Mood disorders Flashcards
State the 3 types of mood disorder
- Depressive disorder
- Single
- Recurrent episodes - Bipolar disorder
- Mania
- Hypomania
- Mixed - Persistent mood disorder
- Cyclothymia (mixed hypomanic and depressive symptoms, does not reach threshold for bipolar)
- Dysthymia (milder form of depression, not meeting threshold)
State the 3 core symptoms of depression
- Continuous low mood for at least 2 weeks
- Low energy
- Anhedonia (lack of interest / enjoyment)
State some somatic symptoms of depression
- Diurnal variation of mood
- Sleep changes (early morning wake cycle)
- Appetite change (typically reduced)
- Weight change (typically loss)
- Psychomotor retardation
- Loss of libido
State some cognitive symptoms of depression
- Poor concentration
- Low self esteem
- Guilt / hopelessness
- Hypochondriacal thoughts
- Suicidal thoughts
- Negative thoughts
How is severity of depression diagnosed based on symptoms
Mild if:
- 2 core symptoms
- 2 ‘other’ symptoms
- Able to function
Moderate:
- 2 core symptoms
- 3-4 other symptoms
Severe:
- 3 core symptoms
- 4+ other symptoms
+/- psychotic symptoms
State 2 additional symptoms that can present in psychotic depression and what type they are
- Hallucinations
- Often auditory - Delusions
- Guilt
- Nihilistic
- Persecutory
- Hypochondriacal
List some risk factors for postnatal depression
Mental health related:
- Previous postnatal depression
- Personal history of depression
- Family history of depression
Other:
- Older age
- Single mother
- Unwanted pregnancy
- Poor social support
State the prevalence of moderate-severe depression in the UK and the M:F ratio
Approx. 1 in 6 have moderate-severe depression
M:F ratio 1:2 (twice as many females as males)
State the prevalence of bipolar affective disorder in the UK and the M:F ratio
Approx. 1 in 50 = 2%
Average onset 19 years
Higher in black / minority ethnic groups
Equal M:F ratio (1:1)
State how hypomania differs from mania
Hypomania and mania are both periods of over-active and high energy behaviour
However hypomania is:
- milder in terms of symptoms
- typically lasts for a shorter period
- doesn’t cause severe disruption to their life (but can cause considerable disruption still)
- may have partial insight
- less likely to have delusions
List some symptoms of hypomania
- Mildly elevated mood / irritable mood
- Increased energy
- Reduced need for sleep
- Increased libido
- Increased self esteem / self importance
- Inability to focus on single task / distractible
- Increased sociability / talkativeness / overfamiliarity
List some symptoms of mania
ICD 10 requires 3/9 to be present for diagnosis
- Elevated mood / irritable mood
- Increased energy
- Reduced need for sleep
- Increased libido
- Increased self esteem / self importance
- Distractibility
- Restlessness / psychomotor agitation
Additional for mania:
- Pressure of speech (can’t be interrupted)
- Flight of ideas
- Delusions of grandeur
- Loss of inhibitions
- Reckless behaviour
Explain cyclothymia
Milder form of bipolar disease, not meeting threshold
- Mild periods of elation / depression
- Early onset
- Chronic course
- Common in relatives of bipolar disorder
Explain dysthymia
Milder form of depression, not meeting threshold
- More mild depression
- Chronicly low mood
Explain mixed affective state
Characterised by a mixture of rapid alternation between: hypomanic, manic and depressive symptoms (typically within a few hours)
- Considered a subtype of bipolar disorder
Explain how bipolar disorder is classified
Requires at least one mania (or hypomania) episode, with at least one further episode of mania or depression
Bipolar type 1:
- Manic episode with further manic or depressive episodes
Bipolar type 2:
- Multiple hypomanic episodes (not manic)
- Multiple depressive episodes
ICD-10 requires at least 2 episodes, of which 1 must be manic or hypomanic
List some biological, psychological and social risk factors for depression
Biological:
- Genetic
- Previous depression
- Female gender
- Chronic physical illness
Psychological:
- Personality type
- Poor coping strategies
- View of self and the world
Social:
- Stressful life event
- Adverse childhood experiences
- Poor social support
- Lack of employment
- Poor socioeconomic status
- Housing / poverty
List some biological and environmental causes for bipolar disorder
Biological:
- Genetic
- Endocrine or neurochemical disturbance e.g. disruption of HPA axis
Environmental:
- Adverse life events
- Stressful events
- Loss of loved one
- Postpartum period
- Substance misuse
State general bio-psycho-social management options for depression
Biological:
- Antidepressants
- Adjuvants e.g. antipsychotics or mood stabilisers, anti-anxiolytics
- ECT if severe, life-threatening or resistant
- Physical activity
Psychological:
- Psychotherapies e.g. CBT, interpersonal therapy, counselling, psychodynamic therapy
Social:
- Social support groups
State how bio-psycho-social management options for depression changes for mild-mod depression and severe depression
Biological:
- Generally don’t use SSRIs as first line in mild-mod depression (first line in severe, +/- adjuvants)
- Group physical activity groups in mild-mod
- ECT considered only in severe
Psychological:
- Self-help programmes as first line mild-mod (don’t consider in severe)
- Computerised CBT, with psychotherapies down the line in mild-mod (straight to more personalised psychotherapies)
Social:
- Social support groups same for both
- Consider psychiatry referral / MHA in severe
Explain the monoamine hypothesis
States that a deficiency of monoamines (NA, serotonin and dopamine) causes depression
- Supported by antidepressants cause an increase in concentration of these neurotransmitters in the synaptic cleft
- This then improve the clinical features of depression
State some drugs from the following categories that can be used in the pharmacological management of depression
- Antidepressants (types not names)
- Mood stabilisers (names)
Antidepressants:
- SSRIs
- SNRIs
- TCAs
- MAOIs
- Noradrenaline and specific serotonergic antidepressants (NASSAs)
Mood stabilisers:
- Lithium
- Sodium valproate
- Carbamazepine
- Lamotrigine
Briefly outline how ECT works (as if explaining to a patient)
- Treatment involves sending an electric current through the brain
- Causes a brief surge of electrical activity within your brain (seizure)
Aim is to relieve severe symptoms of some mental health problems
List some indications for electroconvulsive therapy (ECT) in mood disorders
- Severe treatment-resistant depressive illness
- Life threatening illness
- Prolonged / severe manic episodes
- Catatonia (abnormal movements) / stupor / severe psychomotor retardation
