Mood/affective disorders Flashcards
what is a mood disorder?
also known as an ‘affective disorder’
is any condition characterized by distorted, excessive or inappropriate moods or emotions for a sustained period of time.
►►Affect: Refers to the transient flow of emotion in response to a particular stimulus.
what is the ICD-10 Classification of affective disorders? (7)
- Manic episode: including hypomania, mania without psychotic symptoms and mania with psychotic symptoms.
- Bipolar affective disorder.
- Depressive episode: including mild, moderate, severe and severe with psychotic symptoms.
- Recurrent depressive disorder.
- Persistent mood disorders: cyclothymia, dysthymia.
- Other mood disorders.
- Unspecified mood disorder.
how can u classify of mood disorders?
1* mood disorder: a mood disorder that does NOT result from another medical** or **psychiatric condition.
>> primary mood disorder is either
- unipolar (depressive disorder, dysthymia) or
- bipolar (bipolar affective disorder, cyclothymia).
*2 mood disorder: a mood disorder that DOES results from another medical or psychiatric condition.
DEPRESSIVE EPISODE
Epidemiology and risk factors
Clinical features
CORE SYMPTOMS:
- Anhedonia
- Low mood> at least 2 weeks.
- Lack of energy (anergia)
DEAD SWAMP
- Depressed mood
- Energy loss (anergia)
- Anhedonia
- Death thoughts (suicide)
- Sleep disturbance & sex reduced (early moring awakening)
- Worthlessness or guilt
- Appetite or weight change
- Mentation (concentration)
- Psychomotor retardation
Epidemiology: Onset is most commonly in the 40s and 30s
causes of depression?
ICD-10 Classification of depression
- Mild depression = 2 core symptoms + 2 other symptoms
- Moderate depression = 2 core symptoms + 3–4 other symptoms
- Severe depression = 3 core symptoms + ≥4 other symptoms
- Severe depression with psychosis = 3 core symptoms + ≥4 other symptoms + psychosis
DEPRESSIVE DISORDER
- Diagnosis and investigations
- DDX
questionnaires: PHQ-9, HADS and Beck’s depression inventory
- (if post partum do the edinborough depression scale)*
- other Ix nafs bipolar alaa!*
DDx
- Secondary to physical condition ex; hypothyroidism
- Other mood disorders: BAD, other depressive disorders
- Secondary to psychoactive substance abuse.
- Secondary to other psychiatric disorders: Psychotic disorders, anxiety disorders, adjustment disorder, personality disorder, eating disorders, dementia.
- Normal bereavement.
name some other depressive disorders
Recurrent depressive disorder: when a ptx has ANOTHER depressive episode after their first.
Seasonal affective disorder: depressive episodes recurring ANNUALLY at the SAME time each year, usually during the winter months.
Masked depression: A state in which depressed mood is not particularly prominent, but other features of a depressive disorder are, e.g. sleep disturbance, diurnal variation in mood.
ATYPICALLL depression: typically occurs with mild–moderate depression with REVERSAL of symptoms ex: overeating, weight gain and hypersomnia. There is a relationship btw atypical depression & seasonal affective disorder.
Dysthymia: Depressive state for at least 2 years, which does not meet the criteria for a mild, moderate or severe depressive disorder and is not the result of a partially-treated depressive illness.
Cyclothymia: Chronic mood fluctuation over at least a 2-year period with episodes of elation and of depression which are insufficient to meet the criteria for a hypomanic or a depressive disorder.
Baby blues: 60–70% of women, typically 3–7 days following birth, and is more common in primiparae. Mothers are anxious, tearful and irritable. Reassurance and support is all that is required.
Postnatal depression: Affects approx 10% of women. Most cases start within a month and typically peak at 3 months.
BAD classification (3)
Bipolar 1: episodes of MANIA then depression
Bipolar 2: episodes of HYPOMANIA then SEVERE dep
Rapid cycling: >4 mood swings in a 12-month period with no intervening asymptomatic periods. Poor prognosis.
Bipolar affective disorder
- Pathophysiology/Aetiology
- Epidemiology and risk factors
divided into Enviromental and Biological
- enviromental: stress, exams, post partum, life events
- Biological:
- Endocrine: high cortisol, aldos, thyroid
- Neurological: high Dopamine, serotonin
- Genetic: twins, FHx
Epidem: starts aroud 19 years old
BAD
- definition
- symptoms and signs
- how would you further classify mania?
is a chronic episodic mood disorder, characterized by:
- at least one episode of mania (or hypomania) and
- a further episode of mania or depression.
so in total lazm 2 episodes! where one MUST be mania or hypomania
ICD–> Mania requires 3/9 to be present
- Irritibility
- Distractibility
- Irresponsible/insight impaired
- Gradniose delusions
- Flight of ideas
- Apetitie increased
- Sleep decreased, sex disinhibtion,spending
- Talkative
- ELATED mood/Energy increased
- Reckless/redued concentration
Further classify into:
- Hypomania
- Mania w/ out psychosis
- Mania w/ psychosis
difference btw hypomania, mania without psychosis, & mania with psychosis
HYPOMANIA: Mildly elevated mood or irritable mood present for ≥4 days. symptoms r a lesser extent than mania. not severe disruption of work and social life. Partial insight may be preserved.
ICD-10 divides bipolar disorder into 5 states:
(1) Currently hypomanic
(2) Currently manic;
3) Currently depressed
(4) Mixed Disorder
(5) In remission.
BAD Ix, ddx, MSE
Self-rating scales: e.g. Mood Disorder Questionnaire.
Blood tests:
- FBC (routine)
- TFTs (hyper/hypo are ddx)
- U&Es (baseline function to starting meds),
- LFTs (baseline function to starting meds),
- glucose, calcium (biochemical disturbances can cause mood symptoms).
Urine drug test: Illicit drugs can cause manic symptoms.
CT head: to rule out SOLs (can cause manic symptoms such
as disinhibition).
Bipolar affective disorder
- Management
BAD long term Mx
- why is it given?
- what should be checked before you give it? (4)
4 weeks after an acute episode has resolved…..
LITHIUM first-line to prevent relapses.
- -If lithium is ineffective consider adding valproate.*
- -Olanzapine or quetiapine are alternative options.*
- minimizes the risk of relapse & i_mproves quality of life._
- must check U&E’s, TFTs, pregnancy status, baseline ECG
how can the severity of mania be divided ?
what is DYSTHYMIA?
symptoms?
Persistent depressive disorder, is UNIPOLAR continuous chronic form of depression
HE’S 2 SAD2
- Hopelessness
- Energy loss or fatigue
- Self-esteem is low
- 2 years minimum of depressed mood most of the day, for more days than not
- Sleep is increased or decreased
- Appetite is increased or decreased
- Decision-making or concentration is impaired
what is CYCLOTHYMIA?
Type of bipolar disorder
Chronic mood fluctuation over at least a 2-year period with episodes of feeling LOW to emotionally HIGH which are insufficient to meet the criteria for a hypomanic or a depressive disorder.
(tootah is cycling)
A combination of lithium and sodium valproate is first-line treatment for rapid cycling.
mood vs affect
Mood: refers to emotional experience over a more prolonged period.
Affect: refers to immediate expressions of emotion e.g. smiling at a joke
is assessed by observing a patient’s posture, facial expression, emotional reactivity & speech.
think of it alaa as MOOD is the “season” while AFFECT is the “Weather”
What are the indications for ECT?
- If antipsychotic drugs are ineffective
- Not eating or drinking
- Increase in suicide risk.
- Severe depression with psychotic features
- treatment resistant depression
- catatonia
- severe mania
Management of depression
Mild–moderate: Watchful waiting reassess the ptx again in 2 weeks.
- Bio: nothing unless…. (lasted a long time, Hx of moderate–severe D)
- psycho: Computerized CBT (conventional CBT, involves a computer programme educating them about depression & challenging negative thoughts), Psychotherapy
- Social: Self-help programmes ptx work through a self-help manual, Physical activity
Moderate–severe: Suicide risk assessment!
CONSIDER REFERRAL IF:
- suicide risk is high
- depression is severe
- recurrent depression
- unresponsive to initial treatment.
- Bio: 1ST LINE: SSRI, tca, snri, moa,
- for 6 months after resolution of 1st episode
- for 2 years after resolution of 2nd episode
- Psycho: CBT, IPT ECT
- Social: support groups
