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Affective Disorders

Affective Disorders. Jade Woolley jlw1g10@soton.ac.uk. 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

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  1. AffectiveDisorders Jade Woolley jlw1g10@soton.ac.uk

  2. Affective disorders = Mood disorders • Depression • Bipolar disorder • Anxiety

  3. 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

  4. 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

  5. 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

  6. 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

  7. Treatment • Effective ≈ 80% of pts • Requires GA and muscle relaxant • S/E headache, memory loss

  8. Pharmacological therapies • Monoamine hypothesis: • Depressed pts have less 5HT & NA in the synapse • Drugs increase monoamine levels

  9. 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

  10. Depression • Bipolar disorder • Anxiety

  11. 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

  12. Mania Elevated mood lasting >2 weeks

  13. Mania • Hypomania = mania w/out psychosis • Differentials • Hyperthyroidism • Drugs – eg antidepressants! • Schizophrenia • Dementia • Genetic component • Diagnosis <30 years old

  14. 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

  15. Depression • Bipolar disorder • Anxiety

  16. 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

  17. Anxiety Components of anxiety: • Thoughts – nervous apprehension about the future • Somatic symptoms – autonomic arousal

  18. 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

  19. 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

  20. 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

  21. Psychiatry revision for intermediates 12th May, 32/1015 Dr. Tom Phillips F1 Psychiatry: Just the Facts - a complete guide for medical students

  22. 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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