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Affective Disorders. Jade Woolley [email protected] Affective disorders = Mood disorders. Depression Bipolar disorder Anxiety. Depression. 10% of men and 20% of women have Sx 2 nd most common condition by 2020. Major (core) symptoms Low mood Anhedonia Anergia. ICD-10

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affective disorders mood disorders
Affective disorders = Mood disorders
  • Depression
  • Bipolar disorder
  • Anxiety
depression
Depression

10% of men and 20% of women have Sx

2nd most common condition by 2020

Major (core) symptoms

  • Low mood
  • Anhedonia
  • Anergia

ICD-10

Occurring most days for >2 weeks

depression1
Depression

Minor symptoms

  • Poor appetite/weight loss
  • Disturbed sleep/early morning waking
  • Loss of libido
  • Diurnal variation of mood
  • Psychomotor retardation
  • Poor concentration
  • Feelings of guilt or worthlessness
  • Suicidal ideation

Somatic symptoms

severity
Severity

Mild depressive disorder

2 core + 2 minor symptoms

Moderate depressive disorder

2 core + 3-4 minor symptoms

Severe depressive disorder

3 core + >4 minor symptoms

Severe depression can feature psychosis

  • Delusions – fixed firm beliefs that patientcannot be dissuaded from despite rational evidence to the contrary
  • Hallucinations – perceptions occurring in the absence of external stimuli
risk factors
Risk factors

Non-modifiable

  • Genetics
  • F>M

Modifiable (ish)

  • Organic – alcohol, drugs, chronic disease, chronic pain
    • Hypothyroid, brain tumour, anaemia
    • Post-natal
  • Social – isolation, poverty
  • Mental – other psychiatric disorder
treatment
Treatment
  • Effective ≈ 80% of pts
  • Requires GA and muscle relaxant
  • S/E headache, memory loss
pharmacological therapies
Pharmacological therapies
  • Monoamine hypothesis:
  • Depressed pts have less 5HT & NA in the synapse
  • Drugs increase monoamine levels
slide9

MAO inhibitors

PHENELZINE

Autoreceptor blockers

MIRTAZAPINE

SSRIs

CITALOPRAM

SERTRALINE

FLUOXETINE

SNRIs – VENLAFAXINE

TCAs - AMITRYPTYLINE

AGOMELATINE

SSRIsare first line

Treatment effects take ≈ 6 weeks to appear

slide10

Depression

  • Bipolar disorder
  • Anxiety
bipolar disorder
Bipolar Disorder

Episodes of depression alternating with episodes of maniaor hypomania

  • Type 1 – 1:1 ration depression:mania
  • Type 2 – 1:5 ratio depression:mania
  • Rapid cycling - >4 episodes in a year

Average depressive episode: 6 months

Average manic episode: 4 months

mania
Mania

Elevated mood lasting >2 weeks

mania1
Mania
  • Hypomania = mania w/out psychosis
  • Differentials
    • Hyperthyroidism
    • Drugs – eg antidepressants!
    • Schizophrenia
    • Dementia
  • Genetic component
  • Diagnosis <30 years old
treatment1
Treatment
  • Atypical antipsychotics
    • Quetiapine, olanzapine (few EPSEs)
  • Mood stabilisers
    • Lithium(most common, but unknown mechanism of action, narrow therapeutic index and many side effects)
    • Sodium valproate (teratogenic)
  • Benzodiazepines
    • Lorazepam to tranquilize acute mania
  • Antidepressants - SSRIs
slide15

Depression

  • Bipolar disorder
  • Anxiety
anxiety
Anxiety

‘Excessive, uncontrollable anxiety and worry (apprehensive expectation) about a wide range of events or activities’

With three of the following:

  • Restlessness
  • Being easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance
anxiety1
Anxiety

Components of anxiety:

  • Thoughts – nervous apprehension about the future
  • Somatic symptoms – autonomic arousal
types of anxiety
Types of anxiety
  • Phobias
    • Simple – fear/avoidance of a specific situation
    • Social – fear/avoidance of social situations
    • Agoraphobia – fear/avoidance of public places, crowds
  • Panic disorder
  • Generalisedanxiety disorder
  • OCD
  • PTSD

Non-situational anxiety

non situational anxieties
Non-situational anxieties
  • OCD - symptoms >2 weeks, affect functioning
    • Obsessions: involuntary ideas/impulses
    • Compulsions: stereotyped repetitive behaviours necessary to neutralise anxiety
  • PTSD – following a traumatic event
    • Re-experiencing – flashbacks, hallucinations
    • Increased arousal – hypervigilance, startle response
treatment2
Treatment
  • First line drugs:
    • SSRIs – CITALOPRAM
    • SNRIs – VENLAFAXINE
    • Safe for long duration of therapy (≥6 months)
  • Short acting:
    • Benzodiazepines – DIAZEPAM
      • Increases inhibition at GABAA receptors
psychiatry revision for intermediates
Psychiatry revision for intermediates

12th May, 32/1015

Dr. Tom Phillips F1

Psychiatry: Just the Facts - a complete guide for medical students

supplementary hallucinations
Supplementary - Hallucinations

Pts hear their own thoughts spoken aloud (thought echo)

Pt hear a voice speaking directly to them (which can give commands or be persecutory)

Pts hear themselves referred to in the 3rd person, providing a running commentary

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