Affective disorders
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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

AffectiveDisorders

Jade Woolley

[email protected]


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


Affective disorders

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


Affective disorders

  • 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


Affective disorders

  • 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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