Mood disorders Flashcards
Depression diagnosis
The DSM-5 outlines a list of symptoms of which five or more must be experienced in the same two-week period (including at least one of the first two listed) to make a diagnosis of depression:
* Persistent low mood * Anhedonia * Weight loss or gain * Retardation of thought and action * Fatigue * Feelings of worthlessness or guilt * Diminished ability to concentration * Recurrent suicidal ideation.
Primary features of unipolar depression?
Low mood, reduced energy, anhedonia
Secondary features of unipolar depression?
Weight and appetite changes, reduced concentration, insomnia, hopelessness, suicidal ideation, reduced interest and motivation, low self esteem
Bipolar affective disorder
Classically, periods of prolonged and profound depression alternate with periods of excessively elevated and/or irritable mood, known as mania.
Type 1 bipolar
Full-blown mania or mixed mania and depression
Type 2 bipolar
Recurrent depression and hypomania without episodes of either mania or mixed states.
ICD 10 bipolar disorder diagnosis needs In
At least 2 mood episodes before bipolar diagnosis can be considered, with complete recovery in between the episodes.
DSM bipolar disorder diagnosis
Can be diagnosed even with single manic episode.
Bipolar diagnosis durations for each depressive episode, mania and hypomania
Depressive episode must be present at least for 2 weeks; mania for 7 days (lesser if hospitalized) ; hypomania for 4 days and mixed episodes for 2 weeks before they can be diagnosed using ICD 10.
How is bipolar different in elderly
Shorter periods of interepisodic remissions and more frequent episodes which are considerable longer.
Natural course of mood episodes
Mania lasts for 4 months while depression for 6 months.
Type 2 bipolar primary feature
Elated/irritable mood & increased activity
Type 2 bipolar secondary feature
Grandiosity, racing thoughts, decreased need for sleep, etc
Type 2 bipolar impairment
Change in functioning that is uncharacteristic of the person when not symptomatic. Observable by others
Type 2 bipolar durational criterion
> 4 days
Type 1 bipolar durational criterion
> 7 days
Type 1 bipolar impairment
Impairment in functioning
Type 1 bipolar secondary feature
Grandiosity, racing thoughts, decreased need for sleep, etc
Type 1 bipolar primary feature
Elated/irritable mood & increased activity
Mania
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, with 3 (or more) characteristic symptoms of mania.
Features of mania
Elevated mood (usually out of keeping with circumstances)
Increased energy, which may manifest as Over activity, reduced need for sleep, racing thoughts Pressured speech and flight of ideas
Increased self-esteem- Grandiosity, Overoptimistic ideation, over familiarity, Reduced social inhibition
Reduced attention/increased distractibility
Tendency to engage in behaviour that could have serious consequences like overspending, preoccupation with extravagant schemes
Psychotic symptoms accompany
Mania
Psychotic symptoms
Delusions and hallucinations
Hypomania/hypo manic episode
By definition, not severe enough to interfere with social or occupational functioning, require admission to hospital, or include psychotic features.
Symptoms of hypomania
Hypomania shares symptoms with mania, but these are evident to a lesser degree.
It includes mildly elevated, expansive, or irritable mood, increased energy and activity, increased self-esteem, talkativeness, over familiarity, reduced need for sleep and difficulty in focusing on one task alone.
Mixed states
Manic and depressive symptoms occur simultaneously. The occurrence of both manic/hypo manic and depressive symptoms in a single episode, present every day for at least 1 week (DSMIV) or 2 weeks (ICD-10)
Can rapidly swing between the 2 or symptoms of each can be present at the same time
Rapid cycling
When at least four episodes of bipolar disorder occur within a period of one year, the condition is described as ‘rapid cycling’
Factors associated with the rapid cycling include
The use of tricyclic anti-depressant, low thyroxin level, being a female patient, Bi Polar 2 pattern of illness and the presence of neurological disease.
Postpartum onset refers to
Onset of mania, hypomania or depression with 4 weeks of childbirth.
How many will attempt suicide (bipolar)?
50%
