Mood Disorders

Question 1

What are the overarching types of mood disorder?

Answer 1

1. episodic
2. patterns over time

Question 2

What are the ICD-11 primary mood disorders?

Answer 2

depressive episode
manic episode
mixed episode
hypomanic episode

Question 3

Single episode definition

Answer 3

one mood episode only, no history of mood disorders

Question 4

Recurrent episode definition

Answer 4

history of two or more episodes; there must be NO significant mood disturbance between each episode lasting for several months

Question 5

Describe psychosis in mood disorders

Answer 5

indicator of severity and content is characteristic of the mood

Question 6

Types of delusions in depression

Answer 6

poverty, guilt, hypochondriacal, nihilistic, derogatory auditory hallucinations

Question 7

Types of delusions in mania

Answer 7

grandiose, self-reverential, erotic, religious

Question 8

Pattern of depression

Answer 8

unipolar, either single episode or recurrent

Question 9

Symptoms of depression

Answer 9

Essential features:
- 2 week duration of low mood and diminished activities (apathy/anhedonia) occurring most of the day or nearly every day

Accompanied by 5 others:
- difficulty concentrating, feelings of hopelessness/worthlessness, excessive guilt, thought of death, changes in appetite or weight, changes in sleep, psychomotor agitation or retardation, reduced energy or fatigue with little effort, significant impairment in function

Question 10

Depersonalisation

Answer 10

unpleasant subjective experience where the person feels that they have become unreal (depression)

Question 11

Derealisation

Answer 11

unpleasant subjective experience where the person feels detached from their surroundings, feeling in a dream (depression)

Question 12

Risks to assess in depressive disorders

Answer 12

suicide, homicide, neglect, alcohol and drug use, misuse of prescription drugs or OTC meds

Question 13

Overview of NICE management of depression

Answer 13

choice of treatment is based on severity, past experiences of treatment, and patient preference

Question 14

What proportion of depressive presentations are actually bipolar II?

Answer 14

25-50%, much more common than initially thought. will feel worse on antidepressants

Question 15

Treatment options for less severe depression

Answer 15

guided self-help –> group CBT –> group behavioural activation –> individual CBT –> individual behavioural activation –> group exercises –> interpersonal psychotherapy –> SSRIs –> counselling –> short term psychodynamic psychotherapy

Question 16

Which symptom differentiates between mania and hypomania in the DSM V?

Answer 16

delusions of grandeur

Question 17

NICE guidelines for pharmacological management of depressive disorder

Answer 17

• 1st line SSRI
• if no response in 2-4 weeks, increase dose. if not tolerated, consider switching to different class
• 2nd line different class: SNRI, NaSSA
• if no response, reassess diagnosis and severity, check compliance
• augment with lithium or antipsychotic

Question 18

How long should pharmacological management of depressive disorder be?

Answer 18

continue treatment until patient has returned to premorbid levels plus six months to prevent relapse

Question 19

Treatment resistant depression

Answer 19

doesn’t respond to two different medication classes

Question 20

Prognosis of depressive disorders

Answer 20

one episode = 50% chance reoccurrence
two episodes = 70% chance reoccurrence
three or more episodes = >90% chance reoccurrence

Question 21

Characteristics of bipolar disorders

Answer 21

Episodic mood disorders characterised by episodes of mania, hypomania, mixed presentation (prominent hypomanic/manic symptoms and prominent depressive symptoms)

Question 22

Mania alone

Answer 22

bipolar I

Question 23

Hypomania alone

Answer 23

normal

Question 24

Define bipolar I

Answer 24

episodic mood disorder characterised by one or more manic or mixed episodes

Question 25

Manic episode

Answer 25

at least one week of:
- euphoria, expansiveness, irritability
plus two of (or three if just irritable):
- increased activity and energy, increased self esteem, rapid speech, flight of ideas, decreased need for sleep, distractibility, impulsive/reckless behaviour, rapid changes between mood states

Question 26

Mixed episode

Answer 26

at least two weeks of several prominent manic symptoms and several prominent depressive symptoms occurring most of the dat for nearly every day

Question 27

Common co-occurrence with bipolar I

Answer 27

diagnosis of substance use disorder, recurrent panic disorder (suggests more severe illness, poorer treatment response, and higher risk of suicide)

Question 28

Define bipolar II

Answer 28

episodic mood disorder characterised by one or more hypomanic episodes and at least one depressive episode with no previous history of manic or mixed episodes

Question 29

Depressive episode

Answer 29

same definition as depressive disorder

Question 30

Hypomanic episode

Answer 30

symptoms lasting for at least several days:
persistent elevated mood, persistent irritability, increase in energy/activity, increased speech, rapid thoughts, increased self esteem, decreased need for sleep, distractibility, impulsive/reckless behaviour
WITH NO IMPAIRMENT IN FUNCTIONING

Question 31

Can bipolar II become bipolar I?

Answer 31

yes, 15% may develop manic episodes

Question 32

Management of bipolar disorders

Answer 32

dependent on clinical presentation of mania, hypomania, and depression

Question 33

Acute management manic or hypomanic episode

Answer 33

• consider stopping antidepressant treatment if applicable
• start antipsychotics and titrate carefully
• benzos can be used if necessary

Question 34

Management of acute depressive episode in bipolar depression if not on treatment

Answer 34

fluoxetine plus olanzapine OR quetiapine alone

Question 35

Indications for ECT

Answer 35

severe depression, mania, catatonia, psychosis, severely suicidal patients
LAST RESORT

Question 36

Risks of ECT

Answer 36

anaesthetic risks, short term headaches/nausea/amnesia, long term temporary memory loss