SEVERE depression

A

ALL from the first list AND

Additional from the second list to give 8

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31
Q

How many days after childbirth is there increased risk of psychiatric admission?

A

30 days following childbirth

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32
Q

How many women experience ‘blues’ in the first 2 weeks after childbirth?

A

75%

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33
Q

Differential diagnosis of depression

A
Normal reaction to life event
SAD
Dysthymia
Cyclothymia
Bipolar
Stroke, tumour, dementia
Hypothyroidism, Addison's, hyperparathyroidism 
Drugs
Infection - flu, hepatitis, HIV/AIDs
34
Q

Definition of dysthymia

A

Persistent mild depression

35
Q

Definition of cyclothymia

A

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

36
Q

Treatment of depression

A
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
37
Q

Measurement tools for depression

A
SCID
SCAN 
HDRS
BDI-II
HADS
PHQ-9
38
Q

What measurement tool of depression is associated with ICD-10?

A

SCID

39
Q

How long does a typical episode of depression last?

A

4-6 months

40
Q

How many depression patients have further episodes?

A

80%+

41
Q

How many depressed patients die by suicide?

A

15%

42
Q

Definition of mania

A

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

43
Q

What is mania associated with?

A

Granidose ideas
Disinhibition
Loss of judgement
Similarities to mental effects of stimulant drugs (e.g. AMPH, cocaine)

44
Q

Presentation of hypomania

A

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

45
Q

Presentation of mania

A
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
46
Q

Differential diagnosis of mania

A
Psychiatric 
- mixed affective state
- schizoaffective disorder
- schizophrenia
- cyclothymia
- ADHD
- drugs and alcohol 
Medical 
- stroke
- MS
- tumour
- epilepsy 
- AIDs
- neurosyphilis 
- endocrine; cushings, hyperthyroidism 
- SLE
47
Q

Tools to measure the symptoms of mania

A

SCID
SCAN
Young mania rating scale (YMRS)

48
Q

Treatment of mania

A
Antipsychotics 
- olanzapine
- risperidone 
- quetiapine
Mood stabilisers
- sodium valproate
- lamotrigine
- carbamazepine
Lithium 
ECT
49
Q

Definition of bipolar disorder

A

Consists of repeated (2+) episodes of depression and mania or hypomania

50
Q

Which gender has a higher prevalence for bipolar disorder?

A

Males = females

51
Q

Mean age of onset of bipolar disorder

A

21

52
Q

Unusual age to have onset of bipolar disorder

A

> 30

53
Q

What does early onset bipolar disorder usually suggest?

A

Positive FH

54
Q

How long does a typical manic episode last for?

A

1-3 months

55
Q

How old is early for onset bipolar disorder?

A

15-19

56
Q

How many manic/bipolar patients have further episodes?

A

90%

57
Q

How many manic/bipolar patients die by suicide?

A

10%

58
Q

What delusions can be seen in depression?

A

Paranoid
Guilt (late/unduly)
Dying/world ending aspect -> nihilistic
Ideas of reference

59
Q

Trio of depression cognition

A
  1. guilt
  2. hopelessness
  3. worthlessness
60
Q

Common thoughts content in mania?

A

Thought interference
Grandiosity
Paranoia
Suicidal ideation

61
Q

Risk of suicidal intention in depressed vs manic patients

A

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

62
Q

What questions could be asked for insight in the MSE?

A

Do you think you are ill?
Do you agree with the treatment plan?
Do you think you can get better?

63
Q

What form of thoughts can depressed patients get?

A

Incomplete thoughts

64
Q

What form of thoughts can manic patients get?

A

Flight of thoughts

Tangenitalality

65
Q

What is tangenitalality?

A

Thoughts linked and connected that shouldn’t be connected

66
Q

Two types of mood

A

Subjective - self (what there thinking they feel)

Objective - others

67
Q

Two factors indicative of severe depression

A

Psychotic symptoms

Acting/planning suicide

68
Q

Definition of euthymia

A

Normal mood

69
Q

What is the condition called when there is depression and mania at the same time?

A

Mixed Affective Disorder

70
Q

Absolute contraindication to ECT

A

Raised ICP

71
Q

Short term side effects of ECT

A
Headache
Nausea
Short term memory impairment
Memory loss of events prior to ECT
Cardiac arrhythmia
72
Q

Long term side effects of ECT

A

Some patients report impaired memory

73
Q

Can pseudohallucinations be part of the normal grieving process?

A

Yes

74
Q

Risk of SSRI use in the 3rd trimester

A

Persistent pulmonary HTN of the newborn

75
Q

What is the consistent difference between mania and hypomania?

A

Presence of psychotic symptoms

76
Q

What drug should be avoided in patients taking SSRIs and why?

A

Triptans

Increased risk of serotonin syndrome

77
Q

What is cotard syndrome?

A

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

78
Q

What is cotard syndrome associated with?

A

Severe depression

Schizophrenia sometimes

79
Q

Common blood abnormality as a S/E of SSRIs

A

Hyponatraemia

80
Q

Indications for ECT

A

Treatment resistant severe depression
Manic episodes
An episode of moderate depression known to respond to ECT in the past
Life threatening catatonia

81
Q

What is the tool used by GPs to characterise severity of depression?

A

Patient health questionaree-9 (PHQ-9)