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Affective Disorders Flashcards

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1
Q

Definition of mood disorders

A

Disorders of the mental status and function where altered mood is (or a) core feature

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2
Q

How can a disordered mood present?

A

As a primary problem

As a consequence of other disorder/illness e.g. cancer, dementia, drug misuse or medical treatment (steroids)

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3
Q

Two classification systems of affective disorders

A

ICD-10 (WHO)

DSM-5 (American)

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4
Q

What can depression be seen as?

A

A STATE OF FEELING OR MOOD, that can range from normal experience to severe, life threatning illness

A SYSTEMIC SYMPTOM (complaint) with similarities to fatigue and pain

A FORM OF SADNESS, not just the absence of happiness

A SYNDROME - constellation of symptoms and signs

A RECURRENT ILLNESS - if had it once then likely to recur again

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5
Q

When does depression become abnormal?

A

No clear and convenient division

Consensus problematic, often matter of perspective

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6
Q

What does psychiatry place emphasis on?

A

Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs

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7
Q

Symptoms of depressive illness occurs in 3 spheres

A

Social
Physical
Psychosocial

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8
Q

Symptoms of depression

A 
Diurnal variation - worse in the morning
Anxiety - inability to relax
Perplexity - particularly in puerperal illness. 
- feeling a bit bewildered/overwhelmed 
Anhedonia
Guilt (not really justified, unduly)
Hopelessness/worthlessness
Any neurotic symptoms e.g. 
- hydrochondriasis, agoraphobia, obsessions and compulsions, panic attacks
Ideas of reference 
Delusions and hallucinations if severe
Fatigue 
Sleep - insomnia or early wakening 
Loss of appetite leading to weight loss 
Loss of libido 
Constipation 
Pain 
Psychomotor function 
- agitation (restless sort of anxiety)
- retardation (severe = stupor)
Loss of interests
Irritability
Apathy 
Withdrawal 
Loss of confidence 
Indecisive 
Loss of concentration, registration and memory
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9
Q

Definition of anhedonia

A

Not being able to experience pleasure in the things that you like doing

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10
Q

Definition of ‘ideas of reference’

A

Where there is a casual event e.g. group of friends laughing across the street - and you believe that they are laughing at you - so connecting things to negative things about you

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11
Q

Delusion vs Hallucination example

A

Delusion - actually believe their organs are rotting inside of them
Hallucination - they may smell the rotting flesh (olfactory hallucination)

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12
Q

What is usually wrong with sleep in depression?

A

Early wakening

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13
Q

Definition of agitation

A

A state of relentless overactivity, aimless or ineffective

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14
Q

Definition of anheondia

A

Loss of ability to derive pleasure from experience

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15
Q

Definition of anxiety

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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16
Q

Definition of depression

A

An unpleasant emotion in which sadness or unhappiness predominate

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17
Q

Definition of retardation

A

A slowing of motor responses including speech

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18
Q

What is stupor?

A

A state of extreme psychomotor retardation in which consciousness is in tact, but the patient stops moving, speaking, eating and drinking

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19
Q

On recovery of stupor, what can the patient do?

A

Can clearly describe the events which occurred whilst stuporose

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20
Q

Which gender is more affected by depression?

A

F > M 2:1

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21
Q

Highest age risk of depression

A

18-44 (median 25)

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22
Q

Mean age of onset of depression

A

27

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23
Q

What can the onset of depression (first episode) be associated with?

A

Excess of adverse life events

‘exit events’ - separations and loses

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24
Q

Depression ICD-10 criteria that needs to be met to be diagnosed with depression

A

Lasts for at least 2 weeks
No hypomania or manic episodes in lifetime
Not attributable to psychoactive substance use or organic mental disorder
Somatic syndrome

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25
What is somatic syndrome?
Mood disorder which is characterised by physical symptoms more
26
Presentation of somatic syndrome
Marked loss of interest or pleasure in activities that are normally pleasurable Lack of emotional reactions to event or activities that normally produce an emotional response Waking 2 hours before 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 lidio
27
When diagnosing depression and how severe it is, what is the criteria used?
At least a number of - depressed abnormal mood for most of the day almost everyday for past 2 weeks, largely uninfluenced by circumstances - loss of interest/pleasure - decreased energy or increased fatigability Addition features from this list to give a number - loss of confidence/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
Criteria to diagnose MILD depression
At least 2 from first list AND | Additional from second list to make 4
29
Criteria to diagnose MODERATE depression
At least 2 from first list AND | additional from second list to make 6
30
Criteria to diagnose SEVERE depression
ALL from the first list AND | Additional from the second list to give 8
31
How many days after childbirth is there increased risk of psychiatric admission?
30 days following childbirth
32
How many women experience 'blues' in the first 2 weeks after childbirth?
75%
33
Differential diagnosis of depression
``` Normal reaction to life event SAD Dysthymia Cyclothymia Bipolar Stroke, tumour, dementia Hypothyroidism, Addison's, hyperparathyroidism Drugs Infection - flu, hepatitis, HIV/AIDs ```
34
Definition of dysthymia
Persistent mild depression
35
Definition of cyclothymia
Mood swings between short periods of mild depression and hypomania. The low and the high mood swings never reach the severity or duration of major depressive or full mania episodes
36
Treatment of depression
``` Antidepressants - SSRIs (selective serotonin reuptake inhibitors) - tricyclic antidepressants (TCAs) - monoamine oxidase inhibitors (MOIs) Psychological treatments - CBT - IPT - Individual dynamic psychotherapy - family therapy Physical treatments - ECT - psychotherapy - DBS - VNS ```
37
Measurement tools for depression
``` SCID SCAN HDRS BDI-II HADS PHQ-9 ```
38
What measurement tool of depression is associated with ICD-10?
SCID
39
How long does a typical episode of depression last?
4-6 months
40
How many depression patients have further episodes?
80%+
41
How many depressed patients die by suicide?
15%
42
Definition of mania
Describes a state of feeling, or mood, that can range from near-normal experience to severe, life threatening illness. Considered a form of pathological, inappropriate elevated mood
43
What is mania associated with?
Granidose ideas Disinhibition Loss of judgement Similarities to mental effects of stimulant drugs (e.g. AMPH, cocaine)
44
Presentation of hypomania
Lesser degree of mania, no psychosis Mild elevation of mood several days on end Increased energy and activity Marked feeling of wellbeing Increased sociability, talkativeness, overfamiliarity increased sexual energy decreased need for sleep concentration reduced new interests mild overspending not to the extent of severe disruption of work or social rejections
45
Presentation of mania
``` 1 week Severe enough to disrupt ordinary work or social activities more or less completely Elevated mood Increased energy and overactivity Pressure of speech Decreased need for sleep Disinhibition Grandiosity Alteration of senses (much more intense) Extravagant spending Can be irritable rather than elated ```
46
Differential diagnosis of mania
``` Psychiatric - mixed affective state - schizoaffective disorder - schizophrenia - cyclothymia - ADHD - drugs and alcohol Medical - stroke - MS - tumour - epilepsy - AIDs - neurosyphilis - endocrine; cushings, hyperthyroidism - SLE ```
47
Tools to measure the symptoms of mania
SCID SCAN Young mania rating scale (YMRS)
48
Treatment of mania
``` Antipsychotics - olanzapine - risperidone - quetiapine Mood stabilisers - sodium valproate - lamotrigine - carbamazepine Lithium ECT ```
49
Definition of bipolar disorder
Consists of repeated (2+) episodes of depression and mania or hypomania
50
Which gender has a higher prevalence for bipolar disorder?
Males = females
51
Mean age of onset of bipolar disorder
21
52
Unusual age to have onset of bipolar disorder
>30
53
What does early onset bipolar disorder usually suggest?
Positive FH
54
How long does a typical manic episode last for?
1-3 months
55
How old is early for onset bipolar disorder?
15-19
56
How many manic/bipolar patients have further episodes?
90%
57
How many manic/bipolar patients die by suicide?
10%
58
What delusions can be seen in depression?
Paranoid Guilt (late/unduly) Dying/world ending aspect -> nihilistic Ideas of reference
59
Trio of depression cognition
1. guilt 2. hopelessness 3. worthlessness
60
Common thoughts content in mania?
Thought interference Grandiosity Paranoia Suicidal ideation
61
Risk of suicidal intention in depressed vs manic patients
High risk in mania Lower risk in depressed patients Depressed patients may lack the motivation to do it, however manic people have high energy and do not stop to think
62
What questions could be asked for insight in the MSE?
Do you think you are ill? Do you agree with the treatment plan? Do you think you can get better?
63
What form of thoughts can depressed patients get?
Incomplete thoughts
64
What form of thoughts can manic patients get?
Flight of thoughts | Tangenitalality
65
What is tangenitalality?
Thoughts linked and connected that shouldn't be connected
66
Two types of mood
Subjective - self (what there thinking they feel) | Objective - others
67
Two factors indicative of severe depression
Psychotic symptoms | Acting/planning suicide
68
Definition of euthymia
Normal mood
69
What is the condition called when there is depression and mania at the same time?
Mixed Affective Disorder
70
Absolute contraindication to ECT
Raised ICP
71
Short term side effects of ECT
``` Headache Nausea Short term memory impairment Memory loss of events prior to ECT Cardiac arrhythmia ```
72
Long term side effects of ECT
Some patients report impaired memory
73
Can pseudohallucinations be part of the normal grieving process?
Yes
74
Risk of SSRI use in the 3rd trimester
Persistent pulmonary HTN of the newborn
75
What is the consistent difference between mania and hypomania?
Presence of psychotic symptoms
76
What drug should be avoided in patients taking SSRIs and why?
Triptans | Increased risk of serotonin syndrome
77
What is cotard syndrome?
Rare mental disorder where the patient believes that they are (or in some cases just a part of their body) is either dead or non existent
78
What is cotard syndrome associated with?
Severe depression | Schizophrenia sometimes
79
Common blood abnormality as a S/E of SSRIs
Hyponatraemia
80
Indications for ECT
Treatment resistant severe depression Manic episodes An episode of moderate depression known to respond to ECT in the past Life threatening catatonia
81
What is the tool used by GPs to characterise severity of depression?
Patient health questionaree-9 (PHQ-9)

Psychiatry (18 decks)

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