Mood disorders Flashcards
Define affect?
Expression of a subjectively experienced emotion
Define mood?
Pervasive and sustained emotion
Symptoms of depression?
Low mood Anhedonia Reduced concentration Reduced self-esteem Worthlessness Hopelessness Sleep disturbance Appetite changes Thoughts of suicide
Affects of depression on sleep
Initial insomnia
Broken sleep
Early morning wakening - 2 hours before normal
What is diurnal variation?
Mood at worst in morning, gradually improves during day
What is somatic syndrome?
Presence of at least 4 somatic symptoms of depression Reduced appetite Reduced weight (5%) Constipation Early morning wakening Diurnal variation in mood Reduced libido Amenorrhoea
Appearance in depression? (MSE)
Downturned eyes Sagging of the corner of the mouth Vertical furrow between eyebrows Poor eye contact Evidence of weight loss General neglect + poor self care
Behaviour in depression? (MSE)
Psychomotor retardation - slowing down of thought and a reduction of physical movements
Speech in depression? (MSE)
Slow, with long delays before answering
Mood in depression? (MSE)
Low and sad Hopelessness Bleak future Reduced energy and drive Inability to feel enjoyment Loss of interest
Thoughts in depression? (MSE)
Pessimistic Guilt Delusions of poverty or illness Suicidal thoughts Homocidal thoughts
Perceptions in depression? (MSE)
Mood congruent auditory hallucinations in severe depression
Derogatory
2nd person
Cognition in depression? (MSE)
Poor concentration may result in (mistakenly) that memory is impaired
What is pseudodementia?
Depression presentation in elderly similar to that of diabetes
What is depressive stupor?
Unresponsive
Akinetic
Mute
Fully conscious
What is seasonal affective disorder?
Onset of depressive symptoms during winter months
Symptoms during SAD episode?
Carbohydrate craving
Hypersomnia
Weight gain
Low mood
Investigations carried out for depression?
Metabolic panel FBC - anaemia? THT - hypothyroidism? Folic acid Vitamin B12
Depression differentials?
Organic disorders
Psychoactive substance abuse
Negative symptoms of schizophrenia
Core symptoms of depression ICD-10
Depressed mood
Loss of interest+enjoyment
Increased fatiguability
Mild depressive episode?
Core symptoms
+ 2 additional symptoms
Distressed by symptoms but can somewhat function
Moderate depressive episode?
Core symptoms
+ 4 additional symptoms
Present to a marked degree
Considerable difficulty in work, social and domestic activities
Severe depressive episode?
Core symptoms
Considerable stress and agitation
Somatic syndrome
What is psychotic depression?
Hallucinations
Delusion
Congruent with mood
Indication for ECT?
Treatment resistant depression
Catatonia
Prolonged mania
Complications of ECT?
Anterograde amnesia Headache Nausea Status epilicticus Cardiac instability
Bipolar disorder?
Repeated episodes of mood disturbance
At least one episode of mania
Complete recovery between episodes
What is recurrent depressive disorder?
Repeated episodes of depression with complete recovery between
What is persistent depressive disorder?
Constant depressive mood with no recovery
Mania symptoms?
Elevation of mood Increased energy Overactivity Pressure of speech Loss of social and sexual inhibitions Poor attention and concentration Over spending Sexually promiscuous Inappropriately aggressive Personal neglect
Appearance in a manic episode? (MSE)
Flamboyantly dressed
Self neglect
Behaviour in a manic episode? (MSE)
Overactivity
Fidgety
Poor attention
Speech in a manic episode? (MSE)
Pressure of speech - increased rate and amount
Difficult to interrupt
Mood in a manic episode? (MSE)
Euphoric
Irritable
Angry
Thoughts in a manic episode? (MSE)
Inflated view of importance
Grandiose ideas
Flight of ideas
Perception in a manic episode? (MSE)
Appreciation of colours as vivid
Pre-occupation with fine details
Hyperacusis
Auditory and visual hallucinations - confirming grandiose delusion
What is hyperacusis?
Increased sensitivity to sound
Cognition in a manic episode?
Attention and concentration poor
Insight in a manic episode?
Absent
Types of mania?
Hypomania
Mania without psychosis
Mania with psychosis
What is hypomania?
Persistent mild elevation in mood Increased energy Marked feelings of wellbeing Physical and mental efficiency Increased sociability Talkativeness Over friendliness Increased sexual energy Decreased sleep Do not cause severe disruption at work or social rejection
What is mania without psychosis?
Clinical features of mania without hallucinations or delusions
What is mania with psychosis?
Clinical features of mania with grandiose delusions, hallucination
What is cyclothymia?
Persistent instability of mood, involving numerous periods of mild elation and mild depression
What is dysthymia
Chronic depression of mood which does not fulfil the criteria for recurrent depressive disorder
Normal stages of grief?
Shock + denial Anger Depression + detachment Dialogue and bargaining Acceptance
What is pathological grief?
Disruption of mourning process
Prolonged grief disorder or persistent complex bereavement disorder
What is prolonged grief disorder?
Longing for deceased
Intense emotional pain
Preoccupation with deceased
Inability to experience positive mood
What is persistent complex bereavement disorder?
Preoccupation with circumstances of death
Desire to be with deceased
Difficulty in reminiscing positively
What is recurrent brief depressive disorder
Short episodes of depression but most of the time well
Short term side effects of ECT?
Headache
Nausea
Short term memory impairment
Cardiac arrhythmia
Long term side effects of ECT?
Impaired memory
Indications for ECT?
Treatment resistant depression
Catatonia
Severe life threatening depression
Contraindication for ECT?
Raised intracranial pressure
