Mental health: affective disorders Flashcards
What are affective disorders?
- Disorders that affect your mood
What are unipolar and bipolar mood disorders?
‘Unipolar’ mood disorder: recurrent episodes of
depression
‘Bipolar’ mood disorder: depressive states
alternate with manic states in an irregular fashion
In both unipolar and bipolar disorder, episodes of illness
are separated by periods of normal functioning
What are unipolar disorders?
Low mood usually only for a short period of time
- Major depressive disorder = prolonged severe state of low mood, characterised by a feeling that your emotional state is no longer under your control - interferes significantly with daily life
What are the major characteristics of a major depressive mode?
Major depression = most common mood disorder
* Characterised by
* Lowered mood
* Feelings of worthlessness & guilt
* Decreased pleasure in all activities * Diminished ability to concentrate
(anhedonia)
* Recurrent thoughts of death
* Loss (or increase) in appetite
. Fatigue
* Diagnosed when other disorders are excluded e.g
schizophrenia & no recent bereavement
* Affects —6% of population
each year People UK)
* Lifetime prevalence —16% ( = proportion of a population that
at some point in their life have experienced the condition)
* 90% of suicides in the UK are associated with major
depression
* Only one third of people are undergoing adequate treatment
* Social Stigma (‘mental illness’)
What are risk factors of depression?
Risk Factors
* Sex: Female (unipolar depression more common in women)
Age: 20-40
* Family History (genetic factors)
* Traumatic or stressful life events e.g. physical abuse/parental
death (early)
* Postpartum (increased risk after birth = post-natal depression)
* History of other mental health disorders e.g. anxiety & panic
disorders
Depressive episode of depression last from 2 weeks — 2
years
* Without treatment depression Recurs (50% of cases)
Risk of recurrence higher if first depressive episode before
age 20
Successful early treatment reduces relapse rates
Socioeconomic cost
Ellbn a year (due to loss of earnings & treatment)
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What is bipolar disorder?
Bipolar disorder:
* Characterised by changes in mood
* Main Components:
Depression
* Mania
* Many patients have one predominant state
* Exact cause unknown: Heritability and
psychosocial factors?
What are signs and symptoms of BPD?
Signs & Symptoms
* Syndrome
* Many people with depression have bipolar
traits but not BPD
* Patients with depressive disorders can
develop mania (1 in 5)
* Patients can switch from Unipolarto
Bipolar usually within 5 years of onset of
symptoms
Sign & Symptoms
Bipolar patients have ‘episodes’ (but only a few cycle
‘back and forth’)
* More rapid cycling variants may be more likely to
interfere with social functioning than unipolar depression
* Other patients may only have a few cycles in their entire
lifetime (difficulties in diagnosis?)
Episodes of depression in BPD are shorter than UPD (3-
6 months)
Sometimes badly dealt with by healthcare providers
(long time to diagnosis)
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What are the classifications of BPD?
Classification
Bipolar I disorder:
Defined by the presence of full-fledged
(i.e. disrupting normal social and occupational function)
manic or mixed episodes (with our without a depressive
episode). Occurs in 1% of population.
Bipolar Il disorder:
Defined by the presence of at least 1
major depressive episode with hypomania — a milder
form of mania not linked to impairment in judgement or
performance. Occurs in 0.6% of population.
Bipolar disorder not otherwise specified (NOS):
Disorders with clear bipolar features that do not meet the
specific criteria for other bipolar disorders
* Certain drugs (cocaine, amphetamines, alcohol) can
cause exacerbations in susceptible patients
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What are risk factors of BPD?
Risk Factors
* Sex: Either— roughly equal prevalence
(4%)
* Age: Relatively young onset (teens — early
30’s)
* Mid adolescence
* History of depression and mental illness
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What are the symptoms of mania?
Mania
* Elation, Irritation, Euphoria, Suspicion
Rapid flow of ideas
* Goal directed activity increased
Rapid speech
* Elevated mood
* Continual thought/increased productivity
* Decreased need for sleep (3h)
* Social functioning
* Inflated self esteem/grandiosity (superiority) may be
present
* Distractibility
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What is manic psychosis?
Manic Psychosis
* Rare
* Extreme manifestation of mania
* Schizophrenic like psychotic symptoms
* Grandiose (unrealistic sense of superiority)
* Persecutory delusions (think harm is/is going to
occur)
* Delirium may occur (loss of coherent thought)
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What are depressive states?
Depressive States
Similar to Unipolar depression
Psychomotor retardation, stupor, hypersomnia (excessive sleepiness/sleeping)
Psychomotor retardation: major feature of depression. What is it’s
pathophysiology? Postulated that the basal ganglia play a role and may
also be to do with circuitry in the prefrontal cortex. If you consider other
disorders with psychomotor changes such as PD, HD, Schizophrenia
(which all also have high incidents of depression), you can see why
these theories have arisen.
Anxiety, Sadness
Isolation & guilt
Depressive rumination (focused attention on the symptoms of
one’s distress, and on its possible causes and consequences)
Occasional hallucination in a small minority of patients
What are mixed states?
Mixed States
* Blends of manifestations.
May include short duration switching, e.g.
crying in the manic phase.
* Persecutory delusions, indecisiveness,
sleep, racing thoughts, suicidal ideation.
* Prominent depressive symptoms
superimposed on mania.
What is depressive mixed states?
Depressive mixed states
* Can be induced by antidepressants (sub-acute
irritable depression for many months)
* Genuine experience of depression
High risk of suicide
* Anxiety, extreme fatigue, irritable
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What is the aetiology of affective disorders?
Aetiology of affective disorders
Range of aetiological factors implicated
Heritability
OChildhood environment
Life events
Physical & psychological status
Brain biochemistry
c] Hormones
