Affective (Mood) Disorders

Question 1

When does depression become abnormal?

Answer 1

• persistence of symptoms
• pervasiveness of symptoms
• degree of impairment
• presence of specific symptoms and signs

Question 2

What is anhedonia?

Answer 2

when you no longer take pleasure in things you would otherwise enjoy

Question 3

What is stupor?

Answer 3

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

Question 4

How long must symptoms last to be classed as ‘depression’?

Answer 4

for at least 2 weeks

Question 5

What things must you rule out in your history to make diagnosis of depression?

Answer 5

• no hypomanic or manic episodes in lifetime

- not linked to psychoactive substances or organic mental disorder

Question 6

Presence of what, will automatically make the level of depression severe?

Answer 6

• psychotic symptoms (delusions or hallucinations) or stupor

- diagnosis would be severe depression with psychotic symptoms

Question 7

What are examples of somatic symptoms of depression?

Answer 7

• anhedonia
• apathy (lack of emotional reactions to events or activities that normally produce an emotional response)
• insomnia (waking 2 hrs before normal time)
• depression worse in morning
• objective evidence of psychomotor agitation or retardation
• marked loss of appetite
• weight loss (5% + of body weight in a month)
• marked loss of libido

Question 8

What are the 3 general criteria for diagnosis of depression?

Answer 8

• depressed mood that is abnormal most of the day almost every day for the past 2 weeks, largely uninfluenced by circumstances
• loss of interest or pleasure
• decreased energy or fatiguability

Question 9

What are the 7 additional features of depression considered in the diagnosis?

Answer 9

• 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 apetite

Question 10

How do you diagnose depression using ICD-10?

Answer 10

require 2 of the general criteria of depression and at least 2 of the additional criteria to diagnose mild depression

Question 11

According to ICD-10, what would diagnose moderate depression?

Answer 11

2 general criteria + 4 additional criteria

Question 12

According to ICD-10, what would give a diagnosis of severe depression?

Answer 12

all of the general criteria and at least 5 of the additional criteria

Question 13

What proportion of women will experience ‘blues’ postnatally?

Answer 13

75% within 2 weeks

Question 14

What proportion of women postnatally go on to develop manic depressive disorder?

Answer 14

10% in 3-6 months

Question 15

What would be included in a differential diagnosis for depression?

Answer 15

• normal reaction to life event
• SAD
• dysthymia
• cyclothymia
• bipolar
• stroke, tumour, dementia
• hypothyroidism, Addison’s, hyperparathyroidism
• infections - flu, glandular fever, hepatitis, HIV/AIDS
• drugs

Question 16

What are the medical treatments for depression?

Answer 16

• SSRIs
• Tricyclic antidepressants
• monoamine oxidase inhibitors
• ECT
• psychosurgery
• deep brain stimulation
• vagal nerve stimulation

Question 17

What are the possible psychological treatments for depression?

Answer 17

• CBT
• IPT
• family therapy
• individual therapy

Question 18

What are examples of measurement tools of depression?

Answer 18

• SCID
• SCAN
• PHQ-9

Question 19

What is mania?

Answer 19

• a state of feeling, or mood, that can range from near-normal experience to severe, life threatening illness
• often associated with grandiose ideas, disinhibition, loss of judgement (with similarities to the mental effects of stimulant drugs)
• pathological, inappropriate, elevated mood

Question 20

What is hypomania?

Answer 20

• lesser degree of mania - not to the extent of severe disturbance of work or social rejection
• no psychosis

Question 21

What are characteristics of hypomania?

Answer 21

• mild elevation of mood for several days on end
• increased energy and activity, marked feeling of wellbeing
• increased sociability, talkativeness, overfamiliarity, increased sexual energy, deceased need for sleep
• may be irritable
• concentration reduced, new interests, mild overspending

Question 22

What characterises mania?

Answer 22

• 1 week mania, severe enough to disrupt work and social activities more or less completely
• elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
• disinhibiton
• grandiosity
• alteration of senses
• extravagant spending
• can be irritable rather than elated

Question 23

What would be considered in the differential diagnosis of mania?

Answer 23

• -mixed affective state
• schizoaffective disorder
• schizophrenia
• cyclothymia
• ADHD
• drugs and alcohol
• stroke, MS, tumour, epilepsy, AIDS, neurosyphilis
• Cushing’s, hyperthyroidism, SLE

Question 24

What are tools to measure symptoms in mania?

Answer 24

• SCID
• SCAN
• Young Mania Rating Scale

Question 25

What are possible treatments for mania?

Answer 25

• antipsychotics e.g. olanzapine, risperidone, quetiapine
• mood stabilisers e.g. sodium valproate, lamotrigene, carbamazepine
• lithium
• ECT

Question 26

When would bipolar affective disorder be diagnosed?

Answer 26

• repeated (2+) episodes of depression and mania or hypomania
• if no depression the diagnosis is hypomania or bipolar disorder

Question 27

When is bipolar disorder normally diagnosed?

Answer 27

between ages 15-19, usually with a positive family history

Question 28

In which sex is depression more common?

Answer 28

females 2:1

Question 29

What is the clinical course and outcome generally in major depression?

Answer 29

• typical episode lasts 4-6 months
• over half recovered at 26 weeks
• 80% have further episodes

Question 30

What is the clinical course and general outcome in bipolar disorder/ mania?

Answer 30

• typical manic episode lasts 1-3 months
• 60% recovered at 10 weeks
• 90% have further episodes