Mood Disorders Flashcards
How long do depressive symptoms need to be present for diagnosis?
most of the time, for most of the days, for 2 weeks or more
What is unipolar depressive disorder?
Disorder where symptoms of unhappiness become qualitatively different and pervasive or interfere with normal functioning
What groups tend to get depression?
- More than 50% of cases before age 30
- Onset is usually late 20s-30s
Criteria for depression? (ICD-11 jan 22)
- The depressive episode should last at least 2 weeks
- There have been no hypomanic or manic episodes in the individual’s life
Must have one of the affective cluster symptoms:
- Depressed mood OR
- Markedly diminished interest or pleasure in activities (especially in those that are usually enjoyable)
(Low energy)
(it’s all about MEE- mood, energy, enjoyment)
- And then enough from this list to make total 5
- Loss of concentration
- Beliefs of low self-worth or excessive and inappropriate guilt
- Hopelessness
- Recurrent thoughts of death, suicidal ideation, or evidence of attempted suicide
- Significantly disturbed sleep
- Significant change in appetite
- Psychomotor agitation or retardation
- Reduced energy
- Symptoms must not be accounted for by bereavement, another medical condition, fulfil mixed episode criteria
- Mood disturbance must result in significant impairment in functioning or functioning is only maintained through significant additional effort
What is dysthymia?
This is mild or moderate depressive illness that lasts intermittently for 2 years or more
What is psychotic depression?
- This occurs in those with severe depression where thinking becomes psychotic (not everyone with severe depression will become psychotic though)
- Usually, hallucinations are within the theme of depression e.g. voices telling them they are a failure
Mental State Exam for depression?
- Appearance: slouching, tired, unkempt, disheveled
- Behaviour: upset or teary
- Speech: slowed down speech, monotonal, low volume, poverty of speech
- Mood: feeling low
- Affect: blunted, flattened, not responding much to what you are saying
- Thoughts: suicidal thoughts, thoughts of self harm, guilt, shame, thought blocking
- Perception: probably normal unless psychotic depression
- Cognition: poor concentration and memory, but most likely oriented in time place and person
- Insight: generally aware of how they are feeling
2 screening tools for depression?
phq-9 and HAD
Management of depression?
- Providing a diagnosis can make patients feel better as they understand where their distress is coming from
- Patients who are actively suicidal or severely depressed should be admitted to hospital
- Mild to moderate depression has been shown to respond well to talking therapies, the main one being CBT
- Moderate and severe episodes of depression can be effectively treated using medication (need weeks of continuous administration to work)
- First line anti-depressant is a SSRI
- There is little evidence to suggest one drug is better than an another, escitalopram is probably the best all round SSRI but sertraline is also well established and has a good cardiac safety profile as well as allowing for easy dose titration
- Anti-depressants can take 2-4 weeks before any benefit is felt so patients should be warned about this
- If patients are still not feeling benefit they should be switched to another SSRI
- For a first episode: antidepressant should be given for at least 6 months after full recovery without reducing the dose
- For a second episode or more: antidepressants should be continued for 1-2 years after full recovery without reducing the dose
- Electroconvulsive therapy is the treatment of choice in severe life threatening depressive illness, particularly when psychotic symptoms are present
What are signs of severe depression?
- Psychosis
- Stupor – risk of death by neglect e.g. not drinking, not moving and get pressure sores, and also actual physical functioning slowing down so much
- Needs ECT and anti-depressants
What is bipolar disorder? What are the 2 classifications?
- Disorder where the patient suffers from both bouts of depression or mania
- There are 2 main classifications:
BIPOLAR 1: Have to have had a manic episode that meets the full manic criteria, the patient may have had other episodes that are hypomanic or depressive too, this describes the classic manic-depressive psychosis
BIPOLAR 2: person has had a current or past hypomanic episode but has never met the criteria for a manic episode, they will also suffer from depressive episodes (this is the most common form of bipolar disorder and is not a milder form of illness, there is still a very large amount of disability)
Explain depression vs bipolar?
- A single episode of hypomania or mania is bipolar disorder (even if the patient hasn’t had a depressive episode yet)
- The first episode of hypomania or mania on a background of recurrent depression means that it’s bipolar disorder and not depression anymore
What is hypomania?
a level of disturbance below mania
Hypomania criteria?
Both of these occurring concurrently and persisting for most of the day, nearly every day for at least several days:
* Persistent elevation of mood or increased irritability that represents a significant change from the individual’s usual range of moods and does not include periods where these moods would be contextually occur
* Increased activity or subjective experience of increased energy that represents a significant change from the normal level
In addition, several of the following symptoms representing a significant change from the individual’s usual behaviour:
- Increased talkativeness or pressured speech
- Flight of ideas or subjective experience of thoughts racing
- Increased self-esteem or grandiosity
- Decreased need for sleep (they still feel well rested- contrast to insomnia)
- Distractibility
- Impulsive reckless behaviour
- An increase in sexual drive, sociability or goal-directed activity
Symptoms cannot be a manifestation of another medical condition
Clinical presentation does not fit a mixed episode
The mood disturbance is not sufficiently severe as to cause marked impairment in occupation functioning or in usual social activities or relationships with others and is not accompanied by delusions or hallucinations
Manic episode criteria?
Both of the following features occurring concurrently and persisting for most of the day, nearly every day, during a period of at least 1 week, unless shortened by intervention:
* An extreme mood state characterized by euphoria, irritability, or expansiveness that represents a significant change from the individual’s typical mood. Individuals commonly exhibit rapid changes among different mood states (i.e., mood lability).
* Increased activity or a subjective experience of increased energy that represents a significant change from the individual’s typical level.
Several of the following symptoms, representing a significant change from the individual’s usual behaviour or subjective state:
o Increased talkativeness or pressured speech
o Flight of ideas or experience of rapid or racing thoughts
o Increased self-esteem or grandiosity – this can be manifested as grandiose delusions
o Decreased need for sleep
o Distractibility
o Impulsive reckless behaviour
o An increase in sexual drive, sociability, or goal-directed activity.
The symptoms are not a manifestation of another medical condition
The clinical presentation does not fulfil the diagnostic requirements for a Mixed Episode.
The mood disturbance results in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning, requires intensive treatment (e.g., hospitalization) to prevent harm to self or others, or is accompanied by delusions or hallucinations.
