Affective Disorders- Depression, Mania, Bipolar Flashcards
Define a mood disorder
Disorder of mental status- alters mood
Can be depressed or elevated
Mood disorders can occur as a primary illness or secondary. Name some causes of secondary mood disorders
Cancer
Dementia
Drug misuse
Medical treatment ie steroids
Name the two classification systems used for affective disorders
WHO- International Classification of Disease 10th Edition (ICD10)
APA - Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM5)
Describe dysthymia
Symptoms of low mood below threshold of depression
Still able to carry out daily tasks/responsibilities
Depression can be described by 3 terms- what are they?
Symptom
Syndrome
Recurrent illness
Name some symptoms of depression
State of feeling/mood- sadness - can be normal to lifethreatening
Systemic - fatigue, pain
What is meant by depression when described as a syndrome?
Constellation of signs and symptoms - not the same in any 2 people
What 4 factors indicate a case where depression has become ‘abnormal’?
Persistence of symptoms greater than 2 weeks
Pervasiveness of symptoms
Degree of impairment
Presence of specific signs or symptoms
Symptoms of depression fall under which 3 spheres?
Physical sphere
Psychological sphere
Social sphere
Name the symptoms of depression that fall under the Psychological sphere
Change in mood
Change in thought content
Describe mood changes in depression
Depression- diurnal variation
Anxiety
Anhedonia
Perplexity
Describe changes in thought content seen in depression
Guilt, hopelessness, worthlessness Neurotic symptomology- hypochondriasis, obsession compulsion, panic attacks Ideas of reference Delusions Hallucinations
3 types of neurotic symptomology that may be seen in depression
Hypochondriasis
Obsession compulsion
Panic attacks
What is meant by ideas of reference?
Example- thinking people are laughing at you, talking about you
Describe symptoms of depression within the physical sphere
Change in bodily function
Change in psychomotor function
What changes may be seen in bodily function in people with depression?
Energy Sleep Appetite Libido Constipation Pain
What changes may be seen in psychomotor function in depression?
Agitation
Retardation
What symptoms are exhibited in depression that can be described by the social sphere?
Loss of interest
Irritability
Apathy
Withdrawal
Loss of confidence
Indecisive
Loss of concentration
Memory
Recognition
Which criteria must be met as described by ICD10 to diagnose depression?
Symptoms lasting at least 2 weeks
No hypomaniac or manic episodes in lifetime
Cannot attribute to psychoactive substance or organic mental disorder
Exclude psychotic illnesses
How does somatic syndrome differ from depression>
Depression worse in the morning
No low mood symptoms
Symptoms of somatic syndrome
Marked loss of interest or pleasure Lack of emotional reaction Waking 2 hours before normal time Objective evidence of psychomotor agitation or retardation Marked loss of appetite Weight loss Marked loss of libido
What are the 3 core symptoms for the diagnosis of depression using ICD10
Depressed mood that is abnormal, for most of the day, everyday for the past 2 weeks
Loss of interest or pleasure
Decreased energy or increased fatiguability
Additional symptoms to diagnose depression using ICD10
Loss of confidence or self esteem
Unreasonable feelings of guilt or self reproach / excessive guilt
Recurrent thoughts of death by suicide or any suicidal behaviour
Decreased concentration
Agitation or retardation
Sleep disturbance
Change in appetite
According to ICD10 how many symptoms must be evident to diagnose Mild Depression?
2 of the core symptoms
Any 2 of additional symptoms
= 4
According to ICD10 how many symptoms must be evident to diagnose Moderate Depression?
2 of the core symptoms
Any 4 of additional symptoms
= 6
According to ICD10 how many symptoms must be evident to diagnose Severe Depression?
All 3 of the core symptoms
Any of additional symptoms
= 8
What percentage of women experience ‘baby blues’ and within what time frame after giving birth?
75% within 2 weeks
What percentage of women will develop a Major Depressive Disorder after giving birth?
10% within 3-6 months
Puerpural psychosis and its recurrence occurs at what rate?
1 in 500 deliveries
Recurrence risk of 1 to 3 in subsequent deliveries
Differentials for Depression
Normal reaction to life event Seasonal Affective Disorder Dysthymia Cyclothymia Bipolar Stroke Tumour Dementia Hypothyroidism, Addison's, Hyperparathyroidism Infections - Influenze, infectious mononucleosis, hepatits, HIV/AIDs Drugs
Treatment for depression
Antidepressants - SSRIs, TCAs, MAOIs
CBT, IPT, Individual Dynamic Psychotherapy, Family therapy
ECT, Psychosurgery, DBS, VNS
What psychological therpaies can be used for treatment of depression?
CBT
IPT
IDP
Family therapy
What physical treatmennt can be used for depression?
ECT
Psychosurgery
DBS
VNS
Which measurement tools can be used in depression?
SCID
SCAN
Symptoms of mania
Grandiose ideas
Inhibition
Loss of judgement
Inappropriate elevated mood
Questions for when mania is abnormal?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Specific signs and symptoms present
Classification of Mania by ICD 10- list the different types
Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Other manic epsiodes Manic episode unspecified
What is the difference between mania and hypomania?
Hypomania- lesser degree of mania
No psychosis
Symptoms of hypomania
Mild elevation of mood for several days on end
Increased energy and activity
Increased sociability, talkativeness, overfamiliarity, sexual energy
Decreased need for sleep
Irritable
Concentration reduced
New interest
Mild overspending
Function not drastically impaired - can still work
Symptoms of mania
1 week- severe enough to disrupt ordinary work and social activities Elevated mood Increased energy Overactivity Pressure of speech Decreased need for sleep Disinhibition Grandiosity Alteration of senses Extravagant spending Can be irritable rather than elated
Differentials for Mania - Psychiatric
Mixed affective state Schizoaffective disorder Schizophrenia Cyclothymia ADHD Drugs and alcohol
Differentials for Mania - Medical
Stroke MS Tumour Epilepsy AIDs Neurosyphilis Endocrine- Cushing's hyperthyroidism
measuring tools for mania
SCID
SCAN
Young Mania Rating Scale
Treatment for Mania
Antipsychotics
Mood stabilisers
Lithium
ECT
Diagnosis of Bipolar using ICD10
Repeated episodes of mania/ hypomania and depression
No depression –> hypomania or bipolar
No mania/hypomania –> recurrent depression
Onset of bipolar
Early
With family history
Length of bipolar episodes
Typically 1-3 months
What percentage of bipolar patients go on to have further episodes?
90%
How long are episodes of major depression typically?
4-6 months
What percentage of patients relapse after major depression?
Over 80%
