Affective/Mood Disorders

Question 1

Define Mood disorders

Answer 1

Disorders of mental status and function where altered mood is the/a core feature. This includes depression and mania, they are the most common group of mental disorders.

Mood/affect is a specturm, depression is at one end and mania is at the other. Neutral is called euthymia.
These disorders can present as the primary problem or be secondary to other illnesses such as cancer, dementia or medical treatment e.g. with steroids.
They are also often associated with anxiety symptoms or disorders.

Question 2

How are Mood/ affective disorders classified?

Answer 2

We maninly use the ICD-10 classification (International Classification of Disease edition 10 by World Health Organisation).

This separates Mood/ Affective disorders in to 7 categories (all with subsets): 
Manic episode
Bipolar affective disorder
Depressive episode
Recurrent depressive episode
Peristent Mood disorders
Other mood disorders
Unspecified mood disorder

The most common mood disorders include depression, mania, hypomania and bipolar affective disorder (BAD).

Question 3

What is depression?

Answer 3

This is an emotion which can range from normal experience to a life-threatening illness. It will present with a collection of symptoms which can be quite different between two people.
It is the leading cause of disability in the world.

Question 4

When does depression become abnormal/ an illness?

Answer 4

There is no clear point at which it becomes abnormal.

Normally consists of:
Peristsence of symptoms >2 weeks
Pervasivness of symptoms - not necessarily lasting all day but for quite alot of it 
Degree of impairment 
Presence of specific symtpoms of signs

Question 5

What are the symptoms of depression?

Answer 5

Psychological :
~ change in mood: depression (usually diurnal variation), anxiety(inability to relax), perplexity/confusion/being overwhelmed (particularly in puerperal illness), anhedonia (inability to experience pleasure in the things you would normally)
~change in thought content: guilty, hopelessness, worthlessness, obessions & compulsions, panic attacks

Physical:
~ change in bodily function: energy (faitgue), disturbed sleep, change in appetite, weightloss, reduced libido, constipation and pain
~ change in psychomotor functioning, agitation, retardation

Social:
~loss of interets
~Iritabillity
~Apathy
~Loss of confidence
~withdrawl
~loss of concentration
~ reduced memory

Question 6

Define Puerperal Illness

Answer 6

Illness that occurs during the time of having a baby

Question 7

Define Agitiation

Answer 7

A state of restless overactivity, aimless or inaffective

Question 8

Define Anhedonia

Answer 8

Loss of ability to derive pleaure from experience

Question 9

Define Apathy

Answer 9

Loss of interet in own surroundings

Question 10

Define Anxiety

Answer 10

An unpleasent emotion in which thoughts of apprehension or fear predominate

Question 11

Define Depression

Answer 11

An unpleasent emotion in which thoughts of sadness or unhappiness predominate

Question 12

Define Retardation

Answer 12

a slowing of motor responses including speech

Question 13

Deifine Stupor

Answer 13

A state of extreme retardation on which consiouness is intact. The patient stops moving, spekaing, eating and drinking. On recovery they can describe clealry events which occured whilst stuposed.

Question 14

What is the ICD-10 classification of depression?

Answer 14

Lasts for at least 2 weeks
No hypomanic/manic episodes in life ( if these have occured then would be dipolar affective disorder)
Not attributable to psychoactive substance use or organic mental disorder
If psychotic symptoms or stupor then severe depreession with psychotic symptoms (need to excluded schizoprenia ect).

Criteria:
Main; 
depressed mood that is abnormal for most of the day almost everyday for 2 weeks
loss of interest or pleasure
decreased energy or increased fatigue

Additional symptoms;
loss of confidence/ self esteem
unreasonable feelings of guilt
recurrent suicidal ideation
decreased concentration
Agitation or retardation
sleep disturbance
change in appetite

Mild- at least symptoms, of which at least 2 must be main symptoms
Moderate- at least 6 symptoms, of which at least 2 are main symptoms
Severe- at least 8 symptoms including all three main symptoms

Question 15

What is somatic syndrome?

Answer 15

It is a subtype of depression that is a particular cluster of symptoms

Loss of interest/pleasure in activities they normally enjoy
Lack of emotional reactions
Waking 2 hrs before normal
Depression worse in morning
psychomotor agitation or retardation
marked loss of appetite 
weightloss (5%+ of body weight in a month)
marked loss of libido

Question 16

What is postnatal depression?

Answer 16

It is depression which occurs within 1 year of giving birth. It is very common
75% of women will get baby blues (does not last longer than 2 weeks)
10% of women will develop a major depressive disorder within 3-6 months of delivery

Question 17

What is mania? ICD-10 definition

Answer 17

Lasts at least 1 wekk and is severe enough to disrupt ordinary work and social activites. Can be with or without psychosis
Elevated mood
increased energy
overactivity
pressure of speech
decreased need for sleep 
disinhibition
grandiosity
alteration of senses
extravagant spending
irritable

Question 18

What is hypomania?

Answer 18

Lesser degree of mainia and no psychosis

Not to the extent of severe disruption of work or social rejection

Question 19

What is cyclothymia?

Answer 19

Similar to bipolar affective disorder, it is a mood disorder with lows and highs of mood, most people’s symptoms are mild enough that they do not seek mental health treatment, this often goes undiagnosed but can cause problems with people’s work and social relationships.

Question 20

What is dysthymia?

Answer 20

It is a milder but longer-lasting form of depression, it can also be called peristent depressive disorder.

Question 21

How is mania treated?

Answer 21

Antipsychotics e.g. Olanzapine or Risperidone
Mood stabilisers e.g. sodium valproate, lamotrigene
Lithium
ECT

Question 22

Define Bipolar disorder

Answer 22

BAD has many subtypes including whether the patient is in a current manic, depressive or remissive phase, with or without psychosis.
It is defined as repeated (2+) episodes or depression and mania or hypomania

Question 23

What is the epidemology of BAD?

Answer 23

Equal rates in men and women and in developed/industrialised and non-developed/non-industrialised countries.
Mean age of onset 21, unusal for onset >30 years
Lifetime prevalence 0.7-1.6 per 100
Earlier onset usually 15-19 if positive family history

Question 24

What is the epidemology of depression?

Answer 24

lifetime prevalence rate 2.9-12 per 100

More common in females
highest risk 18-44 (median 25)
However can occur across all ages and onset in old age is not uncommon.

MDD less common in those employed and financially independant

Increased risk in 1st degree relatives
Associated with exit events e.g. separations and losses

Question 25

What is the course/outcome of a MDD?

Answer 25

Typically lasts 4-6 months

54% recovered at 26 weeks/ 6 months
12% fail to recover
80%+ have further episodes
Those treated in primary care have ~40% recurrence rate
15% die by suicide

Question 26

What is the course/outcome of BAD?

Answer 26

Manic episode usually lasts 1-3 months
60% recover at 10 weeks
5% fail to recover
90% have further episodes
1/3 have poor outcome
10% die by suicide