Affective disorders Flashcards Preview

202: Theme 3, Modulatory systems in psychiatry > Affective disorders > Flashcards

Flashcards in Affective disorders Deck (19)
Loading flashcards...
1

Process of diagnosing an affective illness

1. Patient presents with symptoms in their chronology

2. A psychiatric history is taken
-Takes into account how symptoms have presented overtime

3. A mental state examination is taken

2

Features of the mental state examination

Appearance and behaviour

Speech

Mood

Thought

Perception

Cognition

Insight

3

Appearance and behaviour
- Mental state examination

- Lack of personal care can indicate self neglect [depression
- Body language
- Psychomotor retardation [depression]
- Agitation

4

Speech assessment for mental status examination

The production of spontaneous speech is assessed
- Rhythm [fast in mania, slow in depression]
- Pace [can be slow in depression]
- Loudness [Loud in mania, quiet in depression]
- Articulation
- Latency
- Phonation
- Intonation

5

Thought assessment for MSE

Assesses one's thought contents and how it adheres to reality

Can have a flight of ideas
- Thoughts so rapid that speech becomes incoherent


Delusions:
Of guilt- Can rarely present in depression

Suicidal thoughts

Overvalued ideas
Obsessions
Phobias
Preoccupations.

6

Perception assessment for MSE

Assesses the presence of:
- Hallucinations
- Illusions

Auditory hallucinations can appear in depression
- Congruent to one's mood

7

Cognitive assessment for MSE

Assesses:
- Memory [impaired in depression]
- Attention [Impaired in depression]
- Intelligence
- Orientation
- Executive functions

8

Insight assessment for MSE

Assesses one's understanding of their illness.

- Depressed individuals usually have a great understanding of their depression
- Psychotic believe their hallucination + delusions

9

Mood assessment for MSE

Assessed by the individual describing what their mood is
- Anhedonia [cannot experience pleasure/ motivation]
-

10

Affect

Apparent emotion that can be observed from a person
- Can be congruent or incongruent to one's thoughts

Congruent- suggestive of depression
Incongruent- suggestive of schizophrenia

11

Major depressive episode
- Symptoms [9]
- DSM V criteria

MUST occur to be diagnosed as depressive
- Depression of mood
- Anhedonia

Others [at least 3 more to concur with depression, for at least 2 weeks]
- Insomnia/ hypersomnia
- Weight gain/loss/ change in appetite
- Feeling of inappropriate guilt/ worthlessness
- Inability to concentrate or be decisive
- Suicidal thoughts/ attempt
- Fatigue/ loss of energy
- Psychomotor agitation/ retardation

12

Melancholic depression [7]

Depressive disorder characterised by:
- Loss of pleasure in all or almost all activities
- Lack of reactivity

Despondent
Excessive guilt

Early morning awakening, better at night

Psychomotor retardation

Anorexia/ weight loss

13

Atypical depression

Type of depressive order characterised mainly by mood reactivity.

Also includes:
- Hypersomnia
- Weight gain/ increased appetite
- Leaden paralysis
- Interpersonal rejection sensitivity

14

Manic episode DSM V diagnosis

Persistent presentation of an elevated, expansive or irritable mood.
- At leat a week, most of the day
- Severe enough to cause functional impairment or hospitalisation

At least 3 symptoms:
- Grandiosity
- Decreased need for sleep
- Very talkative
- Flight of idea/ racing of thoughts
- Distractibility
- Increased goal-directed activity
- Excessive involvement in high risk activity.

15

Hypomanic episode diagnostic criteria

Less severe form of mania--> At least days
- Does not cause functional impairment of hospitalisation

At least 3 symptoms:
- Grandiosity
- Talkative
- Racing of thoughts/ flight of ideas
- Psychomotor agitation
- High risk activities
- Decreased need for sleep

16

Mixed affective episide

When the full criteria is met for either a hypomanic, manic or depressive episode
AND

At least 3 other symptoms of the opposite polarity presents.

17

Major depressive disorder epidemiology
- Onset
- Sex
- Time period
- Course
- Lifetime prevalence
- Suicide rates

Onset: Age 25-35

Sex: More present in females

Time period: Variably across 12 months

Lifetime prevalence: 20%

Suicide rates: 8-19%

18

Bipolar disorder diagnosis
- Type 1 and 2

Type 1
- At least one manic episode

Type 2:
- At least one HYPOmanic episode with a major depressive episode

19

Bipolar epidemiology
- Peak onset
- Prevalence
- Genetics
- Sex
- Suicide rate
- Time course

Peak onset: 15-24

Prevalence= 0.6-2.4%

Genetics= Individual has a 10x higher risk of developing it if 1st degree relative is affected

Sex: Both men and women affected equally

Suicide rate: >20 higher than general population

Time course:
- Most of life is spent asymptomatic BUT almost half is spent symptomatic
- Nearly a third of the time is in a depressive state