Mood Disorders

Question 1

Define “anhedonia”

Answer 1

Loss of enjoyment and pleasure

Question 2

Define “anergia”

Answer 2

Lack of energy

Question 3

What is euthymia?

Answer 3

Normal mood

Question 4

What is the difference between mood and affect?

Answer 4

Mood: patient’s description of their state (subjective)
Affect: how mood changes to surroundings (objective)

Question 5

List features of appearance and behaviour in low mood

Answer 5

Low, miserable, unhappy
Reduced facial expression
Reduced eye contact
Furrowed brows
Limited gesturing and reactivity
Difficult to establish rapport

Question 6

List features of speech in low mood

Answer 6

Reduced rate
Low volume and pitch
Reduced intonation (monotonous)
Increased latency
Limited content

Question 7

List features of thought in low mood

Answer 7

Form: Normal form
Flow: Slow flow, ponderous
Content: Negative, pessimism
               Failure, guilt
               Delusions
               Hypochondriasis

Question 8

List features of paranoia in low mood

Answer 8

Self-preferential thinking (‘someone is out to get you’)
Psychosis
Depression (increased sensitivity to criticism, more self-conscious, feeling of being under scrutiny)

Question 9

Hallucinations in low mood typically make someone depressed. True/False?

Answer 9

False

Typically, the hallucinations reflect a person’s depression rather than making them depressed

Question 10

What aspect of insight is typically affected in low mood?

Answer 10

Attribution - patients blame experience on their sins, personal failings or weakness, recognition intact

Question 11

How long should a depressive episode last to be classified as depression?

Answer 11

2 weeks

With no hypo-manic or manic symptoms at any time in life

Question 12

List criteria for diagnosing depression

Answer 12

2 of core features

• depressed mood (most of the day, almost every day)
• loss of interest/pleasure
• decreased energy (or increased fatiguability)

Some additional features:

• low confidence
• self-reproach, guilt
• suicidal thoughts
• diminished concentration
• sleep disturbance
• change in appetite

Question 13

Moderate depression involves _ core features and _ additional features

Answer 13

Moderate depression involves 2 core features and 4 additional features

Question 14

Severe depression involves _ core features and _ additional features

Answer 14

Moderate depression involves all core features and 5 additional features

Question 15

DSM-10 classifies bipolar into 3 categories. Describe bipolar I

Answer 15

Meets criteria for mania at least once
Previous depressive or hypomanic episodes
MANIA + DEPRESSION

Question 16

DSM-10 classifies bipolar into 3 categories. Describe bipolar II

Answer 16

Current or past hypomanic episodes + current or past depressive episodes
Never met criteria for mania
HYPOMANIA + DEPRESSION

Question 17

DSM-10 classifies bipolar into 3 categories. Describe bipolar III

Answer 17

Hypomania following use of antidepressants

Question 18

Which form of bipolar - I, II or III - is most common?

Answer 18

Bipolar II

Question 19

Depression changes to bipolar disorder once you have a manic episode. True/False?

Answer 19

True

Question 20

How long should an episode last to be classified as hypomania?

Answer 20

Mood is elevated or irritable, abnormal to the individual for 4 consecutive days

Question 21

List features of hypomania

Answer 21

At least 3 of:
Restlessness/increased activity
Increased talkativeness
Easily distracted
Decreased need for sleep
Increased sexual energy
Recklessness, irresponsibility

Question 22

How long should an episode last to be classified as mania?

Answer 22

Mood elevated, expanive, irritable; abnormal to the individual for minimum 1 week or hospitalisation

Question 23

List distinguishing features (from hypomania) of mania (features of hypomania can also be present)

Answer 23

Racing thoughts
Loss of normal social inhibitions
Inappropriate behaviour
Inflated self-esteem
Sexual indiscretion

Question 24

Depression exhibits features of diurnal variation. Explain.

Answer 24

It is typically worse in the morning, and gets better by the end of the day

Question 25

What features are typical of a depressive person when they describe how they are sleeping?

Answer 25

``` Early morning wakening - waking at least 2 hours before the expected/ normal waking time Initial insomnia (>1/2 hr) ```

Question 26

List features of cognition in low mood

Answer 26

Slow with complaints of poor memory, deficits involving working memory, attention, planning PSEUDO-DEMENTIA

Question 27

Depression is a recurrent disease. True/ False?

Answer 27

True | 10 year recurrence rate is > 80%

Question 28

What are the five Rs of depression?

Answer 28

``` Response Remission Relapse Recovery Recurrence ```

Question 29

Define 'bipolar disorder'

Answer 29

2 or more episode in which patients mood and activity levels are significantly disturbed, disturbance can consist of hypo-mania or mania, typically interspace with depression

Question 30

Define mania without psychotic symptoms. Give examples.

Answer 30

Absence of hallucinations or delusions but perceptual disorders may occur e.g. subjective hyperacusis, appreciation of vivid colours

Question 31

Define mania with psychotic symptoms. Give examples.

Answer 31

Delusions or hallucinations present, other than those seen in typical schizophrenia e.g. grandoise, self-referential, erotic, persecutory

Question 32

Which mood disorder is commonly seen in families, and involves changing between different moods?

Answer 32

Cyclothymia

Question 33

What is psychotic depression?

Answer 33

Occasionally paranoid, mood is congruent or hypochondrial

Question 34

What age does bipolar disorder usually present?

Answer 34

Usually teens or early 20s

Question 35

List some common co-morbid conditions associated with bipolar disorder

Answer 35

``` Anxiety disorders Alcohol and drug misuse Personality disorders Eating disorders Schizoaffective disorder Schizophrenia ```

Question 36

What is 'cyclothymia'?

Answer 36

MILD BIPOLAR DISORDER | Elevated and depressed mood episodes but not extreme enough to be depression or bipolar disorder

Question 37

What is 'mixed affective state'?

Answer 37

A state wherein features unique to both depression and mania—such as despair, fatigue, morbid or suicidal ideation, racing thoughts, pressure of activity, and heightened irritability—occur either simultaneously or in very short succession