Affective (Mood) Disorders Flashcards
When does depression become abnormal?
- persistence of symptoms
- pervasiveness of symptoms
- degree of impairment
- presence of specific symptoms and signs
What is anhedonia?
when you no longer take pleasure in things you would otherwise enjoy
What is stupor?
a state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking. On recovery can describe clearly events which occurred whilst stuporose
How long must symptoms last to be classed as ‘depression’?
for at least 2 weeks
What things must you rule out in your history to make diagnosis of depression?
- no hypomanic or manic episodes in lifetime
- not linked to psychoactive substances or organic mental disorder
Presence of what, will automatically make the level of depression severe?
- psychotic symptoms (delusions or hallucinations) or stupor
- diagnosis would be severe depression with psychotic symptoms
What are examples of somatic symptoms of depression?
- anhedonia
- apathy (lack of emotional reactions to events or activities that normally produce an emotional response)
- insomnia (waking 2 hrs before normal time)
- depression worse in morning
- objective evidence of psychomotor agitation or retardation
- marked loss of appetite
- weight loss (5% + of body weight in a month)
- marked loss of libido
What are the 3 general criteria for diagnosis of depression?
- depressed mood that is abnormal most of the day almost every day for the past 2 weeks, largely uninfluenced by circumstances
- loss of interest or pleasure
- decreased energy or fatiguability
What are the 7 additional features of depression considered in the diagnosis?
- loss of confidence or 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 apetite
How do you diagnose depression using ICD-10?
require 2 of the general criteria of depression and at least 2 of the additional criteria to diagnose mild depression
According to ICD-10, what would diagnose moderate depression?
2 general criteria + 4 additional criteria
According to ICD-10, what would give a diagnosis of severe depression?
all of the general criteria and at least 5 of the additional criteria
What proportion of women will experience ‘blues’ postnatally?
75% within 2 weeks
What proportion of women postnatally go on to develop manic depressive disorder?
10% in 3-6 months
What would be included in a differential diagnosis for depression?
- normal reaction to life event
- SAD
- dysthymia
- cyclothymia
- bipolar
- stroke, tumour, dementia
- hypothyroidism, Addison’s, hyperparathyroidism
- infections - flu, glandular fever, hepatitis, HIV/AIDS
- drugs
What are the medical treatments for depression?
- SSRIs
- Tricyclic antidepressants
- monoamine oxidase inhibitors
- ECT
- psychosurgery
- deep brain stimulation
- vagal nerve stimulation
What are the possible psychological treatments for depression?
- CBT
- IPT
- family therapy
- individual therapy
What are examples of measurement tools of depression?
- SCID
- SCAN
- PHQ-9
What is mania?
- a state of feeling, or mood, that can range from near-normal experience to severe, life threatening illness
- often associated with grandiose ideas, disinhibition, loss of judgement (with similarities to the mental effects of stimulant drugs)
- pathological, inappropriate, elevated mood
What is hypomania?
- lesser degree of mania - not to the extent of severe disturbance of work or social rejection
- no psychosis
What are characteristics of hypomania?
- mild elevation of mood for several days on end
- increased energy and activity, marked feeling of wellbeing
- increased sociability, talkativeness, overfamiliarity, increased sexual energy, deceased need for sleep
- may be irritable
- concentration reduced, new interests, mild overspending
What characterises mania?
- 1 week mania, severe enough to disrupt work and social activities more or less completely
- elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
- disinhibiton
- grandiosity
- alteration of senses
- extravagant spending
- can be irritable rather than elated
What would be considered in the differential diagnosis of mania?
- -mixed affective state
- schizoaffective disorder
- schizophrenia
- cyclothymia
- ADHD
- drugs and alcohol
- stroke, MS, tumour, epilepsy, AIDS, neurosyphilis
- Cushing’s, hyperthyroidism, SLE
What are tools to measure symptoms in mania?
- SCID
- SCAN
- Young Mania Rating Scale
What are possible treatments for mania?
- antipsychotics e.g. olanzapine, risperidone, quetiapine
- mood stabilisers e.g. sodium valproate, lamotrigene, carbamazepine
- lithium
- ECT
When would bipolar affective disorder be diagnosed?
- repeated (2+) episodes of depression and mania or hypomania
- if no depression the diagnosis is hypomania or bipolar disorder
When is bipolar disorder normally diagnosed?
between ages 15-19, usually with a positive family history
In which sex is depression more common?
females 2:1
What is the clinical course and outcome generally in major depression?
- typical episode lasts 4-6 months
- over half recovered at 26 weeks
- 80% have further episodes
What is the clinical course and general outcome in bipolar disorder/ mania?
- typical manic episode lasts 1-3 months
- 60% recovered at 10 weeks
- 90% have further episodes
