Mood disorders (depression) Flashcards
How are mood disorders/ diseases classified
In accordance to:
1. US manual: DSM
The American Psychiatric Association’s “Diagnostic and Statistical Manualof Mental Disorders”, DSM. The latest is DSM-5 from 2013
2. WHO manual: ICD
We also have WHO’s system: International Classification of Diseases (ICD). Latest is ICD-10 from 1994. ICD-11 currently being implemented
What is the current definition of “mood (or affective) disorders” according to ICD-10?
- …where the fundamental disturbance is a change in affect/mood to depression (with or without associated anxiety) or to elation.
- The mood change is usually accompanied by a change in the overall level of activity
- Most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity.
- Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.
What is needed to diagnose a depressive episode?
DSM-5 criteria for depressive episode:
Occurrence of 2 weeks or more of depressed mood
AND the presence of 4 of 8 out of the following:
- Sleep alterations (insomnia or hypersomnia)
- Appetite alterations (increased or decreased)
- Diminished interest or anhedonia
- Decreased concentration
- Low energy
- Guilt
- Psychomotor changes (agitation or retardation)
- Suicidal thoughts
Under what conditions can a diagnosis of a Major Depressive Disorder be made following a depressive episode?
If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD).
What are the types of features for Major Depressive Disorder (MDD)?
- Atypical features (which represent mainly increased sleep and appetite, along with heightened mood reactivity)
- Melancholic features (defined by no mood reactivity, along with marked psychomotor retardation and anhedonia)
- Psychotic features (the presence of delusions/hallucinations).
What are the core symptoms of depression?
- low mood
- Anergia
- Anhedonia
What biological features are affected by depression?
- libido
- Sleep
- Appetite
What psychological symptoms are affected by depression?
- The world
- Oneself
- The future
Describe the typical cycle of low mood (seen in unipolar and bipolar depression)
thoughts:
“whats the point?” ->
feelings:
- low
- flat
- irritable ->
Physiological symptoms:
- exhaustion ->
Behaviors:
- Lie in bed all day
- Ruminate
Describe the typical cycle of high mood (can be seen in mania)
Thoughts:
“I’m the best”
“I can do all these things” ->
Feelings:
Elation excitement ->
Physiological Symptoms:
Increased energy
Race sensation ->
Behaviours:
Impulsive
Increased activity
What are manic episodes?
Euphoric or irritable mood with 3 or more of 7 manic criteria:
- Decreased need for sleep with increased energy
- Distractibility
- Grandiosity or inflated self-esteem
- Flight of ideas or racing thoughts
- Increased talkativeness or pressured speech
- Increased goal-directed activities or psychomotor agitation
- Impulsive behaviour (such as sexual impulsivity or spending sprees)
If such symptoms are present for minimum 1 week with notable functional impairment, a manic episode is diagnosed, leading to a DSM-5 diagnosis of type I bipolar disorder
What is the difference between hypomania and mania?
Hypomania and mania are periods of over-active and excited behaviour that can have a significant impact on your day-to-day life. Hypomania is a milder version of mania that lasts for a short period (usually a few days) Mania is a more severe form that lasts for a longer period (a week or more)
If manic symptoms are present for at minimum 4 days, but without notable functional impairment what is the diagnosis?
a hypomanic episode is diagnosed.
If not a single manic episode had occurred ever, but only hypomanic episodes are present, along with at least one major depressive episode what is the diagnosis?
the DSM-5 diagnosis of type II bipolar disorder is made.
What is the difference between type 1 and type 2 bipolar disorder?
Bipolar I disorder involves periods of severe mood episodes from mania to depression. Bipolar II disorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.
If manic symptoms occur for less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, what diagnosis is made?
“Unspecified Bipolar Disorder”
If psychotic features are present, hypomania can still be diagnosed, true or false?
FALSE:
If psychotic features are present, then hypomania cannot be diagnosed (since such features involve notable impairment by definition).
if a patient is hospitalized, irrespective of duration of manic symptoms, a manic episode is diagnosed, not a hypomanic episode, true or false?
TRUE
If manic or hypomanic episodes are caused by antidepressants, then the diagnosis of bipolar disorder is still made in DSM-5, true or false?
TRUE:
If manic or hypomanic episodes are caused by antidepressants, then the diagnosis of bipolar disorder is still made in DSM-5.
(an important change from DSM-IV where antidepressant- related mania/hypomania was viewed as an exclusion factor)
Are bipolar disorders “mood disorders”?
DEBATABLE:
it can be challenged whether Bipolar Disorders are “mood disorders”: Some argue; MDD can be without sad mood and mania without euphoric mood
In fact, mood is variable in the phenomenology of these conditions, and the most consistent clinical features for diagnosis are psychomotor changes.
What are the different subtypes for bipolar disorder?
Bipolar 1
Bipolar 2
Cyclothymia
What is cyclothymia?
It is a rare mood disorder. Cyclothymia causes emotional ups and downs, but they’re not as extreme as those in bipolar I or II disorder
Describe the difference in illness course between the subtypes of bipolar
Bipolar 1:
- More severe (more extreme)- higher peaks (than bipolar 2 or cyclothymia) during manic and depressive episode
Bipolar 2:
- Lower peaks than Bipolar 1 but similar peaks to cyclothymia in manic episodes
- higher peaks in depressive episodes than cyclothymia but similar to Bipolar 1
- Research studies report around 50-60% relapsing within a year of recovery from a mood episode
- Patients largely autonomous ‘between episodes’
What type of episode is common in Bipolar 1?
The majority of first episodes are depressive;
- 85% have a depressive as first episode
- 10% a manic episode
- 3-5% mixed episode
Most (90-100%) of patients will develop more episodes after their first manic episode; it is important to get diagnosed after just 1 manic episode
