Affective

Disorders

PSYCHIATRY ICU, YEAR 4, Images from www.freepik.com

MBCHB
 Introduction & aims
You have learnt about depression before

These slides are to accompany the small group work and recap
key concepts of epidemiology, diagnosis and severity

Psychiatry ICU, Year 4, MB.ChB

 Learning objectives
•Epidemiology

•ICD 10 criteria for depression and mania

•Recognise severity

Psychiatry ICU, Year 4, MB.ChB

 Depression - Epidemiology
Prevalance Lifetime Rate
5%
20%

:
Psychiatry ICU, Year 4, MB.ChB
 For how long?
At least two weeks
And NOT secondary to the effects of drug / alcohol misuse,
organic illness, or bereavement

Psychiatry ICU, Year 4, MB.ChB

 Core
Symptoms
Low mood – may be worse
in the morning (diurnal
variation)
Anhedonia - inability to
derive pleasure
Anergia – reduced energy
levels

Psychiatry ICU, Year 4, MB.ChB

 Symptoms – ICD 10
Low mood Anhedonia Reduced energy levels

Suicidal Reduced
Poor
concentration thoughts libido

Psychomotor
retardation

Worthless Poor Change in

/guilt sleep appetite

Psychiatry ICU, Year 4, MB.ChB

 Severity - ICD 10
Mild Moderate Severe
2 core + 2 other 2 core + 3 other 3 core + 4 other

Although severity is based on symptom count function is important!

Psychiatry ICU, Year 4, MB.ChB

 Bipolar affective
disorder
•Periods of prolonged profound depression
alternate with periods of excessively elevated
mood.

•May be long periods (years) of recovery

between episodes.

•Untreated, average >10 episodes in a lifetime.

•No cure – aim of treatment is to reduce number

Psychiatry ICU, Year 4, MB.ChB

and severity of relapses.
 Bipolar affective disorder
Epidemiology
Prev a la n ce
1%

: 90%

80%
T W IN S T U D IE S

79%

70%

60%
Aetiology 50%

• Genetic 40%

30%
• Life Events
20%
19%

10%

Psychiatry ICU, Year 4, MB.ChB 0%

MZ DZ
 Manic Episode – ICD 10
Elevated Increased Reduced
mood energy concentration

Inflated self- Reckless behaviour

Reduced need
esteem – – overspending,
for sleep promiscuity
grandiosity

Increased Racing thoughts, Irritability,

pressured speech
libido
Psychiatry ICU, Year 4, MB.ChB aggression
 Manic Episode - Diagnosis
•Distinct period of abnormally elevated mood with ≥3
symptoms

•Last at least 1 week

•Impair occupational and social functioning

Psychiatry ICU, Year 4, MB.ChB

 Hypomania
•Symptoms not to the extent that they lead to severe disruption
of work or result in social rejection.

•Irritability, conceit, and boorish behaviour may be more

prominent than elation.

•No psychotic symptoms

Psychiatry ICU, Year 4, MB.ChB

 Bipolar affective disorder
At least 2 episodes of disturbed mood, one of which should be
manic or hypomanic.
Usually complete recovery between episodes

Psychiatry ICU, Year 4, MB.ChB

 Mood is a spectrum

depression
with mania with
psychotic mild-mood hypomania psychotic
symptoms depression euthymia symptoms

severe mania
depression