1.1. Affective (Mood) Disorders - Depression

Question 1

What are Mood Disorders?

Answer 1

Disorders of Mental Status and Function, where the Mood is a Core Feature:
1. Mania
2. Depression
Note - These are the Commonest Group of Mental Disorders

Question 2

How can Affective (Mood) Disorders present?

Answer 2

1. Primary Problem
2. Secondary Problem - As a Consequence of another Disorder / Illness (Cancer / Dementia / Drug Misuse)
3. Post-Natal Depression

Question 3

What are Affective (Mood) Disorders associated with?

Answer 3

1. Anxiety Symptoms

2. Anxiety Disorders

Question 4

What are the 2 Classifications Systems for Affective (Mood) Disorders?

Answer 4

1. ICD-10 - International Classification of Disease - 10th Edition
2. DSM-5 - Diagnostic and Statistical Manual of Mental Disorders - 5th Edition

Question 5

What is Depression?

Answer 5

1. A Symptom - An emotion within the range of Normal Experience
2. A Syndrome - A Constellation of Symptoms and Signs
3. A Recurrent Illness - Recurrent Depressive Disorder

Question 6

What are the Emphasized Areas in which Depression will become Abnormal?

Answer 6

1. Persistence of Symptoms
2. Pervasiveness of Symptoms
3. Degree of Impairment
4. Presence of Specific Symptoms / Signs

Question 7

What are the 3 Spheres Symptoms of Depressive Illness can occur in?

Answer 7

1. Psychological
2. Physical
3. Social

Question 8

What are the Symptoms of Depression in the Psychological Sphere?

Answer 8

1. Change in Mood - Depression / Anxiety / Perplexity / Anhedonia
2. Change in Thought Content - Guilt / Hopelessness / Worthlessness / Neurotic Sympomatology / Ideas of Reference / Delusions and Hallucinations

Question 9

What are the Symptoms of Depression in the Physical Sphere?

Answer 9

1. Change in Bodily Function - Energy / Sleep / Appetite / Libido / Constipation / Pain
2. Change in Psychomotor Functioning - Agitation / Retardation

Question 10

What are the Symptoms of Depression in the Social Sphere?

Answer 10

1. Loss of Interests
2. Irritability
3. Apathy
4. Withdrawal / Loss of Confidence / Indecisive
5. Loss of Concentration / Registration / Memory

Question 11

What is the Definition of:

1. Anhedonia?
2. Apathy?
3. Anxiety?
4. Depression?
5. Psychomotor Retardation?

Answer 11

1. Loss of Ability to Derive Pleasure from Experience
2. Loss of Interest in Surroundings
3. An Unpleasant Emotion in which Thoughts of Apprehension and Fear Predominate
4. An Unpleasant Emotion in which Sadness / Unhappiness Predominates
5. A Slowing of the Motor Responses, Including Speech

Question 12

What is Stupor?

Answer 12

A State of Extreme Psychomotor Retardation in which consciousness is intact. The patient stops Moving, Speaking, Eating, and Drinking.
On recovery can describe clearly events which occured whilst Stuporosed

Question 13

What are the ICD-10 General Criteria for Depression?

Answer 13

1. Depressed Mood that is Abnormal for most of the day, almost everyday, for 2 weeks
2. Loss of Interest / Pleasure (Anhedonia)
3. Decreased Energy / Increased Fatigability

Question 14

What are the ICD-10 Additional Criteria for Depression?

Answer 14

1. Loss of Confidence / Self-Esteem
2. Unreasonable Feelings of Guilt / Self-Reproach
3. Any Suicidal Behaviour (Recurrent thoughts of Death by Suicide)
4. Decreased Concentration
5. Agitation / Retardation
6. Sleep Disturbance of any sort
7. Change in Appetite

Question 15

What is the ICD-10 Diagnosis Criteria for Mild Depression?

Answer 15

At least 2 of the General Criteria + At least 2 of the Additional Criteria

Question 16

What is the ICD-10 Diagnosis Criteria for Moderate Depression?

Answer 16

At least 2 of the General Criteria + At least 4 of the Additional Criteria

Question 17

What is the ICD-10 Diagnosis Criteria for Severe Depression?

Answer 17

All 3 of the General Criteria + At least 6 of the Additional Criteria
Note - Psychotic Symptoms / Stupor with Depression = Sever Depression with Psychotic Symptoms

Question 18

What are the Features of Somatic Syndrome?

Answer 18

1. Anhedonia
2. Lack of Emotional Reactions to Events
3. Waking 2 hours before normal Time
4. Depression worse in the Morning
5. Objective Psychomotor Agitation / Retardation
6. Marked Loss of Appetite / Weight Loss
7. Marked Loss of Libido
   Note - This is a sub-group of depression

Question 19

How long do Depressive Symptoms need to be happening for, to have a Diagnosis of Depression?

Answer 19

At Least 2 weeks - A Bad Couple of Days isn’t enough

Question 20

What Criteria would Eliminate Depression as a Diagnosis?

Answer 20

1. Hypomanic / Manic Episodes in Lifetime
2. Attributable to Psychoactive Substance Use
3. Attributable to Organic Mental Disorder

Question 21

What are the Features of:

1. Baby Blues?
2. Post-Natal Depression?
3. Puerperal Psychosis?

Answer 21

1. Mild Depressive Symptoms which will pass
2. Major Depressive Disorder
3. Psychotic Condition - Admit to Hospital

Question 22

What is the Differential Diagnosis for Depression?

Answer 22

1. Normal Reaction to Life Event
2. Seasonable Affective Disorder
3. Dysthymia (Persistent Mild Depression)
4. Cyclothymia (Less Severe than Bipolar)
5. Bipolar
6. Stroke / Tumour / Dementia
7. Hypothyroidism / Addison’s / Hyperparathyroidism
8. Infections
9. Drugs

Question 23

How is Depression Treated?

Answer 23

1. Antidepressants - SSRI’s / TCA’s / MAOI’s / Others
2. Psychological Treatments - CBT / IPT / Family Therapy / Individual Dynamic Psychotherapy
3. Physical Treatments - Electroconvulsive Therapy (ECT) / Psychosurgery / Deep Brain Stimulation (DBS) / Venous Nerve Stimulation (VNS)

Question 24

What are the Measurement Tools available for Depression?

Answer 24

Structured Interviews:

1. Structured Clinical Interview for DSM Disorders (SCID)
2. Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

Questionnaires aimed at assessing Symptom Severity:

1. Hamilton Depression Rating Scale (HDRS)
2. Beck Depression Inventory - II (BDI-II)
3. Hospital Anxiety and Depression Scale (HADS)
4. Patient Health Questionnaire - 9 (PHQ-9)