Mood disorders Flashcards
What are the core symptoms of depression?
Continuous low mood for at least 2 weeks
Lack of energy
Lack of enjoyment / interest (anhedonia)
What are the biological (somatic) symptoms of depression?
Sleep changes inc. EMW
Appetite and weight changes
Diurnal variation of mood
Psychomotor retardation / agitation
Loss of libido
What are the cognitive symptoms of depression?
Low self-esteem
Guilt / self-blame
Hopelessness
Hypochondriacal thoughts
Poor concentration / attention
Suicidal thoughts
What are the classifications of depression?
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
What is psychotic depression?
Depression with hallucinations (often auditory)
+/- delusions (hypochondriacal / guilt / nihilistic / persecutory)
What is the incidence of post-natal depression?
10-15% of women within 1-2 months postpartum
Can appear later in some women
What are the risk factors of post-natal depression?
Personal / family history of depression
Older age
Single mother
Unwanted pregnancy
Poor social support
Previous PND
How can PND present?
Typical symptoms of depression
Worries about baby’s health
Worries about her ability to cope adequately with baby
What is the prognosis of PND?
1/4 mothers with PND are still depressed 1 year after delivery
What is the epidemiology of depression?
M:F 1:2
Lifetime prevalence is 10-20%
2-3x more common in individuals with chronic physical health problems
What are the symptoms of hypomania?
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
What are the symptoms of mania?
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
What are the types of persistent mood disorder?
Cyclothymia
Dysthymia
What are the symptoms of cyclothymia?
Mild periods of elation / depression
Early onset with chronic course
Common in relatives of BPD
What are the symptoms of dysthymia?
Chronic low mood
Not fulfilling criteria of depression
What characterises a mixed affective state?
Mix / rapid alteration (hours) of hypomanic, manic, and depressive symptoms
What are the classifications of Bipolar?
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
What is the epidemiology of bipolar disorder?
1-2 % prevalence
Median onset: 25 years
M=F
What is the prognosis of Bipolar disorder?
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
DDx of mood disorders
Normal fluctuations in mood
PTSD, bereavement, adjustment disorders
Dementia and other brain disorders
Personality disorders
Anxiety disorders
Causes of mood disorders
Biological (genetic, brain illness, physical illness)
Psychological (childhood experiences, view of yourself and the world, personality traits)
Social (work, housing, finance, relationships, support)
Treatment modalities of mood disorders
Biological
Psychological
Social
Pharmacological
Electroconvulsive treatment (ECT)
Repetitive TMS (rTMS)
Transcranial direct current stimulation (tDCS)
What are some examples of pharmacological treatments used for mood disorders?
Antidepressants (SSRI, SNRI, TCA, NASSA, MAOI, NRI, SARI, Melatonin receptor agonist)
Mood stabilisers (Lithium, valproate, carbamazepine, lamotrigine)
Antipsychotics
Anxiolytics
Combination therapies
What modalities of physchological treatment are available for mood disorders?
Psychoeducation
CBT
Interpersonal therapy (IPT)
Psychodynamic
Mindfulness
What is the prognosis of depression?
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
What is a mood disorder
AKA affective disorder
Any condition characterised by distorted, excessive, or inappropriate moods or emotions for a sustained period of time
What is the ICD-10 classification of mood disorders?
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
What are the clinical features of neuroleptic malignant syndrome?
Recent administration of antipsychotics (neuroleptics)
Clinical syndrome of mental status change, rigidity, fever, and dysautonomia
Inc. hyperhydrosis, tremor
