Mood disorders: Depression - Definition - Mood disorder characterized by Pervasive lowering of mood accompanied by psychosocial and biological symptoms

- Typical depressive episode described in terms of Core symptoms + additional features in ICD-10 - Depressive episode further classified, according to severity of symptoms and impairment of social functioning, to - Mild - Moderate - Severe - Severe with psychosis - Aetiology - Genetic - Strong Genetic Link proven by adoption studies (presumably find separated twins and see if they both have depression) - MZ:DZ 2:1 - Over all risk of mood disorder for 1st degree relative is 20% - Biochem - 5HT dysfunction - Cognitive Distortions - Depressed pts can be viewed as having cognitive distortions (e.g. overgeneralization, personalization, minimisation) and -ve views about (Beckers triad) themselves, the world and the future - Most depressive episodes follow an adverse life event - Associations/RF (those events or circumstances being:) - Chronic Illness - Divorce - Unemployed - Lack of confidente - Low self-esteem - Poor social support - Low social class - Co-morbid psych illness (Alcohol, anxiety etc.) - Epi - Lifetime risk: 10-20% - M:F 1:2 - Onset any time from childhood to old age but most - 30s for women - 40s for men - Hx - ICD-10 classification (ALL for at least 2w) - Mild - 2 Core + 2 Add. - Moderate - 2 Core + 3 Add. - Severe - 3 Core + 4 Add. - Severe depression with psychotic symptoms = w/ delusions, hallucinations and stupor - Core - Low Mood

- Anhedonia (Loss of interest and enjoyment in things you used to enjoy) - Fatigue - Additional - Reduced conc. and attention - Reduced self-esteem - Ideas of guilt and worthlessness - Pessimistic views of future - Ideas or acts of self-harm or suicide - Disturbed sleep - Diminished appetite - Biological Symptoms (4 or more for Dx of somatic syndrome) - Anhedonia - Lack of emotional reactivity - Early morning wakening >2h - Diurnal variation of mood - Psychomotor retardation or agitation - Marked loss of appetite - Marked loss of libido - Weight loss - At a point depression can get serious and they can have psychotic symptoms, with delusions and hallucinations that are around the main themes: worthlessness, guilt, poor health, poverty. - It could be that they believe they have cancer when they dont - They could think the world ceases to exist (nihilistic), usually at a serious point of disease. - Depressive Stupor is uncommon but also a serious manifestation. They literally get so sad that they dont move or talk. Its bradykinesia and poverty of speech at the most extreme. - OE - Appearance - Self-neglect - Weight loss - Dirty/ clothing unkempt - Behaviour - Low mood - Poor eye contact - Downcast eyes - Tearful - Speech - Slow - Quiet - Not Spontaneous - Mood - Low - +/- Suicidal ideation - Thought - Pessimistic - Ideas of guilt and worthlessness - Nihilistic delusions or others - Perception

- Usually 2nd person auditory hallucinations - Often derogatory - Cognition - Poor concentration - Insight - Good insight - Ix - Blood tests to exclude medical cause - TFT - FBC - LFT - U/Es - Ca - Glucose - Mx - Risk assessment: (remember to look this part up) - Risk of suicide - Risk of self-harm - Risk of harming others - Minimise adverse life events - Care: - Primary care if mild - Referral if severe - Hospitalization if dangerous (suicidal/psychotic) - Tx - Antidepressant (TCA, SSRIs) - Need to be continued for 6mo after symptoms subsided - Can be taken prophylactically if multiple episodes before - Lithium if refractory - Antipsychotics used if delusions and hallucinations - ECT if severe or Tx resistant - Psychotherapies: - Supportive - IPT - CBT - Complications - Social isolation - Unemployment - Self-harm/Suicide - Drug/alcohol abuse - Prognosis - 15% Lifetime suicide risk - After first episode, 90% recover but has another episode < 10 years - 10% have chronic recurring episodes Actual ICD-10 Guidelines: + Add-ons from lectures, so more accurate
Key symptoms: persistent sadness or low mood;and/or loss of interests or pleasure fatigue or low energy

at least one of these, most days, most of the time for at least 2 weeks if any of above present, ask about associated symptoms: disturbed sleep poor concentration or indecisiveness low self-confidence poor or increased appetite suicidal thoughts or acts agitation or slowing of movements guilt or self-blame the 10 symptoms then define the degree of depression and management is based on the particular degree not depressed (fewer than four symptoms) mild depression (four symptoms) moderate depression (five to six symptoms) severe depression (seven or more symptoms, with or without psychotic symptoms) symptoms should be present for a month or more and every symptom should be present for most of every day KEY DIFFERENCES: - They dont count core + additional, its just any of the 10, and classify them accordingly - Core has to be >2w, almost all the time everyday - Of all of them, has to be 1mo, again almost all the time everyday - Also not ass. with bereavement or substance use or medical condition - Ass with significant distress and impairment of functioning - Clarification with Classes: - Mild - Distress + difficulty with usual activities - Moderate - 5+ symptoms to marked degree - Unable to continue with some usual activities - Withdrawal from relationships - Severe - 7+ symptoms - Severe agitation + distress - Usual activities ceased - Problems with basic self care - Risk of suicide - Severe with psychotic