Mood Disorders Flashcards
State the ICD-11 Criteria essential for diagnosing a manic episode
- Both of the following for a period of at least 1 week most of the day nearly everyday
- Extreme mood stare characterised by Euphoria, uplifted mood, fantastic…
- Increased activity (cannot sit still) - Several of the following
- Increased talkativeness or pressured speech + Flight of ideas (illogical switching from one idea to the next)
- Increased self-esteem/ delusion of grandiosity - brightly coloured flamboyant clothing (feels like they way be famous or accomplish tasks beyond skill level)
- Increased reckless behaviour (financial/impulsiveness)
- Increased sexual drive (libido)/sociability (sexual promiscuity)
- Decreased need for sleep
- Decreased concentration/distractibility (playing with an object during interview)
+/- Psychotic symptoms (e.g persecutory delusions of being conspired against because of someone;s special identity or abilities)
Symptoms are not due to another medical condition (brain tumour), effects of a substance (cocaine, amphetamines), or brain injury
Differentiate between a manic and hypomanic episode in terms of
Symptoms
Psychosis
Duration
Associated bipolar disorder
Impairment in day-to-day functioning
Symptoms in hypomania are less severe than in mania. Hypomania is just the persistent elevation of mood (may be represented as just irritability) compared to the manic state which is an extreme mood state. Hypomanic patients are easier to interrupt if they start jumping from one idea to the next and also can sit for the interview a lot more easily.
Psychotic symptoms, including delusions of grandiosity, are not present in hypomania (instead it is just higher self-esteem)
Duration required for diagnosis in hypomania is symptoms occurring most of the time nearly every day for several days instead of for at least a week.
Mania is associated with Bipolar type I, Hypomania is type II
Impairment: Not severe enough to cause impairment in functioning. Manic patients have evident and significant impairment in functioning.
Define and State the ICD-11 guidelines for a mixed episode
A mixed episode is characterised by:
- Several prominent manic AND depressive symptoms occurring simultaneously or alternating very rapidly from day-to-day or within the same day
- Symptoms must include an altered mood state consistent with a manic or depressive episode
- Symptoms must be present for at least two weeks (unless shortened by treatment)
If a patient is diagnosed with a mixed episode:
1. Assuming manic symptoms predominate, what are common contrapolar symptoms?
2. Assuming depressive symptoms predominate, what are common contrapolar symptoms?
3. Assuming they are alternating rapidly, what is a characteristic symptom? What would treatment would they require?
- Dysphoric mood, expressed beliefs of worthlessness, hopelessness, and suicidal ideation
- Irritability (present normally is depressed children and adolescents), racing and crowded thoughts, increased talkativeness, and increased activity.
- Extreme emotional reactivity (alternating periods of flat affect and intense/exaggerated reactiveness). DBT
A patient you have previously treated sees you again complaining of alternating moods over the past few days after prescribing an SSRI for 2 weeks. What is your plan?
Discontinue SSRI as this may be a antidepressant-induced mixed episode. If the symptoms persist after the discontinuing and meet the criteria of a mixed episode, patient becomes diagnosed with a mixed episode.
What are the different possible diagnoses for Depressive Disorders?
Single episode depressive disorder
Recurrent depressive disorder
Dysthymic Disorder
Mixed Depressive and Anxiety Disorder
Other specified depressive disorders
Single and Recurrent Episode Depressive Disorder:
How are these disorders classified?
Are there any differences between the disorder? If so what are they?
They are classified according to the severity of the episode (mild, moderate, and severe)/stage of remission (partial or full) where moderate and severe episodes are further classified according to the presence or absence of psychotic symptoms.
The only real difference is that recurrent episode needs 2 or more episodes (including current episode) for diagnosis.
T or F: Panic Attacks may occur in depression where recurrent panic attacks are an indication of severity
True
What is the average age of onset for depressive disorders
Mid-20s
Are depressive disorders more common in women or men?
Twice as common in women. Women are also more likely to experience co-occurring anxiety or fear-related disorders as well as appetite changes whereas men are more likely to have alcohol or other substance abuse during the episode. Men are also more impulsive in these states and hence undertake more risky behaviours.
Dysthymic Disorder:
Define and state the ICD-11 features of this disease
How would this disease appear in children and adolescents?
What are the gender differences for this disorder?
Persistent depressed mood, lasting 2 years or more, for most of the day, for more days than not. The depressed mood is accompanied by the same yet milder symptoms seen in a depressive episode. There also must have never been a two-week (required for diagnosis of a depressive episode) period in the first two years which the number and duration of symptoms were sufficient to meet the diagnostic requirements for a depressive episode nor a prolonged (>2 months) symptom-free period
Children and adolescents depressed mood can manifest as pervasive irritability
There are no notable differences between genders except in early life where women are more susceptible.
When would you give a diagnosis of “Other specified depressive disorders”
When the presentation is characterised by mood symptoms that share primary clinical features with other depressive disorders but do not fulfil the diagnostic requirements for any other disorder in the normal grouping
Mixed Depressive and Anxiety Disorder:
Define and state the ICD-11 guidelines
It is characterised by the presence of both depressive and anxiety symptoms for most of the time for a duration of at least 2 weeks yet when considered separately do not meet the diagnostic requirements for another depressive or an anxiety disorder (as well as no history of manic or mixed episodes)
What are some symptoms of anxiety that you would look out for when taking a history from a patient presenting with low mood?
What part of the past medical history would be significant when discussing anxiety and depression?
Feeling “on-edge”, Inability to control worrying thoughts, fear that something awful will happen, trouble relaxing, muscle tension, or SYMPATHETIC AUTONOMIC SYMPTOMS (=symptoms of anxiety => sweating, palpitations, dry mouth, lightheadedness/orthostatic hypotension, upset stomach)
Hypothyroidism (more likely than hyper). If this is present, it cannot be diagnosed.
Bipolar Type I Disorder:
Define and State the ICD-11 Criteria for diagnosis
The typical course of this disease is characterised by the recurrent depressive and manic (or mixed) episodes. One episode of mania (not hypomania, although that exists in the disorder, it cannot be used in diagnosis) alone is enough to diagnose this.
In combination with a history of one or more depressive episodes, a mixed, manic, or hypomanic episode arising during anti-depressant treatment including medication or ECT, if the symptoms persist after treatment discontinues, how will you diagnose this patient?
Bipolar Disorder Type I
What is the most heritable mental disorder?
Bipolar Disorders
Individuals initially diagnosed with bipolar type II are at high risk of experiencing a manic or mixed episode during their lifetime. If this occurs, does the diagnosis change?
Yes, diagnosis changes to Bipolar Disorder Type I.
What are common medical conditions experienced with patients diagnosed with bipolar disorders? Why?
Due to the side effects of bipolar medications, medical conditions affecting the cardiovascular system such as hypertension are common. Glucose levels should be checked before prescribing these medications they also have metabolic effects such as hyperglycaemia.
T or F: More than half of manic episodes are followed by a depressive episode
True
T or F: The risk of recurrence increases with each cycle in bipolar disorders.
True
T or F: Manic episodes are more common and severe in men and have earlier onset whereas women are more likely to experience depressive episodes, mixed episodes, and rapid cycling.
True
