Elevated and Depressed Mood

Question 1

at what age do mood disorders peak

Answer 1

usually peak in 30s

Question 2

what is anhedonia

Answer 2

loss of enjoyment/pleasure

Question 3

mood affective disorders are typically worse at what time of day

Answer 3

first thing when patient wakes up

Question 4

how does appearance and behaviour present in someone with depression

Answer 4

reduced facial expression
reduced eye contact and gesturing
rapport is difficult to establish

Question 5

how does speech present in someone with depression

Answer 5

reduced rate, pitch and volume
monotony
increased speech latency –> longer pauses when asked a question
limited content of speech

Question 6

how does mood and affect present in a depressed patient

Answer 6

describe mood as low, down, unhappy, numb

limited reactivity and may report emotional paralysis - ask how they would feel if they lost someone close to them

Question 7

how is thought described in the mental state examination

Answer 7

form, flow and content

Question 8

describe the form, flow and content of a depressed persons thoughts

Answer 8

form is normal
flow is reduced or absent
content is usually negative, pessimistic with suicidal thinking

Question 9

describe perception in a depressed patient

Answer 9

perception is typically normal, if hallucinations are present they are usually auditory and with negative themes

Question 10

describe cognition in a patient with depression

Answer 10

slowing of thoughts
perform poorly on cognition tests
pseudo-dementia may be present

Question 11

what is insight like in a patient with depression

Answer 11

insight is usually preserved, they are aware of their condition

Question 12

how long must depressive symptoms be present for before a diagnosis is confirmed

Answer 12

at least 2 weeks with no remission

Question 13

what are the 3 core symptoms of depression of which 2 must be present for diagnosis

Answer 13

depressed mood that is uninfluenced by circumstances
loss of interest/enjoyment
decreased energy/increased fatiguability
THINK MEE (mood, enjoyment, energy)

Question 14

what are the 7 additional symptoms of depression of which 4 must be present for diagnosis

Answer 14

loss of confidence 
unreasonable guilt 
suicidal thoughts/behaviours 
reduced ability to think/concentrate 
change in psychomotor activity 
sleep disturbance 
changes in appetite

Question 15

what qualifies for a moderate depressive episode

Answer 15

2 core symptoms with 4 additional symptoms

Question 16

what qualifies for a severe depressive episode

Answer 16

3 core symptoms with 5 additional symptoms

Question 17

describe mild depression

Answer 17

most common type, commonly managed in primary care

do not require antidepressants and instead manage through CBT etc

Question 18

what is bipolar I

Answer 18

has to have met criteria for mania

Question 19

what is bipolar II

Answer 19

has experienced a past or current hypomanic or depressive episode but has never met criteria for mania

Question 20

what is bipolar III

Answer 20

hypomania after commencing antidepressants

Question 21

describe the difference between depression and bipolar

Answer 21

depression is a unipolar disease of only low mood whereas bipolar there will be a combination of elevated and depressed mood

Question 22

how long is mood elevated in a hypomanic episode

Answer 22

4 days

Question 23

list some of the signs present in a hypomanic episode

Answer 23

increased activity 
increased talking 
difficulty concentrating 
decreased need for sleep 
increased sexual energy 
mild spending sprees

Question 24

how long is mood elevated in a manic episode

Answer 24

1 week

Question 25

list some of the differences in elevated mood between hypomania and mania

Answer 25

loss of social inhibition
inflated self-esteem
pressure of speech
sexual indiscretions

Question 26

describe the thoughts of a person with mania

Answer 26

increased flow
flight of ideas, loosening of associations
grandiosity as content

Question 27

list the comorbidities for bipolar

Answer 27

anxiety disorder
alcohol and drug misuse 
personality disorder
eating disorder 
schizophrenia

Question 28

list some predictors of poor outcome for bipolar disorder

Answer 28

early onset 
low socio-economic status 
subsyndromal mood symptoms 
rapid mood fluctuation 
psychosis 
comorbid disorders