W01 - PSYCH: Affective Disorders; Pshychological Therapies

Question 1

Be able to describe the range of symptoms experiences in affective disorders.

Answer 1

mood disorder = altered mood core feature: depression or mania; 1º or 2º to other illness

+anxiety association

Question 2

To explain how depressive disorders are classified in the International Classification of Diseases-10.

Answer 2

Depressive Episodes in ICD-10
* mild/moderate ep. +/-somatic symptoms
- abn mood for most of day, almost everyday, circumstantial
- loss of interest
- energy and fatigue

• severe +/-psychotic symptoms
• all of qualifying symptoms
• recurrent nature with above classifying features
• for at least 2w
• no hypomanic or manic ep
• not attributable to substance use or organic mental disorder
• psychotic symptom or stupor = severe

Question 3

To identify evidence-based treatments for depressive disorders.

Answer 3

a

Question 4

Depression Symptoms

Answer 4

Symptoms
* PSYCHOLOGICAL:
- mood: diurnal nature, anxiety, perplexity, anhedonia
- thought content: incl. neurotic sympt., delusions, ideas of reference

• PHYSICAL
• energy, appetite, libido, constipation, pain
• agitaation, retardation
• SOCIAL
• loss of interest, irritability, apathy, withdrawal, indecisive

Question 5

Somatic Syndrome of Depression

Answer 5

• relationship with external environment, experiences, and factors
• waking earlier, worse symptoms in morning
• loss of appetite, wt. loss, libido

Question 6

Differential Dx for Depression

Answer 6

• normal reaction to life event
• sAD
• Dysthymia, cyclothymia
• bipolar
• stroke, tumour, dementia
• addisons, other endocrine
• infection

Question 7

Tx for Depression

Answer 7

> SSRI: selective serotonin reuptake inhibitors

> TCA: tricyclic antidepressants

> monoamine oxidase inhibitors

> Mirtzapine: good for older ppl

> Antipsychotics

> Mood stabilisers

> CBT, IBT, individual dynamic psychotherapy, family therapy
+ antidepressants = best outcome

> ECT, psychosurgery, DBS, VNS

Question 8

Measurement of Depression

Answer 8

SCID (struc. clin. interv. for DSM disorders)

SCAN

HDRS

BDI-II

HADS

PHQ-9

Question 9

Affective Disorders - Substance Induced

Answer 9

Substance/medication-induced mental disorders refer to depressive, anxiety, psychotic, or manic symptoms that occur as a physiological consequence of the use of substances of abuse or medications. It may occur during active use, intoxication or withdrawal.

Question 10

Affective Disorders - Secondary

Answer 10

Precipitation of affective disorder secondary to existing disorder:

Physical disorders include:

malignancy
hypothyroidism
hyperparathyroidism
Cushing’s syndrome
Addison’s disease
multiple sclerosis
parkinsonism
post-infection
Psychiatric disorders include:

schizophrenia
alcoholism
dementia
personality disorder
Drug-induced depression

Question 11

Post-natal depression

Answer 11

1/3 begin in pregnancy and persist VS several months postpartum

*independent of baby blue hormonal changes

+psychosis / manic syptoms

Question 12

Mania

Answer 12

• part of disorder

Extreme mood state, energy, pressured speech, increased self-esteem

• delusions of grandeur
  *hypomania: less severe with minimal functional impairtment, nil hospitalisation nil psychosis
• mixed affective disorder: mania and depressive symptoms most of the day
• rapidly alternate

Question 13

Bipolar I Vs Bipolar II

Answer 13

I => one manic or mixed episode +/- psychosis
* recurrent

II => nil manic episode, 1 or more hypomanic, at least one depressive episode, nil hx.

Question 14

Cyclothymia

Answer 14

Persistent instability of mood over a period of at least 2 years

numerous hypomania
depressive but never severe or prolonged for diagnostic depression

> psychotherapy
mood stabilisers: lithium, carbamezapine
antidepressants

Question 15

DDx of bipolar

Answer 15

• ADHD
• schizoaffective disorders

Question 16

Tx of Mania

Answer 16

> Benzodiazepines

> antipsychotics: olanzapine, risperidone, quetiapine

> mood stabilisers: sodium valporate, lithium

> ECT

Question 17

Clinical outcomes of depression and mania

Answer 17

4-6mos for depression episode

1-3 mos for manic episodes
- tx required dt 90% have further episodes, and poorer outcomes

Question 18

CBT

Answer 18

a talking therapy that can help you manage your problems by changing the way you think and behave. It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

Step One – Make A List.
Step Two – Record Unproductive Thoughts.
Step Three – Create Replacement Thoughts.
Step Four – Read Your List Often.
Step Five – Notice And Replace.

Question 19

Behavioural Activation

Answer 19

Behavioral activation helps us understand how behaviors influence emotions, just like cognitive work helps us understand the connection between thoughts and emotions. Here are some examples of how BA may be used: Jim deals with depression and anxiety.

approach to mental health that focuses on using behaviors to “activate” pleasant emotions. The idea is that by putting action first, a person does not need to wait to feel motivated, but they can still gain the benefits that the action has on their well-being.

*concept of depression and inactivity circling back to each other

Question 20

Interpersonal Tx

Answer 20

IPT is a talking treatment that helps people with depression identify and address problems in their relationships with family, partners and friends. The idea is that poor relationships with people in your life can leave you feeling depressed.

• family therapy
• group therapy

Question 21

Motivational Interviewing

Answer 21

patient-centred counselling style that aims to help patients explore and resolve their ambivalence about behaviour change. It combines elements of style (warmth and empathy) with technique (e.g. focused reflective listening and the development of discrepancy).

A core tenet of the technique is that the patient’s motivation to change is enhanced if there is a gentle process of negotiation in which the patient, not the practitioner, articulates the benefits and costs involved. A strong principle of this approach is that conflict is unhelpful and that a collaborative relationship between therapist and patient, in which they tackle the problem together, is essential.