Mood disorders and suicidality Flashcards
Length of time a depressive episode must last in ICD 10 and ICD 11
2 weeks
ICD 11 requirements for a depressive episode
Period of depressed mood or diminished interest in activities
Most of the day, nearly every day
For at least two weeks
Accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness, excessive guilt, hopelessness, recurrent thoughts of death or suicide, changes in energy or sleep, psychomotor agitation or retardation, and reduced energy or fatigue
DSM criteria for major depressive disorder
Most of the day, nearly every day for at least two weeks FIVE OR MORE OF Depressed mood Loss of interest Change in weight or appetite Change in sleep Psychomotor retardation or agitation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Diminished cognition Recurrent thoughts of death or suicide
Criterion A symptoms of depression in ICD 10
Depressed mood
Loss of interest and enjoyment
Reduced energy leading to fatiguability and decreased activity
Criterion B symptoms of depression in ICD 10
Reduced concentration and attention Reduced self-esteem and self-confidence Ideas of guilt or worthlessness Bleak and pessimistic views about the future Ideas or acts of self harm or suicide Disturbed sleep Diminished appetite
ICD 10 requirements for a mild episode of depression
At least 2 criterion A symptoms with at least 4 symptoms total
ICD 10 requirements for a moderate episode of depression
At least 2 criteria A symptoms and at least 6 symptoms total
ICD 10 requirements for a severe episode of depression
At least 2 criteria A symptoms and at least 8 symptoms total
Length of time depressive episodes must be separated in ICD for a diagnosis of recurrent depressive disorder
Several months
DSM IV restrictions for a diagnosis of depression after bereavement - removed for DSM V
Cannot be diagnosed for 2 months after a bereavement
Length of time required to diagnose a manic episode in ICD 10 or ICD 11
1 week
Shorter if hospitalised
Shorter if has a history of previous manic episodes
Length of time required to diagnose a hypomanic episode in ICD 10
4 days
Number of discrete mood episodes required to diagnose bipolar disorder in ICD 10 and ICD 11
2
Difference between hypomanic and manic episode in ICD 11
Manic episode usually needs to last 1 week; hypomanic episode needs to last several days
Manic episode should significantly with usual functioning; hypomanic episode should not
Manic episode may occur with or without delusions or hallucinations; hypomanic episode should not have delusions or hallucinations
Characteristics of a manic episode of which at least three must be present in ICD 10
Increased activity of physical restlessness
Increased talkativeness
Flight of ideas of subjective feeling of thoughts racing
Loss of normal social inhibitions
Decreased need for sleep
Increased self-esteem or grandiosity
Distractibility
Foolhardy or reckless behaviour where the risks are not recognised
Marked sexual energy or indiscretions
Usual features of auditory hallucinations in mania
Second person
Mood congruent
Time frame for mania or hypomania to occur post-birth to be referred to as post-partum
4 weeks
Number of episodes of bipolar disorder required per year to be classed as ‘rapid cycling’ in DSM
4
Sex predominantly affected by rapid cycling bipolar affective disorder
Female
Diagnosis where there is chronic, mildly depressed mood not severe enough to meet criteria for a depressive illness, lasting 2 years or more
Dysthymia
Criteria in ICD 10 for diagnosing seasonal affective disorder
3 or more affective episodes within the same 90 days of the year for 3 or more consecutive years
Diagnosis where there are episodes of elevated and low mood, but not enough to meet a criteria for manic, mixed or depressive episodes - there may be episodes which meet criteria for a hypomanic episode
Cyclothymia
Classical presentation for a depression with a seasonal pattern
Reversed biological features in the winter
Atypical features common with seasonal affective disorder
Hypersomnia
Weight gain
Increased appetite
Qualifiers for depressive episodes in ICD 11
Melancholic features
Anxiety symptoms
Panic attacks
Seasonal pattern
Symptom of depression which would automatically class it as severe in ICD 10 - removed in ICD 11
Psychosis
Natural course for an untreated episode of mania
4 months
Natural course for an untreated episode of depression
6 months
Factors associated with rapid cycling bipolar affective disorder
Tricyclic antidepressants Female sex Hypothyroidism Having bipolar II Having a neurological disease
Frequency of episodes of bipolar disorder with age
Increase with age
12 month prevalence of major depression in the community
2-5%
Likely lifetime prevalence of depression
10-20%
Mean age to develop depression
27
Sex more commonly affected by depression
Female
Ratio of women:men who develop depression
2:1
Condition predicted to be the leading cause of disease burden worldwide by 2030
Depression
Severity and prevalence in elderly population compared to the general population
Prevalence no different except more prevalent in nursing homes and medical wards
More severe
Family factors which have been shown to be protective against suicide
Being a twin
Having parents alive and together
Having young children
Being married
Most common method of completed suicide in the UK
Hanging
Sex hanging is a more common method of completed suicide for
Male
Most common method of completed suicide in the USA
Firearms
Features of atypical depression
Change in functioning Low but reactive mood Hyperphagia and weight gain Hypersomnia Feeling of heaviness in the arms and legs Sensitivity to rejection
Treatment option of choice for atypical depression
MAOIs
Lifetime prevalence of suicidal ideation
9.2%
Lifetime prevalence of suicide attempts
2.7%
Lifetime prevalence of suicide plans
3.1%
Time frame within which postpartum depression normally occurs
2-3 months
Time frame within which postpartum depression must occur
Within 1 year of giving birth
Increase in risk of coronary heart disease in an otherwise healthy person with depression
Doubles the risk
Mean age of onset of bipolar disorder in community studies
17
Lifetime risk for bipolar disorder
0.3-1.5%
Relative morbidity and mortality in a patient with ischaemic heart disease who also has depression, compared to a patient with just ischaemic heart disease
2x
Lifetime prevalence of major depression
20%
Most common method of completed suicide among older people
Drowning
Chance of developing bipolar disorder with one affected parent
4-15%
Chance of developing depression with one affected parent
9%
