Depression / Mood Disorders Flashcards
(40 cards)
What diagnostic criteria is used to diagnose mood disorders?
DSM-V or ICD-10
When was the biggest change in the DSM?
DSM-III (1980)
DSM before had been the same for around 100 years, with Manic Depressive Illness (MDI) defined as any recurrent mood episodes of any kind (whether you had bipolar or unipolar) - called the Kraepelinian definition
What defines an illness as a mood disorder as supposed to an affective disorder?
Where the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation
Usually accompanied by a change in the overall level of activity
Tend to be recurrent and the onset of
individual episodes can often be related to stressful events or situations
What is MDD?
What is the prevalence of MDD?
What is the prevalence of Bipolar disorder?
Major Depressive Disorder
10-20% lifetime rate
1% lifetime rate for Bipolar-I, 1% lifetime rate for Bipolar-II
What is the difference between sex in depression?
What is the difference between sex in bipolar disorder?
Twice as many woman suffer depression
Bipolar-I = women and men diagnosed around the same Bipolar-II = more women than men
What is the impact of mental and substance abuse disorders on DALYs?
Accounts for 7% of disability adjusted life years
What is the typical cycle of low mood?
Thoughts - What is the point?
Feelings - Low, irritable
Physiological symptoms - Exhaustion, low energy
Behaviours - Lie in bed all day, ruminate
What is the DSM-5 criteria for depressive episode?
Occurrence of 2 weeks or more of depressed mood
AND the presence of 4 of 8 out of the following:
• Sleep alterations (insomnia or hypersomnia)
• Appetite alterations (increased or decreased)
• Diminished interest or anhedonia
• Decreased concentration
• Low energy
• Guilt
• Psychomotor changes (agitation or retardation)
• Suicidal thoughts
When is MDD diagnosed?
If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD)
What are the DSM subtypes for MDD?
Atypical features (which represent mainly increased sleep and appetite, along with heightened mood reactivity)
Melancholic features (defined by no mood reactivity, along with marked psychomotor retardation and anhedonia)
Psychotic features (the presence of delusions/hallucinations)
What are the core symptoms of depression?
What are the psychological symptoms of depression?
What are the biological symptoms of depression?
Low mood
Low energy
Anhedonia
The world
Oneself
The future
Sleep
Libido
Appetite
What is the typical cycle of high mood?
Thoughts - I’m the best
Feelings - elation, excitement
Physiological symptoms - increased energy, race sensation
Behaviours - impulsive, increased activity
What are the DSM diagnosis criteria for Mania/Bipolar?
Euphoric or irritable mood with 3 or more of 7 manic criteria:
- Decreased need for sleep with increased energy
- Distractibility
- Grandiosity or inflated self-esteem
- Flight of ideas or racing thoughts
- Increased talkativeness or pressured speech
- Increased goal-directed activities or psychomotor agitation
- Impulsive behaviour (such as sexual impulsivity or spending sprees)
What is the diagnosis criteria for Bipolar-I?
What is the diagnostic criteria for a hypomanic episode?
What is the diagnostic criteria for Bipolar-II?
What is the diagnostic criteria for Unspecified Bipolar Disorder?
Minimum 1 week with notable functional
impairment leading to a DSM-5 diagnosis of type I bipolar disorder
Minimum 4 days, but without notable functional impairment, a hypomanic episode is diagnosed
Only hypomanic episodes present alone with at lead one MD episode = DSM-5 diagnosis of Bipolar-II
Less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, then “Unspecified Bipolar Disorder”
What can manic episodes be characterised by?
What can hypomania not be diagnosed?
Psychotic features e.g. delusions/hallucinations
If psychotic features are present and/or if patient is hospitalised
Is bipolar disorder still diagnosed even if it is caused by anti-depressants?
Yes in the DSM-V, was not considered in the DSM-IV
What is illness course for Bipolar-I?
Big mood swings, reaches the thresholds for proper manic and depressive episodes (amplitude of wave is huge in both directions)
What is the Bipolar II?
Less elation for mania
Greater depressive episodes - reaches the same amplitude as Bipolar-I for depression
What is Cyclothymia?
‘mood swings’
Not huge either way
What percentage of patients relapse within a year of recovery from a mood disorder?
50-60%
Patients largely autonomous between episodes
What are the stats for the first episode in bipolar I?
85% have a depressive as first episode
10% a manic episode
3-5% mixed episode
What must not be ignored in people with bipolar disorder?
Anxiety
30-70% of bipolar patients have anxiety
Presence of anxiety leads to worse prognosis and outcomes
What are the similarities between bipolar and unipolar illness?
MDD is also diagnosed young
MDD is also recurrent
Genetics had found frequency occurrence of bipolar illness in relatives of those with unipolar depression
Treatments overlap
Lithium effective in both unipolar and bipolar types
What are the differences between bipolar and unipolar illness?
Bipolar is has higher heritability
Insight is preserved in depression but impaired in mania
Bipolar illness has an earlier age of onset
More frequent episodes in bipolar than unipolar
Shorter depressive episodes in bipolar than unipolar
