Mood Disorders Flashcards
why is there a decrease in depression in older patients
under-reporting
what is euthymia
normal mood
what is hyperthymia
elevated mood
what is cyclothymia
varied mood
what is dysthymia
persistent low mood
what is anhedonia
loss of enjoyment/pleasure
what is anergia
loss of energy
whast is stupor
absence of relational functions like action and speech
what is psychomotor retardation
subjective/objective slowing of thoughts/movement
MSE depression - appearance/behaviour?
reduced facial expression
furrowing of brows
reduced eye contact and gesturing
hard to establish rapport
MSE depression - mood?
associated with what pt describes
low, down, miserable, unhappy, sad, empty, black, numb
MSE depression - affect?
depressed, limited reactivity, emotional paralysis
MSE depression - thought?
usually normal form flow may be slowed or absent may have delusion in content guilt, nihilism, hypochondriasis, poverty suicidal cotards syndrome
MSE depression - perception?
may have increased self referential thinking - people talking aobut them
hallucinations possible - 2nd person and derogatary
MSE depression - cognition?
slowed, often poor memory
pseudo-dementia
MSE depression - insight?
insight almost always preserved and aware of symptoms
MSE depression - speech?
reduced rate, pitch, intonation, volume
limited content
general criteria (not core) for the patient to meet a depression diagnosis
no evidence of mania
>2wks
must be clearly abnormal and severely impact function
core features of depression
at least 2/3
low mood and present almost every day for at least 2 weeks
low energy
loss of interest or pleasure in activities
additional features of depression
need at least 4 loss of confidence/self esteem feelings of guilt wishing to die difficulty in concentration change in psychomotor activity, either subjective/objective agitation/retardation sleep disturbance change in appetite
grading of severity of depression
moderate - 2 core symptoms and 4 others to give 6
severe - all 3 and 5 others to give 8
features fo psychotic depression
paranoid, mood congruent or hypochondriacal
cotards syndrome
what is cotards syndrome
nihilistic delusion in which the patient belives they are not alive or do not exist
what is disruptive mood dysregulation disorder
alterantive to bipolar disorder in children 6-18 and cannot be better explained by another disorder
criteria for DMDD
Severe recurrent temper outbursts inconsistent with developmental level >3x per week persistently angry most of the day and nearly every day present more than >1yr with relief >3m
what is bipolar I
current or past episode of mania
what is bipolar II
current/past hypomanic episode with current/pasdt depressive episode
what is bipolar III
hypomanic episode following antidepressants
what is bipolar affective disorder
two or more episodes where mood/activity levels are significantly disturbed
mania, hypomania or depression
distinguishing depression from bipolar
single episode mania/hypomania before depression is highly likely bipolar
first episode mania/hypomania on background of recurrent depression means it is bipolar and no longer depression
criteria for hypomanic episode
present 4 consecutive days >/= 3 of the following increased activity/restless increased talkativeness difficulty concentrating decreased need for sleep increased libido mild spending spree/reckless and irresponsbile behaviour
criteria for manic episode
elevated/irritable mood and definitely abnormal at least 1 week unless needs admitted >/=3 of increased activity/restless talkativeness flight of ideas loss normal social inhibition decreased need for sleep grandiosity/inflated self esteem distractible reckless behaviour marked increase sexual energy
typical onset bipolar
20s
FHx implies lower sge onset
how much of the time are bipolar pts symptomatic
50%
1/3 manic 2/3 depressed
