Flashcards in Mood Disorders Deck (72):
What is mood?
A sustained emotional state.
What is the difference between subjective and objective mood?
Subjective - patient's own view.
Objective - as described by assessor.
What is affect?
Transient flow of emotion in response to stimuli.
When do fluctuations in mood become a mood disorder?
When they interfere with ADLs.
What is a mood/affective disorder?
Condition with distorted, excessive, or inappropriate moods or emotions for sustained periods of time.
What is a primary mood disorder?
Does not result from another medical or psychiatric condition.
Give an example of a unipolar primary mood disorder.
Depressive disorder - mild, moderate, severe, psychotic, dysthymia.
Given an example of a bipolar primary mood disorder.
What is a secondary mood disorder?
From another medical or psychiatric condition.
What are the physical disorders that can lead to secondary mood disorders?
Anaemia, hypothyroidism, malignancy, Cushing's syndrome, Addison's disease, MS, parkinsonism.
What are the psychiatric disorders that can lead to secondary mood disorders?
Schizophenia, alcoholism, dementia, personality disorder.
Which drugs can induce secondary mood disorders?
Interferon-alpha, corticosteroids, digoxin, antiepileptic drugs, B-blockers, antidepressants.
What is depressive disorder?
Affective mood disorder characterised by persistent low mood, loss of pleasure, and/or lack of energy accompanied by emotional, cognitive, biological symptoms.
What is the monoamine hypothesis for depressive disorders?
Deficiency of monoamines (noradrenaline, serotonin, dopamine) causes depression.
What are the predisposing factors for depressive disorders? (Biopsychosocial model).
Bio - female, postnatal, FHx, neurochemical (low monoamines), endocrine (increased HPA), co-morbidities, past Hx.
Psycho - personality type, lack of coping mechanisms, mental health co-morbidities.
Social - stressful life events, lack of support.
What are the precipitating factors of depressive disorders? (Biopsychosocial model).
Bio - poor compliance with medication, corticosteroids.
Psycho - stressful life event.
Social - unemployment, poverty, divorce.
What are the perpetuating factors of depressive disorders? (Biopsychosocial model).
Bio - chronic health problem.
Psycho - poor insight, negative thoughts about self, the world, and the future.
Social - alcohol and substance misuse, poor social support, low social status.
What are the core symptoms of depressive disorders?
Anhedonia, low mood, and anergia.
What is meant by anhedonia?
Lack of interest in things which were previously enjoyable.
What is meant by anergia?
Lack of energy.
What are the cognitive symptoms of depressive disorders?
Lack of concentration, negative thought about self/world/future, excessive guilt and feeling worthless, suicidal ideation.
What are the biological symptoms of depressive disorders?
Diurnal variation in mood (lower in morning), early morning wakening, loss of libido, psychomotor retardation, weight loss and loss of appetite.
What is meant by early morning wakening?
2 hours earlier than usual.
What can be the atypical biological symptoms of depressive disorder?
Excessive sleep, increased appetite, increased weight.
What is psychomotor retardation in depressive disorders?
Slow speech and movement.
What are the psychotic symptoms of depressive disorders?
Hallucinations (second person auditory hallucinations), delusions (hypochondrial, guilt, nihilistic, persecutory).
Talk through a day with a depressive disorder, covering the core, cognitive and biological symptoms.
Wake up earlier than usual and with low mood, and no energy. No appetite for breakfast so lose weight. Can't concentrate at work, low motivation for this, tasks take a long time to do. Thinks about suicide during the day. Nothing interests them in the evening, feels guilty about this. Not in the mood for sex. Goes to bed feeling worthless and hopeless.
What is the ICD-10 classification for mild/moderate/severe/severe with psychosis depression?
Mild = 2 core symptoms + 2 other symptoms.
Moderate = 2 core symptoms + 3/4 other symptoms.
Severe depression = 3 core symptoms + >4 other symptoms.
Severe depression with psychosis = 3 core symptoms + >4 other symptoms + psychosis.
What will the features of depressive disorder be on MSE?
Appearance - self-neglect, thin, unkempt, tearful.
Behaviour - poor eye contact, hard to build rapport, psychomotor retardation or agitation.
Speech - slow, non-spontaneous, reduced volume and tone.
Mood - low subjectively and objectively depressed.
Thoughts - pessimistic, guilty, worthless, helpless, suicidal, delusions.
Perception - 2nd person auditory, derogatory.
Cognition - impaired.
Insight - usually good.
Risk - risk to self, others, suicide.
Which investigations are used in depressive disorder diagnosis?
Exclude organic causes: FBC (anaemia), TFTs (hypothyroidism), U+Es, LFTs, Ca, glucose.
Imaging - MRI or CT if atypical or suspicious of intracranial lesions.
Questionnaires: PHQ-9, HADS, Beck's depression inventory.
What are the mood disorder differentials for depressive disorder?
Bipolar affective disorder, recurrent depressive disorder, seasonal affective disorder, masked depression, atypical depression, dysthymia, cyclothermia, baby blues, postnatal depression.
What is recurrent depressive disorder?
Another depressive episode after the first.
What is seasonal affective disorder?
Depressive episodes recurring annually at the same time each year.
What is masked depression?
Depressed mood isn't prominent but there are the other features.
What is atypical depression?
Reversal of symptoms and mild-moderate depression.
What is dysthymia?
Depressive state for at least 2 years which doesn't meet the ICD-10 criteria and not due to partially-treated depressive illness.
What is cyclothermia?
Chronic mood fluctuation over 2 years with elated and depressive episodes that don't meet criteria for hypomanic or depressive disorder.
What are baby blues?
3-7 days post birth anxiety, tearfulness, irritability.
How many women are affected by baby blues?
60-70% post natal women.
What is the management of baby blues?
Reassurance and support.
What is postnatal depression?
Within a month of giving birth, peaks at 3 months, with depressive clinical features.
How many women are affected by postnatal depression?
What is a medical differential for depressive disorder?
What are the psychiatric differentials for depressive disorder?
Psychotic disorders, anxiety disorders, adjustment disorder, personality disorder, eating disorders, dementia.
What are the management steps of mild-moderate depression?
Watchful waiting for 2 weeks, reassess. Antidepressants if long-term mild-depression or history of more severe depression, interventions have failed, or complicates physical health. Self-help programmes. Computerised CBT. Physical activity programme. Psychotherapies.
What are the management steps of severe depression?
Suicide risk assessment, psychiatry referral if high. Antidepressants - 1st line SSRIs, then TCAs/SNRIs/MAOIs (MAOIs only from specialists) - use for 6 months after resolution of symptoms for first episode and 2 years after second episode resolves. Psychotherapy. Social support. ECT for acute treatment.
What is BPAD?
Chronic episodic mood disorder with at least one episode of mania/hypomania and a further episode of mania or depression.
What is the monoamine hypothesis of BPAD?
Elevated mood due to increased central monoamines (NA and serotonin).
What are the biological factors associated with BPAD?
Genetics, neurochemical increase in dopamine and serotonin, endocrine increased cortisol/aldosterone/thyroid hormone.
What are the environmental factors associated with BPAD?
Adverse life events, exams, post-partum period, loss of a loved one.
What is the mean onset age for BPAD?
What are the risk factors of BPAD?
Early 20s, anxiety, depression, strong family history, substance misuse, stressful life events.
What are the levels of severity of mania?
Hypomania, mania without psychosis, mania with psychosis.
What are the symptoms of mania?
Irritability, distractibility, disinhibited, impaired insight, increased libido, grandiose delusion, flight of ideas, activity increased, appetite increased, sleep decreased, pressure of speech, elevated mood, increased energy, reduced concentration, reckless behaviour and spending.
What are the symptoms of hypomania?
Mildly elevated mood or irritable >4 days, manic symptoms to a lesser extent, interferes with work and social life but not severe disruption, partial insight.
What are the symptoms of mania without psychosis?
Hypomania to greater extent, symptoms >1 weeks, complete disruption of work and social activities, grandiose ideas and excessive spending, sexual disinhibition, reduced sleep, exhaustion.
What are the symptoms of mania with psychosis?
Severely elevated or suspicious mood with psychotic features - grandiose or persecutory delusions, auditory hallucinations that are mood congruent.
What is the ICD-10 criteria for diagnosis of mania?
3/9 of: grandiosity/inflated self-esteem, decreased sleep, pressure of speech, flight of ideas, distractibility, psychomotor agitation, reckless behaviour, loss of social inhibitions, marked sexual energy.
What is the ICD-10 criteria for diagnosing BPAD?
2 episodes where mood and activity levels are significantly disturbed.
What are the 5 states of BPAD?
Currently hypomanic, currently manic, currently depressed, mixed disorder, in remission.
What would be the features of an MSE for BPAD?
Appearance - flamboyant, heavy makeup and jewellery, neglect if severe.
Behaviour - overfamiliar, disinhibited, increased psychomotor activity, distractible, restless.
Speech - loud, increased rate and quantity, pressure of speech, uninterruptible, puns and rhymes, neologisms.
Mood - elated, euphoric, and/or irritable.
Thought - optimistic, pressured thought, flight of ideas, loosening of association, circumstantiality, tangentiality, overvalued ideas, grandiose/persecutory delusions.
Perception - no hallucinations, mood-congruent auditory hallucinations may occur.
Cognition - impaired, fully orientated.
Insight - very poor.
What are the investigations for BPAD?
Self-rating scales - mood disorder questionnaire.
Bloods - FBC, TFTs, U+Es, LFTs, urine drug tests, CT head.
What are the mood disorder differentials for BPAD?
Hypomania, mania, mixed episode, cyclothermia.
What are the psychotic disorder differentials for BPAD?
Schizophrenia, schizoaffective disorder.
What are the medical condition differentials for BPAD?
Hyper/hypothyroidism, Cushing's disease, cerebral tumour, stroke.
What are the drug related differentials for BPAD?
Illicit drugs, acute drug withdrawal, side effect of corticosteroid.
What are the personality disorder differentials for BPAD?
Histrionic, emotionally unstable.
What are the social factors that need managing for BPAD?
Risk assessment, driving and DVLA referral, MHA used if violent or endangered.
What are the pharmacological management options for acute manic episodes/mixed episodes?
Acute manic/mixed: antipsychotic, mood stabilisers, benzodiazepines to aid sleep, rapid tranquilisation.
What are the pharmacological management options for bipolar depressive episodes?
Antitypical antipsychotics, mood stabilisers.
What is the long-term management of BPAD?
Lithium for 4 weeks after resolution, valproate if lithium is ineffective, olanzapine and quetiapine if not.