Mood Disorders

Question 1

Types of mood disorders

Answer 1

Types of mood disorders

1. Depressive
   - Single or recurrent
2. Bipolar
   - Mania, hypomania, mixed
3. Persistent
   - Cyclothymia, dysthymia

Question 2

Depression
- Symptoms (Core, somatic, cognitive)

Answer 2

Depression
- Symptoms

1. Core
   - Continuous low mood (2 weeks)
   - Anergia
   - Anhedonia
2. Somatic
   - Sleep changes
   - Appetite and weight change
   - Diurnal mood variation
   - Retardation/agitation
   - Libido loss
3. Cognitive symptoms
   - Self esteem
   - Guilt/self blame
   - Hypochondrial
   - Suicidal

Question 3

Depression
- Classification

Answer 3

Depression
- Classification

• Mild
  2 core symptoms
  2 other symptoms
• Moderate
  2 core symptoms
  3 other symptoms
• Severe
  3 core symptoms
  4 other symptoms
• Severe with psychotic symptoms
  1. Hallucinations (often auditory)
  2. Delusions
• Hypochondrial/guilt/nihilistic/persecutory

Question 4

Post-natal depression
- Prevalence
- Thoughts
- RFs

Answer 4

Post-natal depression

• Prevalence
  10-15% within 1-2 months
• Thoughts
  1. Worries about baby
  2. Inability to cope with baby
• RFs
  1. PMH/FHx
  2. Older age
  3. Single mother

Question 5

Hypomania
- Symptoms

Answer 5

Hypomania
- Symptoms

1. Mildly elevated
   - Expansive/irritable
2. Increased energy
   - Difficulty focussing
3. Increased self-esteem
   - sociability/talkativeness
4. Increased sex drive
5. Increased need for sleep

Question 6

Mania
- Symptoms

Answer 6

Mania
- Symptoms

1. Mood elevation (1week)
   - Expansive/irritable
2. Increased energy
   - Agitation
3. Grandiosity
4. Pressure of speech
   - FLight of ideas
5. Lost inhibition
   - Increased libido
   - Reduced sleep
6. Psychotic symptoms

Question 7

Persistent mood disorders

Answer 7

Persistent mood disorders

• Cyclothymia
  1. Mild periods
• elation
• depression
  2. Early onset/chronic
  3. FHx of BPD
• Dysthymia
  1. Chronic low mood
  2. Not criteria of depression

Question 8

Mixed affective state
- Definition

Answer 8

Mixed affective state
- Definition

1. Mixture or rapid alternation
2. Manic/depressed sx

Question 9

Bipolar
- Classification

Answer 9

Bipolar
- Classification

Bipolar 1
- 1 or more manic or mixed
- 1 or more depressive

Bipolar 2
- 1 or more depressive
- 1 or more HYPOmanic

Question 10

Bipolar
- Prevalence
- Median onset
- Suicide rate
- Genecity

Answer 10

Bipolar

• Prevalence
  1%
• Median onset
  25yo
• Suicide rate
  20x base rate
• Genecity
  70% monozygotic twins

Question 11

Mood disorder
- Biological treatments

Answer 11

Mood disorder
- Biological treatments

1. Pharmacological
   - Anti-Ds
   - Mood stabilisers
   - Combinations
2. ECT
3. rTMS
   - Repetitive
   - Transcranial-magnetic-stimulation
4. tDCS
   - Transcranial-Direct-Cranial-Stimulation

Question 12

Four
- Mood stabilisers

Answer 12

Four
- Mood stabilisers

1. Lithium
2. Valproate
3. Carbamazepine
4. Lamotrigine

Question 13

ECT
- Indications
- Effectiveness rate

Answer 13

ECT
- Indications
1. Severe depression
2. High suicide risk

• Effectiveness rate
  60-70%

Question 14

Psychological treatments

Answer 14

Psychological treatments

0. Mindfulness
1. Psychoeducation
2. CBT
3. IPT
   - Interpersonal
4. Psychodynamic
   - Freudian

Question 15

Depression
- Prognosis/treatment

Answer 15

Depression
- Prognosis/treatment

1. First episode
   - 80% will have further episode
   - 6-12mo continue ADs
2. Multiple episodes
   - 10% severe unremitting
   - Continue ADs a long time

Question 16

Bipolar
- Poor prognosis RFs

Answer 16

Bipolar
- Poor prognosis RFs

1. Severe episodes
2. Early onset
3. Cognitive deficits

Question 17

Mania vs hypomania

Answer 17

Mania vs hypomania

1. Disablement level
2. Mania severely impacts life
3. Psychosis or admission indicates mania
4. Duration
   - Hypomania 4 days
   - Mania 7 days

Question 18

Bipolar
- AD use

Answer 18

Bipolar
- AD use

1. Only used with stabiliser
   - Lithium is the most effective
2. Unopposed can provoke high mood

Question 19

Bipolar medications
- Three types

Answer 19

Bipolar medications
- Three types

1. Mood stabiliser
   - Prophylaxis
2. Anti-depressant
3. Anti-manic
   - Antipsychotics
   eg. Olanzapine (most sedating)

Question 20

Antipsychotics
- Three uses

Answer 20

Antipsychotics
- Three uses

1. Antipsychotic
2. Antimanic
3. Mood-stabilising

Question 21

Sleep disturbance
- Important question

Answer 21

Sleep disturbance
- Important question

1. How is your mood?
2. Are you feeling suicidal?

Question 22

Congruent delusions
- Depression
- Mania

Answer 22

Congruent delusions

• Depression
  1. Guilt
  2. Persecution
  3. Illness
• Nihilism
• Cotard (death)
• Mania
  1. Grandeur
• Status
• Abilities
  2. Messianic

Question 23

Congruent hallucinations
- Depression
- Mania

Answer 23

Congruent hallucinations

• Depression
  1. You’re worthless
• Mania
  1. You should do this
  2. ‘Voice of God’

Question 24

Depression presentation
- History question

Answer 24

Depression presentation
- History question

1. Past mania/hypomania?

Question 25

Depressive cognitions
- Part of MSE?
- Examples

Answer 25

Depressive cognitions

• Are thoughts.
• Cognitive distortions
  1. Bad/irrational assessments

2. Attribute problems to themselves
   - including non-related qualities
   eg. I prescribed badly, I am a bad husband
3. My errors are all unfixable

Question 26

Depression
- Personal question

Answer 26

Depression
- Personal question

1. Have you had any change in your sex drive

Question 27

Alcoholism Vs alcohol misuse

Answer 27

Alcoholism Vs alcohol misuse

1. Addiction
2. Above recommend
   3.