Mood Disorders

Question 1

What are affective (mood) disorders?

Answer 1

Illnesses that affect the way you think and feel, symptoms can be quite severe and the most common are BIPOLAR and DEPRESSION

Question 2

What is the definition for depression?

Answer 2

An affective mood disorder, which is characterised by: a persistent low mood, anhedonia, lack of energy.

Question 3

What are the risk factors for depression?

Answer 3

Female gender 
Post natal period 
FHx
Chronic health conditions 
Increased activity of co morbidities 
Lack of social support

Question 4

What are the symptoms of depression?

Answer 4

Core: continous low mood, anhedonia, lack of energy

Biological: DVM, early morning waking, appetite and weight changes, psychomotor retardation/ agitation/ loss of libido

Cognitive: low self esteem, guilt or self blame, hopelessness, suicidal thoughts, poor concentration

Question 5

What investigations may you do for depression?

Answer 5

Not always needed, do if your thinking of an organic cause
Diagnostic questionares used: PHQ-9, BECKS, HADS

Bloods: FBC (infection), U and Es, LFTS, Ca2+, TFTS, glucose (anergia)

Imaging: CT/MRI if suspecting a cranial lesion

Question 6

What is the ICD-10 classification of depression?

Answer 6

Mild= 2 core symptoms present and 2 others
Moderate= 2 core symptoms and 3-4 other symptoms
Severe= 3 core symptoms + > or equal to 4 other symptoms
Severe with psychosis= the above + psychosis

Question 7

What is psychotic depression?

Answer 7

Major depressive episode which is accompanied by psychotic symptoms

Question 8

What are the 5 types of hallucinations you can get in psychotic depression?

Answer 8

Auditory 
Visual 
Olfactory 
Somatosensory (touch) 
Gustatory (taste)

Question 9

What is a hallucination?

Answer 9

An experience involving the apparent

perception of something not present

Question 10

What is a delusion?

Answer 10

A belief which is clearly false and indicates an abnormality in the affected persons content of thought

Question 11

What is post natal depression?

Answer 11

Type of mood disorder which is associated with childbirth

Question 12

What are the risk factors for post natal depression?

Answer 12

Personal/FH of depression 
Older age 
Single mother 
Unwanted pregnancy 
Poor social support 
Previous PND

Question 13

What is bipolar?

Answer 13

This is a chronic episodic mood disorder, it is characterised by at least one episode of mania and a further episode of mania or depression

Question 14

What is meant by mania?

Answer 14

A mental illness which is characterised by periods of great excitement/ euphoria/delusions/ over activity

Question 15

What are the symptoms of mani?

Answer 15

Elevated/expansive/irritable mood 
Increased energy/ activity 
Grandiosity/ increased self esteem 
Pressure of speech 
Flight of ideas/ racing thoughts 
Distractible 
Reduced need for sleep 
Increased libido 
Loss of social inhibitions 
Psychotic symptoms

Question 16

What is the pathophysiology of bipolar?

Answer 16

Monoamine hypothesis
Dysfunction of the HPA axis
Strong heritability
Stressful/ significant life events may precipitate the onset of the first manic episode

Question 17

What are the clinical features of BPAD?

Answer 17

Can be remembered by ‘IDIGFASTER’ 
I= irritability 
D= distractibility 
I= insight impaired/ increased libido 
G= grandiose delusions 
F= flight of ideas 
A= activity/appetite increased 
S= sleep decreased 
T= talkative (pressure of speech) 
E= elevated mood/energy increased 
R= reduced concentration and reckless behaviour/ spending

Question 18

What are the different types of mania?

Answer 18

1= hypomania 
2= mania without psychosis 
3= mania with psychosis

Question 19

What is hypomania?

Answer 19

Mildly elevated or irritable mood for more than or equal to 4 days. Symptoms of mania are to a lesser extent than true mania. You get considerable interference with work and social life but not a severe disruption. Partial insight may be preserved.

Question 20

What is mania without psychosis

Answer 20

As with hypomania but to a greater extent. Symptoms are present for >1 week with complete disruption of work and social activities. They may have grandiose ideas and excessive spending which could lead to debts.

Question 21

What is mania with psychosis?

Answer 21

Severely elevated or suspicious mood with the addition of psychotic features ie: grandiose or persecutory delusions and auditory hallucinations that are mood congruent. Patient may show signs of aggression.

Question 22

What are the different classifications of bipolar?

Answer 22

Bipolar 1= one or more manic episodes or mixed episodes with or without one or more depressive episodes.

Bipolar 2 is where there is 1 or more depressive episodes with at least 1 hypomanic episode.

Question 23

What is the management of bipolar?

Answer 23

CALMER 
Consider hospitalisation/CBT 
A= antipsychotics 
L= lorazepam 
M= mood stabilisers 
E= electroconvulsion 
R= risk assesment

Question 24

What can be offered for a bipolar depressive episode?

Answer 24

Atypical antipsychotics (onlanzapine) 
Mood stabilisers- lamotrigine

Question 25

What is the long term management of BPAD?

Answer 25

Lithium
If lithium isn’t affective then consider adding valproate
Alternative options- onlanzapine or Quetiapine

Question 26

What are the side effects of lithium?

Answer 26

Polydipsia, polyuria, fine tremor, weight gain, oedema, hypothyroidism, impaired renal function, memory problems and teratogenicity in first trimester.

Question 27

Before starting a bipolar patient on treatment what should be checked?

Answer 27

U and Es (lithium has a renal excretion), TFTs, pregnancy status, ECG (check for prolonged QT syndrome). Lithium has a very narrow therapeutic window and therefore drug levels should be closely monitored and patients should be informed of potential side effects and toxicity.