**_🤯Psychiatry🤯 - Mood Disorders

Question 1

What are the 3 core symptoms of depression?

Answer 1

Low mood
Low energy
Anhedonia

Question 2

What are the depression triads?

Answer 2

Question 3

What features are examined in the Mental State Examination (MSE)?

Answer 3

Appearance and behaviour
Speech
Mood / Affect
Thought (content and form)
Perceptions
Cognition
Insight

Question 4

What are the most important questions to ask in a history of presenting complaint of depression?

Answer 4

Insidious versus acute onset (e.g. secondary to a life event)
Core/cognitive/biological symptoms
Diurnal variation? (e.g. mood improves throughout the day)
Suicidal ideation/self-harm (thoughts, plans, intent)
Exacerbating and relieving factors (are they taking medication and is it helping? Psychosocial stressors/support?)
Relevant physical health conditions (e.g. hypothyroidism, anaemia, Cushing’s, chronic pain)

Question 5

What questions would you ask in a past psychiatric history?

Answer 5

Previous episodes? How long did they last?
Did previous episode(s) resolve with or without treatment?
History of any other mental illness? – Important to rule out manic episodes
Previous admissions? (informal versus under the mental health act)
Collateral history (important if patient is being guarded/poor historian)
Medical notes if available
Previous self-harm or suicide attempts

Question 6

What questions would you want to ask relating to drugs/medications?

Answer 6

Question 7

What could you consider in a forensic psychiatric history?

Answer 7

Offending as a youth (consider oppositional defiance disorder and conduct disorder), Youth Rehabilitation Orders
Arrests/cautions/incarcerations/forensic mental health act admissions/probation involvement
Include offences that were perpetrated but for which they were not caught
N.B – Co-morbid substance misuse is the biggest risk factor for offending

Question 8

What are the key points of information you would want to gather in a personal psychiatric history?

Answer 8

Birth & early developmental (e.g. antenatal/perinatal complications, developmental milestones)
Schooling (academic performance, truancy at school and peer relationships/bullying)
Higher/further education
Employment
Psychosexual history
Premorbid personality

Question 9

What must be considered in a psychiatric risk assessment?

Answer 9

Risk to self
Risk to others
Risk from others

Question 10

What would be included under “risk to self”?

Answer 10

Current suicidal ideation/plans/intent
Previous attempts (method/how many episodes/how did they feel when they survived)
Self-harm
Self neglect/poor care of physical health
Risk of misadventure (accidental injury due to impulsive and disinhibited acts e.g. in mania)

Question 11

What would be included under “risk to others”?

Answer 11

Rarer in depression
Thoughts/plans to harm others
Command hallucinations (general risk factor for violence)
Relevant forensic history

Question 12

What would be included under “risk from others”?

Answer 12

Vulnerability to exploitation
Risk of retaliation from others (esp. in manic states when overfamiliar, irritable, disinhibited)

Question 13

What are the main differentials to also consider when considering a mood disorder?

Answer 13

Bipolar disorder vs unipolar depression
Bipolar disorder vs borderline personality disorder/EUPD
Depression vs psychotic prodrome
Psychotic depression vs schizoaffective disorder (depressive type)
Mania vs schizoaffective disorder (manic type)
Hypomania vs Attention Deficit Hyperactivity Disorder

Question 14

In the context of personality disorders, what is the definition of paranoid?

Answer 14

Pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent

Question 15

In the context of personality disorders, what is the definition of schizoid?

Answer 15

Lack of interest and detachment from social relationships, apathy, and restricted emotional expression

Question 16

In the context of personality disorders, what is the definition of schizotypical?

Answer 16

Extreme discomfort interacting socially, and distorted cognition and perceptions

Question 17

In the context of personality disorders, what is the definition of antisocial?

Answer 17

Pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behaviour

Question 18

In the context of personality disorders, what is the definition of borderline?

Answer 18

Pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behaviour andaffect, often leading to self-harm and impulsivity

Question 19

In the context of personality disorders, what is the definition of histrionic?

Answer 19

Pervasive pattern ofattention-seekingbehaviour and excessive emotions

Question 20

In the context of personality disorders, what is the definition of narcissistic?

Answer 20

Pervasive pattern ofgrandiosity, need for admiration, and a perceived or real lack of empathy

Question 21

In the context of personality disorders, what is the definition of avoidant?

Answer 21

Pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation

Question 22

In the context of personality disorders, what is the definition of dependent?

Answer 22

Pervasive psychological need to be cared for by other people

Question 23

What are the similarities between bipolar affective disorder (BPAD) and borderline personality disorder (BPD)?

Answer 23

Rapid mood changes
Unstable interpersonal relationships
Impulsive sexual behaviour
Suicidality

Question 24

In the context of personality disorders, what is the definition of obsessive-compulsive personality disorder?

Answer 24

rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships (distinct fromobsessive-compulsive disorder)

Question 25

What are the main differences between BPAD and BPD?

Answer 25

BPAD is episodic, BPD changes over the course of hours/days rather than days/weeks
BPAD typically features grandiosity, BPD features fear of abandonment, feeling of emptiness and poor self-image
BPAD mood states are typically less affected by environment
BPAD is very heritable

Question 26

Outline BPAD vs schizoaffective disorder

Answer 26

Both can both can present with psychosis and mood symptoms (both depression and mania)
Typically in Schizoaffective disorder there is more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations

Question 27

What are the similarities between BPAD and ADHD?

Answer 27

Hyperactivity
Impulsivity
Impaired concentration
Impairment of executive function
Abnormal working and short term memory

Question 28

What are the differences between BPAD and ADHD?

Answer 28

BPAD not necessarily present in childhood
BPAD is episodic
BPAD shows strong family history (heritability+++)
BPAD features recurrent depressive episodes
In BPAD, amphetamines worsen mania

Question 29

What are the possible organic causes for mood disorder symptoms?

Answer 29

Endocrine
Systemic
Deficiencies
Neurological
Medications

Question 30

What endocrine issues can cause mood disorder-like presentations?

Answer 30

Hyper/hypothyroidism
Hyper/hypoparathyroidism
Hypoglycaemia
Cushing’s syndrome
Addison’s disease

Question 31

What systemic issues can cause mood disorder-like symptoms?

Answer 31

Viral infections
SLE
HIV
Cancers
Cytokines manifested in systemic diseases are considered to be a cause of depression

Question 32

What deficiencies can cause mood disorder-like symptoms?

Answer 32

Vitamin B12
Folic acid

Question 33

What neurological issues can cause mood disorder-like symptoms?

Answer 33

Multiple sclerosis
Alzheimer’s
Parkinson’s

Question 34

What medications can cause mood disorder-like symptoms?

Answer 34

Beta-blockers
Steroids
anti-Parkinson’s
Some antibiotics (e.g. ciprofloxacin)
Statins
Oestrogen
Opiates
Acne medications