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Systems: Psychiatry AB > Affective Disorders > Flashcards

Affective Disorders Flashcards

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1
Q

What are mood disorders?

A
  • They are disorders of mental status and function where altered mood is a core feature
  • It is a term that refers to states of depression and of mania
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2
Q

How can mood disorders present?

A

Disordered mood can present as a primary problem or as a consequence of another disorder or illness

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3
Q

What are mood disorders often associated with?

A

Anxiety symptoms and anxiety disorders

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4
Q

Give 2 examples of classification systems.

A
  • ICD10

- DSM5

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5
Q

What is depression when thought of as a symptom?

A

A state of feeling or mood that can range from normal experience to a severe, life-threatening illness, typically associated as a form of sadness

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6
Q

What is depression when thought of as a syndrome?

A

A constellation of symptoms and signs

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7
Q

What is depression when thought of as a recurrent illness?

A

Recurrent depressive disorder

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8
Q

When does depression become abnormal?

A

Not clear cut but psychiatry places emphasis on

  • Persistence of symptoms
  • Pervasiveness of symptoms
  • Degree of impairment
  • Presence of specific symptoms or signs
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9
Q

What are the 3 spheres that depressive illness symptoms occur in?

A
  • Psychological
  • Physical
  • Social
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10
Q

What changes can occur in the psychological sphere with depression?

A
  • Changes in mood

- Changes in thought content

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11
Q

What changes in mood can occur with depression?

A
  • Depression (can have diurnal variation)
  • Anxiety
  • Perplexity
  • Anhedonia
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12
Q

What changes in thought content can occur with depression?

A
  • Undue guilt
  • Hopelessness
  • Worthlessness
  • Any neurotic symptomatology
  • Ideas of reference
  • Delusions and hallucinations
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13
Q

What changes can occur in the physical sphere with depression?

A
  • Change in bodily function

- Change in psychomotor functioning

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14
Q

What changes with bodily function can occur with depression?

A
  • Energy decline (fatigue)
  • Sleep disturbance
  • Appetite changes (most often results in weight loss)
  • Libido loss
  • Constipation
  • Pain
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15
Q

What changes with psychomotor functioning occur with depression?

A
  • Agitation

- Retardation

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16
Q

What changes can occur to the social sphere in depression?

A
  • Loss of interests
  • Irritability
  • Apathy
  • Withdrawal, loss of confidence, indecisive
  • Loss of concentration, registration and memory
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17
Q

Agitation

A

A state of restless over activity, aimless or ineffective

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18
Q

Anhedonia

A

Loss of ability to derive pleasure from experience

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19
Q

Anxiety

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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20
Q

Apathy

A

Loss of interest in own surroundings

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21
Q

Depression

A

An unpleasant emotion in which sadness or unhappiness predominates

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22
Q

Retardation

A

A slowing of motor responses including speech

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23
Q

Stupor

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A

A state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking. On recover, they can describe clearly events which occurred whilst stuporose

24
Q

What is the ICD10 criteria for depression?

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A
  • At least 2 week history
  • No hypomanic/manic episodes ever
  • Not attributable to substances or organic mental disorder
  • Must have excluded other diagnosis if presents with psychosis
25
What occurs in somatic syndrome?
- Loss of interest in liked activities - Loss of emotional response - Waking 2 hours earlier than usual - Depression worse in the morning - Psychomotor agitation or retardation - Marked loss in appetite - Weight loss - Marked loss of libido
26
What is the general criteria for depression.
- 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
27
What is the additional criteria for depression?
- 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
28
According to ICD10, what is the criteria for mild depression.
- At least 2 general criteria | - Additional criteria to give score of at least 4
29
According to ICD10, what is the criteria for moderate depression?
- At least 2 general criteria | - Additional criteria to give score of at least 6
30
According to ICD10, what is the criteria fro sever depression?
- All of the general criteria - Additional criteria to give score of at least 8 - If psychotic symptoms or stupor then severe depression
31
How many people experience post-natal depression?
- 75% of women will experience the baby blues within 2 weeks - 10% will develop MDD within 3-6 months - Puerperal psychosis occurs in 1 in 500 deliveries with risk of recurrence of 1-3 with subsequent deliveries
32
Give examples of differential diagnosis for depression.
- Normal reaction to life event - SAD - Dysthymia - Cyclothymia - Bipolar - Stroke, tumour, dementia - Hypothyroidism, Addison’s, Hyperparathyroidism - Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS - Drugs
33
What treatment options are there for depression?
- Antidepressants - Psychological treatments - Physical treatments
34
What types of antidepressants are there?
- Selective Serotonin Reuptake Inhibitors (SSRIs) - Tricyclic antidepressants (TCAs) - Monamine Oxidase Inhibitors - Other antidepressants
35
What forms of psychological treatment are there for depression?
- CBT - IPT - Individual dynamic psychotherapy - Family therapy
36
What forms of physical treatment are there for depression?
- ECT - Psychosurgery - DBS - VNS
37
What are the 2 main measurement tools used in depression?
- SCID (Structured Clinical Interview for DSM disorders) | - SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
38
What is mania?
- A term to describe a state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness - Typically considered as a form of pathological, inappropriate elevated mood
39
What is mania often associated with?
- Grandiose ideas - Disinhibition - Loss of judgement - Similarities to the mental effects of stimulant drugs
40
Give examples of classifications of mania.
- Hypomania - Mania without psychotic symptoms - Mania with psychotic symptoms - Other manic episodes - Manic episode, unspecified
41
What is hypomania?
- A lesser degree of mania | - Psychosis is absent
42
What is the ICD10 criteria for hypomania
- Mild elevation of mood for several days on end - Increased energy and activity, marked feeling of wellbeing - Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep - May be irritable - Concentration reduced, new interests, mild overspending - Not to the extent of severe disruption of work or social rejection
43
What is the ICD10 criteria for mania (with or without psychosis)?
- 1 Week, severe enough to disrupt ordinary work and social activities more or less completely - Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep - Disinhibition - Grandiosity - Alteration of senses - Extravagant spending - Can be irritable rather than elated.
44
Give examples of differential diagnosis for mania.
- Mixed affective state - Schizoaffective disorder - Schizophrenia - Cyclothymia - ADHD - Drugs and Alcohol - Stroke, MS, epilepsy, AIDS, neurosyphilis - Cushing's, hyperthyroidism, SLE
45
What measurement tools are there for mania?
- SCID - SCAN - Young mania rating scale (YMRS)
46
What treatment options are there for mania?
Antipsychotics - Olanzapine - Risperidone - Quetiapine Mood stabilisers - Sodium valproate - Lamotrigine - Carbamazepine Lithium ECT
47
Give examples of ICD10 classifications of bipolar disorder.
- BAD, currently hypomanic - BAD, current manic without psychosis - BAD, current manic with psychosis - BAD, Current mild/mod depression - BAD, current severe depression without psychosis - BAD, current severe depression with psychosis - BAD, current episode mixed - BAD, current episode in remission - Other bipolar affective disorders - Bipolar affective disorder, unspecified
48
What is bipolar affective disorder?
It is a condition which consists of repeated (2+) episodes of depression and mania or hypomania
49
If a patient presents with no episodes of mania or hypomania, what is the diagnosis?
Recurrent depression
50
If a patient presents with no depression, what is the diagnosis?
Hypomania or bipolar disorder
51
What is the epidemiology of bipolar disorder?
- Lifetime prevalence rate: 0.7-1.6 - M=F - Mean age of onset= 21 (unusual after 30) - 1/3 have onset <20 years
52
When does early onset of bipolar disorder usually occur?
When there is a family history
53
What is the epidemiology of depression?
-Lifetime prevalence risk: 2.9-12 (less severe manifestations= 20) -F:M 2:1 -highest risk 18-44 (median 25) -Mean age of onset =27 -
54
What is the typical outcome of major depression?
- Typical episode 4-6 months - 80% have further episodes - 54% have recovered by 26 weeks - 15% die by suicide - 12% do not recover
55
What is the typical outcome of bipolar disorder/mania?
- Typical manic episode 1-3months - 90% have further episodes - 60% recovered by 10 weeks - 10% die by suicide - 5% fail to recover

Systems: Psychiatry AB (18 decks)

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