Affective Disorders

Question 1

Define mania

Answer 1

Mental illness marked by periods of great excitement or euphoria, delusions, and overactivity that lasts at least 7 days.

Question 2

Define hypomania

Answer 2

A mild form of mania, marked by elation and hyperactivity.

Question 3

Define euthymia

Answer 3

A normal, tranquil state/mood that is neither manic nor depressive, yet distinguishable from the state of healthy (commonly associated with bipolar disorder).

Question 4

define subthreshold depression

Answer 4

Clinically relevant depressive symptoms that do not meet the criteria for a major depressive disorder.

Question 5

Define major depression

Answer 5

Persistently depressed mood and long-term loss of pleasure of interest in life

Question 6

Define mixed state

Answer 6

A state wherein features unique to both depression and mania occur wither simultaneously or in very short succession.

Question 7

What is unipolar depression?

Answer 7

Unipolar depression is another name for a major depressive episode. This name indicates that the condition is different from bipolar depression.

Question 8

What can unipolar depression be divided into?

Answer 8

1. First occurence
2. Recurrent episodes

Question 9

What is bipolar depression?

Answer 9

reoccurrences of mania and depression

Question 10

What are the 3 core symptoms of depression (ICD-10)?

Answer 10

1. Low mood
2. Anhedonia
3. Reduced energy levels (anergia)

Question 11

Give some other symptoms of depression

Answer 11

• Reduced libido
• Change in appetite
• Poor sleep
• Suicidal thoughts
• Poor concentration
• Worthless/guilt
• Psychomotor retardation

Question 12

Diagnostic criteria for mild depression

Answer 12

2 core symptoms + 2 other

Question 13

Diagnostic criteria for moderate depression

Answer 13

2 core + 3 other

Question 14

Diagnostic criteria for severe depression

Answer 14

3 core + 4 other

N.B. Although ICD suggests diagnosing on symptom count, in practise you get to realise what is mild moderate and severe depression without counting symptoms, and realise that level of functioning is also key

Question 15

Give some risk factors for depression

Answer 15

• Female (2x more common)
• PMH of depression
• Significant physical illness
• Other mental health problems
• Social issues e.g. divorce, unemployment, poverty
• Childhood experience e.g. parental bereavement, sex abuse

Question 16

How long do symptoms have to be present to make depression diagnosis?

Answer 16

• Need symptoms for at least two weeks
• And NOT secondary to the effects of drug / alcohol misuse, organic illness, or bereavement

Question 17

What is diurnal mood variation in depression?

Answer 17

Diurnal mood variation, also known as morning depression, refers to depression that is most severe in the morning and typically lessens as the day progresses.

Question 18

Give some psychiatric differential diagnoses for depression

Answer 18

• Bipolar disorder
• Schizophrenia
• Dementia
• Seasonal affective disorder (SAD)
• Bereavement
• Anxiety

Question 19

What are some neurological differentials for depression?

Answer 19

Parkinson’s disease
Dementia
MS
Huntington’s disease

Question 20

What are some endocrine differentials for depression?

Answer 20

Thyroid dysfunction
Hypoadrenalism (e.g. Addison’s disease)
Hyperadrenalism (e.g. Cushing’s disease)

Question 21

What are some drugs that can cause low mood?

Answer 21

Steroids
isotretinoin (Roaccutane)
alcohol
beta-blockers
benzodiazepines
methyldopa

Question 22

What are some chronic conditions that can cause low mood?

Answer 22

diabetes
obstructive sleep apnoea
longstanding infections (e.g. mononucleosis)

Question 23

What cancer can notably cause low mood?

Answer 23

Pancreatic cancer

Question 24

What assessments would be done in depression?

Answer 24

• Full History
• MSE
• Risk assessment – to self and others
• Cognitive assessment
• PHQ-9 and other questionnaires, hospital anxiety and depression scale
• Physical exam to rule out suspected physical causes

Question 25

What investigations can be done in depression?

Answer 25

Exclude treatable causes from differentials --> FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, Calcium

Question 26

What is the stepwise management of depression?

Answer 26

Stepped care model depending on severity of presentation, comorbidity with chronic physical health problems or personal preference 1) Low intensity psychological interventions, group-based CBT 2) Pharmacological therapy or a high intensity psychosocial intervention e.g. CBT or interpersonal therapy (can be offered in conjuction with drugs)

Question 27

What is the 1st line pharmacological option in depression?

Answer 27

Selective serotonin reuptake inhibitor (SSRI) e.g. Sertraline

Question 28

Patients who have benefitted from antidepressants should be continued on them for how long after remission to reduce the risk of relapse?

Answer 28

At least 6 months

Question 29

If antidepressants alone do not work in severe depression, what can they be augmented with?

Answer 29

Lithium

Question 30

What is bipolar affective disorder?

Answer 30

A mental disorder characterised by periods (2 or more) of depression and periods of elevated mood (mania). N.B. may be long periods (years) of recoverybetween episodes

Question 31

What can a 'manic switch' sometimes be induced by?

Answer 31

- Someone with BAD taking antidepressants to treat a depressive episode - Stressful life events - Physical illness - Illicit substance misuse

Question 32

Give some features of a 'manic episode'

Answer 32

- Elevated mood - Increased energy - Reduced concentration - Reduced NEED for sleep - Inflated self esteem (grandiosity) - Reckless behaviour - overspending, promiscuity - Increased libido - Racing thoughts, pressured speech - Irritability, aggression - Psychomotor agitation - Disinhibition

Question 33

What is required for a diagnosis of a 'manic episode'?

Answer 33

- Distinct period of abnormally elevated moodwith 3 or more symptoms - Last at least 1 week - Impair occupational and social functioning

Question 34

Give some features of 'hypomania'

Answer 34

- Symptoms not to the extent that they lead to severe disruption of work or result in socialrejection - Irritability, conceit, and boorish behaviour maybe more prominent than elation - No psychotic symptoms

Question 35

Mood spectrum:

Answer 35

Depression with psychotic symptoms --> severe depression --> mild-mood depression Euthymia Hypomania --> mania --> mania with psychotic symptoms

Question 36

What is the gold standard medication for bipolar disorder?

Answer 36

Lithium

Question 37

What is the impact of depression on long term conditions?

Answer 37

- Decreased ability to self manage - Decreased ability to develop strategies - Decreased ability to recruit support - More symptoms - Symptoms perceived as worse / more threatening - Symptoms last longer - Reduced adherence to treatment - More adverse effects - Longer stays in hospital - Greater risk of readmission