week 1- altered mood Flashcards
What are mood disorders?
Disorders affecting mood e.g. depression and bipolar.
Meaning of anhedonia?
Loss of enjoyment/pleasure
Meaning of anergia?
Lack of energy
Meaning of amotivation?
Lack of motivation
What does diurnal variation mean?
Mood varies over the day
Describe early morning wakening
Wakening atleast two hours before the appropriate waking time.
What is psychomotor retardation?
Slowing of thoughts/ movement.
What is stupor?
The absence of relational functions e.g. action or speech.
Completely unresponsive- can’t talk and don’t respond.
What is euthymia?
Normal mood.
How would someone with depression present appearance/behavioral wise?
Reduced facial expression Brow is classically furrowed. Reduced eye contact Limited gesturing Rapport is often difficult to establish.
How would someone with depression present speech wise?
Reduced rate of speech Lowered pitch Reduced volume Reduced intonation- monotone Limited content. Increased speech latencies- longer time between them being asked a question and them answering.
How might someones thought be changed in depression?
The thought form is generally normal. However the content can be negative, self accusatory, failure, guilt, low self esteem, dellusional?
They may also be paranoid e.g. that person is talking about me.
How do pyschosis and depression differ in terms of paranoia?
Depressed people will have increased sensitivity to criticism, however psychotic patients will just be bizarre e.g. I’m being watched by aliens.
Depressed people are a lot more self conscious whereas psychotic patients have a lack of perception.
Insight is often lost in psychotic patients.
What will hallucinations be like in depression?
Almost always auditory.
Usually a second person and being derogatory- “you are a bad person… etc”
Typically reflect negative and depressive themes.
How is the cognition with patients with depression?
Typically slow and their memory is bad. Pseudo-dementia.
What is the patients insight like in depression?
Unlike other mood disorders- insight is typically good. People are generally aware of their symptoms.
What are the two tools used to classify depression?
ICD-10
DSM-5
Name the three core features of depression
Depressed mood- abnormal for the individual. Present for most of the day and almost every day. Uninfluenced by circumstances.
Loss of interest or pleasure- in activities that are normally pleasurable.
Decreased energy.
What additional symptoms can be seen in depression?
Loss of confidence or self esteem.
Unreasonable feelings of self reproach or unreasonable guilt.
Recurrent thoughts of death or suicide- or any suicidal behaviour
Complaints or evidence of diminished ability to think or concentrate
Change in psychomotor activity
Sleep disturbance of any type
Change in apetite.
How can severity of depression be assessed?
rating scales- either Hamilton rating scale, ICD-10 or Montgomary asperg
How is a moderate depressive episode classified?
At least two of the core symptoms and 4 others
How is a severe depressive episode classified?
All three core criteria and 5 others.
What is atypical depression?
Mood reactivity- mood brightens in response to actual or potential positive events
(2 or more of the following)
-weight gain
-hypersomnia
-leaden paralysis- heavy feelings in the hands and legs.
-Long standing pattern of interpersonal rejection sensitivity- results in significant personal or occupational impairment.
What is psychotic depression?
Occasionally paranoid, typically mood congruent (sustained emotion) or hypochondriacal.
e.g. “I’ve got cancer, I know I have, its because I deserve it”
What is cortards syndrome?
More common in the elderly
Nihillistic views- life being meaningless.
“I can’t eat because my bowels have turned to dust”
“I’m dead, the world doesn’t exist anymore”
What is somatic syndrome?
Four of the following symptoms
1) marked loss of interest in activities that are usually pleasurable
2) Lack of emotional reaction to events that are usually pleasurable
3) waking in the morning 2 hours before they are supposed too
4) Depression worse in the morning
5) Objective evidence of marked psychomotor retardation
6) Marked loss of apetite
7) weight loss
8) loss of libido
What classification systems classify bipolar disorder?
ICD 10 and DSM 5
What does DSM describe in terms of bipolar disorder?
Course and pattern
Described as bipolar 1 or 2.
What does ICD describe in terms of bipolar disorder?
Episode severity.
What is bipolar I?
Typical bipolar- episodes of depression and episodes of mania.
What is bipolar II?
Current or past hypomanic episode and current or past depressive episode. Perceived as being the lesser form of bipolar I.
How is bipolar affective disorder defined in ICD 10?
A disorder characterised by two or more episodes in which the patients mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of mania or hypomania and on others depression.
What is the difference between bipolar affective disorder and bipolar disorder?
Repeated episodes of hypomania or mania only are classified as bipolar
When can you classify it as bipolar disorder not depression?
The first episode of mania/hypomania on a background of recurrent depression means that its bipolar disorder and not depression anymore.
A single episode of hypomania/mania (even if you haven’t been depressed yet) is bipolar disorder.
What is a hypomanic mood?
Mood is elevated or irritable to a degree that it is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days.
At least three of the following signs must be present leading to some interference with personal function
-Increased activity or physical restlessness
-Increased talkativeness
-Difficulty in concentration or distractibility
-Decreased need for sleep
-Increased sexual energy
-Mild spending sprees- or other types of reckless/irresponsible behaviour.
What is a manic episode?
Mood must be predominantly elevated expansive or irritable and definitely abnormal for the individual concerned. The mood change must be predominant and unchanged for approximately a week.
Atleast three of the following signs must be present (4 if the mood is just irritable) leading to severe impairment of ADL
-increased activity or restlessness
-increased talkativeness (pressured speech)
-Flight of ideas or the subjective experience of thoughts racing.
-Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances.
-Decreased need for sleep
-Inflated self esteem or grandiosity.
-Distractability or constant change in activity/plans
-Behaviour which is foolhardy or reckless.
-Marked sexual energy or sexual indiscretions
What is mania with psychotic symptoms?
Delusions or hallucinations are present.
When does bipolar usually present?
Onset usually in the late teens to early 20’s.
How does a family history of bipolar affect the onset?
Usually presents earlier and in less stressful situations.
What other co-morbidities is bipolar disease associated with?
Anxiety disorders Alcohol and drug misuse Personality disorders Eating disorders Schizoaffective disorder Schizophrenia
Name some predictors of poor outcome in adolescence
Early onset Low socioeconomic status Subsyndromal mood symptoms Long duration of illness Rapid mood fluctuation Mixed presentations Pyschosis Comorbid disorders
