moods characterise the state of mind or inner disposition of a person; a mood is a result of prolonged feelings and colour the whole mental life while it lasts (Karl Jaspers, 1913)

_Mood disorders - classification_ There no diagnostic tests for mood disorders Diagnosis is based on identification of symptoms which clusters into “syndromes” ...-5 and ...-10 - standard sets of criteria used to classify all psychiatric disorders

There no diagnostic tests for mood disorders Diagnosis is based on identification of symptoms which clusters into “syndromes” DSM-5 and ICD-10 - standard sets of criteria used to classify all psychiatric disorders the Diagnostic and Statistical Manual for Mental Disorders (DSM) the International Classification of Diseases (ICD

_MDD diagnostic criteria (DSM V) - Depression_ ... of more symptoms during ... weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or ... 5.Psychomotor ... or retardation 6.... or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or .., or indecisiveness 9... suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

_MDD diagnostic criteria (DSM V) - Depression_ Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished ... or ... 3.Weight loss / weight gain or ... decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of ... or excessive or inappropriate ... 8.Diminished ability to ... or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically ... distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

_MDD diagnostic criteria (DSM V) - Depression_ Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.... or hypersomnia 5.Psychomotor agitation or ... 6.Fatigue or loss of ... 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent ... ideation or a ... attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

_MDD diagnostic criteria (DSM V) - Depression_ ... of more symptoms during ... weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period: 1.Depressed mood most of the day, nearly every day 2.Diminished interest or pleasure 3.Weight loss / weight gain or appetite decrease / increase 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or excessive or inappropriate guilt 8.Diminished ability to think or concentrate, or indecisiveness 9.Recurrent suicidal ideation or a suicide attempt/plan The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

_depression with melancholic features_ Loss of ... in all, or almost all, activities Lack of reactivity to usually ... stimuli Profound despondency, despair, ... mood Depression regularly worse in the ... ...-... awakening Marked psychomotor agitation or retardation Significant ... or weight ... Excessive or inappropriate ...

Loss of pleasure in all, or almost all, activities Lack of reactivity to usually pleasurable stimuli Profound despondency, despair, empty mood Depression regularly worse in the morning Early-morning awakening Marked psychomotor agitation or retardation Significant anorexia or weight loss Excessive or inappropriate guilt

_Atypical depression_ Mood ... and Significant weight ... or ... in appetite ...somnia ... paralysis (i.e., heavy, leaden feelings in arms or legs) interpersonal ... sensitivity

Mood reactivity and Significant weight gain or increase in appetite Hypersomnia Leaden paralysis (i.e., heavy, leaden feelings in arms or legs) interpersonal rejection sensitivity

_Atypical depression_ Mood reactivity and Significant weight gain or increase in ... Hypersomnia Leaden ... (i.e., heavy, leaden feelings in arms or legs) ... rejection ...

Mood reactivity and Significant weight gain or increase in appetite Hypersomnia Leaden paralysis (i.e., heavy, leaden feelings in arms or legs) interpersonal rejection sensitivity

_MDD - Epidemiology_ Most common mental disorder in primary care Higher rates of depressed patients in ... care office age of onset ...-... years (but can be at any age) ... more than ... 1 in 5 lifetime prevalence (...); ...:10% Variation in 12-months prevalence, av. 7% Variable course 8 -19% die by suicide

Most common mental disorder in primary care Higher rates of depressed patients in primary care office age of onset 25-35 years (but can be at any age) Females more than males 1 in 5 lifetime prevalence (females); males:10% Variation in 12-months prevalence, av. 7% Variable course 8 -19% die by suicide

_MDD - Epidemiology_ Most common mental disorder in primary care Higher rates of depressed patients in primary care office age of onset 25-35 years (but can be at any age) Females more than males 1 in 5 lifetime prevalence (females); males:...% Variation in 12-months prevalence, av. ..% ... course ..-...% die by suicide

Most common mental disorder in primary care Higher rates of depressed patients in primary care office age of onset 25-35 years (but can be at any age) Females more than males 1 in 5 lifetime prevalence (females); males:10% Variation in 12-months prevalence, av. 7% Variable course 8 -19% die by suicide

_Impact of MDD_ Greater than most ... medical diseases ... morbidity/mortality from co-existing medical conditions Decreased work ... Suicide ... leading cause among 15-29 years old Immense costs to society

Greater than most chronic medical diseases Increased morbidity/mortality from co-existing medical conditions Decreased work productivity Suicide 2nd leading cause among 15-29 years old Immense costs to society

Affective Disorders Clinical Aspects Flashcards by Chrissy Taaffe

What is mood?

moods characterise the state of mind or inner disposition of a person; a mood is a result of prolonged feelings and colour the whole mental life while it lasts (Karl Jaspers, 1913)

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How to assess mood?

Descriptive psychopathology: phenomenological (emphatic) assessment of subjective experience. It describes and categorizes the abnormal experiences reported by the patients - and observed in behaviours

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Diagnostic test for mood disorder?

There no diagnostic tests for mood disorders
Diagnosis is based on identification of symptoms which clusters into “syndromes”

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Mood disorders - classification

There no diagnostic tests for mood disorders
Diagnosis is based on identification of symptoms which clusters into “syndromes”
- …-5 and …-10 - standard sets of criteria used to classify all psychiatric disorders

There no diagnostic tests for mood disorders
Diagnosis is based on identification of symptoms which clusters into “syndromes”
- DSM-5 and ICD-10 - standard sets of criteria used to classify all psychiatric disorders
  - the Diagnostic and Statistical Manual for Mental Disorders (DSM)
  - the International Classification of Diseases (ICD

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Mood Disorders: the episodes (4)

Major Depressive Episode
Manic Episode
Hypomanic Episode
Mixed affective episode

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Classification of Mood Disorders

… depression
… disorder

Unipolar depression
Bipolar disorder

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Major Depressive Disorder

Free from symptom period, then periods of major depressive episode

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Symptoms of depression - list

Depression of mood
Anhedonia
Psychomotor retardation
Diurnal variation of mood
Thoughts of
guilt , self-reproach, self-blame, worthlessness, depersonalization
Agitation / restlessness
Anxiety / preoccupation
Somatic symptoms
Hypochondriasis
Weight loss
Insomnia
Suicidal thoughts

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What is anhedonia?

Anhedonia is the inability to feel pleasure. It’s a common symptom of depression as well as other mental health disorders.

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MDD diagnostic criteria (DSM V) - Depression

… of more symptoms during … weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or …
- 5.Psychomotor … or retardation
- 6…. or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or .., or indecisiveness
- 9… suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

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MDD diagnostic criteria (DSM V) - Depression

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished … or …
- 3.Weight loss / weight gain or … decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of … or excessive or inappropriate …
- 8.Diminished ability to … or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically … distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

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MDD diagnostic criteria (DSM V) - Depression

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4…. or hypersomnia
- 5.Psychomotor agitation or …
- 6.Fatigue or loss of …
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent … ideation or a … attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

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MDD diagnostic criteria (DSM V) - Depression

… of more symptoms during … weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

Five of more symptoms during 2 weeks period:
- 1.Depressed mood most of the day, nearly every day
- 2.Diminished interest or pleasure
- 3.Weight loss / weight gain or appetite decrease / increase
- 4.Insomnia or hypersomnia
- 5.Psychomotor agitation or retardation
- 6.Fatigue or loss of energy
- 7.Feelings of worthlessness or excessive or inappropriate guilt
- 8.Diminished ability to think or concentrate, or indecisiveness
- 9.Recurrent suicidal ideation or a suicide attempt/plan
  - The symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition

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depression with melancholic features

Loss of … in all, or almost all, activities
Lack of reactivity to usually … stimuli
Profound despondency, despair, … mood
Depression regularly worse in the …
…-… awakening
Marked psychomotor agitation or retardation
Significant … or weight …
Excessive or inappropriate …

Loss of pleasure in all, or almost all, activities
Lack of reactivity to usually pleasurable stimuli
Profound despondency, despair, empty mood
Depression regularly worse in the morning
Early-morning awakening
Marked psychomotor agitation or retardation
Significant anorexia or weight loss
Excessive or inappropriate guilt

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Atypical depression

Mood …
and
- Significant weight … or … in appetite
- …somnia
- … paralysis (i.e., heavy, leaden feelings in arms or legs)
- interpersonal … sensitivity

Mood reactivity
and
- Significant weight gain or increase in appetite
- Hypersomnia
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
- interpersonal rejection sensitivity

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Atypical depression

Mood reactivity
and
- Significant weight gain or increase in …
- Hypersomnia
- Leaden … (i.e., heavy, leaden feelings in arms or legs)
- … rejection …

Mood reactivity
and
- Significant weight gain or increase in appetite
- Hypersomnia
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
- interpersonal rejection sensitivity

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MDD - Epidemiology

Most common mental disorder in primary care
Higher rates of depressed patients in … care office
age of onset …-… years (but can be at any age)
… more than …
1 in 5 lifetime prevalence (…); …:10%
Variation in 12-months prevalence, av. 7%
Variable course
8 -19% die by suicide

Most common mental disorder in primary care
Higher rates of depressed patients in primary care office
age of onset 25-35 years (but can be at any age)
Females more than males
1 in 5 lifetime prevalence (females); males:10%
Variation in 12-months prevalence, av. 7%
Variable course
8 -19% die by suicide

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MDD - Epidemiology

Most common mental disorder in primary care
Higher rates of depressed patients in primary care office
age of onset 25-35 years (but can be at any age)
Females more than males
1 in 5 lifetime prevalence (females); males:…%
Variation in 12-months prevalence, av. ..%
… course
..-…% die by suicide

Most common mental disorder in primary care
Higher rates of depressed patients in primary care office
age of onset 25-35 years (but can be at any age)
Females more than males
1 in 5 lifetime prevalence (females); males:10%
Variation in 12-months prevalence, av. 7%
Variable course
8 -19% die by suicide

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Impact of MDD

Greater than most … medical diseases
… morbidity/mortality from co-existing medical conditions
Decreased work …
Suicide … leading cause among 15-29 years old
Immense costs to society

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Greater than most chronic medical diseases
Increased morbidity/mortality from co-existing medical conditions
Decreased work productivity
Suicide 2nd leading cause among 15-29 years old
Immense costs to society

Impact of MDD

Greater than most chronic medical diseases
Increased morbidity/mortality from co-existing medical conditions
Decreased work productivity
Suicide 2nd leading cause among ..-… years old
Immense costs to …

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Greater than most chronic medical diseases
Increased morbidity/mortality from co-existing medical conditions
Decreased work productivity
Suicide 2nd leading cause among 15-29 years old
Immense costs to society

Bipolar Disorder

EPISODES
- … / …
- Subthreshold … and major …
- Neither = euthymia (no mood disturbances)

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EPISODES
- Mania / Hypomania
- Subthreshold Depression and major depression
- Can be euthymia (no mood disturbances)

Bipolar Disorder

EPISODES
- Mania / Hypomania
- … Depression and … depression
- Neither = … (no mood disturbances)

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EPISODES
- Mania / Hypomania
- Subthreshold Depression and major depression
- Can be euthymia (no mood disturbances)

The manic episode - DSM V diagnosis

The mood disturbance is sufficiently severe to cause marked functional … or to necessitate … to prevent harm to self or others, or there are … features.
The episode is not attributable to the … effects of a … or to another … condition.
Can be associated to psychotic symptoms such as … and …

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The mood disturbance is sufficiently severe to cause marked functional impairment or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The episode is not attributable to the physiological effects of a substance or to another medical condition.
Can be associated to psychotic symptoms such as delusions and hallucinations

The manic episode - DSM V diagnosis

Abnormally and persistently elevated, expansive, or … mood
For a period lasting at least … … and present most of the day, nearly every day:
abnormally and persistently … activity or …
… or more of the the following symptoms
- 1.Inflated self-esteem or grandiosity
- 2.Decreased need for …
- 3.More t… than usual or pressure to keep talking
- 4.Flight of ideas or r… thoughts
- 5.d…
- 6.Increase in goal-directed activity or psychomotor agitation
- 7.Excessive involvement in high risk activities

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Abnormally and persistently elevated, expansive, or irritable mood
For a period lasting at least one week and present most of the day, nearly every day:
abnormally and persistently increased activity or energy
3 or more of the the following symptoms
- 1.Inflated self-esteem or grandiosity
- 2.Decreased need for sleep
- 3.More talkative than usual or pressure to keep talking
- 4.Flight of ideas or racing thoughts
- 5.Distractibility
- 6.Increase in goal-directed activity or psychomotor agitation
- 7.Excessive involvement in high risk activities

_The manic episode - DSM V diagnosis_ * Abnormally and persistently elevated, expansive, or irritable mood * For a period lasting at least one week and present most of the day, nearly every day: * abnormally and persistently increased activity or energy * 3 or more of the the following symptoms * 1.Inflated ...-... or g... * 2.... need for sleep * 3.More talkative than usual or ... to keep talking * 4.Flight of ... or racing thoughts * 5.Distractibility * 6.Increase in goal-directed activity or ... agitation * 7.Excessive involvement in ... ... activities

* Abnormally and persistently elevated, expansive, or irritable mood * For a period lasting at least one week and present most of the day, nearly every day: * abnormally and persistently increased activity or energy * 3 or more of the the following symptoms * 1.Inflated **self-esteem or grandiosity** * 2.**Decreased** need for sleep * 3.More talkative than usual or **pressure** to keep talking * 4.Flight of **ideas** or racing thoughts * 5.Distractibility * 6.Increase in goal-directed activity or **psychomotor** agitation * 7.Excessive involvement in **high risk** activities

_The hypomanic episode - DSM V diagnosis_ * Same as Mania except * lasting at least ... days … * The episode is not severe enough to cause marked functional impairment or to necessitate ... * The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not ... * The disturbance in mood and the change in functioning are ... by others.

* Same as Mania except * lasting at least **4** days … * The episode is not severe enough to cause marked functional impairment or to necessitate **hospitalization** * The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic * The disturbance in mood and the change in functioning are **observable** by others.

_Bipolar Disorder(s) – DSM V definitions_ * Acute episodes: * ... -\> elevated mood & increased energy + marked functional impairment * ... -\> elevated mood & increased energy + no marked functional impairment * ... -\> depressed mood or ... * Bipolar Disorder Type I * at least 1 Manic episode * Bipolar Disorder Type II : * 1 Hypomanic episode + * 1 Depressive episode

* Acute episodes: * **Mania** -\> elevated mood & increased energy + marked functional impairment * **Hypomania** -\> elevated mood & increased energy + no marked functional impairment * **Depression** -\> depressed mood or **anhedonia** * Bipolar Disorder Type I * at least 1 Manic episode * Bipolar Disorder Type II : * 1 Hypomanic episode + * 1 Depressive episode

_Bipolar Disorder(s) – DSM V definitions_ * Acute episodes: * Mania -\> elevated mood & increased energy + marked functional impairment * Hypomania -\> elevated mood & increased energy + no marked functional impairment * Depression -\> depressed mood or anhedonia * Bipolar Disorder Type I * at least ... ... episode * Bipolar Disorder Type II : * .. ... episode + * ... ... episode

* Acute episodes: * Mania -\> elevated mood & increased energy + marked functional impairment * Hypomania -\> elevated mood & increased energy + no marked functional impairment * Depression -\> depressed mood or anhedonia * Bipolar Disorder Type I * at least **1** **Manic** episode * Bipolar Disorder Type II : * **1** **Hypomanic** episode + * **1** **Depressive** episode

_Bipolar Disorder(s)_ * Clinical Specifiers * ... distress * ... features * ... features * rapid ... * melancholic, atypical, * mood .../incongruent psychotic features * ... pattern * others

* Clinical Specifiers * **anxious** distress * **psychotic** features * **mixed** features * rapid **cycling** * melancholic, atypical, * mood **congruent**/incongruent psychotic features * **seasonal** pattern * others

_Bipolar Disorder(s)_ * Clinical Specifiers * anxious ... * psychotic features * mixed features * ... cycling * ..., atypical, * mood congruent/incongruent ... features * seasonal pattern * others

* Clinical Specifiers * anxious **distress** * psychotic features * mixed features * **rapid** cycling * **melancholic**, atypical, * mood congruent/incongruent **psychotic** features * seasonal pattern * others

_Mixed affective episodes_ * Full criteria met for either ... or ... episode, and * at least ... symptoms of the opposite ... are present

* **Full criteria met for either (hypo)manic or depressive episode, and** * **at least 3 symptoms of the opposite polarity are present**

_Features that may be associated to both depression and mania_ * ... * Restlessness, tension, worry, anticipatory anxiety, fear of losing control * ... symptoms * Delusions and hallucinations, mood congruent or incongruent * C...

* **Anxiety** * Restlessness, tension, worry, anticipatory anxiety, fear of losing control * **Psychotic** symptoms * Delusions and hallucinations, mood congruent or incongruent * **Catatonia**

_Features that may be associated to both depression and mania_ * Anxiety * Restlessness, T..., worry, ... anxiety, fear of ... ... * Psychotic symptoms * Delusions and ..., mood ... or ... * Catatonia

* **Anxiety** * **Restlessness, tension, worry, anticipatory anxiety, fear of losing control** * **Psychotic symptoms** * **Delusions and hallucinations, mood congruent or incongruent** * **Catatonia**

_The problem for early detection of Bipolar Disorder_ * ... usually early onset * Full episode of ... * Then ... symptoms * Full episode of ... later * Diagnosis usually later - age ....

* **Depression usually early onset** * **Full episode of depression** * **Then mania symptoms** * **Full episode of mania later** * **Diagnosis usually later - age 30 roughly**

_Recognition of Bipolar Depression - A probabilistic approach (from Mitchell et al., 2008)_ * Probable Bipolarity: * ...somnia * Hyper... * ... sx (leaden paralysis) * Psychomotor retardation * ... features * Mood ...; irritability * ... onset * Multiple ... * ... family hx of BPAD

* Probable Bipolarity: * **Hypersomnia** * **Hyperphagia** * **Atypical** sx (leaden paralysis) * Psychomotor retardation * **Psychotic** features * Mood **lability**; irritability * **Early** onset * Multiple **episodes** * **Positive** family hx of BPAD

_Recognition of Bipolar Depression - A probabilistic approach (from Mitchell et al., 2008)_ * Probable Unipolarity: * Initial .../reduced ... * Appetite/weight loss * Increased ... levels * ... complaints * ... onset * ... episode duration * ... family hx of BPAD

* **Probable Unipolarity:** * **Initial insomnia/reduced sleep** * **Appetite/weight loss** * **Increased activity levels** * **Somatic complaints** * **Late onset** * **Long episode duration** * **Negative family hx of BPAD**

_Bipolar Disorder_ * Familial aggregation (... times higher risk in 1st degree relatives) * Men & women affected ... (BP-I) * Lifelong risk of ...

* Familial aggregation (**10** times higher risk in 1st degree relatives) * Men & women affected **equally** (BP-I) * Lifelong risk of **recurrence**

_Bipolar Disorder - Natural History_ * Highly ... * May have ... course * High rates of ... * Low rates of fully ... recovery * High rates of ... remission * Rate of suicide up to ... times higher than general population * 30%-50% of patients attempt suicide

* **Highly recurrent** * **May have progressive course** * **High rates of depression** * **Low rates of fully sustained recovery** * **High rates of incomplete remission** * **Rate of suicide up to 20 times higher than general population** * **30%-50% of patients attempt suicide**

_Bipolar Disorder - Natural History_ * ... recurrent * May have progressive course * ... rates of depression * ... rates of fully sustained recovery * High rates of incomplete ... * Rate of suicide up to 20 times higher than general population * ..-..% of patients attempt suicide

Bipolar patients are symptomatic almost ... their lives

Bipolar patients are symptomatic almost **half** their lives

_Prevalence - all bipolar disorders_ * all BPADs: ...% * sub-threshold: 1.4% * Type I: ...% * Type II: ...% * Age of onset * Early onset group - 17 yrs (3 SD): 42% * Middle onset group - ... yrs (5 SD) : 25% * Late onset group – 32 yrs (12 SD) : 33% * Familial aggregation (10 times higher risk in 1st degree relatives) * 70-80% Monozygotic concordance rate * Men & women affected ... (BP-I)

* all BPADs: **2.4**% * sub-threshold: 1.4% * Type I: **0.6**% * Type II: **0.4**% * Age of onset * Early onset group - 17 yrs (3 SD): 42% * Middle onset group - **24** yrs (5 SD) : 25% * Late onset group – 32 yrs (12 SD) : 33% * Familial aggregation (10 times higher risk in 1st degree relatives) * 70-80% Monozygotic concordance rate * Men & women affected **equally** (BP-I)

_Prevalence - all bipolar disorders_ * all BPADs: 2.4% * sub-threshold: ...% * Type I: 0.6% * Type II: 0.4% * Age of onset * Early onset group - ... yrs (3 SD): 42% * Middle onset group - ... yrs (5 SD) : 25% * Late onset group – 32 yrs (12 SD) : ...% * Familial aggregation (... times higher risk in 1st degree relatives) * ...-..% Monozygotic concordance rate * Men & women affected equally (BP-I)

* all BPADs: 2.4% * sub-threshold: **1.4**% * Type I: 0.6% * Type II: 0.4% * Age of onset * Early onset group - **17** yrs (3 SD): 42% * Middle onset group - **24** yrs (5 SD) : 25% * Late onset group – 32 yrs (12 SD) : **33**% * Familial aggregation (**10** times higher risk in 1st degree relatives) * **70-80**% Monozygotic concordance rate * Men & women affected equally (BP-I)

_Progressive nature of Bipolar disorder_ * the risk of ... increases with the number of ... and that current standard treatment regimens do not stop this ...

* **the risk of recurrence increases with the number of episodes and that current standard treatment regimens do not stop this progression**

_Staging model of Bipolar Disorder_

Link between dementia and bipolar?

Link between depressive episodes and dementia/mild cognitive impairment?

Affective Disorders Clinical Aspects Flashcards

(46 cards)