Mood disorders

Question 1

Major depressive disorder DSM 4

Answer 1

Duration: most of the day, nearly every day for at least 2 weeks
5 or more of the following
1. depressed mood
2. loss of interest
3. weight loss or gain
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or excessive or inappropriate guilt
8. diminished ability to think or concentrate
9. recurrent thoughts of death, suicide

Question 2

Major depressive disorder ICD-10

Answer 2

-Duration: at least 2 weeks
Criterion A: depressed mood, loss of interest and enjoyment and reduced energy leading to increased fatiguability and diminished activity
Criterion B: other common symptoms
-reduced concentration
-reduced self esteem
-ideas of guilt and unworthiness
-bleak and pessimistic views of the future
-ideas or acts of self-harm or suicide
-disturbed sleep
-diminished appetite

Mild depression: 2 criterion A with 4 symptoms in total required
Mod depression: 2 criterion A with 6 symptoms in total
Severe depression: 2 criterion A with 8 symptoms in total

Question 3

Recurrent depressive disorder

Answer 3

-both DSM and ICD 10 agree that this is more than one episode of depression
ICD 10- can be given to a patient with depression if there has been one previous major depressive episode separated by the current episode by at least 2 months

Question 4

DSM4 v 5 depression

Answer 4

• in 4 diagnosis of depression cant be given if there has been a bereavement 2 months ago
• 5 allows this

Question 5

Bipolar affective disorder

Answer 5

-periods of prolonged and profound depression alternate with elevated and irritable mood, known as mania

Question 6

ICD-10 BPAD

Answer 6

• needs at least two mood episodes with complete recovery between them
• depression must be for at least 2 weeks
• mania for 7 days, hypomania for 4 days and mixed episodes for 2 weeks

Question 7

DSM 4 BPAD

Answer 7

-can be diagnosed after one manic episode

Question 8

Type 1 BPAD

Answer 8

-full blown mania or mixed mania with depression

Question 9

Type 2 BPAD

Answer 9

-recurrent depression and hypomania without episodes of either mania or mixed states

Question 10

ICD definition of mania (v. similar in DSM4)

Answer 10

• distinct period of abnormally and persistently elevated, expansive or irritable mood with 3 or more characteristic symptoms of mania ( increased activity, pressure of speech, flight of ideas, lossof normal inhibitions, decreased need for sleep, inflated self esteem, distactibility, risky behaviour and marked sexual energy
• disturbance must be sufficiently severe to impair occupational and social functioning
• psychotic features may be present

Question 11

Hypomania

Answer 11

ICD10-shares symptoms of mania but to a lesser degree and not severe enough to impair functioning
Does not require admission to hospital
Does not have psychotic features

Question 12

Mixed states

Answer 12

• cases where manic and depressive symptoms occur simultaneously
• occurence of both manic/hypomanic and depressive symptoms in a single episode, present every day for at least 1 week (DSM-4) or 2 weeks (ICD-10)

Question 13

Rapid cycling

Answer 13

DSM-4

• at least 4 episodes a year
• mostly 70-80% women
• ultra-rapid cycling refers to the situation wen fluctuations are over days or hours

Question 14

Post-partum onset

Answer 14

refers to the onset of mania, hypomania or depression within 4 weeks of childbirth
DSM

Question 15

Seasonal pattern

Answer 15

refers to recurrences of BPAD over several years with most episodes typically start and end at the same time each year
DSM

Question 16

Secondary mania

Answer 16

occurs as a result of alcohol missuse or drugs

can also occur in thyroid disease, MS and lesions in the brain

Question 17

Bipolar 3

Answer 17

-a variant used to describe minimal depression complicated by antidepressant-induced hypomania

Question 18

Dysthymia (ICD-10) Dysthymic disorder (DSM 4)

Answer 18

-chronic, mildly depressed mood and diminished enjoyment not severe enough to be a depressive illness
Double depression is major depression superimposed on Dysthymia

Question 19

Cyclothymia

Answer 19

• individual experiences oscillating high and low moods without ever having a significant manic or depressive episode
• these are unrelated to life events

Question 20

Seasonal Affective Disorder

Answer 20

• SAD
• included in ICD-10
• 3 or more affective episodes must occur with onset within the same 90 day perioid of the year for 3 or more consecutive years
• most commonly depressive in nature
• hypersomnia, increased appetite, carbohydrate craving and weight gain are common
• most commonly in autumn/winter
• phototherapy is used for daily exposure of up to 2 hours