Mood disorders

Question 1

How can mood disorders be broadly classified?

Answer 1

Into unipolar (depression) or bipolar (mania) disorders

Question 2

What is the demographic for depression?

Answer 2

Women in late twenties

Question 3

What are the three cardinal symptoms of depression?

Answer 3

Depressed mood
Loss of interest and enjoyment - anhedonia
Reduced energy levels

These must be present for at least 2 weeks and not secondary to an external factor

Question 4

What are some of the biological symptoms of depression?

Answer 4

• Loss of interest - Lack of emotional reactivity - Disturbed sleep, generally with early morning awakening 2 hours before normal - Diurnal variation, with symptoms worst in the morning - Objective evidence of psychomotor retardation - Poor appetite and weight loss (>5% of body weight in one month) - Loss of libido

Question 5

What are the 4 categories of depressive disorder?

Answer 5

Mild depressive disorder - 2 cardinal symptoms + 2 others, usually able to continue work and social life
Moderate depressive disorder - 2 cardinal symptoms + 4 others, difficulty carrying out work and social life
Severe with no psychotic symptoms - 3 cardinal symptoms + 5 others - suicide risk high, unlikely to continue work or social life
Severe with psychotic symptoms - as above with delusions, hallucinations or depressive stupor

Question 6

What are the investigations that should be done for depression?

Answer 6

Should obtain a baseline before treatment using the Beck depression inventory
Then need to exclude treatable causes e.g. malnutrition and alcohol misuse
FBC, ESR, B12/Folate, U and E, LFT TFTs, glucose

Question 7

What is the management for mild depression?

Answer 7

It is treated with the biopsychosocial model

• Watchful waiting
• Sleep and anxiety management
• Structured and supervised exercise
• Guided self help
• Counselling and CBT
• Antidepressants if history or moderate or severe depression

Question 8

What is the treatment for moderate to severe depression?

Answer 8

First like are SSRIs including - fluoxetine, sertraline
Antidepressants and CBT are used in resistant cases
Try to gradually reduce dose over 4 weeks after 6-9 months

Question 9

What is the main side effect of ECT?

Answer 9

Short term memory loss

Question 10

What is dysthymia?

Answer 10

persistent affective disorder, leading to a long-standing depression of mood that falls just below the threshold for clinical depression

Question 11

How is dysthymia managed?

Answer 11

SSRIs mainstay of treatment e.g. citalopram

Question 12

What are the three classifications of mania?

Answer 12

Hypomania - a lesser form of mania
mania without psychotic symptoms
Mania with psychotic symptoms

Question 13

What are the cardinal symptoms of mania?

Answer 13

Elevated, irritable or expansive mood
Definitely abnormal for the individual involved
Sustained for one week

For a diagnosis of mania there must be all cardinal symptoms alongside at least 3 other symptoms

Question 14

What are the investigations and management for mania?

Answer 14

The investigations are as they are for depression
Management involves:
Lithium should be offered first line to all patients with mania for prophylaxis. Lithium is a medication with a very narrow therapeutic index and severe side effects, it therefore requires various monitoring regimens.
Acute episodes are managed by starting an antipsychotic including olanzapine or haloperidol
If they are on an antidepressant then this should be stopped
If they are already on an antipsychotic then consider adding lithium

Question 15

When should lithium levels be monitored?

Answer 15

Lithium levels should be checked every 3 months when stable, and every week until stability is achieved

Question 16

What is bipolar affective disorder?

Answer 16

This is 2 or more periods of hypomania or mania alternating with depression

Question 17

How long do manic and depressive episodes in bipolar typically last?

Answer 17

Manic is usually 4 months and depressive is usually 6 months

Question 18

How do you manage bipolar depression?

Answer 18

If moderate to severe then use a combination of olanzapine and fluoxetine

Question 19

What is cyclothymia?

Answer 19

This is a persistent instability of mood with numerous periods of mild depression and mild eleation

Question 20

What is the management of cyclothymia?

Answer 20

Low dose mood stabaliser e.g. lithium

Psychological intervention to help patient understand their condition

Question 21

How is depression diagnosed in the elderly?

Answer 21

Using the geriatric depression scale

Question 22

What consequence can using lithium during the first trimester of pregnancy have on the foetus?

Answer 22

Ebstein’s abnormality

Question 23

What is somatic syndrome?

Answer 23

This is depression manifesting itself as physical symptoms

Question 24

What are some of the features of mania?

Answer 24

Irritable
Elevated mood
Fast speech
Flight of ideas
Grandiosity
Excessive spending
Insomnia
Delusions of wealth

Question 25

What monitoring tests need to be done for lithium?

Answer 25

Renal function through U and E and thyroid function