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Um I can see someone's joined. Um So that's great. Um So guy welcome. Um I'm Aaca, I'm currently in third year. So this is all still relatively fresh. Um Phase one B BRS. And today I'm gonna be doing uh we lecture on depression and mood disorders. So I will just present um Yeah, present entire screen share. Oh my goodness. Yeah, here we go. OK. So yeah, that's me. I like you, you more. Um And I have edited these slides so these are more up to date. Um compared to the older slides, I would recommend using these ones. Um There's not gonna be a mentee running through um in this lecture, but there will be cases as well as some SBA S as well as to get you guys um thinking. So this is what we're covering. Um We cover mood disorders um and depression as it says here as well as the pharmacology and pathophysiology of depression, um which is its own kind of different tutorial that comes under pharmacology if I remember right on in Sunday. So this kind of compiles all of that, which I think is quite good. It's all one place for you guys. Um Yeah, we'll cover bipolar disorder, personality disorders and a bunch on depression and major depressive disorder. So I know at first it's all quite confusing cause it just seems like it's all overlapping symptoms and it's all the same thing. Um But there are fine nuances and I think with practice and hopefully after this lecture, you guys will understand it a little bit better. These are the Tylo's, we don't need to maybe focus on that. Ok. So it's really important first that we define mood disorders. So these are different to personality disorders. Um and other things such as psychosis. Um schizophrenia actually, no schizophrenia comes under this. Um But yeah, psychosis is something that's different as well. So it can be confusing cause they might seem to appear to be the same thing, but they're not here. Um We have a fundamental disturbance um and a and a change in mood from normal to something else. So here we've got depression or elation um and anxiety doesn't really come into this. So it says with or without anxiety. Um and it says that here it can be triggered by stressful events. Um So it's something that is important to remember. OK. So first, um we'll talk about bipolar disorder. I also do just want to say so with mood disorders, um most of the symptoms that occur in a mood disorder tends to be as a result of the change in mood, the fundamental change in mood, whether that is depression and that leads to eating less or sleeping less or elation, which might lead to impulsive um activity or um like speaking really, really fast. That's also a symptom. So ultimately, it's the change in mood that causes all the different symptoms and signs. So, bipolar disorder, um there are differentials and there's also within bipolar disorder, there's two different types, type one and type two. ok. And we'll start off with just a clinical case and just to get you guys thinking what this could be and then hopefully we'll, I'll explain to you all the different types of differentials and bipolar disorders and then you can kind of see what, what this case comes under. So here we have a 19 year old female presents to the GP due to concerns from her dad. He reports that she's been feeling more elated than usual over the past two weeks previously, she had been experiencing intermittent low mood since she was 16. So that's three years recently, she has been barging into his room late at night saying how amazing and powerful she was for barely needing any sleep and still having lots of energy. She's unable to attend school as she's quite disruptive. And when speaking to her, you're not able to get her to answer your questions because she goes on a tangent, you also know she's speaking abnormally fast. Ok. So you're seeing a lot of symptoms here. Um Questions are, what is the most likely diagnosis and what is the treatment for this condition? Um We'll come back to that at the end. But you can, you guys can have a, we think of what you think. OK. So it's quite important. So this is what the questions in the BRS paper will be asking about. So these are what you wanna focus on. If you're gonna take anything from this lecture, it's how to diagnose and differentiate the diagnosis of manic episodes versus hypomanic and all the other differentials. So this is quite specific, you need to remember that it's three or more of the seven manic symptoms plus this euphoric and irritable mood that's described. Um Generally, they will write it quite plainly in the question that they're feeling much more elated, they'll use that word elated. So you look out for that or feeling generally much more happy or even they might use the words euphoric and irritable. Straight from DSM five. You wanna make sure you count at least three symptoms as well. If there's not at least three symptoms, then um it won't be a manic episode diagnosis and these are the seven manic episode um manic symptoms. Um First is a decreased need for sleep with increased energy. Um Yeah, it's all kind of it, it says what it is distractibility again. So in the previous case, um just a hint, it was the way that they can describe that is by someone going off on a tangent, they get easily distracted, grandiosity or inflated self esteem. Um So if you remember from the case, the girl was describing that she thinks she's so powerful um fight of idea or racing thoughts kind of similar to distractibility. Um But it's more about the sudden nature of a, a bunch of thoughts or a bunch of ideas, talkativeness, pressured speech. Um pressure speech essentially describes um like uncontrollable, rapid, excessive speaking. Um Like you can't interrupt and they're not able to have a cohesive conversation. Um That's what pressure speech means, increased goal directed activities or psychomotor agitation and impulsive behavior. So they will normally describe impulsive behavior as sexual impossibility or spending sprees in the BRS questions. Next is how to diagnose a depressive episode. So, a depressive, it is important to think about the difference between an episode and an illness. So, and I'm sure you guys are aware that depression is its own mental illness. Um But you can also get depressive episodes. So these episodes would be come under more of bipolar disorder where it's a certain period of time where you're experiencing these symptoms. And then this could change to a high mood, a euphoric mood that we were just talking about before. So again, previously, it was three out of seven here, they want five or more depressive symptoms in under DSM five. and it needs to have low mood or anhedonia and it says here, lack of pleasure. So normally that just describes, oh, the patient doesn't find joy in football, which he used to love or something like that. Um For two weeks or more as well, the timing is really important to remember. So these are the symptoms. So it's again out of seven, but you need five for depression and three for a manic episode and this is just how I would remember it. Um Sad and low energy gps, don't forget the s at the end of GPS. Um So you can see here s ad sad sleep appetite and decreased concentration. So for sleep and appetite, um this can be increased or decreased. So you can uh be going through a depressive episode and be really struggling to get to sleep. Um And therefore you're, you have insomnia or you could just find solace in sleeping and end up sleeping maybe 15 to 20 hours a day. Um as well. So both are described and both come under this. So it's basically just cha any changes in sleep, it doesn't matter which way it goes. And the same is for appetite as well. Um low energy and low energy. That's literally just what it is. Guilt, psychomotor changes can be agitation or retardation. So again, it's the same as sleep and appetite can be more or less. Um And suicidal thoughts of course, is quite a big thing to I think about. So with the types of bipolar disorders again, like I was saying, um before there's episodes and then there's disorders. So it's really important cause a question can sometimes be confusing in that. It'll give you a case just like the one I presented earlier and then I'll ask you for a diagnosis. Um And if it's a very short answer question, you need to be very careful. Um And even if it's an SBA actually, um if this is an episode or a disorder, so normally if it's a.