Mood Disorders Flashcards
What are the “mood disorders”?
Depression
Bipolar disorder
Persistent Mood disorder
What patterns can depression come in?
Single episode or recurrent episodes
What 3 types of symptoms can pts with depression get?
- Core
- Biological/Somatic
- Cognitive
What are the core symptoms of depression?
- Low mood for 2 weeks +
- Lack of energy
- Anhedonia
What are the biological/somatic symptoms of depression?
- Sleep changes
- Appetite/weight changes
- Diurnal variation in mood
- Psychomotor retardation
- Loss of libido
What are the cognitive symptoms of depression?
- Low self esteem
- Guilt/self blame
- Hopelessness
- Hypochondrial thoughts
- Poor concentration/attention
- Suicidal thoughts
What are the 4 types of depression wrt severity?
Mild, moderate, severe, and severe with psychotic symptoms
How is mild depression diagnosed?
2 core symptoms + 2 other. Pt able to function.
How is moderate depression diagnosed?
2 core symptoms + 3/4 other. Pts ability to function is affected.
How is severe depressions diagnosed?
3 core symptoms + at least 4 other. Pts ability to function is affected.
What is the lifetime prevalence of depression?
10-20%
What is the ration of M:F in depression?
1:2 M:F
How much more common is depression in people with long term conditions?
2-3x more common
What kind of hallucination is most common in psychosis with severe depression?
Auditory
What is post-natal depression?
Depression experienced by mothers usually 1-2 months post-partum (majority of cases are within a year of childbirth)
What % of mothers are affected by post-natal depression?
10-15%
Can post-natal depression affect partners/fathers?
Yes, although it is less common
In addition to symptoms of depression, what other symptoms does post-natal depression have?
- Difficulty bonding with baby
- Frightening thoughts e.g. about hurting the baby
- Feeling that they’re unable to look after the baby
What therapies are there for post-natal depression?
- Self-help, often with family and freinds as support
- CBT
- Antidepressants
What is bipolar disorder according to ICD10?
Two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting sometimes of hypomania or mania, and sometimes of depression.
What is hypomania?
State where mood is mildly elevated, pt is expansive, or the pt is irritable in mood. Increased activity, self esteem, sociability, sex drive, familiarity. Decreased need for sleep.
What is mania?
State where mood is leated, expansive, or irritable, increased energy/activity, agitation, pressure of speech, evidence of formal thought disorder, easily distracted, disinhibited, impaired judgement, and may experience psychotic symptoms.
What is persistent mood disorder?
Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes.
What is cyclothymia?
A persistent mood disorder chracterised by mild periods of elation/depression (none of which severe enough for bipolar)
Who frequently gets cyclothymia?
Relatives of those with bipolar affective disorder
What is dysthymia?
A persistent mood disorder characterised by chronic depression of mood lastng severeal years or more (which is not sufficiently severe/prolonged to class as depression)
What is mixed affective state?
A mixture or rapid alternation of hypomania, mania, and depression
What are the different types of bipolar?
Bipolar 1 and Bipolar 2
What is bipolar 1?
1 or more manic episode or mixed +/- 1 depressive episode
What is bipolar 2?
At least 1 severe depressive and 1 hypomanic episode
Name some differential diagnoses for mood disorders?
Normal mood flux Bereavement PTSD Dementia Other organic brain disorders
Name some biological causes of mood disorders
Genetic
Physical illness
Mental Illness
Name some psychological causes of mood disorders
Childhood experiences
View of self
View of the world
Personality traits
Name some social causes of mood disorders
Work/(un)employment Housing Finance Relationships Support
What biological treatments are there for mood disorders?
Pharmacological treatments
ECT
TMS
tDCS
What is ECT licensed for in the UK?
Moderate/Severe depression (treatment resistant or life threatening)
What is TMS and what is it licensed for in the UK?
Transcranial Magnetic Stimulation
Approved by NICE but limited availability in UK for treatment of severe depression
What is tDCS? What is it licensed for?
Transcranial direct current stimulation
Severe depression
What psychological treatments are there available for mood disorders?
Education about condition
CBT
IPT
Mindfulness
What is IPT?
Interpersonal therapy - psychotherapy that focuses on the pt and their relationships with others
What social treatments are there for mood disorders?
Targeted social interventions
Behavioural activation
What are the 5 stages of grief according to the 5 stages model?
Denial, Anger, Bargaining, Depression, and Acceptance
Is a grief reaction a medical issue?
No, it is normal, but it may cause people to experience worrying symptoms.
How can denial manifest in a grief reaction?
Feeling numb; pseudohallucinations of deceased; preparing a meal for the deceased; focus on physical objects that remind them of the deceased
Who usually bares the brunt of the anger expressed in the second stage of grief?
It is usually directed at family and medical professionals
Which demographic group of people are more likely to experience abnormal or atypical grief reactions?
Women
What risk factors are there for having an atypical or abnormal grief reaction?
Poor social support; griever being female; deceased being young or death unexpected; relationship problems prior to death.
What is the main feature of an atypical grief reaction?
Different timeline - either prolonged or delayed
When would you suspect a delayed grief reaction?
After 2+ weeks pass before grieving begins
When would you suspect a prolonged grief reaction?
Difficult to define - normal grieving can take 12+ months.
A patient presents with TATT. They have no physical signs or any biochemical abnormalities. What other symproms should we screen for here?
- Low mood*
- Loss of interest in hobbies etc*
- Feelings of worthlessness/guilt
- Recurrent thoughts of death/suicide
- Diminished ability to concentrate
- Agitation/irritability
- Insomnia/hypersomnia
- Weight loss/appetite changes
What is the most important cause of a missed diagnosis of depression?
Why?
Somatisation.
Over-investigation and creating health anxiety, as well as missing an important diagnosis and untimely treatment,
