Mood disorders Flashcards
Depression core symptoms
Persistent low mood
Anhedonia
Fatigue
Mild/mod/severe depression
Mild: at least 2 core features; 4 in total
Moderate: at least 2 core features; 5+ in total
Severe: all 3 core features; 7+ in total (+/- pyschosis)
Depression additional symptoms
Sleep disturbance Psychomotor retardation or agitation Change in appetite/weight Low confidence/self-esteem Feeling worthless or guilty Poor concentration Thoughts of suicide/self-harm
Hypomania
Some interference with function Elevated/irritable mood 4+ days, PLUS 3 or more of: Increased activity/physical restlessness Increased talkativeness Difficulty concentrating/distractability Decreased need for sleep Increased sexual energy Mild spending sprees/other reckless behaviour Increased sociability Overfamiliarity
Mania
Severe interference with function
Elevated/irritable mood, prominent or 7+ days, PLUS
3 or more of:
Increased activity/physical restlessness
Increased talkativeness
Flight of ideas/thoughts racing
Loss of social inhibition → inappropriate behaviour
Decreased need for sleep
Inflated self-esteem/grandiosity
Distractability/constant changes in activity/plans
Risks not recognised → foolhardy/reckless behaviour
Increased sexual energy/sexual indiscretions
With/without delusions or hallucinations
Depression epidemiology: Gender Social class Age Other factors
Female 2x male
More common in lower socio-economic class
Peak age 25-40
Urban population>rural
Bipolar epidemiology:
Gender
Social class
Age
No difference
No difference
Peak age late 20s - early 30s
Recurrent depressive disorder definition
2 episodes reaching criteria for mild, moderate or severe depression
Lasting at least two weeks
Period of several months without significant mood disturbance
Bipolar affective disorder definition
2 episodes reaching criteria for a mood disorder
At least one of which must have been mania or hypomania
Lasting at least two weeks (depressive episode) or 1 week (manic episode)
Period of several months without significant mood disturbance
Biological factors in mood disorders
Genetic - familial link
Endocrine - HPA axis (↑ cortisol); thyroid
5HT transmitters - fewer or reduced response
Psychological factors in mood disorders
Loss/adverse life events
Cognitive distortions/errors
Behavioural - chronic stress
Social factors in mood disorders
Predisposing: lack of confiding relationship; unemployment; 3 or more children (assault, redundancy)
Prognosis of depression
90% will recover, but they are likely to relapse
Length of episode: 3-6 months (with treatment); 6-13 months (without treatment)
Repeated episodes: mean is 5-6 over 20 years
Other variables: 15% die by suicide
Prognosis of bipolar disorder
90% will recover, but they are likely to relapse
Length of episode: 3 months
Repeated episodes: mean of 9 over lifetime (2-30)
Other variables: Mania often followed by depression
Mania treatment: short term
Physical: neuroleptics, consider lithium
Psychological: support for patient and family
Social: consider admission to hospital
