T3 L5 Affective disorders clinical aspects Flashcards
Describe the steps of the mental status examination
Appearance & behaviour Speech Mood Thought Perception Cognition Insight
What are the different types of affective episodes?
Major depressive episode
Manic episode
Hypomanic episode
Mixed affective episode
What are the symptoms of depression?
Depression of mood Anhedonia Psychomotor retardation Agitation / restlessness Anxiety / preoccupation Diurnal variation of mood Insomnia Feelings of guilt, self reproach, worthlessness Somatic symptoms Hypochondriasis Weight loss Suicidal thoughts
What is the DSM V criteria for a major depressive episode?
Five or more symptoms during 2 week period:
1) Depressed mood most of day, nearly every day
2) Diminished interest or pleasure
3) Weight loss / weight gain or appetite decrease / increase
4) Insomnia or hypersomnia
5) Psychomotor agitation or retardation
6) Fatigue or loss of energy
7) Feelings of worthlessness or excessive or inappropriate guilt
8) Diminished ability to think or concentrate or indecisiveness
9) Recurrent suicidal ideation or a suicide attempt / plan
Symptoms must cause significant distress or functional impairment
What are some melancholic features?
Loss of pleasure in all or almost all acitivties
Lack of reactivity to usually pleasurable stimuli
Profound despondency, despair, empty mood
Depression regularly worse in the morning
Early-morning awakening
Marked psychomotor agitation or retardation
Signifiant anorexia or weight loss
Excessive or inappropriate guilt
What are the symptoms of atypical depression?
Mood reactivity &: Significant weight gain or increase in appetite Hypersomnia Leaden paralysis Interpersonal rejection sensitivity
What is a manic episode?
Abnormally & persistently elevated, expansive or irritable mood
Mood disturbance severe enough to cause marked functional impairment or hospitalisation to prevent harm to self or others
What is the DSM V diagnosis of a manic episode?
Period lasting at least 1 week & present most of the day, nearly everyday
3 or more of the following symptoms:
1) Inflated self-esteem or grandiosity
2) Decreased need for sleep
3) More talkative than usual or pressure to keep talking
4) Flight of ideas or racing thoughts
5) Distractibility
6) Increase in goal-directed activity or psychomotor agitation
7) Excessive involvement in high-risk activities
What is a hypomanic episode?
Period lasting at least 4 days & present most of the day nearly every day
Same symptoms as manic episode
Not severe enough to cause marked functional impairment or necessitate hospitalisation
What features can be associated with depression & mania?
Anxiety: restlessness, tension, worry, anticipatory anxiety, fear of losing control
Psychotic symptoms: delusions & hallucinations, mood congruent or incongruent
Catatonia
What is a mixed affective episode?
Full criteria met for either (hypo)manic or depressive episode & ≥3 symptoms of opposite polarity present
What is the epidemiology of major depressive disorder?
Age of onset peaks at 25-35 years Females more than males Variable course 1 in 5 lifetime prevalence 8-19% die by suicide
What are the 2 types of bipolar disorder?
Bipolar disorder I
Bipolar disorder II
What is bipolar disorder I?
At least 1 manic episode
What is bipolar disorder II?
At least 1 hypomanic episode
At least 1 major depressive episode
