Affective Disorders

Question 1

What are mood disorders?

Answer 1

Is any disorder of mental status and function where altered mood is the core feature:

• Can be primary or can be consequence of other illness

Question 2

What classification system is used for mood disorders?

Answer 2

• International Classification of Disease (ICD-10)
  
  • WHO
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  
  • American Psychiatric Association

Question 3

What are the different meanings of the word depression?

Answer 3

• Symptom
  
  • An emotion within normal range of experience, is a form of sadness
• Syndrome
  
  • A constellation of symptoms and signs involved
• Recurrent illness

Question 4

Aetiology/risk factors - depression

Answer 4

• Not employed
• Not financially independent
• Not in stable marriage
• Lower educational attainment
• Family history
• Exit events
  
  • Separations, losses

Question 5

Epidemiology - depression

(how common, sex, age)

Answer 5

• Leading cause of disability
• Common
  
  • Lifetime prevalence 3-12/100 people
• M:F 1:2
• Age 20-40

Question 6

When does psychiatry consider depression to become abnormal?

Answer 6

• Not clear
• Psychiatry places emphasis on
  
  • 1 persistence of symptoms
  • 2 pervasiveness of symptoms
  • 3 degree of impairment
  • 4 presence of specific symptoms or signs

Question 7

What are the 4 things psychiatry puts emphasis on for depression to be considered abnormal?

Answer 7

• 1 persistence of symptoms
• 2 pervasiveness of symptoms
• 3 degree of impairment
• 4 presence of specific symptoms or signs

Question 8

What are the symptoms of depressive illness?

Answer 8

• Change in mood
  
  • Depression
  • Anxiety
  • Perplexity
  • Anhedonia
• Change in thought content
  
  • Guilt
  • Hopelessness
  • Worthlessness
  • Any neurotic symptomatology
  • Delusions and hallucinations
• Change in bodily function
  
  • Energy (fatigue)
  • Sleep
  • Appetite (weight loss)
  • Libido
  • Constipation
  • Pain
• Change in psychomotor functioning
  
  • Agitation
  • Retardation
• The social sphere
  
  • Loss of interests
  • Irritability
  • Apathy
  • Withdrawal, loss of confidence, indecisive
  • Loss of concentration, registration and memory

Question 9

What possible changes in mood can be seen in depression?

Answer 9

• Depression
• Anxiety
• Perplexity
• Anhedonia

Question 10

What possible changes in thought content can be seen in depression?

Answer 10

• Guilt
• Hopelessness
• Worthlessness
• Any neurotic symptomatology
• Delusions and hallucinations

Question 11

What changes in bodily function can be seen in depression?

Answer 11

• Energy (fatigue)
• Sleep
• Appetite (weight loss)
• Libido
• Constipation
• Pain

Question 12

What changes in psychomotor functioning can be seen in depression?

Answer 12

• Agitation
• Retardation

Question 13

What change can be seen in the social sphere in depression?

Answer 13

• Loss of interests
• Irritability
• Apathy
• Withdrawal, loss of confidence, indecisive
• Loss of concentration, registration and memory

Question 14

What is required to be diagnosed with depression in general?

Answer 14

• Last for at least 2 weeks
• No hypomanic or manic episodes in lifetime
  
  • Consider diagnose of bipolar disorder if have
• Not attributable to psychoactive substance use
• If psychotic symptoms need to exclude illnesses like schizophrenia

Question 15

What is the criteria to be diagnosed with mild depression?

Answer 15

Question 16

What are some measurement tools that can be used to help diagnose depression?

Answer 16

• SCID (Structured clinical interview for DSM disorders)
• SCAN (Schedules for clinical assessment inn neuropsychiatry)
• HDRS (Hamilton depression rating scale)
• BDI-II (Beck depression inventory II)

Question 17

Treatment - depression

Answer 17

• Antidepressants
  
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclic antidepressants (TCAs)
  • Monamine oxidase inhibitors
  • Other antidepressants
• Psychological treatments
  
  • CBT, IPT, individual dynamic psychotherapy, family therapy
• Physical treatments
  
  • ECT, psychosurgery, DBS, vagas nerve stimulation (VNS)

Question 18

What is somatic syndrome?

Answer 18

Type of depression with characteristic symptoms, unlike regular depression which varies between people

Question 19

Somatic syndrome - presentation

Answer 19

• Loss of interest
• Lack of emotional reactions
• Waking 2 hours before normal time
• Depression worse in morning
• Evidence of psychomotor agitation or retardation
• Marked loss of appetite
  
  • Weight loss, 5% of body weight in month
• Marked loss of libido

Question 20

What is post-natal depression?

Answer 20

Increased risk of psychiatric admission in 30 days following childbirth

Question 21

Epidemiology - postnatal depression

Answer 21

• 75% woman experience ‘blues’ within 2 weeks
• 10% develop major depressive disorder (MDD) within 3-6 months

Question 22

Differential diagnosis - depressive disorder

Answer 22

• Normal reaction to life event
• Seasonal affective disorder
• Dysthymia
• Cyclothymia
• Bipolar
• Stroke, tumour, dementia
• Hypothyroidism, Addison’s, hyperparathyroidism
• Infections
  
  • Influenza, infectious mononucleosis, hepatitis, HIV/AIDs
• Drugs

Question 23

What is mania?

Answer 23

Mania = describes state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness

Question 24

What is mania associated with?

Answer 24

• Loss of judgement
• Grandiose ideas
• Disinhibition
• With similar effects of stimulant drugs like cocaine

Question 25

When is behaviour considered to be mania?

Answer 25

* Not clear * Same 4 psychiatric emphasis as depressive disorders * 1 persistence of symptoms * 2 pervasiveness of symptoms * 3 degree of impairment * 4 presence of specific symptoms or signs

Question 26

Classifications of mania?

Answer 26

* Hypomania * Mania without psychotic symptoms * Mania with psychotic symptoms * Other manic episodes * Manic episode, unspecified

Question 27

What tools can be used to measure mania?

Answer 27

* SCID * SCAN * Young mania rating scale (YMRS)

Question 28

What is hypomania?

Answer 28

Lesser degree of mania with no psychosis

Question 29

Presentation - hypomania

Answer 29

* Mild elevation of mood for several days on end * Increased energy and activity * Increased sociability and talkativeness * Increased libido * Decreased need for sleep * May be irritable * Concentration reduced, new interests, mild overspending * Not to extent of severe disruption of work or social rejection

Question 30

What is required to be diagnosed with mania?

Answer 30

* Symptoms for a week that are enough to disrupt normal activates like work * Symptoms * Elevated mood, increased energy, over activity, pressure of speech, decreased need for sleep * Disinhibition * Grandiosity * Alteration of senses * Extravagant spending * Can be irritable rather than elated

Question 31

Differential diagnosis - mania

Answer 31

* Psychiatric * Mixed affective state * Schizoaffective disorder * Scizophrenia * Cyclothymia * ADHD * Drugs and alcohol * Medical * Stroke * MS * Tumour * Epilepsy * AIDS * Neurosyphilis * Endocrine * Cushing’s, hyperthyroidism * SLE

Question 32

Treatment - mania

Answer 32

* Antipsychotics * Olanzapine * Risperidone * Quetiapine * Mood stabilisers * Sodium valproate * Lamotrigene * Carbamazepine * Lithium * ECT

Question 33

Aetiology/risk factors - bipolar disorder

Answer 33

* Family history

Question 34

Epidemiology - bipolar disorder | (prevalence, sex, age)

Answer 34

* Prevalence 1/100 to have in lifetime * M=F * Age usually \<30

Question 35

What is the diagnostic criteria for bipolar disorder?

Answer 35

* 2 episodes of depression and either mania or hypomania * If no mania or hypomania then diagnosis is recurrent depression * If no depression then diagnosis is hypomania or bipolar disorder

Question 36

Compare depression and mania: - how long episode lasts - how many recovery and how long - how many have further episodes - how many die by suicide

Answer 36