Mood Disorders

Question 1

Mood vs affect

Answer 1

• Mood - pervasive and sustained
• Affect - variable, in response to changing emotional states
• Subjective - what a patient describes
• Objective - what observer sees

Question 2

Normal vs abnormal mood

Answer 2

• Normal to have mood reactive events
• Abnormal may be extremes of these but with disturbance of:
  
  • Thought
  • Psychomotor state
  • Motivation
  • Physiology
  • Psychosocial function
• Mood state becomes abnormal on account of severity, persistence, duration and presence of characteristc symptoms

Question 3

Symptoms of depression

Answer 3

• 3 key features:
  
  • Low mood
  • Anhedonia (loss of enjoyment)
  • Reduced energy leading to fatigue and diminished activity
• Other symptoms:
  
  • Reduced self-esteem and self-confidence
  • Feelings of guilt and worthlessness
  • Bleak and pessimistic views of the future
  • Ideas or acts of self-harm or suicide
  • Reduced concentration and attention
  • Decreased emotional reactivity
  • Early morning wakening
  • Depression worse in morning
  • Psychomotor agitation or retardation
  • Marked loss of apetite
  • Weight loss
  • Decreased libido

Question 4

Depressive episode

Answer 4

• Key symptoms
  
  • Low mood
  • Loss of interest/enjoyment
  • Reduced energy/increased fatigability
• Present at least 2 weeks
• 3 grades of severity
  
  • Mild - at least 2 of these plus 2 others
  • Moderate - 2 or 3 of these plus 3 or 4 others
  • Severe - 3 of these plus 4 others, some marked

Question 5

Consequences of a depressive episode

Answer 5

• Disruption in social and occupational functioning
• Isolation
• Self neglect
• Neglect of home
• Malnutrition
• Dehydration
• Self harming and suicide
• Violence/rarely homocide
• Death
• Severe episodes and high risk require hospitalisation

Question 6

Differential diagnosis of low mood

Answer 6

• Physical ill health including dementia and delirium
• Organic mood disorders (bipolar, depressive, mixed affective)
• Psychoactive substance use
• Depressive episode
• Recurrent depressive disorder
• Presistent mood disorders (cyclothymia, dysthymia)
• Reaction to severe stress and adjustment disorders
• Schizo-affective disorder
• Schizophrenia
• Acute and transient psychotic disorders
• Somatoform disorders
• Other neurotic disorders
• Eating disorders
• Specific personality disorders
• Co-morbid disorders (phobias, other anxiety disorders, alcohol/drug use, OCD)

Question 7

Symptoms of elated mood

Answer 7

• Elation of mood
• Increased energy and activity
• Decreased need for sleep
• Increased sociability
• Grandiose ideas and inflated self-esteem
• Impaired concentration and attention
• Impaired judgement and impulsive behaviour including gross over-spending/poor decision-making ability
• Irratibility
• Enhanced libido often leading to disinhibition and inappropriate sexual activity
• Rapid, pressured speech (may be unintelligible)
• Flight of ideas
• Psychotic symptoms

Question 8

What is a manic episode?

Answer 8

• 3 degrees of severity
  
  • Hypmania (lesser degree, not severe disruption of work/social rejection)
  • Mania without psychotic symptoms
  • Mania with psychotic symptoms

Question 9

Potential consequences of a manic episode

Answer 9

• Disruption in social and occupational functioning
• Risk of ruining reputation with inappropriate/bizarre behaviour
• Risk of serious financial, legal or physical harm
• Poor insight
• Death (dehydration, exhaustion, suicide, rarely homocidal)
• Hospitalisation usually required

Question 10

Differential of elated mood

Answer 10

• Physical ill health
• Organic mood disoderd (BPAD, mixed affective, organic mania)
• Psycho-active substance use
• Hypomanic episode
• Manic episode
• Schzo-affective disorder
• Psychotic disorder
• Persistent mood disorders (cyclothymia)

Question 11

Persistent mood disorders

Answer 11

• Cyclothymia
  
  • Persistent instability of mood, not meeting criteria for BPAD
• Dysthymia
  
  • Long-standing depression of mood, not meeting criteria for depressive episode

Question 12

Psychotic symptoms and mood disorder

Answer 12

• Mood-congruent symptoms are concerned with the same themes and non-delusional thinking in moderate affective disorders
• Non mood-congruent symptoms are present with prominent affective symptoms, consider alternative diagnosis

Question 13

Schizophrenia vs schizo-affective disorder

Answer 13

• Characteristic schizophrenic symptoms present in both
• If prominent affective symptoms are present at the same time then diagnosis is schizo-affective disorder (manic, depressive or mixed type)
• In schizophrenia, depressive symptoms can appear after psychotic symptoms start to recede (i.e. post-schizophrenic depression)

Question 14

Management of mood disorders

Answer 14

• Biological
  
  • Antidepressants (augment monoamine transmission)
  • Antipychotics (for psychotic symptoms)
  • ECT
  • Mood stabilisers (to prevent fluctuations)
• Psychological
  
  • Psychoeducation
  • CBT
  • Psychodynamic psychotherapy
  • Family therapy
  • Supportive psychotherapy
• Social
  
  • Helping with debt/housing issues
  • Increased socialisation
  • OT
  • Education