Session 1 - Introduction to Mood Disorders

Question 1

What does ICD-10 stand for?

Answer 1

International classification of disease

Question 2

Patients with depression often experience pessimistic thoughts:
Thinking about the:
Past) can include guilt and self blame
Present) low self esteem and low confidence
And what about the future?

Answer 2

Future: idea of the future is viewed with ruin & misfortune. This can lead to ideas of suicidal thoughts

Question 3

What are the 3 main symptoms of Depression?

Answer 3

1. A pervasive low mood for at least 2 weeks
2. Lack of enjoyment and interest (which are normally liked)
3. There is a lack of energy

Question 4

List 3 biological/ somatic symptoms of depression:

Answer 4

Lack of energy
Early morning waking (emw) ~ waking up at least 2 hours earlier than normal, and not going back to bed
Diurnal mood variation (mood is worse in the morning - link to HPA axis)
Reduced appetite
- leads to weight loss
Marked loss of libido
Psychomotor retardation (thinking of patient is slowed down (psycho), as well as movement and activities (motor))

Question 5

List 3 changes of appearance in someone with depression:

Answer 5

Reduced rate of blinking 
Shoulders are bent 
Patient looks downwards
Patient makes poor eye contact 
Evidence of neglect of dress and grooming
Downward turning of the mouth

Question 6

What are other ways depression can present?

Answer 6

Alongside Agitation 
Masked Depression 
Atypical Depression 
Psychotic Depression 
Depression in a specific context

Question 7

What is the difference between typical depression and agitation in how they present?

Answer 7

Someone with typical depression has psychomotor retardation, however someone who is agitated is instead restless and irritable

Question 8

Define: Masked Depression

Is it therefore hard to diagnose?

Answer 8

The term is used to describe a patient who doesn’t obviously look depressed and often denies being in a low mood.

The diagnoses can often be difficult to make from a clinical standpoint

Question 9

How does someone with Atypical depression present differently to Typical depression?

Answer 9

Instead of weight loss there is weight gain (due to eating more)

Instead of early morning waking, there is over sleeping

Sometimes, there is also severe anxiety

Question 10

Define: psychosis

Answer 10

Psychosis is used to describe a patient who has lost touch with reality, and includes delusions and hallucinations.

Question 11

Delusions are experienced in someone who is psychotic.

Define delusions:

Answer 11

Delusions are firmly held ideas or belies on inadequate grounds, and are not in keep with the patients cultural background

E.g. “Delusion you are always being watched by someone”

Question 12

Hallucinations can appear in someone with psychosis.

What is an hallucination?

Answer 12

A hallucination is a false perception, where there is no external stimulus.

Someone who has passed away may cause someone to become depressed, and thus, may hallucinate that they can see or hear them

Question 13

Classification of mood disorders is outlined by the ICD-10.

How are episodes of depression characterised?

Answer 13

Mild
Moderate
Severe
Severe, with psychotic symptoms

Question 14

List 3 changes of appearance in someone with depression:

Answer 14

Reduced rate of blinking 
Shoulders are bent 
Patient looks downwards
Patient makes poor eye contact 
Evidence of neglect of dress and grooming
Downward turning of the mouth

Question 15

What are other ways depression can present?

Answer 15

Alongside Agitation 
Masked Depression 
Atypical Depression 
Psychotic Depression 
Depression in a specific context

Question 16

What is the difference between typical depression and agitation in how they present?

Answer 16

Someone with typical depression has psychomotor retardation, however someone who is agitated is instead restless and irritable

Question 17

Define: Masked Depression

Is it therefore hard to diagnose?

Answer 17

The term is used to describe a patient who doesn’t obviously look depressed and often denies being in a low mood.

The diagnoses can often be difficult to make from a clinical standpoint

Question 18

How does someone with Atypical depression present differently to Typical depression?

Answer 18

Instead of weight loss there is weight gain (due to eating more)

Instead of early morning waking, there is over sleeping

Sometimes, there is also severe anxiety

Question 19

Define: psychosis

Answer 19

Psychosis is used to describe a patient who has lost touch with reality, and includes delusions and hallucinations.

Question 20

Delusions are experienced in someone who is psychotic.

Define delusions:

Answer 20

Delusions are firmly held ideas or belies on inadequate grounds, and are not in keep with the patients cultural background

E.g. “Delusion you are always being watched by someone”

Question 21

Hallucinations can appear in someone with psychosis.

What is an hallucination?

Answer 21

A hallucination is a false perception, where there is no external stimulus.

Someone who has passed away may cause someone to become depressed, and thus, may hallucinate that they can see or hear them

Question 22

Classification of mood disorders is outlined by the ICD-10.

How are episodes of depression characterised?

Answer 22

Mild
Moderate
Severe
Severe, with psychotic symptoms

Question 23

Mania is another mood disorder.

What is meant by the term Mania?

Answer 23

Mania is a mental illness marked by periods of great excitement or euphoria, delusions and over activity

Question 24

Give an example of a special circumstance with depression

Answer 24

Post natal depression

Question 25

Give 4 symptoms of mania

Answer 25

Increased activity
Ideas of self importance
Patients feel generally cheerful and optimistic about future
May be irritable rather than euphoric
Rapid speech - sometimes the patient can’t stop talking (pressure of speech)
Sleep is often reduced
Sexual desires (libido) may be increased
Delusions and hallucinations may occur

Question 26

Describe how manic episodes can be categorised

Answer 26

1. Hypomania (describe lesser degrees of mania with less severe symptoms)
2. Mania
3. Mania with psychotic episodes

Question 27

When can someone be categorised as having a ‘bipolar affective disorder’?

Answer 27

If patients suffer from 2 or more episodes of elevated mood (mania) or lowered mood (depression)

Question 28

What is Recurrent Depressive Disorder?

Answer 28

This is when depression is viewed as a condition that is repetitive during a lifetime

Question 29

What is the point prevalence of depressive symptoms?

These include low moods, weight loss etc, but not diagnosed as depressed

Answer 29

Point prevalence = 13-20%

Question 30

What is the lifetime risk of getting a depressive illness?

Answer 30

5-17%

Question 31

Obtaining a bipolar mood disorder is considerably less common than getting a depressive illness. What is the lifetime risk of getting a BMD?

Answer 31

0.5-1.5%

Question 32

How can ‘Causes’ of Mood Disorders be categorised?

First way

Answer 32

Precipitating ~ events that directly relate to the episode.
(Often represent some form of loss. E.g. Loss of loved one, the loss of a job or good health)

Predisposing ~ relate to someone’s psychological make up
(partly determinant by genetic factors. E.g. Traumatic childhood experiences)

Maintaining ~ chronic stressful situations
(E.g. Marital disharmony and financial strain, alcohol and drug abuse)

Question 33

Mood Disorder Causes can be categorised into two ways, what is one way?
(Not PPM)

Answer 33

Biological ~ relates to genetics and changes in brain neurochemistry

Psychological ~ relate to how people view themselves, the future and the world around them

Social factors ~ includes someone’s social support, financial situation, hobbies and habits

Question 34

Define Dysthymia:

Answer 34

A condition describing a chronic lowering in mood, not quite fulfilling the criteria for a clinical depression.
A lesser depression.

Question 35

Define cyclothymia:

Answer 35

Describes a patient with a persistent instability in mood, not quite fulfilling the criteria for a bipolar disorder.

Question 36

Briefly outline the 3 main methods for treating mood disorders:

Answer 36

Psychological ~ CBT
Biological ~ medication, ECT (electro convulsive therapy)
Social ~ support groups