Disorders of Mood

Question 1

Although efforts to distinguish subtypes of unipolar depression have been only partially successful, what are the three agreed subtypes?

Answer 1

Melancholic depression
Atypical depression
Dysthmia

Question 2

Melancholic depression

Answer 2

40-60% of depression
Worse in the morning, insomnia with early morning wakening, anorexia with significant weight loss, psychomotor agitation and mental pain, disinterest and blunted affect, anhedonia
Characteristic sleep pattern abnormalities, psychomotor, emotional or intellectual retardation
Preferentially respond to ECT, TCAs and SSRIs

Question 3

Atypical depression

Answer 3

Less than 15% of patients hospitalised for mood disorders
Appears to be chronic rather than phasic, cheer up temporarily when good things happen, hypersomnia, weight gain, symptoms worse in the evening, prominent symptoms of anxiety (by all accounts, the opposite of melancholic depression

Question 4

Dysthymia

Answer 4

Persistent but milder, lasts for at least two years but the symptoms fall short of a diagnosis of major depression

Question 5

How many patients with major depression will also experience a manic episode?

Answer 5

25% (if only a mild one)

Question 6

Bipolar disorder affects men and women…

Answer 6

… equally, unlike unipolar depression which appears more common in women

Question 7

The average age of onset of bipolar disorder

Answer 7

20, compared to around 30 for unipolar depression

Question 8

Manic episode in bipolar are characterised by

Answer 8

elevated, expansive or irritable mood laste at least one week, with at least one of: overactivity; pressure of speech; social intrusiveness; increased energy and libido; flight of ideas; grandiosity; distractibility; decreased need for sleep and reckless spending
in the most severe cases mania can be accompanied by hallucinations and/or delusions

Question 9

Some patients with unipolar and bipolar disease show a functional abnormality in the PFC ventral to the genu of the corpus callosum

Answer 9

During the depressive phases of BD activity is decreased, while during the manic phases it is increased, in both cases this is localised to the agranular region of the anterior cingulate gyrus ventral to the corpus callosum

Question 10

Why is the cingulate gyrus important in terms of affective disorders?

Answer 10

The cingulate gyrus is thought to be the centre of production for conscious emotional feelings