Mood disorders

Question 1

What are the core symptoms of depression?

Answer 1

Continuous low mood for at least 2 weeks
Lack of energy
Lack of enjoyment / interest (anhedonia)

Question 2

What are the biological (somatic) symptoms of depression?

Answer 2

Sleep changes inc. EMW
Appetite and weight changes
Diurnal variation of mood
Psychomotor retardation / agitation
Loss of libido

Question 3

What are the cognitive symptoms of depression?

Answer 3

Low self-esteem
Guilt / self-blame
Hopelessness
Hypochondriacal thoughts
Poor concentration / attention
Suicidal thoughts

Question 4

What are the classifications of depression?

Answer 4

Mild - 2 core + 2 other symptoms (but able to function)
Moderate - 2 core + 3 (or 4) others
Severe - 3 more + at least 4 others
Severe with psychotic symptoms

Question 5

What is psychotic depression?

Answer 5

Depression with hallucinations (often auditory)
+/- delusions (hypochondriacal / guilt / nihilistic / persecutory)

Question 6

What is the incidence of post-natal depression?

Answer 6

10-15% of women within 1-2 months postpartum
Can appear later in some women

Question 7

What are the risk factors of post-natal depression?

Answer 7

Personal / family history of depression
Older age
Single mother
Unwanted pregnancy
Poor social support
Previous PND

Question 8

How can PND present?

Answer 8

Typical symptoms of depression
Worries about baby’s health
Worries about her ability to cope adequately with baby

Question 9

What is the prognosis of PND?

Answer 9

1/4 mothers with PND are still depressed 1 year after delivery

Question 10

What is the epidemiology of depression?

Answer 10

M:F 1:2
Lifetime prevalence is 10-20%
2-3x more common in individuals with chronic physical health problems

Question 11

What are the symptoms of hypomania?

Answer 11

Mildly elevated, expansive or irritable mood
Increased energy / activity
Increased self-esteem
Sociability, talkativeness, over familiarity
Increased sex drive
Reduced need for sleep
Difficulty in focussing on one task alone

Question 12

What are the symptoms of mania?

Answer 12

Elevated / expansive / irritable mood (>1 week)
Increased energy / activity (inc agitation)
Grandiosity / increased self-esteem
Pressure of speech
Flight of ideas / racing thoughts
Distractible
Reduced need for sleep
Increased libido
Social inhibitions lost
+/- Psychotic symptoms

Question 13

What are the types of persistent mood disorder?

Answer 13

Cyclothymia
Dysthymia

Question 14

What are the symptoms of cyclothymia?

Answer 14

Mild periods of elation / depression
Early onset with chronic course
Common in relatives of BPD

Question 15

What are the symptoms of dysthymia?

Answer 15

Chronic low mood
Not fulfilling criteria of depression

Question 16

What characterises a mixed affective state?

Answer 16

Mix / rapid alteration (hours) of hypomanic, manic, and depressive symptoms

Question 17

What are the classifications of Bipolar?

Answer 17

Bipolar I - manic episodes (1 or more) or mixed episodes +/- depressive episodes (1 or more)
Bipolar II - depressive episodes (1 or more) with at least 1 hypomanic episode
ICD 10 - requires at least 2 episodes: 1 hypomanic, manic, or mixed episode

Question 18

What is the epidemiology of bipolar disorder?

Answer 18

1-2 % prevalence
Median onset: 25 years
M=F

Question 19

What is the prognosis of Bipolar disorder?

Answer 19

Suicide rate is 20x the normal population
Poor prognosis suggested by sev episodes, early onset, cognitive difficulties
Treatment is more effective earlier in course of illness
80% relapse after 1st episode within 5-7 years

Question 20

DDx of mood disorders

Answer 20

Normal fluctuations in mood
PTSD, bereavement, adjustment disorders
Dementia and other brain disorders
Personality disorders
Anxiety disorders

Question 21

Causes of mood disorders

Answer 21

Biological (genetic, brain illness, physical illness)
Psychological (childhood experiences, view of yourself and the world, personality traits)
Social (work, housing, finance, relationships, support)

Question 22

Treatment modalities of mood disorders

Answer 22

Biological
Psychological
Social
Pharmacological
Electroconvulsive treatment (ECT)
Repetitive TMS (rTMS)
Transcranial direct current stimulation (tDCS)

Question 23

What are some examples of pharmacological treatments used for mood disorders?

Answer 23

Antidepressants (SSRI, SNRI, TCA, NASSA, MAOI, NRI, SARI, Melatonin receptor agonist)
Mood stabilisers (Lithium, valproate, carbamazepine, lamotrigine)
Antipsychotics
Anxiolytics
Combination therapies

Question 24

What modalities of physchological treatment are available for mood disorders?

Answer 24

Psychoeducation
CBT
Interpersonal therapy (IPT)
Psychodynamic
Mindfulness

Question 25

What is the prognosis of depression?

Answer 25

First ADs for 6-12 months at least
Multiple episodes need ADs for much longer
80% will have further depressive episodes
10% severe unremitting depression

Question 26

What is a mood disorder

Answer 26

AKA affective disorder
Any condition characterised by distorted, excessive, or inappropriate moods or emotions for a sustained period of time

Question 27

What is the ICD-10 classification of mood disorders?

Answer 27

Manic episode (inc hypomania and mania +/- psychotic symptoms)
Bipolar affective disorder
Depressive episode
Recurrent depressive disorder
Persistent mood disorders
Other mood disorders
Unspecified mood disorders

Question 28

What are the clinical features of neuroleptic malignant syndrome?

Answer 28

Recent administration of antipsychotics (neuroleptics)
Clinical syndrome of mental status change, rigidity, fever, and dysautonomia
Inc. hyperhydrosis, tremor