Mood Disorders: Intro & Depression Flashcards
Define Mood - like the climate
Patient’s sustained, experienced emotional state over a period of time
Can be Dysthymic (Low), Euthymic (Normal) or Elevated
fluctuations in mood are a normal part of human experience - only a disturbance when mood is severe enough to cause impairment in the activities of daily living
Define Affect - like the weather
Transient flow of emotion in response to a particular stimulus
Define Mood Disorder (aka affective disorder)
Condition characterised by distorted/excessive/inappropriate moods for a sustained period of time
State the ICD10 class 1-7 for mood disorders
1 - Manic Episode (inc Hypomania)
2 - BPAD
3 - Depressive Episode
4 - Recurrent Depressive Episode
5 - Persistent Mood Disorders (Dysthymia, Cyclothymia)
6 - Other Mood Disorders
7 - Unspecified Mood Disorders
State the two classifications of primary Mood Disorder and give examples of each
Unipolar - Depressive Disorders, Dysthymia
Bipolar - Cyclothymia, BPAD
State three causes of Secondary Mood Disorders
Physical Disorders (Hypothyroid, Cushing, malignancy, anaemia, addisons’s, MS, parkinsons)
Psychiatric Disorders (Schizophrenia, Dementia)
Drug Induced
Define Depressive Disorder
Affective mood disorder characterised by persistent low mood, loss of pleasure and lack of energy accompanied by emotional, cognitive and biological symptoms
Give Bio, Psycho, and Social PREDISPOSING factor for Depressive Disorder
Bio - Female, postnatal, genetics, neurochemical, endocrine, physical co-morbidities, PMHx of depression
Psycho - Failure of effective stress control, poor coping strategies, personality type, co-morbidities ie dementia
Social - Lack of support, stressful life events, asylum seeker or refugee
Give a Bio, Psycho, and Social PRECIPITATING factor for Depressive Disorder
Bio - Poor Medication Compliance, corticosteroids
Psycho - Acute stressful life event,
Social - Unemployment, divorce, poverty
Give a Bio, Psycho, and Social PERPETUATING factor for Depressive Disorder
- *Bio** - Chronic Health Problems
- *Psycho** - Poor Insight, becks triad
- *Social** - Alcohol and Substance Misuse, poor social status, low social status
what are the 3 core symptoms of depressive disorder?
anhedonia - lack of interest in things which were previously enjoyable to the pt
low mood for at least 2 weeks
lack of energy aka anergia
what are the cognitive symptoms of depressive disorder?
- Lack of concentration
- Negative thoughts - becks cognitive triad
- Excessive guilt
- Suicidal ideation
what are the biological symptoms of Depressive Disorder?
Diurnal Variation in mood - often feel worse in the morning
Loss of Appetite
early morning wakening
loss of libido
psychomotor retardation - slow speech and movement
State the ICD10 classification of Mild, Moderate and Severe Depressive Disorder respectively
Mild - 2 core symptoms and 2 other symptoms
Moderate - 2 core symptoms and 3-4 other symptoms
Severe - 3 core symptoms and >4 other symptoms
severe depression with psychosis = 3 core symptoms + >4 others + psychosis
Outline the expected Appearance, Behaviour, Speech and Mood of a patient with Depressive Disorder (MSE)
Appearance - Self neglect, unkempt
Behaviour - Poor Eye Contact, Slow Responses
Speech - Slow, Reduced Volume and Tone
Mood - Low (Subjectively) and Depressed (Objectively)
Describe the expected Thought, Cognition and Insight of a patient with Depressive Disorder (MSE)
Thought - Guilt, Worthless
Cognition - Impaired Concentration
Insight - Usually Good
Name three diagnostic questionnaires for Depressive Disorder
PHQ9
HADS
Becks depression inventory
what blood tests are often done to exclude organic causes of depressive disorder and why?
FBC - anaemia
TFTs - hypothyroidism
U&Es, LFTs, calcium levels - biochemical abnormalities may cause physical symptoms which can mimic depressive symptoms
glucose - diabetes can cause anergia
What is Seasonal Affective Disorder?
Where mood is severely affected by change in seasons
Mood normally lowest in Winter months
What is Masked Depression
Depressed mood not prominent, but other features of depression are
What is Atypical Depression?
mild–moderate depression with reversal of symptoms e.g. overeating, weight gain and hypersomnia. There is a relationship between atypical depression and seasonal affective disorder.
Define Dysthymia and Cyclothymia
Dysthymia - Depressive state for two years not meeting threshold and is not the result of a partially-treated depressive illness
Cyclothymia - Chronic Mood Fluctuation for two years, with episodes of elation and depression, insufficient to meet threshold for hypomanic or depressive disorder
The normal management aim for Mild to Moderate Depression is to ‘Watchful Wait’. What is this?
Reviewing the patient again in two weeks
Give four non Pharmacological mainstay treatments of Depression
- *Self Help Programmes** - Patient works through a self-help manual with a healthcare professional providing support and checking progress.
- *CBT**
- *Physical Activity Programmes** and group exercise classes
- *Psychotherapies**
When would you use Antidepressants in Mild to Moderate Depression?
- Lasted a long time
- History of Moderate - Severe depression
- Failure of other interventions
- depression complicates the care of other physical health problems
What is the first step in management of a Moderate to Severe depressed patient?
Suicide Risk Assessment
When would you refer a Depressed patient to Psychiatry?
- Suicide Risk High
- Severe Depression
- Recurrent Depression
- Unresponsive to Initial treatment
Describe the pharmacological therapy of Moderate to Severe Depression
SSRIs first line (continued for 6m after symptom resolution for first episode, or 2y if second, long term in individuals who have had multiple severe episodes)
other antidepressants - tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, monoamine oxidase inhibitors
Adjuvants with Lithium or Antipsychotics
Describe the non pharmacological management of Mod to Severe Depression
Psychotherapy (CBT, IPT)
Social Support
When could ECT be recommended for a Depressed patient?
- acute treatment of severe depression which is life-threatening
- rapid response required
- depression with psychotic features
- severe psychomotor retardation or stupor
- failure of other treatments
how can mood disorders be classified?
primary and secondary
what is Beck’s triad?
negative views about oneself
negative views of the world
negative views of the future
what are the psychotic symptoms of depressive disorder?
hallucinations - usually second person auditory hallucinations
delusions - usually hypochondrical, guilt, nihilistic or persecutory in nature
what imaging can be done where presentation/examination may be atypical or where there is suspicion of an intracranial lesion
MRI
CT
what are some differentials for depressive disorder?
bipolar affective disorder, other depressive disorders, physical condition such as hypothyroidism, secondary to psychoactive substance abuse, secondary to an other psychiatric disorder (such as psychotic or anxiety disorders, adjustment disorder, personality disorder, eating disorders, dementia), normal bereavement
what is recurrent depressive disorder?
recurrent episode refers to when a patient has another depressive episode after their first
describe how psychotherapies used to manage depression
