Mood Disturbances - Burton Flashcards
What is a primary and secondary mood disorder?
Primary - does not result from another medical or psychiatric condition
Secondary - results from another medical or psychiatric condition, such as anaemia, hypothyroidism, or substance misuse.
What are the main types of primary mood disorders?
Unipolar - depressive disorder, dysthymia
Bipolar - bipolar disorder, cyclothymia
What is dysthymia?
Described as mild chronic depression, and as such is characterised by depressive symptoms that are not sufficiently severe to meet the criteria for depressive disorder.
What is hypomania?
A lesser degree of mania, with symptoms similar to those of mania but less severe or extreme. No psychotic symptoms and no marked impairment of social functioning.
How do you meet the criteria for bipolar disorder in the ICD-10?
Patient must have suffered at least two episodes of mood disturbance, at least one of which must have been mania or hypomania.
Can you diagnose bipolar or hypomania with no depressive symptoms?
Yes, as sooner or later a depressive episode is almost certain to happen.
What is cyclothymia?
Mild chronic bipolar disorder. Characterised by recurrent episodes of mild elation and depressive symptoms that are not sufficiently severe or prolonged to meet the criteria for bipolar or dysthymia.
What are the three groups of symptoms in depression?
Core symptoms
Psychological symptoms
Physical symptoms
What are the core symptoms of depression?
Low mood
Loss of interest and enjoyment
What are the psychological symptoms?
Poor concentration Poor self-esteem Inappropriate guilt Pessimism Recurring thoughts of death or suicide
What are the physical symptoms?
Sleep disturbance (often early morning waking) Fatigability Loss of appetite and weight loss Loss of libido Anhedonia Agitation or retardation
What are the core symptoms of depression in the ICD-10?
Persistent low mood
Anhedonia
Low energy
What are the non-core symptoms of depression in the ICD-10?
Reduced concentration and attention Reduced self-esteem and self-confidence Ideas of guilt Pessimism Ideas of self-harm or suicide Disturbed sleep Poor appetite
How long should you have symptoms of depression for a diagnosis?
At least two weeks, shorter periods may be reasonable.
How many symptoms should be present for diagnosis of mild, moderate and severe depressive episodes?
Mild - Two core + two non-core
Moderate - 2/3 core + 3/4 non-core
Severe - 3 core + 5/6 non-core, psychotic symptoms may be present and high risk of suicide.
What are the psychiatric differential diagnoses for depressive disorders?
Depression Dysthymia Cyclothymia Bipolar disorder Mixed affective states Schizoaffective disorder Schizophrenia and other psychotic disorders Adjustment disorder Seasonal affective disorder PTSD Generalised anxiety disorder OCD Eating disorder
What are the organic differential diagnoses for depressive disorders?
Neurological: stroke, alzheimer’s and other dementias, parkinson’s, huntington’s, MS, epilepsy, intracranial tumours
Endocrine: Cushing’s syndrome, Addison’s disease, hypothyroidism, hyperparathyroidism
Metabolic: Iron deficiency, B12 or folate deficiency, hypercalcaemia, hypomagnesaemia
Infective: Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
Neoplastic: Non-metastatic effects of carcinoma
Drugs: L-dopa, steroids, beta blockers, digoxin, cocaine, amphetamines, opioids, alcohol
When is peak prevalence of depressive disorders in men and women?
Men - old age
Women - middle age
What is the ratio of men to women in depressive disorders?
1:2 M:F
What is the prevalence of depression in first degree relatives of people with depression compared to general population?
15% in 1st degree relatives
5% in general population
What is the concordance rate of major depressive disorder in monozygotic twins compared to dizygotic twins?
46% dizygotic
20% monozygotic
What does the monoamine hypothesis of depression say?
Depression results from a depletion of monoamine neurotransmitters, particularly serotonin and noradrenaline.
What are the investigations for depressive disorders?
Physical examination FBC Urea and electrolytes Liver function tests Thyroid function tests ESR B12 and folate Toxicology screen Antinuclear antibody HIV test Dexamethosone suppression test
What role does endocrine abnormalities have in depression?
Depression often occurs in Cushing’s, Addison’s, hypothyroidism, and hyperparathyroidism.
Plasma cortisol levels are increased in about 50% of depression suffererer, and that 50% of depression sufferers fail to respond to the dexamethosone suppression test.
What are the common psychological treatments for depression?
Counselling CBT Dynamic psychotherapy Family therapy Interpersonal therapy
What medications are people given for ECT?
Standard anaesthetic (propafol) Muscle relaxant (suxamethonium)
When is ECT indicated?
Treatment-resistant severe depression
What is the average length of a major depressive episode?
6 months
What are the three degrees of severity for manic episode in the ICD-10?
Hypomanic
Mania without psychotic symptoms
Mania with psychotic symptoms
What are the symptoms of mania without psychotic symtoms?
Elation, increased energy, pressure of speech, decreased need for sleep.
Normal social inhibitions are lost, lack of concentration.
Self-esteem is inflated, and grandiose or over-optimistic ideas are freely expressed.
How long should symptoms last for a diagnosis of mania to be made?
At least one week and should be severe enough to disrupt ordinary work and social activities more or less completely.
What are the psychiatric differential diagnoses for mania and bipolar disorder?
Schizoaffective disorder Schizophrenia Puerperal psychosis Cyclothymia Attention deficit hyperactivity disorder
What are the organic differential diagnoses for mania and bipolar disorder?
Drugs (alcohol, amphetamines, cocaine, hallucinogens, anti-depressants, L-dopa, steroids)
Sleep deprivation
Delirium
Brain disease of the frontal lobes (dementia, stroke, multiple sclerosis, tumour, epilepsy, aids, neurosyphilis)
Endocrine disorders (hypothyroidism, Cushing’s)
Systemic lupus erythematosus
What is the lifetime risk for bipolar disorder?
What are the effects of gender and geography?
0.5-1%
All races, populations and genders are equally affected.
What is the mean age of onset of bipolar disorder?
21 years
Keep in mind a first episode of mania after 50 ought to prompt an investigation for a primary cause (endocrine, brain disease)
What is the unusual epidemiological fact about bipolar disorder?
More common in higher socioeconomic groups.
What is the most common medication in a manic episode and in a depressive episode?
Manic - antipsychotic
Depressive - antidepressant
How does should treatment progress in a patient with a manic episode?
Start an antipsychotic and wait for the person to recover before considering a long-term mood stabiliser.
Patient should not be started on mood stabiliser as unable to consent and may affect long-term compliance.
How long will a manic episode and a depressive episode last on average untreated?
Manic - 4 months
Depressive - 6 months
