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Affect Disorders Flashcards

1
Q

What are the core symptoms of depression? What are some other symptoms?

A

Low mood > 2 weeks
Loss of energy
Loss of pleasure

DEAD SWAMP

depressed
energy loss
anhedonia
death thoughts

sleep disturbance
worthlessness/guilt
appetite/weight loss
mentation
psychomotor agitation
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2
Q

How would you classify mild, moderate and severe depression?

A

Mild - core + 2/3 others +/- somatic symptoms

Moderate - core + 4 others +/- somatic symptoms

Severe - core + several symptoms (suicidal, marked loss of functioning) with/without psychotic symptoms

*psychotic symptoms (nihilistic, guilty delusions, derogatory voices)

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3
Q

What are some examples of somatic symptoms seen In depression?

A

decreased appetite

decreased weight (5% reduction in body weight/month)

constipation

early morning waking (atleast 2 hrs before usual time)

diurnal variation of mood (feel worst on waking)

decreased libido

amenorrhoea

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4
Q

What investigations would you carry out for depression?

A

PHQ2/9

Edinburgh Postnatal Depression scale

Hamilton Depression Rating Scale

Hamilton Anxiety Rating Scale

Addenbrooke’s Cognitive Examination

FBC, U&E, TFT, LFT

Illicit drugs

EEG, CT, MRI

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5
Q

What is treatment for Depression?

A 
CBT
SSRIs (fluoxetine, citalopram, sertraline)
SNRIs (duloxetine, venlafaxine)
TCAs (amitriptyline)
MAOIs (phenelzine)
NassA (mirtazapine)
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6
Q

What are some side effects of SSRIs?

A

GI side effects

Serotonin syndrome

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7
Q

What are some side effects of TCAs?

A

arrythmias - prolonged QT

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8
Q

What precautions need to be taken for MAOIs?

A

Increased risk of hypertension, avoid tyramine containing foods (cheese, red wine, broad beans)

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9
Q

What drugs can cause Serotonin Syndrome?

A

SSRIs, MAOIs, Ectasy and Amphetamines

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10
Q

How would Serotonin Syndrome present?

A

Cognitive : agitation, confusion, euphoria, insomnia, hypomania

Autonomic : tachycardia, HTN, fever, arrthymia

Neuromuscular : tremor, hyperreflexia, clonus, ataxia

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11
Q

What are symptoms of SSRI withdrawal? What can be done to avoid this?

A

headache, nausea, vomiting. anxiety

withdraw by tapering over >/ 4 weeks

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12
Q

What is the ICD-10 definition of Bipolar?

A

Hitsory of atleast two episodes of mood disturbance with one being mania or hypomania

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13
Q

How would you differentiate Bipolar I from Bipolar II?

A

Bipolar 1 disorder : a minimum of one manic or mixed episode.

Bipolar 2 disorder : at least one episode of hypomania along with one episode of major depression.

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14
Q

How a manic patient present?

A

elevation of mood (elation/irritability or anger)

increased energy

over-activity

pressure-of-speech

reduced sleep

loss of social and sexual inhibition

poor attention and concentration

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15
Q

How do you differentiate Hypomania from Mania?

A

hypomania doesn’t disrupt work or social rejection

lasts around 4 days while mania is more than 7 days

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16
Q

What are differential diagnosis for Bipolar?

A

Increased activity and restlessness = hyperthyroid and anorexia nervosa

Schizophrenia

Agitated Depression

Severe OCD

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17
Q

What are some risk factors for Bipolar?

A

Family History

Recent life event - 6 months before

working class women

physical illness

anti-depressant

amphetamines

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18
Q

What is the management of Bipolar?

A

In an acute episode of Mania - haloperidol, olanzapine, quetiapin or risperidone

Long term management:

Lithium

S.Valproate

Carbamezepine

ECT

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19
Q

What is the therapeutic range for Lithium?

A

0.4 - 1.0

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20
Q

What are some signs of Lithium Toxicity?

A

blurred vision

coarse tremor

muscle weakness

ataxia

N&V

seizures and coma

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21
Q

What are contraindications for Lithium?

A

renal insufficiency

CVS insufficiency

Addison’s

Untreated Hypothyroism`

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22
Q

When does Schizophrenia present?

A

2nd-3rd decade

And a smaller peak late middle age

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23
Q

What are first rank symptoms of schizophrenia?

A

Auditory Hallucinations

Thought Alienation - insertion, withdrawal and broadcasting

Passivity Phenomena

Delusional Perception

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24
Q

What are secondary symptoms of schizophrenia?

A

Delusions

Persistent Hallucinations

Catatonic Behaviour

Negative Behaviour - marked apathy, poverty of speech, social withdrawal

Change in personal behaviour

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25
What are some paranoid schizophrenia symptoms?
Persecution Reference Exalted Birth Bodily change Jealousy Hallucinating voices of threat or issue commands
26
What is a distinct sign of Hebephrenic Schizophrenia?
Irrresponsible and unpredictable behaviour - pranks etc.
27
What is paraphrenia?
Late onset schizophrenia - after 60 years old
28
What are differentials for schizophrenia?
Bipolar Mania Depression Personality Disorder
29
What are some risk factors for schizophrenia?
Family History (if both parents 46%) Intrauterine complications/infections Social Isolation triggered by : stress, high emotion and drug misuse
30
How would you investigate schizophrenia?
FBC. U&E, LFTs, TFTs, glucose, calcium, cortisol, cultures exclude organic causes - head injury, CNS infection, hypernatraemia, hypocalcaemia hyperthyroid, cushings alcohol, stimulants, hallucinogens
31
What is the PHQ and SADPERSONs score?
PHQ-9 score. This is a 9 question survey that is used to establish the severity of an individuals depression SADPERSONs score is used to calculate suicide risk, and might be appropriate if this patient revealed a suicidal intent, but would not be used as an initial assessment of depressio .
32
How would you manage Schizophrenia?
Conventional - Haloperidol, Chlorpromazine Atypical - Risperidone, Olanzapine (increased weight and sedative), Quetiapine *treatment resistant - Clozapine CBT
33
What are side-effects associated with conventional antipsychotics?
Extrapyramidal side-effects Parkinsonism acute dystonia (e.g. torticollis, oculogyric crisis) akathisia (severe restlessness) tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
34
What is schizoaffective disorder? What are the types?
Episodic disorder in which both symptoms of mood and schizophrenia are prominent within same illness, either simultaneously or within a few days of each other Depressive and Manic
35
How would you manage schizo affective disorder?
Depressive - depressant treatment Manic - same as schizophrenia
36
What are some delusional/paranoid disorders?
Pathological/Delusional jealousy - Othello syndrome Erotomania - someone famous/unattainable is in love with them Persecutory Delusions
37
What is Personality disorder?
Extreme persistent variation from normal range of one or more personality attributes, which causes an individual and/or family to suffer
38
When is diagnosis of Personality disorder normally made?
Unlikely to be made before 16 or 17
39
What are the 3 main clusters of PD?
Withdrawn Personality (A) Antisocial Personality (B) Dependant Personality (C)
40
Examples of withdrawn PD?
paranoid PD schizoid PD (similar to aspergers) schizotypal (risk of full blown schizophrenia)
41
Examples of dependant PD?
anxious avoidant PD dependant PD passive-aggressive PD
42
Examples of antisocial PD?
histrionic PD - OTT, emotional, atten seeking emotionally unstable PD - short fuse, impulsive borderline PD - intense, unstable relationships, most meet criteria for 2nd or 3rd PD psychopathic PD
43
How would you manage PD?
social skills training anger management group therapy nidotherapy
44
What is GAD and when does it start?
Generalised Anxiety Disorder - unrealistic or excessive anxiety and worry, which is generalized and persistent and not restricted to particular environmental circumstances 15 - 25 y/o
45
What are RFs for GAD?
>24 separated widowed divorced unemployed
46
How does GAD present?
feelings of threat and foreboding difficulty concentrating distractible insomnia nightmares
47
What things would you exclude before diagnosisng GAD?
caffeine, drug and alcohol use thyrotoxicosis if > 35 - more likely some other psychiatric disorder
48
management of GAD?
SSRI anti-depressants buspirone (5-HT1A partial agonist) beta-blockers benzodiazepines: use longer acting preparations e.g. diazepam, clonazepam cognitive behaviour therapy relaxation techniques
49
How can a panic attack present?
fear+ autonomic symptoms SOB palpitations chest pain tremor faintness
50
How would an anorexic patient present?
delayed menarche amenorrhoea bradycardia hypotension enlarged salivary glands lanugo hair Russell's sign
51
How would you investigate an anorexic patient?
rule out IBD, coeliac, hyperthyroid SUSS - sit up, squat and stand Muscle Power Reduced ECG U&Es magnesium - If hypokalaemia is refractory to replacement with potassium, may be due to concomitant hypomagnesaemia. This deficit must be corrected first calcium - same as above phosphate - refeeding can cause hypophosphataemia urinalysis - ketonuria
52
What blood results would you see in an anorexic patient?
hypokalaemia & hyponatraemia (laxative use) low FSH, LH, oestrogens and testosterone raised cortisol and growth hormone impaired glucose tolerance hypercholesterolaemia LFTs raised hypercarotenaemia (impaired metabolism) low T3 (TSH and T4 normal)
53
What is the criteria for diagnosing anorexia?
1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
54
How would you manage anorexia?
CBT-ED MANTRA - Maudsley anorexia nervosa treatment for adults *children - anorexia focused family therapy
55
What is refeeding syndrome?
Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person following a period of starvation
56
What are the metabolic results in refeeding syndrome?
hypophosphataemia hypokalaemia hypomagnesaemia abnormal fluid balance
57
How would you manage refeeding syndrome?
NICE recommend that if a patient hasn't eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days. NO RISK OF REFEEDING - Therapeutic feeding at caloric prescriptions of 1500-1800 kcal/day. Caloric prescriptions may increase by 400 kcal/day every 48-72 hours if patients tolerate prior caloric level, in order to achieve consistent weight change approximating 1-2 kg/week for inpatients
58
What is bulimia?
Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.
59
What is the criteria for diagnosing bulimia?
recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances) a sense of lack of control over eating during the episode recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. the binge eating and compensatory behaviours both occur, on average, at least once a week for three months. self-evaluation is unduly influenced by body shape and weight. the disturbance does not occur exclusively during episodes of anorexia nervosa.
60
How would you manage bulimia?
CBT-ED fluoxetine
61
What are risk factors for suicide?
male divorced, single, widowed lack of employment higher during spring and summer chronic illness history of deliberate self-harm
62
Self harm more common in which sex?
women
63
What are some questions to ask to assess severity of self-harm/suicide?
Was act planned and preparations made? Will or suicide note? Precautions taken to avoid discovery patient didn't seek help violence of the act? reaction to not dying? do they want to die?
64
What is OCD?
non-situational preoccupation in which there is subjective compulsion despite conscious resistance. Preoccupations can be thoughts (ruminations or obsessions) or acts (rituals or compulsions) insight is maintained anxiety precedes ruminations or rituals - which are seen as defence against anxiety
65
RFs for OCD?
genetic disposition Tourette's head injury encephalitis anankastic (obsessive-compulsive pd)
66
Management for OCD?
CBT (exposure and response prevention) Clomipramine (TCA) SSRIs
67
What is PTSD?
experience of trauma intrusive recollections in the form of thoughts, nightmares and flashbacks emotional blunting to avoid reminders of trauma increased arousal and hypervigilance must last atleast one month re-experiencing: avoidance: hyperarousal: emotional numbing
68
Management of PTSD?
high level of clinical suspicion watchful waiting may be used for mild symptoms lasting less than 4 weeks trauma-focused cognitive behavioural therapy (CBT) eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases paroxetine or mirtazapine
69
What are is ADHD?
incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent development delay up to the age of 16 years, six of these features have to be present; in those aged 17 or over, the threshold is five features
70
Management of ADHD?
a ten-week 'watch and wait referral to CAMHS Methylphenidate is first line in children and should initially be given on a six-week trial basis lisdexamfetamine
71
When can postpartum psychosis occur?
up to 12 weeks after after 6 weeks = lactational psychoses risk of further episode 50%
72
What are some RFs for postpartum psychoses?
first pregnancy bipolar fam hx psychoses adoption psychoses from husband
73
How does postpartum psychoses present?
depressive psychosis schizophrenia manic episode delirium 70% affective psychoses 25% schizophrenia lucid interval, prodoromal period with insomnia, irritability and restlessness may occur and then confusion
74
What are risk associated with postpartum psychoses?
suicide infantcide
75
How would you manage postpartum osychsoes?
admit AD and ECT if depressive anti-psych if mania and schizo (may cause cessation of breastfeeding as is sedative in nature) supportive psychotherapy required
76
What is postnatal puerperal depression?
non-psychotic minor or major depressive disorder develops later than psychoses or maternal blues usually around 3rd week
77
What are risk factors for puerperal depression?
increased risk with age decreasing social class high levels of anxiety in 1st and 3rd trimester prev. psych hx lacking personal social support lack of fish consumption stressful events before and after preg unplanned pregnancy
78
What scale to be used to assess puerperal depression?
Edinburgh Postnatal Depression Scale
79
Management for postpartum psychosis?
90% self-limiting, lasts less than a month Preventative - education, good anternatal care, treat depression during pregnancy Supportive psychotherapy MAOIs - secreted In breasts milk but not adverse effects 40% > recurrent mood disease
80
How would you differentiate Malingering and Munchausen's?
Munchausen's - PURPOSEFULLY causing symptoms - e.g. hypoglycaemia Malingering - faking symptoms - for personal gain
81
How would you differentiate Conversion disorder and Dissociative disorder?
Conversion - loss of function with no cause Dissociative - similar but loss of function is non-physical e.g. loss of memory
82
Anorexia features? G's and C;s?
``` Growth hormone Glucose Salivary glands Cortisol Cholesterol Carotinaemia ``` all LOW
83
When treating someone with mental health disease? What non-medical considerations to taken into account?
``` Risk themselves Risk to orders Risk of exploitation Insight? - compliance social circumstance and support ```

Psychiatry (3 decks)

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