Mood Disorders

Question 1

What are the “mood disorders”?

Answer 1

Depression
Bipolar disorder
Persistent Mood disorder

Question 2

What patterns can depression come in?

Answer 2

Single episode or recurrent episodes

Question 3

What 3 types of symptoms can pts with depression get?

Answer 3

• Core
• Biological/Somatic
• Cognitive

Question 4

What are the core symptoms of depression?

Answer 4

• Low mood for 2 weeks +
• Lack of energy
• Anhedonia

Question 5

What are the biological/somatic symptoms of depression?

Answer 5

• Sleep changes
• Appetite/weight changes
• Diurnal variation in mood
• Psychomotor retardation
• Loss of libido

Question 6

What are the cognitive symptoms of depression?

Answer 6

• Low self esteem
• Guilt/self blame
• Hopelessness
• Hypochondrial thoughts
• Poor concentration/attention
• Suicidal thoughts

Question 7

What are the 4 types of depression wrt severity?

Answer 7

Mild, moderate, severe, and severe with psychotic symptoms

Question 8

How is mild depression diagnosed?

Answer 8

2 core symptoms + 2 other. Pt able to function.

Question 9

How is moderate depression diagnosed?

Answer 9

2 core symptoms + 3/4 other. Pts ability to function is affected.

Question 10

How is severe depressions diagnosed?

Answer 10

3 core symptoms + at least 4 other. Pts ability to function is affected.

Question 11

What is the lifetime prevalence of depression?

Answer 11

10-20%

Question 12

What is the ration of M:F in depression?

Answer 12

1:2 M:F

Question 13

How much more common is depression in people with long term conditions?

Answer 13

2-3x more common

Question 14

What kind of hallucination is most common in psychosis with severe depression?

Answer 14

Auditory

Question 15

What is post-natal depression?

Answer 15

Depression experienced by mothers usually 1-2 months post-partum (majority of cases are within a year of childbirth)

Question 16

What % of mothers are affected by post-natal depression?

Answer 16

10-15%

Question 17

Can post-natal depression affect partners/fathers?

Answer 17

Yes, although it is less common

Question 18

In addition to symptoms of depression, what other symptoms does post-natal depression have?

Answer 18

• Difficulty bonding with baby
• Frightening thoughts e.g. about hurting the baby
• Feeling that they’re unable to look after the baby

Question 19

What therapies are there for post-natal depression?

Answer 19

• Self-help, often with family and freinds as support
• CBT
• Antidepressants

Question 20

What is bipolar disorder according to ICD10?

Answer 20

Two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting sometimes of hypomania or mania, and sometimes of depression.

Question 21

What is hypomania?

Answer 21

State where mood is mildly elevated, pt is expansive, or the pt is irritable in mood. Increased activity, self esteem, sociability, sex drive, familiarity. Decreased need for sleep.

Question 22

What is mania?

Answer 22

State where mood is leated, expansive, or irritable, increased energy/activity, agitation, pressure of speech, evidence of formal thought disorder, easily distracted, disinhibited, impaired judgement, and may experience psychotic symptoms.

Question 23

What is persistent mood disorder?

Answer 23

Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes.

Question 24

What is cyclothymia?

Answer 24

A persistent mood disorder chracterised by mild periods of elation/depression (none of which severe enough for bipolar)

Question 25

Who frequently gets cyclothymia?

Answer 25

Relatives of those with bipolar affective disorder

Question 26

What is dysthymia?

Answer 26

A persistent mood disorder characterised by chronic depression of mood lastng severeal years or more (which is not sufficiently severe/prolonged to class as depression)

Question 27

What is mixed affective state?

Answer 27

A mixture or rapid alternation of hypomania, mania, and depression

Question 28

What are the different types of bipolar?

Answer 28

Bipolar 1 and Bipolar 2

Question 29

What is bipolar 1?

Answer 29

1 or more manic episode or mixed +/- 1 depressive episode

Question 30

What is bipolar 2?

Answer 30

At least 1 severe depressive and 1 hypomanic episode

Question 31

Name some differential diagnoses for mood disorders?

Answer 31

``` Normal mood flux Bereavement PTSD Dementia Other organic brain disorders ```

Question 32

Name some biological causes of mood disorders

Answer 32

Genetic Physical illness Mental Illness

Question 33

Name some psychological causes of mood disorders

Answer 33

Childhood experiences View of self View of the world Personality traits

Question 34

Name some social causes of mood disorders

Answer 34

``` Work/(un)employment Housing Finance Relationships Support ```

Question 35

What biological treatments are there for mood disorders?

Answer 35

Pharmacological treatments ECT TMS tDCS

Question 36

What is ECT licensed for in the UK?

Answer 36

Moderate/Severe depression (treatment resistant or life threatening)

Question 37

What is TMS and what is it licensed for in the UK?

Answer 37

Transcranial Magnetic Stimulation Approved by NICE but limited availability in UK for treatment of severe depression

Question 38

What is tDCS? What is it licensed for?

Answer 38

Transcranial direct current stimulation Severe depression

Question 39

What psychological treatments are there available for mood disorders?

Answer 39

Education about condition CBT IPT Mindfulness

Question 40

What is IPT?

Answer 40

Interpersonal therapy - psychotherapy that focuses on the pt and their relationships with others

Question 41

What social treatments are there for mood disorders?

Answer 41

Targeted social interventions | Behavioural activation

Question 42

What are the 5 stages of grief according to the 5 stages model?

Answer 42

Denial, Anger, Bargaining, Depression, and Acceptance

Question 43

Is a grief reaction a medical issue?

Answer 43

No, it is normal, but it may cause people to experience worrying symptoms.

Question 44

How can denial manifest in a grief reaction?

Answer 44

Feeling numb; pseudohallucinations of deceased; preparing a meal for the deceased; focus on physical objects that remind them of the deceased

Question 45

Who usually bares the brunt of the anger expressed in the second stage of grief?

Answer 45

It is usually directed at family and medical professionals

Question 46

Which demographic group of people are more likely to experience abnormal or atypical grief reactions?

Answer 46

Women

Question 47

What risk factors are there for having an atypical or abnormal grief reaction?

Answer 47

Poor social support; griever being female; deceased being young or death unexpected; relationship problems prior to death.

Question 48

What is the main feature of an atypical grief reaction?

Answer 48

Different timeline - either prolonged or delayed

Question 49

When would you suspect a delayed grief reaction?

Answer 49

After 2+ weeks pass before grieving begins

Question 50

When would you suspect a prolonged grief reaction?

Answer 50

Difficult to define - normal grieving can take 12+ months.

Question 51

A patient presents with TATT. They have no physical signs or any biochemical abnormalities. What other symproms should we screen for here?

Answer 51

* **Low mood*** * **Loss of interest in hobbies etc*** - Feelings of worthlessness/guilt - Recurrent thoughts of death/suicide - Diminished ability to concentrate - Agitation/irritability - Insomnia/hypersomnia - Weight loss/appetite changes

Question 52

What is the most important cause of a missed diagnosis of depression? Why?

Answer 52

Somatisation. Over-investigation and creating health anxiety, as well as missing an important diagnosis and untimely treatment,