Download Mood (affective) disorders (F30-F39)

MINISTRY OF HEALTH OF UKRAINE
BUKOVYNIAN STATE MEDICAL UNIVERSITY
“Approved”
on the methodical meeting
of the Department of neurology, psychiatry
and medical psychology nm. S.M.Savenko
“____” ___________ 2009 (Report № __).
Chief of the Department
_______________________
Professor V.M. Pashkovsky
METHODICAL INSTRUCTION
for 4-th year students of medical faculty №2
(the speciality “medical affair”)
for independent work during preparing to practical class
Theme 26: MOOD (AFFECTIVE DISODERS). CLINICAL
DISPLAYS, TYPES OF MOTION. PRINCIPLES OF
THERAPY.
MODULE 2. SPECIAL (NOSOLOGY) PSYCHIATRY
TOPICAL MODULE 6. POLYETIOLOGICAL MENTAL DISORDERS.
Сhernivtsi, 2009
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1. ACTUALITY OF THEME:
AFFECTIVE DISORDERS
The word “affect” is a synonym for “emotion” and “mood”, and affective disorders are so
named because their main feature is abnormality of mood. It is part of normal experience to feel
unhappy at times of adversity and elated at times of good fortune. Depressed mood is also a
component of many psychiatric syndromes and occurs commonly with physical illness; elation
can occur as part of several psychiatric disorders. The central features of these syndromes are on
the one hand depressed mood, pessimistic thinking, lack of enjoyment, reduced energy, and
slowness, and on the other hand elevated mood, over activity, and self important ideas. The first
is called depressive disorder; the second is called mania (or, if it is not severe, hypomania).
Depressive disorder is frequent in general and hospital practice but is often undetected.
Unrecognized depressive disorder is a common cause of distress, and also of slow recovery from
physical illness. Therefore it is important that all doctors should be able to recognize the
condition, treat the less severe cases, and identify those requiring specialist care because of
suicidal risk or for other reasons. Mania is less common than depressive disorder. Nevertheless it
is important that the mania is recognized in its early stages because in the later stages the patient
becomes increasingly unwilling to accept treatment.
2. DURATION OF PRACTICAL CLASSES - 2 HOURS.
3. EDUCATIONAL PURPOSE
3.1. To know:
1. Etiology and pathogenesis of bipolar affective disoders.
2. Clinical manifestations of manic episode.
3. Clinical manifestations of depressive episode.
4. Classifications of depressive disoders.
5. Somatic and neurotic signs of bipolar affective disoders.
6. The types of motion of affective disorders.
7. Treatment of patients with mania.
8. Treatment of patients with depression.
9. Prophylactic of affective disorders.
3.2. Able:
1. To diagnose basic symptoms of affective disorders.
2. To diagnose somatic and neurotic signs of bipolar affective disoders.
3. To give first aid about manic excitement.
4. To give first aid about depressive (melancholik) excitement.
5. To conduct differential diagnosis.
3.3. To capture practical skills:
1. To collect anamnesis in patients on affective disorders.
2. To collect family anamnesis.
3. To diagnose manic and depressive disoders.
4. To prescribe a treatment of patients on affective disorders.
5. To conduct artificial feeding of patients with affective disorders.
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4. INTERSUBJECT INTEGRATION (base level of preparation).
Names of previous disciplines
1. Normal and pathologic physiology.
2. General psychology.
3. Medical psychology.
4. Medical genetic.
Skills are got
1. To know physiology and pathologic physiology of
HNA, types of HNA.
2. To know and determine psychological features
thinking, emotion and behaviour of human.
3. To describe state of thinking, emotional, will activity
of different types of personality.
4.To possess of methods examination genetic diseases
of human.
5. ADVICES TO STUDENTS.
5.1. CONTENTS OF THEME.
Etiology and Pathogenesis
A. Biochemical Factors: Although many differences in biochemical indices have been
described when bipolar patients are compared to normal control subjects, there is no agreement
about which alterations have etiologic significance and which are secondary effects or
epiphenomena. Since the "switch" from depression into mania (and vice versa) can occur in
minutes, attempts have been made to identify biochemical changes that might be associated with
the switch. Specific changes in brain monoamine neurotransmitter metabolism and receptor
function appear to be the most likely mechanisms. Although now regarded as too simplistic, the
catecholamine hypothesis suggested that catecholamine deficiency was associated with motor
retardation and depression, while catecholamine excess could result in excitement and euphoria.
Increases in dopaminergic function and adrenergic-cholinergic system imbalance have been reported during manic episodes. Overall, however, there have been few biologic studies of mania,
since the nature of the syndrome interferes with the necessary compliance with research
procedures.
Electrolyte disturbances have also been found in bipolar disorders and may represent a
defect of cellular membrane function. In general, sodium retention increases during depression,
together with increased potassium and water excretion. The reverse is true during manic
intervals. Others investigating the role of regulatory enzymes have reported alterations in
monoamine oxidase (MAO) and catechol-O-meth-yltransferase (COMT) activity. A variety of
neuroendocrine changes have also been reported for patients with bipolar disorder who are in the
depressed phase. About half of both bipolar and unipolar depressed patients show evidence of
any or all of the following during a severe depressive episode: increased adrenal glucocorticoid
function, decreased thyroid-stimulating hormone response to thyrotropin-releasing hormone,
decreased basal prolactin levels, and decreased growth hormone response to insulin challenge.
Although several studies have also reported significant differences between bipolar patients in
the depressed phase and patients with unipolar disorder, the findings are preliminary and must
await confirmation.
B. Psychosocial Factors: There is no reliable evidence that psychosocial factors cause
bipolar disorder, though such influences may precipitate manic or depressed bipolar states and
may in fact be necessary for the expression of symptomatology in milder bipolar syndromes. A
project deadline at work, for example, may result in decreased sleep and increased psychosocial
stress, which in turn may trigger a mild manic episode in certain susceptible individuals.
Retrospective analyses are unreliable, since every examined life contains historical matter that
could account for behavioral changes. Over the course of their illness, most persons with bipolar
disease experience manic or depressive episodes completely unrelated to life experiences. Recent
research in biologic circadian rhythmicity indicates that subtle changes in the light-dark cycle
(eg, seasonal variations) are a better predictor of risk.
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Mood (affective) disorders
(F30-F39)
This block contains disorders in which the fundamental disturbance is a change in affect or
mood to depression (with or without associated anxiety) or to elation. The mood change is
usually accompanied by a change in the overall level of activity; most of the other symptoms
are either secondary to, or easily understood in the context of, the change in mood and
activity. Most of these disorders tend to be recurrent and the onset of individual episodes can
often be related to stressful events or situations.
F30
Manic episode
All the subdivisions of this category should be used only for a single episode.
Hypomanic or manic episodes in individuals who have had one or more previous
affective episodes (depressive, hypomanic, manic, or mixed) should be coded as
bipolar affective disorder (F31.-).
F30.0 Hypomania
A disorder characterized by a persistent mild elevation of mood, increased energy
and activity, and usually marked feelings of well-being and both physical and mental
efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual
energy, and a decreased need for sleep are often present but not to the extent that they
lead to severe disruption of work or result in social rejection. Irritability, conceit, and
boorish behaviour may take the place of the more usual euphoric sociability. The
disturbances of mood and behaviour are not accompanied by hallucinations or
delusions.
F30.1 Mania without psychotic symptoms
Mood is elevated out of keeping with the patient's circumstances and may vary
from carefree joviality to almost uncontrollable excitement. Elation is accompanied
by increased energy, resulting in overactivity, pressure of speech, and a decreased
need for sleep. Attention cannot be sustained, and there is often marked
distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence.
Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy,
or inappropriate to the circumstances, and out of character.
F30.2 Mania with psychotic symptoms
In addition to the clinical picture described in F30.1, delusions (usually grandiose)
or hallucinations (usually of voices speaking directly to the patient) are present, or the
excitement, excessive motor activity, and flight of ideas are so extreme that the
subject is incomprehensible or inaccessible to ordinary communication.
F31 Bipolar affective disorder
A disorder characterized by two or more episodes in which the patient's mood and
activity levels are significantly disturbed, this disturbance consisting on some
occasions of an elevation of mood and increased energy and activity (hypomania or
mania) and on others of a lowering of mood and decreased energy and activity
(depression). Repeated episodes of hypomania or mania only are classified as bipolar.
F31.0 Bipolar affective disorder, current episode hypomanic
The patient is currently hypomanic, and has had at least one other affective episode
(hypomanic, manic, depressive, or mixed) in the past.
F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms
The patient is currently manic, without psychotic symptoms (as in F30.1), and has
had at least one other affective episode (hypomanic, manic, depressive, or mixed) in
the past.
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F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms
The patient is currently manic, with psychotic symptoms (as in F30.2), and has had
at least one other affective episode (hypomanic, manic, depressive, or mixed) in the
past.
F31.3 Bipolar affective disorder, current episode mild or moderate depression
The patient is currently depressed, as in a depressive episode of either mild or
moderate severity (F32.0 or F32.1), and has had at least one authenticated
hypomanic, manic, or mixed affective episode in the past.
F31.4 Bipolar affective disorder, current episode severe depression without psychotic
symptoms
The patient is currently depressed, as in severe depressive episode without
psychotic symptoms (F32.2), and has had at least one authenticated hypomanic,
manic, or mixed affective episode in the past.
F31.5 Bipolar affective disorder, current episode severe depression with psychotic
symptoms
The patient is currently depressed, as in severe depressive episode with psychotic
symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or
mixed affective episode in the past.
F31.6 Bipolar affective disorder, current episode mixed
The patient has had at least one authenticated hypomanic, manic, depressive, or
mixed affective episode in the past, and currently exhibits either a mixture or a rapid
alteration of manic and depressive symptoms.
F31.7 Bipolar affective disorder, currently in remission
The patient has had at least one authenticated hypomanic, manic, or mixed
affective episode in the past, and at least one other affective episode (hypomanic,
manic, depressive, or mixed) in addition, but is not currently suffering from any
significant mood disturbance, and has not done so for several months. Periods of
remission during prophylactic treatment should be coded here.
F32 Depressive episode
In typical mild, moderate, or severe depressive episodes, the patient suffers from
lowering of mood, reduction of energy, and decrease in activity. Capacity for
enjoyment, interest, and concentration is reduced, and marked tiredness after even
minimum effort is common. Sleep is usually disturbed and appetite diminished. Selfesteem and self-confidence are almost always reduced and, even in the mild form,
some ideas of guilt or worthlessness are often present. The lowered mood varies little
from day to day, is unresponsive to circumstances and may be accompanied by socalled "somatic" symptoms, such as loss of interest and pleasurable feelings, waking
in the morning several hours before the usual time, depression worst in the morning,
marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of
libido. Depending upon the number and severity of the symptoms, a depressive
episode may be specified as mild, moderate or severe.
F32.0 Mild depressive episode
Two or three of the above symptoms are usually present. The patient is usually
distressed by these but will probably be able to continue with most activities.
F32.1 Moderate depressive episode
Four or more of the above symptoms are usually present and the patient is likely to
have great difficulty in continuing with ordinary activities
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F32.2 Severe depressive episode without psychotic symptoms
An episode of depression in which several of the above symptoms are marked and
distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal
thoughts and acts are common and a number of "somatic" symptoms are usually
present.
F32.3 Severe depressive episode with psychotic symptoms
An episode of depression as described in F32.2, but with the presence of
hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary
social activities are impossible; there may be danger to life from suicide, dehydration,
or starvation. The hallucinations and delusions may or may not be mood-congruent.
F33
Recurrent depressive disorder
A disorder characterized by repeated episodes of depression as described for
depressive episode (F32.-), without any history of independent episodes of mood
elevation and increased energy (mania). There may, however, be brief episodes of
mild mood elevation and overactivity (hypomania) immediately after a depressive
episode, sometimes precipitated by antidepressant treatment. The more severe forms
of recurrent depressive disorder (F33.2 and F33.3) have much in common with
earlier concepts such as manic-depressive depression, melancholia, vital depression
and endogenous depression. The first episode may occur at any age from childhood
to old age, the onset may be either acute or insidious, and the duration varies from a
few weeks to many months. The risk that a patient with recurrent depressive disorder
will have an episode of mania never disappears completely, however many
depressive episodes have been experienced. If such an episode does occur, the
diagnosis should be changed to bipolar affective disorder (F31.-).
F33.0 Recurrent depressive disorder, current episode mild
A disorder characterized by repeated episodes of depression, the current episode
being mild, as in F32.0, and without any history of mania.
F33.1 Recurrent depressive disorder, current episode moderate
A disorder characterized by repeated episodes of depression, the current episode
being of moderate severity, as in F32.1, and without any history of mania.
F33.2 Recurrent depressive disorder, current episode severe without psychotic
symptoms
A disorder characterized by repeated episodes of depression, the current episode
being severe without psychotic symptoms, as in F32.2, and without any history of
mania.
F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms
A disorder characterized by repeated episodes of depression, the current episode
being severe with psychotic symptoms, as in F32.3, and with no previous episodes of
mania.
F33.4 Recurrent depressive disorder, currently in remission
The patient has had two or more depressive episodes as described in F33.0-F33.3, in
the past, but has been free from depressive symptoms for several months.
F34 Persistent mood [affective] disorders
Persistent and usually fluctuating disorders of mood in which the majority of the
individual episodes are not sufficiently severe to warrant being described as
hypomanic or mild depressive episodes. Because they last for many years, and
sometimes for the greater part of the patient's adult life, they involve considerable
distress and disability. In some instances, recurrent or single manic or depressive
episodes may become superimposed on a persistent affective disorder.
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F34.0 Cyclothymia
A persistent instability of mood involving numerous periods of depression and mild
elation, none of which is sufficiently severe or prolonged to justify a diagnosis of
bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This
disorder is frequently found in the relatives of patients with bipolar affective disorder.
Some patients with cyclothymia eventually develop bipolar affective disorder.
F34.1 Dysthymia
A chronic depression of mood, lasting at least several years, which is not sufficiently
severe, or in which individual episodes are not sufficiently prolonged, to justify a
diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).
Treatment of Depressive Disorder
Standard Antidepressant Drugs. A wide range of antidepressant drugs has been tested
in clinical trials. The first to be introduced, and still the standards against which others are
judged, are the tricyclic drugs imipramine and amitriptyline. These drugs are effective in both
mild and severe depressive disorders; in severe disorders they are as effective as ECT, but they
take 2 weeks or more to achieve an effect while ECT has a more rapid action.
Newer Antidepressant Drugs. Many antidepressant drugs have been developed since
imipramine and amitriptyline were first introduced, but none has been shown to have a greater or
more rapid effect. If a depressive disorder fails to respond to full doses of imipramine or
amitriptyline, there is no evidence that it will respond to another drug, therefore, the value of
alternatives resides in differences in side-effects and toxicity in overdose.
Monoamine Oxidase Inhibitors. These drugs are generally less effective than tricyclics
for severe depressive disorders and no more effective for the mild disorders. However, some
cases fail to respond to tricyclic antidepressants but do respond to monoamine oxidase inhibitors.
These drugs reach their maximum effect slowly and up to 6 weeks may be needed. Because
monoamine oxidase inhibitors potentiate the effects of pressor amines including tyramine (found
in some common foods) and synthetic amines used as decongestants and vasoconstrictors, these
interactions can cause dangerous increases in blood pressure. Therefore it is better not to use
these drugs as the first treatment but to reserve them for patients who have not improved with
adequate dosage of a tricyclic drug.
It has been reported that the effect of a tricyclic and a monoamine oxidase inhibitor in
combination is greater than that of either drug alone, but this report has not been confirmed by
convincing clinical trials.
Electroconvulsive Therapy. Clinical trials have shown that the antidepressant action of
ECT is quicker than that of tricyclics - it starts earlier and is significantly greater after 4 weeks of
treatment. After 6 months, however, the results of the two treatments are similar. ECT is most
effective for severe depressive disorders, particularly those with marked weight loss, earlymorning wakening, retardation, and delusions. It is much less effective when there is evidence of
poor premorbid adjustment, hypochondriacal and histrionic features, and a fluctuating course,
features that also predict a poor response to imipramine. Delusions and retardation are the best
predictors of improvement with ECT as against improvement during ECT placebo treatment.
Patients with a depressive disorder and delusions also respond better to ECT than to tricyclic
antidepressants, and so ECT seems to be the treatment of choice for this group.
Lithium. Lithium is generally used to prevent mood disorder, but it can also be used to
treat depressive disorder. Lithium has a therapeutic effect in the acute stage of depressive
disorders, but it is less than that of tricyclic drugs; hence lithium is seldom used for this purpose,
either as a first treatment or after failed tricyclic therapy. However, there is some evidence that
combined treatment. With lithium and a tricyclic antidepressant, or with lithium and a
monoamine oxidase inhibitor, is effective in patients who have not responded to a single
antidepressant. Both forms of combined treatment should be initiated by a specialist and used
cautiously, particularly when lithium is given with a monoamine oxidase inhibitor.
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Psychological Treatment. All depressed patients require supportive treatment to
sustain them until improvement takes place. Such treatment has less effect than drug treatment
on the biological symptoms of depression; but it can reduce interpersonal problems that are
important in maintaining depressive symptoms.
Treatment for mania
Antipsychotic Drugs. Antipsychotic drugs such as chlorpromazine and haloperidol have
proven value in the treatment of acute mania. Lithium carbonate has also been shown to be
effective; however, it takes a week or more to produce its effects and is therefore not the first
choice for acutely disturbed patients.
ECT (Electroconvulsive Therapy). ECT has a therapeutic effect in mania as well as in
depressive disorder. To produce a sustained effect, this treatment has to be given more frequently
ill mania than in depressive disorder (usually three times as against twice a week). Hence ECT is
not a first-line treatment. ECT is occasionally used in the rare cases when antipsychotic drugs are
ineffective and the patient is so seriously disturbed that to await natural recovery is not justified.
Prevention of Relapse and Recurrence
Strictly speaking, relapse means the return of symptoms after initial improvement during
a single episode of illness, and recurrence means the start of a new episode of illness after
recovery from the first. In practice the two terms are often interchangeable. Continuation
treatment refers to prevention of relapse, whilst prophylactic (or preventative) treatment refers to
the prevention of recurrence; however, this distinction is not always maintained.
The relapse rate for unipolar depressive disorders is reduced by antidepressant treatment
for 6 months after recovery from the acute illness. Longer treatment prevents longer recurrence.
Lithium carbonate also reduces recurrence, though it may be less effective than tricyclic
antidepressants.
For bipolar depressive disorders, continuation treatment with lithium carbonate is
effective in preventing relapse into mania and is as effective as antidepressant drugs in
preventing relapse into depressive disorder. Carbamazepine may be used for patients who do not
respond to lithium carbonate, though the evidence for its preventative effects is less strong than
for lithium. Relapse into mania may be induced by the continued use of antidepressant medication.
Social and psychological factors also contribute to relapse in unipolar and bipolar
disorders. Marital disharmony seems to be important, particularly in the form of repeated
criticism of the patient by the spouse. Although there is no proof that attention to these factors is
helpful, it is reasonable to try to reduce social stresses in patients who relapse despite adequate
drug treatment.
It has been proposed that cognitive therapy reduces the relapse and recurrence rate after a
depressive disorder. The evidence is not yet strong enough to support the routine use of cognitive
therapy, but this treatment may be tried for patients who have repeated episodes of depression
related to depressive forms of thinking.
5.2. THEORETIC QUESTIONS:
1. Etiology and pathogenesis of bipolar affective disoders.
2. Clinical manifestations of manic episode.
3. Clinical manifestations of depressive episode.
4. Classifications of depressive disoders.
5. Somatic and neurotic signs of bipolar affective disoders.
6. The types of motion of affective disorders.
7. Treatment of patients with mania.
8. Treatment of patients with depression.
9. Prophylactic of affective disorders.
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5.3. PRACTICAL TASKS ON THE CLASS:
1. To collect anamnesis, clinical psychopathological examination of patients with mood
disoders.
2. To diagnose manic and depressive episodes.
3. Make up plan of examination and treatment of patient with mood disoders.
4. Urgent help at excitement of patient with BAD.
5.4. MATERIAL FOR SELF-CONTRROL.
A. Questions of self-controls:
1. Etiology and pathogenesis of bipolar affective disoders.
2. Clinical manifestations of manic episode.
3. Clinical manifestations of depressive episode.
4. Classifications of depressive disoders.
5. Somatic and neurotic signs of bipolar affective disoders.
6. The types of motion of affective disorders.
7. Treatment of patients with mania.
8. Treatment of patients with depression.
9. Prophylactic of affective disorders.
B. TESTS:
1. BAD begins in next age:
A. 10-15 years
B. 15-20 years
C. after 25 years
D. after 55 years
E. after 75 years
2. What symptoms are specific for maniac episode:
A.Rapidity association
B.High spirit
C.High psychomotor activity (excitement)
D.Rapidity of thought
E.All above mentioned
3. All signs are present about depressive episode, except:
A. Retarted thinking
B. Psychomotor retardation
C. Cloudiness of consciousness
D. Suicidal ideas
E. Guilty thoughts and self-condemnation
4. What medicines are using at maniac excitement:
A. Antidepressants
B. Antipsychotic
C. Anticonvulsive
D. Anxiolitics
E. Lithium
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5. What medicines are using in remission with purpose prevent of bouts BAD:
A. Antidepressants
B. Anxiolitics
C. Lithium
D. Antipsychotic
E. Soporific
6. What antidepressant is tricyclic drugs:
A. Zoloft
B. Imipramine
C. Lithium
D. Floxetin
E. Lerivon
7. The patient is excited and restless, incessantly walks around the room, wrings her
hands, weeps and groans. There is an expression of fear on her face. Asks the people around her
to save her family, which is sure to be in great danger. Promises to give the people much money
for rescuing her relations. The personnel can’t dissuade her: the patient stays extremely anxious.
Couldn't sleep for two nights, and hasn't eaten any food for three days, saying, “How can I eat,
when my dear ones are dying?” Tried to commit suicide.
Name the syndromal diagnosis.
A. Hypochondriac syndrome
B. Anxiety and depressive syndrome
C. Agitated depression syndrome
D. Masked depression syndrome
E. Catatonic syndrome
8. A male patient 22 years old, a bank clerk, two weeks ago had flu, but didn't stay in bed
and continued to work. Complains of constant pain in his throat, supposes that he “is ill with the
larynx tuberculosis”, that his throat “has decomposed”, all his teeth have fallen out, and the brain
“has dissolved”. Refuses to walk, because all his organs were "pasted together." Assured everybody around that he has died, remaining "a living corps." His mood is gloomy and depressed.
Refuses to communicate with people, because his “mouth is full of dangerous germs”.
What is the syndromal diagnosis?
A. Cotard's syndrome
B. Paranoiac syndrome
C. Depressive-paranoid syndrome
D. Hypochondriac syndrome
E. Paranoid syndrome
9. Patient A., female, 30 years old, at the psychiatric inpatient department lies all the time
in bed, without changing her posture. Manifests no reaction to the changes in the environment,
presence of other people, and sounds. Is absolutely devoid of activity. Doesn’t eat on her own,
has to be fed from the spoon. When a doctor or some other person speaks to her, the patient
doesn't answer, but seems to listen and sometimes tears appear in her eyes. Her facial expression
is constantly sad. Her muscular tonus is somewhat increased.
Name the syndromal diagnosis:
A. Psychogenic stupor
B. Catatonic stupor
C. Asthenic stupor
D. Apathetic and abulic stupor
E. Depressive stupor
С. TASK
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1. A 20-year-old patient is known as using to clash with teachers and classmates in school, to
shout, to be able to throw with fists. He was detained several times for fighting and was
convicted. He has changed several places of work due to conflicts and aggression. Psychiatric
status: he is focused correctly, answers loudly, using obscene words. He demands "to leave him
in rest "because "he does not control himself". In department he shows aggression for the most
insignificant reasons. What is your preliminary diagnosis?
A. *Maniacal-depressive psychosis
B. Explosive psychopathy
C. Hysterical psychopathy
D. Hysterical neurosis
E. Schizophrenia
2. In mental status of a 22-year-old man there is a stable pathological depressed mood. The
patient is sociable, replies briefly but to the point. The speech is laconic, tempo is slowed, and
movements are constrained and inhibited. Speaks on the ideas of self-accusation and selfhumiliation. Medications of what group are to be prescribed to this patient?
A. Tranquilizers
B. Hypnotics
C. *Antidepressants
D. Neuroleptics
E. Normotimics
3. A 32-year-old female complains of feeling too lazy, reduction of work capacity, and
hopelessness of life. The suicide idea takes place. During 2 weeks before, the raised activity,
uncontrollable fun and levity was observed. What is your diagnosis?
C. *Bipolar affective disorder
A. Recurrent depressive disorder
B. Schizoaffective disorder
D. Depressive episode
E. Maniacal episode
4. The mental status of a 22-year-old man is characterized by a stable pathological depressed
mood. The patient is sociable, replies briefly but to the point. The speech is laconic, in slowed
tempo, movements are constrained and inhibited. Speaks on the ideas of self-accusation and selfhumiliation. Medications of what group are to be prescribed to this patient?
D. *Antidepressants
A. Tranquillisers
B. Neuroleptics
C. Hypnotics
E. Normotimics
5. A woman aged 35 has been suffering with pulmonary tuberculosis for 10 years. When in
phthisiatric clinic, she started to act strangely: put on a gaudy make-up, gathered the other
patients around her, was singing and dancing with them. Highly excited, passed all the time
among males, flirted, started sexually-biased conversations. The whole night absented from the
clinic ("was on a date"). What leading syndrome of mental disorders is observed?
D. *Maniacal
A. Morion-like
B. Psychopathy-like
C. Xenophobic
E. Hebephrenic
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6. A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long
time. He has got fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses
from treatment. What measures are the most expedient for the prevention of suicide?
A. Out-patient treatment
B. Strict supervision at home
C. Psychotherapeutic conversation
D. *Admission to the mental hospital
E. Admission to the neurological department
7. A male patient, 37 years old, became too cheerful for no particular reason, he has a subjective
feeling of high creative abilities, enthusiasm, elation and increased productivity, in spite of
manifest disability to concentrate (impaired attention); his speed of thinking processes is too
high. He is uncritical to his state, and finds it normal.
Name the syndrome:
A. Manic (non-psychotic) syndrome
B. Syndrome of dysphoria
C. Hypomanic (non-psychotic) syndrome
D. Obsessive syndrome
E. Depersonalization syndrome
1.
2.
3.
4.
6. RECOMMENDED LITERATURE IS:
6.1. Basic:
Clinical Psychiatry from Synopsis of Psychiatry by H.I.Kaplan, B.J.Sadock. – New York:
Williams @ Wilkins. – 1997.
Psychiatry. Course of lectures. – Odessa: The Odessa State Medical University. – 2005. –
336 p.
Lectures.
Internet resource.
6.2. Additional:
1. Морозов Т.В., Шумский Н.Г. Введение в клиническую психиатрию. – Н.Новгород:
Изд-во НГМА, 1998.
2. Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. – М., 1997.
3. Сонник Г.Т. Психіатрія: Підручник / Г.Т.Сонник, О.К.Напрєєнко, А.М.Скрипніков.
– К.: Здоров’я, 2006.
Prepared by assistant
S.D.Savka