Mood Disorders Flashcards
What are the overarching types of mood disorder?
- episodic
- patterns over time
What are the ICD-11 primary mood disorders?
depressive episode
manic episode
mixed episode
hypomanic episode
Single episode definition
one mood episode only, no history of mood disorders
Recurrent episode definition
history of two or more episodes; there must be NO significant mood disturbance between each episode lasting for several months
Describe psychosis in mood disorders
indicator of severity and content is characteristic of the mood
Types of delusions in depression
poverty, guilt, hypochondriacal, nihilistic, derogatory auditory hallucinations
Types of delusions in mania
grandiose, self-reverential, erotic, religious
Pattern of depression
unipolar, either single episode or recurrent
Symptoms of depression
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
Depersonalisation
unpleasant subjective experience where the person feels that they have become unreal (depression)
Derealisation
unpleasant subjective experience where the person feels detached from their surroundings, feeling in a dream (depression)
Risks to assess in depressive disorders
suicide, homicide, neglect, alcohol and drug use, misuse of prescription drugs or OTC meds
Overview of NICE management of depression
choice of treatment is based on severity, past experiences of treatment, and patient preference
What proportion of depressive presentations are actually bipolar II?
25-50%, much more common than initially thought. will feel worse on antidepressants
Treatment options for less severe depression
guided self-help –> group CBT –> group behavioural activation –> individual CBT –> individual behavioural activation –> group exercises –> interpersonal psychotherapy –> SSRIs –> counselling –> short term psychodynamic psychotherapy
Which symptom differentiates between mania and hypomania in the DSM V?
delusions of grandeur
NICE guidelines for pharmacological management of depressive disorder
- 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
How long should pharmacological management of depressive disorder be?
continue treatment until patient has returned to premorbid levels plus six months to prevent relapse
Treatment resistant depression
doesn’t respond to two different medication classes
Prognosis of depressive disorders
one episode = 50% chance reoccurrence
two episodes = 70% chance reoccurrence
three or more episodes = >90% chance reoccurrence
Characteristics of bipolar disorders
Episodic mood disorders characterised by episodes of mania, hypomania, mixed presentation (prominent hypomanic/manic symptoms and prominent depressive symptoms)
Mania alone
bipolar I
Hypomania alone
normal
Define bipolar I
episodic mood disorder characterised by one or more manic or mixed episodes
Manic episode
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
Mixed episode
at least two weeks of several prominent manic symptoms and several prominent depressive symptoms occurring most of the dat for nearly every day
Common co-occurrence with bipolar I
diagnosis of substance use disorder, recurrent panic disorder (suggests more severe illness, poorer treatment response, and higher risk of suicide)
Define bipolar II
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
Depressive episode
same definition as depressive disorder
Hypomanic episode
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
Can bipolar II become bipolar I?
yes, 15% may develop manic episodes
Management of bipolar disorders
dependent on clinical presentation of mania, hypomania, and depression
Acute management manic or hypomanic episode
- consider stopping antidepressant treatment if applicable
- start antipsychotics and titrate carefully
- benzos can be used if necessary
Management of acute depressive episode in bipolar depression if not on treatment
fluoxetine plus olanzapine OR quetiapine alone
Indications for ECT
severe depression, mania, catatonia, psychosis, severely suicidal patients
LAST RESORT
Risks of ECT
anaesthetic risks, short term headaches/nausea/amnesia, long term temporary memory loss
