Mood Disorders Flashcards
What does anhedonia mean?
Loss of enjoyment/pleasure
What does anergia mean?
Lack of energy
What does early morning wakening mean?
Waking at least 2 hours before normal/expected time
What is psychomotor retardation?
Slowing of thoughts and/or movement
What might be seen in the appearance and behaviour of someone with depression?
Reduced facial expression Brow furrowed Reduced eye contact Limited gesturing - slow/absent movements Rapport difficult to establish
What might be seen in the speech of a patient with depression?
Slow, reduced pitch, quiet, monotonous
Increased speech latencies (longer time between end of question + them starting to speak)
Limited content
How might affect be described in depression?
Reduced range
Limited reactivity
May report emotional paralysis
How might thought be affected by depression?
Form usually normal Control normal Content: - negative, guilt, self-accusatory - delusions of guilt, nihilism, poverty, hypochondriasis - suicidal thoughts
How might perception be affected in depression?
Usually not disturbed
May be auditory hallucinations:
- 2nd person, derogatory, depressive themes
How might cognition be affected by depression?
Slow, poor memory
Pseudo-dementia
Often worsened by anxiety
How might insight be affected by depression?
Typically preserved
May attribute symptoms to sins, personal failings etc
How is depression diagnosed?
General criteria + at least 2 core features
What are the general criteria for depression?
A. Depressive episode for at least 2 weeks
B. No hypomanic/manic symptoms at any time in individual’s life
What are the core features of depression?
- depressed mood: abnormal, most of day, almost every day, for at least 2 weeks
- loss of interest or pleasure
- reduced energy or increased fatiguability
What are the additional features seen in depression?
- loss of confidence
- guilt
- suicidal ideas or behaviours
- poor concentration
- agitation/retardation
- sleep disturbance
- changes in appetite
How is depression classified?
Moderate: 2 core features + 4 additional
Severe: all 3 core features + 5 additional
What are the features of somatic syndrome?
Early morning wakening Diurnal variation of mood Psychomotor retardation Reduced libido Weight loss
What are the features of Atypical depression?
Mood reactivity
Weight gain/increased appetite
Hypersomnia
Leaden paralysis
What are the features of psychotic depression?
Paranoid, mood congruent, hypochondriac psychosis
Cotard’s syndrome
What is Cotard’s syndrome?
Nihilistic delusions e.g. bowels turned to dust
Most common in elderly patients
How is Bipolar Affective Disorder defined in the ICD-10?
2 or more episodes in which the patient’s mood + activity levels are significantly disturbed
- at least one episode is mania/hypomania, others can be depression
What is the diagnostic criteria for a hypomanic episode?
A. Mood is elevated or irritable to a degree that is definitely abnormal + sustained for at least 4 consecutive days
B. 3 or more of the following, leading to some interference with daily functioning:
- increased activity or restlessness
- increased talkativeness
- difficulty in concentration
- reduced need for sleep
- increase sexual energy
- mild spending sprees or other types of reckless/irresponsible behaviour
What is the diagnostic criteria for a manic episode?
A. Mood elevated or irritable for at least 1 week (or severe enough to be hospitalised)
B. 3 or more of the following, severe interference with daily functioning:
- same as for hypomania PLUS
- flight of ideas/thoughts racing
- loss of social inhibitions
- inflated self esteem or grandiosity
- foolhardy/reckless behaviour
- marked sexual energy or sexual indiscretions
What are the features of mania with psychotic symptoms?
Delusions or hallucinations present
- commonly grandiose, self-referential, erotic etc
How is bipolar disorder classified in the DSM-5?
Bipolar 1 and Bipolar 2
What is the criteria for bipolar 1?
Met criteria for mania
- previous episodes may be hypomanic or depressive
‘classic’ manic-depressive psychosis
What is the criteria for bipolar 2?
Current or past hypomanic episode AND current or past depressive episode
- never met the criteria for mania
Which, of bipolar 1 and 2, is most common?
Bipolar 2
Which conditions are often co-morbid with bipolar disorder?
Anxiety disorders Alcohol and drug misuse Personality disorders (especially borderline) Eating disorders Schizoaffective disorder Schizophrenia
