Affective Disorders Flashcards
What is an affective disorder?
They are a set of psychiatric disorders aka mood disorders, the main disorders include: depression, bipolar and anxiety.
- Can present as a primary disorder for many
- Or secondary as a result of another illness
What two classification systems do we have for affective disorders?
- ICD-10: International Classification of Disease 10th Edition – World Health Organisation
- DSM-5: Diagnostic and Statistical Manual of Mental Disorders 5th Edition – American Psychiatric Association
What is depression: symptom?
- An emotion within the range of normal experience
- describe a state of feeling, or mood, that can range from normal experience to severe, life-threatening illness
- a ‘systemic’ symptom (complaint) with similarities to fatigue and pain
- typically considered as a form of sadness, not just an absence of happiness
What is depression: syndrome?
A constellation of symptoms and signs.
When does depression become abnormal?
(the consensus is often a matter of perspective)
Psychiatry focuses on:
- persistence of symptoms (how long)
- pervasiveness of symptoms (widely impact of symptoms)
- degree of impairment
- presence of specific symptoms or signs
What three spheres do the symptoms of depression exist in?
- Psychological
- Physical
- Social
Explain the psychological sphere of depressive symptoms:
Change in mood
- DEPRESSION May find diurnal variation (sometimes worse in the morning)
- ANXIETY inability to relax
- PERPLEXITY particularly in Puerperal illness
- ANHEDONIA - not being able to experience pleasure in what you normally enjoy.
Change in thought content
- GUILT
- HOPELESSNESS
- WORTHLESSNESS
- ANY NEUROTIC SYMPTOMATOLOGY e.g.. Hypochondriasis, agoraphobia, obsessions & compulsions, panic attacks.
- IDEAS OF REFERENCE - “such as thinking random people laughing, are in fact, laughing at you”
- DELUSIONS AND HALLUCINATIONS if severe
Explain the physical sphere of depressive symptoms:
Change in bodily function:
- ENERGY Fatigue
- SLEEP - waking early seen in Severe Depression
- APPETITE weight loss
- LIBIDO
- CONSTIPATION
- PAIN
Change in psychomotor functioning:
- AGITATION
- RETARDATION
Explain the social sphere of depressive symptoms:
- LOSS OF INTERESTS
- IRRITABILITY
- APATHY
- WITHDRAWAL, LOSS OF CONFIDENCE, INDECISIVE
- LOSS OF CONCENTRATION, REGISTRATION & MEMORY
What is the classification of depression in ICD-10?
- Last for at least 2 weeks
- No hypomanic or manic episodes in lifetime
- Not attributable to psychoactive substance use or organic mental disorder
- If psychotic symptoms or stupor then severe depression with psychotic symptoms
- Need to exclude other psychotic illnesses first like schizophrenia
What is the criteria of depression as a somatic syndrome? [characterised by physical symptoms more commonly]
- Marked loss of interest or pleasure in activities that are normally pleasurable
- lack of emotional reactions to events or activities that normally produce an emotional response
- waking 2 hrs before the normal time
- Depression worse in the morning
- Objective evidence of psychomotor agitation or retardation
- Marked loss of appetite
- Weight loss (5%+ of body weight in a month)
- Marked loss of libido
Criteria for mild depression (ICD-10)?
At least two of:
- Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
- Loss of interest or pleasure
- Decreased energy or increased fatigability
And 2 from list below:
- Loss of confidence or self esteem
- Unreasonable feelings of guilt or self reproach or excessive guilt
- Recurrent thoughts of death by suicide or any suicidal behaviour
- Decreased concentration
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
Criteria for moderate depression (ICD-10):
At least two of:
- Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
- Loss of interest or pleasure
- Decreased energy or increased fatigability
And from this list to make up to 6:
- Loss of confidence or self esteem
- Unreasonable feelings of guilt or self reproach or excessive guilt
- Recurrent thoughts of death by suicide or any suicidal behaviour
- Decreased concentration
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
Criteria for severe depression (ICD-10):
All of below:
- Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
- Loss of interest or pleasure
- Decreased energy or increased fatiguability
Additional from this list to make up 8:
- Loss of confidence or self esteem
- Unreasonable feelings of guilt or self reproach or excessive guilt
- Recurrent thoughts of death by suicide or any suicidal behaviour
- Decreased concentration
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
Explain briefly post natal depression:
- increased risk of psychiatric admission in the 30 days following childbirth (risk for 24m)
- 75% of women experience ‘blues’ within 2 weeks
- 10% of women develop MDD within 3-6 months
- ‘puerperal psychosis’ - 1 in 500 deliveries with a risk of recurrence of 1-3 with subsequent deliveries
- despite intuitive appeal - no association with hormonal changes has ever been demonstrated
