Affective / Mood disorders Flashcards
what classification system is used for depression and anxiety?
International classification of disease - 10
Diagnostic and statistical manual for mental disorders DSM-5 used for research
how do you assess if depression or elevated mood is normal or abnormal?
pervasiveness symptoms
persistence symptoms
degree of impairment
specific symptoms and signs
what are the psychological symptoms of depression?
change in mood:
- depression
- anxiety
- puerplexity
- anhedonia
change in thought content:
- guilt
- hopelessness
- neurotic symptoms i.e. hypochondriasis, agoraphobia
- ideas of reference
- delusions and hallucinations
what are the social symptoms of depression ?
loss of interests irritability apathy withdrawal indecisive loss of confidence, concentration, registration and memory
what are the physical symptoms of depression?
change in bodily function
- sleep
- appetite
- enegy
- libido
- constipation
- pain
change in psychomotor function
- stupor
- agitation
- retardation
what are the treatment options for depression?
pharmacological antidepressants;
- selective serotonin rey-take inhibitors
- tricyclic antidepressants
- monoamine inhibitors
non-pharmacological;
- CBT
- behavioural activation
- interpersonal psychotherapy
- family therapy
- electro convulsant therapy
- deep brain stimulation
- vagus nerve stimulation
- psychosurgery
what is the diagnostic criteria for depression?
lasts for 2 weeks
no hypomanic or manic episodes in lifetime
not attributable to psychoactive substance of other organic mental disorder
if psychotic symptoms or stupor then severe depression (need to exclude schizophrenia / schizophrenic disorder)
what is somatic syndrome?
a cluster of symptoms that occur with depression
what are the symptoms of somatic syndrome?
weight loss (5% of body weight)
wakening up 2 hours before they usually do
marked loss of interests or pleasure
lack of emotional reaction to events or activities that normally produce emotional response
worse in the morning
marked loss of libido
evidence of agitation or psychomotor retardation
give differential diagnoses of depression.
normal reaction to life event seasonal affective disorder bipolar disorder dysthymia cyclothymia
AIDS/HIV hyperparathyroidism hypothyroidism addisons tumour, stroke, dementia
what are the measurement tools for affective disorders?
SCID
SCAN
young mania rating scale (YMRS) for mania
what is the typical time course of a depressive episode?
4 - 6 months
what percentage of people have recurrent depressive episodes?
80%
what are the features of mania?
grandiose ideas lack of inhibition loss of judgement over spending increased libido reckless behaviour racing thoughts flight of ideas pressure of speech similarities to the effects of stimulants i.e. amphetamines and cocaine pathological elevated mood
what are differential diagnoses of mania?
schizophrenic disorder schizophrenia cyclothymia hyperthyroidism ADHD drugs and alcohol tumour, stroke, cushings, epilepsy, neurosyphyllis, SLE
what are the treatment options for mania?
antipsychotics;
- olazapine
- quetiapine
- risperidone
mood stabilisers;
- lamotrigine
- sodium valproate
- carbamazepine
lithium
ECT
what is bipolar?
repeat episodes (> 2) of depression and mania/hypomania
if a patient presents with recurrent episodes of mania but no depression, what is the possible diagnoses?
bipolar disorder
hypomania disorder
what is the mean age of onset of bipolar?
21 years
in what sex is bipolar most common in?
M = F
in what sex is depression most common in?
F > M
what is the average duration of a manic episode?
1-3 months
what percentage of patients have recurrent manic episodes?
90%
what is the first line treatment for a patient with cyclical bipolar ?
sodium valproate
what is the first line treatment for someone who has ongoing depression and has one episode of mania?
lithium
a patient is on a SSRI maximum dose for depression but he still doesn’t feel an effect. what 2nd line treatment will you give?
switch from SSRI to SNRI
what are the different stages of treating depression?
1st line: antidepressant e.g. SSRI setralline, fluoxetine
2nd line: switch to another antidepressant
3rd line: adjunct with mirtazepine
4th line: adjunct with lithium
5th line: adjunct with antipsychotic e.g. olazapine, quetiapine, rispiradone
6th line: ECT
what are protective factors for depression?
no family history
employment status
good coping skills
good social / support network
what drugs can cause depressive symptoms?
steroids
beta blockers
what personality traits increases someones risk of depression?
avoidant
dependant
anxious
what is the first line treatment for a patient who has catatonia?
lorazepam
or ECT if life threatening
what defines rapid cycling bipolar?
4 or more episodes within 12 months
what are the core symptoms of depression?
Mood is low
Interest is low
Energy is low
(MIE)
what are the ICD-10 criteria for mild, moderate and severe depression?
Mild;
- 2 core + 2 cognitive symptoms
Moderate;
- 2 core + at least 3/4 cognitive symptoms
Severe;
- 3 core + at least 5 cognitive symptoms
what are the cognitive symptoms of depression which are part of the diagnostic criteria?
weight loss/gain insomnia/hypersomnia decreased concentration decreased energy/fatugue recurrent thoughts of death by suicide unreasonable feelings of guilt or self blame agitation or retardation
what classes of drugs are used to treat mania?
mood stabalizers i.e. carbamazepine
anti-psychotics i.e. olanzapine
what is BDI screening?
becks depression inventory
screening tool to assess the severity of depression
what is MADRAS screening?
montgomery-asperg depression rating scale
what are the consequences of untreated depression?
usually resolves in 6-12 months but even if it does resolve without treatment they are often left with some symptoms such as insomnia
suicide psychosis social problems; - problems with work/unemployment - family problems - social isolation
what psychotic features can be found in mania?
flight of ideas
hallucinations - 2nd person auditory
delusions - grandiose ‘I am king of the world’
what is the diagnostic criteria for bipolar?
at least 2 episodes of mania
OR
at least 1 episode of mania + 1 episode of depression
