Affective disorders Flashcards by Jade Kiersten

What are mood disorders?

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

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Examples of affective disorders

States of depression and of mania

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What are the most common group of medical disorders?

affective/mood disorders

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Secondary causes of altered mood

consequence of other disorder or illness eg cancer, steroids, drug misuse, dementia

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2 classification systems for affective disorders

ICD-10

DSM-5

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3 ways to classify depression

symptom
syndrome
recurrent illness

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Depression as a symptom

can e systemic eg fatigue

form of sadness

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depression as a syndrome

constellation of symptoms and signs

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Depression as a recurrent illness

recurrent depressive disorder

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The 4 things which indicate if depression or bipolar becomes abnormal

persistence of symptoms
pervasiveness
degree of impairment
specific symptoms or signs

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3 spheres of symptoms of depressive illness

psychological
physical
social

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2 main parts of the psychological sphere of depression

change in mood

change in thought content

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Change in mood - depression

depression - diurnal variation
anxiety
perplexity - puerperal illness
anhedonia

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Change in thought content - depression

unjustified guilt
hopelessness 
worthlessness 
neurotic eg hypochondriasis, obsessions, phobias
delusions and hallucinations if severe

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2 categories of the physical sphere of depression

change in bodily function

change in psychomotor function

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change in bodily function - depression

energy - fatigue 
sleep 
libido
appetite
constipation 
pain

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Change in psychomotor functioning - depression

agitation

retardation

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Change in social sphere - depression

loss of interests
irritability 
apathy 
withdrawal, loss of confidence and indecisive
loss of concentration and memory

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Agitation

A state of restless overactivity, aimless or ineffective

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anhedonia

loss of ability to derive pleasure from experience

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Apathy

Loss of interest in own surroundings

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anxiety

An unpleasant emotion in which thoughts of apprehension and fear predominate

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Depression

An unpleasant emotion in which sadness or unhappiness predominate

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Retardation

Slowing of motor responses including speech

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Stupor

A state of extreme retardation in which consciousness is intact but stop speaking, eating moving Remember the events after recovery

How long must depression symptoms last to diagnose?

2 weeks

If there have been hypomanic or manic episodes in their life, can depression be diagnosed?

no - bipolar etc

Psychoactive substances and organic mental disorder- depression

Must not be attributable to these for ICD-10

If psychotic symptoms or stupor what must you exclude before diagnosing depression?

other psychotic illnesses eg schizophrenia

Components of depression - somatic syndrome

``` anhedonia lack of emotional reactions waking 2 hours before normal time depression worse in morning psychomotor agitation or retardation loss of appetite weight loss loss of libido ```

3 general criteria for depression | ICD-10

depressed mood, most of the day, almost everyday for atleast 2 weeks anhedonia decreased energy or increased fatigability

Additional criteria for depression: ICD-10

``` loss of confidence and self esteem unreasonable guilt suicidal thoughts decreased concentration agitation or retardation sleep disturbance change in appetite ```

mild depression - ICD-10 : how many criteria?

at least 2 general | additional list to give 4

moderate depression: ICD-10: how many criteria?

at least 2 general | additional list to give 6

severe depression: ICD-10: how many criteria?

all of general | additional list to give 8

% of women who experience the blues within 2 weeks after birth

% of women who develop MDD within 3-6 months

Differential diagnosis for depression

``` SAD normal reaction to life event dysthymia cyclothymia bipolar stroke, tumour, dementia hypothyroidism infections drugs ```

Treatments for depression - broadly in 3 categories

antidepressants eg SSRI, SnRI, MAOI, TCA etc psychological eg CBT, IPT physical eg ECT, DBS, VNS

Measurement tools for depression - main 2

SCID and SCAN

Other measurement tools for depression

HDRS BD1-11 HADS PHQ-9

What is mania often associated with?

grandiose ideas disinhibition loss of judgement

Mania

pathological, inappropriate elevated mood

Hypomania - ICD-10

``` Lesser degree of mania, no psychosis mild elevation of mood increased energy and activity increase sociability concentration reduced ```

Does hypomania affect work or social circumstances?

not severely

ICD-10, mania - how long?

1 week

ICD-10, mania | classification

``` disrupt work and social elevated mood, increase energy, pressure of speech disinhibition grandiose alteration of senses extravagant spending irritable overactivity ```

Psychiatric differential diagnosis of mania

``` mixed affective state schizoaffective disorder schizophrenia cyclothymia dysthymia ADHD ```

dysthymia

persistent mild depression

cyclothymia

relatively mild depression and hypomania

Medical differential diagnosis for mania

stroke, MS, tumour, hyperthyroid, epilepsy, AIDS

Tools to measure mania

SCID and SCAN | YMRS

Main treatments of mania

antipsychotics eg risperidone, olanzapine mood stabiliser eg lamotrigine, sodium valproate lithium ECT

Bipolar affective disorder - what it consists of

repeated (2+) episodes of depression and mania or hypomania

If no mania or hypomania it is not bipolar but what instead?

recurrent depression

No depression but mania or hypomania

hypomania or bipolar

DSM-5: What is sufficient to diagnose bipolar?

1 episode of mania

What has improved agreement for mood disorders?

SCID and SCAN

What has hindered agreement for mood disorders?

differences in diagnostic classifications

Epidemiology of bipolar

M=F, age = 21 early onset with positive FH no difference with income, education etc prevalence increased in first degree relatives

Epidemiology of depression

2.9-12 lifetime prevalence 2:1 for females mean age 27 MDD less in those employed lower education, unstable marriage etc excess of adverse live events

clinical outcome of major depression

4-6 months 80% have further episodes 15% suicide

Clinical outcomes of bipolar/mania

1-3 months manic episode 90% further episodes 10% suicide

Affective disorders Flashcards

(63 cards)