Mood Disorders

Question 1

How are mood disorders defined?

Answer 1

According to particular types of mood episodes and their pattern over time

Question 2

Outline depressive episode

Answer 2

Can be mild, moderate or severe

Low mood, anhedonia, anergia or diminished interest

Question 3

ICD duration of depressive episode

Answer 3

Most of the day, nearly every day for at least 2 weeks

Question 4

Other symptoms of depressive mood

Answer 4

Poor concentration, inattention, memory

Diurnal variation in mood

Reduced sleep with early morning waking

Change in appetite

Psychomotor changes

Reduced libido

Feeling of guilt, hopelessness, worthlessness

Poor self-esteem

Suicidal ideation

Psychotic features - usually mood congruent

Question 5

What is a hypomanic episode?

Answer 5

Similar to a manic episode but milder

Change from baseline but not markedly impaired

No psychotic symptoms

Question 6

Features of a manic episode

Answer 6

Euphoria, irritability or expansiveness

Increased activity or subjective increased energy

Question 7

Additional features of a manic episode

Answer 7

Increased talkativeness (pressured speech)

Reduced need for sleep

Increased self-esteem or grandiosity

Flight of ideas

Distractibility

Increased sexual drive, sociability or goal-directed behaviour

Impulsive reckless behaviour

Mood lability

Question 8

Are psychotic symptoms present in mania and hypomania?

Answer 8

Mania: sometimes

Hypomania: no

Question 9

Duration of a manic or hypomanic episode

Answer 9

At least 7 days

Question 10

What is a mixed episode?

Answer 10

Several manic and depressive symptoms, occurring simultaneously or in rapid alternation (day to day or within same day)

Question 11

What is bipolar disorder 1?

Answer 11

One or more manic or mixed episodes

Question 12

What is bipolar disorder 2?

Answer 12

One or more hypomanic episodes and at least one depressive episode

No history of manic or mixed episodes

Question 13

What is rapid cycling bipolar disorder?

Answer 13

Multiple (4 or more) discreet episodes within 12 months

Usually hypomaniac and major depressive episodes

May switch spontaneously or during treatment for current episode

Question 14

Acute management of bipolar disorder

Answer 14

Stop any antidepressant

Antipsychotic (haloperidol, olanzapine, quetiapine or risperidone)

If antipsychotic not sufficient, consider adding lithium

Question 15

Maintenance management of bipolar disorder

Answer 15

Lithium most effective

Alternatively valproate, carbamazepine

Antipsychotics: olanzapine, quetiapine

Question 16

What is unipolar depression?

Answer 16

No history of hypomanic or manic episodes

Question 17

Outline bipolar depression

Answer 17

Depressive episode in bipolar illness

Higher frequency and severity

Rapid onset, shorter duration

Increased likelihood of psychotic symptoms

Question 18

What is serotonin syndrome?

How is it caused?

Answer 18

Excessive serotonin activity

Excessive antidepressant use

Question 19

Symptoms of serotonin syndrome

Answer 19

Headache, agitation, hypomania, mental confusion, hallucinations, coma

Shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhoea

Myoclonus, hyperreflexia, tremor

Question 20

Psychological therapy for depression

Answer 20

CBT - addresses maladaptive cognitions and behaviours that can influence depressive symptoms

Interpersonal therapy

Solution-focussed therapy

Counselling

Question 21

What is bipolar affective disorder?

Answer 21

Two or more episodes of mood disturbance, the disturbance consisting on some occasions of mania or hypomania and on others depression

Question 22

Define dysthmia

Answer 22

A chronic depression of mood which does not currently fulfil the criteria for recurrent depressive disorder

Question 23

Define cyclothymia

Answer 23

A persistent instability of mood, involving numerous periods of mild depression and mild elation