Affective Disorders - Depression And Bipolar

Front 1

What are mood disorders?

Back 1

Mood disorders are when a patient has the wrong mood for the situation.

i.e they have continuously low mood every day when there is no real reason to.

*often associated with anxiety*

Front 2

What is the most common group of mental disorders?

Back 2

Mood disorders are the most common group of mental disorders.

Front 3

What 4 things indicate that depressive symptoms have become depression?

Back 3

Persistance of symptoms - 2 weeks

Pervasiveness of Symptoms - symptoms continuos throughout the day

Degree of impairment - makes it difficult for a person to function

Presence of specific symptoms or signs

Front 4

Change in mood is one of the main symptoms of depression. What changes to mood commonly occur in depression?

Back 4

Anxiety

Perplexity - patient bewildered/overwhellmed

Anhedonia - when patient no longer feels pleasure in things they used to

Front 5

In depression what changes in thought process can commonly occur?

Back 5

Guilt

Hopelessness

Worthlessness

Neurotic symtomology - agoraphobia, obsessions, compulsions

Delusions

Hallucinations - commonly sense of smell or auditory

Front 6

What are the physical changes that can occur in the body in a patient who suffers from depression?

Back 6

Fatigue

Sleep cycle disturbed - early morning wakening most common

Appetite change - normally loss

Labido

Constipation

Pain

Psychomotor change - agitation/retardation

Front 7

What affect can depression have on a patients social sphere?

Back 7

Loss of interests

Irritibilty

Apathy

Withdrawal

Loss of confidence/Indecisiveness

Loss of concentration/registration/memory

*often all of these things have knock on effect on relationships, work and study*

Front 8

One of the more extreme symptoms of Depression is stupor, what is Stupor?

Back 8

Stupor is a state of extreme retardation where consciousness is still intact.

Front 9

Somatic Syndrome is a form of depression, what are the psychological, physical and social changes that occur in a patient with Somatic syndrome according to the ICD-10 guidelines?

Back 9

Marked loss of interest or pleasure in activities that are normally pleasurable

Lack of emotional reaction to events or activities that normally produce an emotional response

Waking 2 hours before the normal time

Depression worse in the morning

Marked loss of appetite

Weight loss

Marked loss of Labido

Front 10

For a patient to be diagnosed with mild, moderate or severe depression they need to fulfil at least two symptoms from the 3 main categories, what are these 3 main symptoms of depression?

Back 10

Three main symptoms of depression (patient needs to have 2 for diagnosis):

Depressed mood that is abnormal most of the day, at least everyday for the past two weeks - largely uninfluenced by circumstances

Loss of interest or pleasure

Decreased energy or fatiguability

Front 11

Beyond the 3 main symptoms of depression, what are the 8 additional symptoms which distinguish wether the patient has mild, moderate or severe depression?

Back 11

Loss of confidence or self esteem

Unreasonable feelings of guilt

Recurrent thoughts of death by suicide

Decreased concentration

Agitation or retardation

Sleep disturbances of any sort

Change in appetite

*mild = any 4, moderate = any 6, severe = all 8*

Front 12

How many days following childbirth is a mother at increased risk of psychiatric admission for?

Back 12

Mothers are at increased risk of Psychiatric admission for 30 days post childbirth - called the baby blues.

Front 13

What percentage of woman experience some form of the baby blues after childbirth?

Back 13

75% of women experience some form of the baby blues within 2 weeks of childbirth.

Front 14

What percentage of woman develop a MDD (major depressive disorder) within 3-6 months of childbirth?

Back 14

10% of woman experience a MDD within 3-6 months of child birth.

Front 15

List 5 other possible differential diagnosis for a patient presenting with depressive symptoms

Back 15

Normal reaction to life event

Stroke

Dementia

Tumour

Endocrine - Hypothyroid, addisons

Infections - influenza, hepatitis

Front 16

What is Dysthymia and Cyclothymia?

Back 16

Dysthymia - low mild depression lasting for at least 2 years

Cyclothymia - mood disorder that causes highs and lows, more mild version of bipolar

Front 17

What is the first line pharmacological treatment for a patient presenting with new onset depression?

Back 17

SSRIs are commonly the first line drug treatment for depression.

e.g Citalopram, Fluoxetine

Front 18

Along with pharmacological treatments, Psychological therapy is also used to treat mood disorders - what are the common first line Psychological treatments?

Back 18

Psychological treatments for depression:

CBT - Cognitive behavioural therapy

IPT - Interpersonal therapy

Individual dynamic psychotherapy

Family therapy

Front 19

Often as a last resort physical treatments can be used to treat depression, what are these physical treatments?

*only used when all other treatments have failed*

Back 19

Physical treatments:

ECTs

Physcosurgery

DBS - Deep brain stimulation

Front 20

Name the 2 most common measurements tools used to assess the improvements or changes in a patients depression

Back 20

Measurement tools for assessing depressive disorders:

SCID - StructuredClinical Interview for DSM disorders

SCAN - Schedules for Clinical assessment in Neuropsychiatry

Front 21

What is Mania Disorder?

Back 21

A mood which is predominantly elevated, expansive or irritable and definitely abnormal for the individualconcerned.

This mood change must be prominent and sustained for at least a week.

Different from bipolar due to the absence of lows.

Often recognised first by family members.

Manic highs can be money, work and life threatening.

*highs are similar to the effects cocaine would have on the brain*

Front 22

According to ICD-10, what are the two types of mania disorders?

Back 22

2 types of mania disorders:

Mania (with or without psychosis)

Hypomania - lesser degrees of mania, no psychosis

Front 23

What are the symptoms of Hypomania?

Back 23

Lesser degree of manic moments

Mild elevation of mood for 4 days or less

W

Increased energy and wellbeing

Increased sociability, sex drive

Reduced need for sleep

May be irritable

New interests, mild overspending

Front 24

What are the symptoms of Mania (with or without psychosis)?

Back 24

1 week extreme manic episodes

Enough to disrupt work, social life ect

Disinhibition

Gradiosity, extreme spending

Can be irritable rather than elated

Front 25

Name 2 psychiatric and 2 medical differential diagnosis for a patient who presents with the symptoms of Manic disorder?

Back 25

2 psychiatric:

Schizophrenia

ADHA

2 medical:

Stroke

MS

Front 26

What 3 tools could you use to measure the severity of a patient who presents with Mania?

Back 26

SCID

SCAN

YMRS - Young mania rating scale

Front 27

What 2 types of drugs are commonly used to treat Manic disorder?

Back 27

Antipsychotics - e.g Olanzapine

Mood stabilisers - Sodium Valproate

Front 28

What differentiates Bipolar Affective Disorder from depression mania or hypomania?

Back 28

Bipolar disorder is the combination of repeated episodes of depression AND mania/hypomania

Not simply one or the other and has to be alternating.

What makes it Bipolar is that its a combination of the the two syndromes.

Front 29

What sex and age group is bipolar disorder most common in?

Back 29

Bipolar disorder is equally common in males and females.

Common onset is 21.

Front 30

What sex and age group is Depression most common in?

Back 30

Depression is more common in women at a ratio of 2:1

Mean age of onset is 18-44

Front 31

How long do episodes of major depression typically last for?

Back 31

Typically episodes of major depression last for 4-6 months.

Almost half recover at 56 weeks.

80% have future episodes.

Front 32

How long do manic episodes typically last for in Bipolar disorder?

Back 32

Manic episodes in bipolar disorder typically last for 1-3 months.

Front 33

What are the three core symptoms of depression?

Back 33

Low mood

Anhedonia - loss of interest

Low energy

Front 34

What are the 8 sub symptoms of depression?

Back 34

Loss of confidence/esteem

Unreasonable feelings of guilt

Recurrent thoughts of death or suicide

Decreased concentration

Agitation or retardation

Sleep disturbances

Change in appetite

Low labido

Front 35

What are the 4 types of hallucinations that involve the 4 different senses?

Back 35

Auditory hallucinations - most common. e.g earning voices that aren't there

Visual hallucinations

Tactile hallucinations - e.g spiders crawling over skin

Olfactory hallucinations - second most common

Gustatory Hallucinations

Front 36

When performing a mental state examination on a depressed patient what two features may you be looking for in their behaviour?

Back 36

Mental retardation or agitation

Reduced eye contact

Front 37

When performing a mental state examination on a depressed patient what two features may you be looking for in their thought?

Back 37

For thought you are looking for the CONTENT and the STREAM of their thought.

ie. Does it make sense what they are saying = Content

Does there sentences make sense = Stream

Front 38

What 3 things might you expect to see in the speech of a patient who presents with depression?

Back 38

Slowed speech

Quite volume

Monotonous tone

Front 39

Suggest two treatments for if the perceived cause of the depression is biological?

Back 39

If the depression is biological then treat with...

1st Line - Antidepressants

2nd line last resort - ECT

Front 40

Suggest two treatments for if the cause of depression is Psychological?

Back 40

If the underlying cause of depression is psychological then treat with...

CBT

or

IPT (interpersonal psychotherapy)

Front 41

How long is antidepressant medication commonly continued for?

Back 41

Antidepressants are commonly continued for 6-12 months

Front 42

In what circumstance would antidepressants be continued long term?

Back 42

Long term continuation of antidepressants if...

Patient has chronic depression

They have psychotic symptoms/suicidal thoughts

Front 43

Name three complications that commonly occur in untreated depression

Back 43

Untreated depression can lead to:

Psychosis

Suicide

Social and occupational dysfunction - e.g relationship and work problems

Front 44

What is the most appropriate 1st line treatment for mild depression?

Back 44

For new onset mild depression most appropriate treatment is:

Psychotherapy - e.g CBT and IPT

Front 45

What are the 9 criteria for mania which a patient has to have 3 of to be diagnosed with Mania (without psychotic symptoms)?

Back 45

Increased activity and physical restlessness

Increased talkitivness (pressure of speech)

Ideas feel like they are racing

Loss of normal social inhibition

Decreased need for sleep

Inflated self esteem or grandiosity

Distractibility or restlessness

Activity which is devoid of risk considerations

Marked sexual energy or indiscretions

Front 46

What are the psychotic symptoms that are seen in people who have Mania with psychotic symptoms?

Back 46

Most commonly related to dellusional ideas of grandiose, self referential (speaking about oneself in the 3rd person), erotic or persecutory.