definition of mood disorder
disorder of mental status + function where altered mood is the core feature
they are recurrent and disabling
depression - aetiology
F > M
peak 30yo
insight common
typical episode: 4-6mnths
criteria used for diagnosis of depression
ICD 10
definition of depression from ICD 10
At least 2 wks, no hypomanic or manic episodes, not attributable to psychoactive substance or organic mental disorder (exclude schizophrenia, bipolar)
core symptoms of depression
- low mood - every day for 2 wks, worse in the morning
- anhedonia: loss of enjoyment
- low energy - fatiguability
additional symptoms of depression
- loss of concentration
- low libido
- hyper somnolence - early morning awakenings
- loss of appetite - weight loss
- guilt, worthlessness
- suicidal thoughts (self harm)
- agitation, anxiety, retardation
abnormal depression - 4 aspects
- persistent
- pervasive (majority of the time)
- impact on QOL / function
- presence of s+s of depression
DDx for depression
SAD, bipolar, Stroke, Dementia, hypothyroidism, Addison’s, normal reaction to a life event
Different management of depression
pharmacological: SSRI, TCA, MAOI
psychological tx: CBT, fam therapy, IPT
physical tx: ECT (severe, resistant depression)
definition of stigma
social construct that devalues people due to a distinguishing characteristic/mark
mania - definition
pathological inappropriate elevated mood
3 core features of mania
- disinhibition (loss of restraint)
- grandiose ideas
- loss of judgement
common features associated with mania
- thought disorder: withdrawal (CIA stealing ideas)
- pressured speech (fleeting ideas, hard to follow)
- lacks insight - family referral
- decreased sleep (can lead to neglect)
- extravagant spending
hypomania?
features of mania - but doesn’t fulfil full ICD-10 criteria - and pt still able to function
mania in isolation common?
very uncommon likely to have a come down - bipolar disorder more common
DDx for mania
mixed affective state
schizoaffective disorder
schizophrenia
ADHD
drug + alcohol
stroke, hyperthyroidism, SLE
tx for mania
antipsychotics: olanzapine
mood stabilisers:
- lithium
- sodium valproate
- lamotrigene
tools to assess mania
SCID, SCAN + Young Mania Rating Scale (YMRS)
if 2+ episodes of depression and no hypo/mania at time of diagnosis then ?
recurrent depression
if 2+ episodes of mania - but no depression then?
hypomania, or bipolar - very unlikely to be manic without depression
definition of BAD
consists of 2+ episodes of depression + mania/hypomania
gender ratio for BAD
M=F
mean onset age of BAD
21
early onset BAD 15-19 - common RF?
FHx
acute phase tx BAD
lithium or
valproate
maintenance for BAD
lithium/valproate/olanzipine 2 yrs
but relapse rate high (90%)
how long does a typical manic episode last in bipolar disorder
1-3 months (12wks)
BAD % die by suicide?
10%
RFs for suicide
divorce male substance misuse previous attempt FHX age >45yo physical or psychiatric illness