Mood Disorders Flashcards
Define “anhedonia”
Loss of enjoyment and pleasure
Define “anergia”
Lack of energy
What is euthymia?
Normal mood
What is the difference between mood and affect?
Mood: patient’s description of their state (subjective)
Affect: how mood changes to surroundings (objective)
List features of appearance and behaviour in low mood
Low, miserable, unhappy Reduced facial expression Reduced eye contact Furrowed brows Limited gesturing and reactivity Difficult to establish rapport
List features of speech in low mood
Reduced rate Low volume and pitch Reduced intonation (monotonous) Increased latency Limited content
List features of thought in low mood
Form: Normal form Flow: Slow flow, ponderous Content: Negative, pessimism Failure, guilt Delusions Hypochondriasis
List features of paranoia in low mood
Self-preferential thinking (‘someone is out to get you’)
Psychosis
Depression (increased sensitivity to criticism, more self-conscious, feeling of being under scrutiny)
Hallucinations in low mood typically make someone depressed. True/False?
False
Typically, the hallucinations reflect a person’s depression rather than making them depressed
What aspect of insight is typically affected in low mood?
Attribution - patients blame experience on their sins, personal failings or weakness, recognition intact
How long should a depressive episode last to be classified as depression?
2 weeks
With no hypo-manic or manic symptoms at any time in life
List criteria for diagnosing depression
2 of core features
- depressed mood (most of the day, almost every day)
- loss of interest/pleasure
- decreased energy (or increased fatiguability)
Some additional features:
- low confidence
- self-reproach, guilt
- suicidal thoughts
- diminished concentration
- sleep disturbance
- change in appetite
Moderate depression involves _ core features and _ additional features
Moderate depression involves 2 core features and 4 additional features
Severe depression involves _ core features and _ additional features
Moderate depression involves all core features and 5 additional features
DSM-10 classifies bipolar into 3 categories. Describe bipolar I
Meets criteria for mania at least once
Previous depressive or hypomanic episodes
MANIA + DEPRESSION
DSM-10 classifies bipolar into 3 categories. Describe bipolar II
Current or past hypomanic episodes + current or past depressive episodes
Never met criteria for mania
HYPOMANIA + DEPRESSION
DSM-10 classifies bipolar into 3 categories. Describe bipolar III
Hypomania following use of antidepressants
Which form of bipolar - I, II or III - is most common?
Bipolar II
Depression changes to bipolar disorder once you have a manic episode. True/False?
True
How long should an episode last to be classified as hypomania?
Mood is elevated or irritable, abnormal to the individual for 4 consecutive days
List features of hypomania
At least 3 of: Restlessness/increased activity Increased talkativeness Easily distracted Decreased need for sleep Increased sexual energy Recklessness, irresponsibility
How long should an episode last to be classified as mania?
Mood elevated, expanive, irritable; abnormal to the individual for minimum 1 week or hospitalisation
List distinguishing features (from hypomania) of mania (features of hypomania can also be present)
Racing thoughts Loss of normal social inhibitions Inappropriate behaviour Inflated self-esteem Sexual indiscretion
Depression exhibits features of diurnal variation. Explain.
It is typically worse in the morning, and gets better by the end of the day
What features are typical of a depressive person when they describe how they are sleeping?
Early morning wakening - waking at least 2 hours before the expected/ normal waking time Initial insomnia (>1/2 hr)
List features of cognition in low mood
Slow with complaints of poor memory, deficits involving working memory, attention, planning
PSEUDO-DEMENTIA
Depression is a recurrent disease. True/ False?
True
10 year recurrence rate is > 80%
What are the five Rs of depression?
Response Remission Relapse Recovery Recurrence
Define ‘bipolar disorder’
2 or more episode in which patients mood and activity levels are significantly disturbed, disturbance can consist of hypo-mania or mania, typically interspace with depression
Define mania without psychotic symptoms. Give examples.
Absence of hallucinations or delusions but perceptual disorders may occur e.g. subjective hyperacusis, appreciation of vivid colours
Define mania with psychotic symptoms. Give examples.
Delusions or hallucinations present, other than those seen in typical schizophrenia e.g. grandoise, self-referential, erotic, persecutory
Which mood disorder is commonly seen in families, and involves changing between different moods?
Cyclothymia
What is psychotic depression?
Occasionally paranoid, mood is congruent or hypochondrial
What age does bipolar disorder usually present?
Usually teens or early 20s
List some common co-morbid conditions associated with bipolar disorder
Anxiety disorders Alcohol and drug misuse Personality disorders Eating disorders Schizoaffective disorder Schizophrenia
What is ‘cyclothymia’?
MILD BIPOLAR DISORDER
Elevated and depressed mood episodes but not extreme enough to be depression or bipolar disorder
What is ‘mixed affective state’?
A state wherein features unique to both depression and mania—such as despair, fatigue, morbid or suicidal ideation, racing thoughts, pressure of activity, and heightened irritability—occur either simultaneously or in very short succession