Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Affect Disorders > Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is treatment for Depression?

A 
CBT
SSRIs (fluoxetine, citalopram, sertraline)
SNRIs (duloxetine, venlafaxine)
TCAs (amitriptyline)
MAOIs (phenelzine)
NassA (mirtazapine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some side effects of SSRIs?

A

GI side effects

Serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some side effects of TCAs?

A

arrythmias - prolonged QT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What precautions need to be taken for MAOIs?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs can cause Serotonin Syndrome?

A

SSRIs, MAOIs, Ectasy and Amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would Serotonin Syndrome present?

A

Cognitive : agitation, confusion, euphoria, insomnia, hypomania

Autonomic : tachycardia, HTN, fever, arrthymia

Neuromuscular : tremor, hyperreflexia, clonus, ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are differential diagnosis for Bipolar?

A

Increased activity and restlessness = hyperthyroid and anorexia nervosa

Schizophrenia

Agitated Depression

Severe OCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the therapeutic range for Lithium?

A

0.4 - 1.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some signs of Lithium Toxicity?

A

blurred vision

coarse tremor

muscle weakness

ataxia

N&V

seizures and coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are contraindications for Lithium?

A

renal insufficiency

CVS insufficiency

Addison’s

Untreated Hypothyroism`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When does Schizophrenia present?

A

2nd-3rd decade

And a smaller peak late middle age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are first rank symptoms of schizophrenia?

A

Auditory Hallucinations

Thought Alienation - insertion, withdrawal and broadcasting

Passivity Phenomena

Delusional Perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some paranoid schizophrenia symptoms?

A

Persecution

Reference

Exalted Birth

Bodily change

Jealousy

Hallucinating voices of threat or issue commands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a distinct sign of Hebephrenic Schizophrenia?

A

Irrresponsible and unpredictable behaviour - pranks etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is paraphrenia?

A

Late onset schizophrenia - after 60 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are differentials for schizophrenia?

A

Bipolar

Mania

Depression

Personality Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some risk factors for schizophrenia?

A

Family History (if both parents 46%)

Intrauterine complications/infections

Social Isolation

triggered by : stress, high emotion and drug misuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would you investigate schizophrenia?

A

FBC. U&E, LFTs, TFTs, glucose, calcium, cortisol, cultures

exclude organic causes - head injury, CNS infection, hypernatraemia, hypocalcaemia

hyperthyroid, cushings

alcohol, stimulants, hallucinogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the PHQ and SADPERSONs score?

A

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 .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How would you manage Schizophrenia?

A

Conventional - Haloperidol, Chlorpromazine

Atypical - Risperidone, Olanzapine (increased weight and sedative), Quetiapine

*treatment resistant - Clozapine

CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are side-effects associated with conventional antipsychotics?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is schizoaffective disorder? What are the types?

A

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
Q

How would you manage schizo affective disorder?

A

Depressive - depressant treatment

Manic - same as schizophrenia

36
Q

What are some delusional/paranoid disorders?

A

Pathological/Delusional jealousy - Othello syndrome

Erotomania - someone famous/unattainable is in love with them

Persecutory Delusions

37
Q

What is Personality disorder?

A

Extreme persistent variation from normal range of one or more personality attributes, which causes an individual and/or family to suffer

38
Q

When is diagnosis of Personality disorder normally made?

A

Unlikely to be made before 16 or 17

39
Q

What are the 3 main clusters of PD?

A

Withdrawn Personality (A)

Antisocial Personality (B)

Dependant Personality (C)

40
Q

Examples of withdrawn PD?

A

paranoid PD

schizoid PD (similar to aspergers)

schizotypal (risk of full blown schizophrenia)

41
Q

Examples of dependant PD?

A

anxious avoidant PD

dependant PD

passive-aggressive PD

42
Q

Examples of antisocial PD?

A

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
Q

How would you manage PD?

A

social skills training

anger management

group therapy

nidotherapy

44
Q

What is GAD and when does it start?

A

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
Q

What are RFs for GAD?

A

> 24

separated

widowed

divorced

unemployed

46
Q

How does GAD present?

A

feelings of threat and foreboding

difficulty concentrating

distractible

insomnia

nightmares

47
Q

What things would you exclude before diagnosisng GAD?

A

caffeine, drug and alcohol use

thyrotoxicosis

if > 35 - more likely some other psychiatric disorder

48
Q

management of GAD?

A

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
Q

How can a panic attack present?

A

fear+ autonomic symptoms

SOB

palpitations

chest pain

tremor

faintness

50
Q

How would an anorexic patient present?

A

delayed menarche

amenorrhoea

bradycardia

hypotension

enlarged salivary glands

lanugo hair

Russell’s sign

51
Q

How would you investigate an anorexic patient?

A

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
Q

What blood results would you see in an anorexic patient?

A

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
Q

What is the criteria for diagnosing anorexia?

A
  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
Q

How would you manage anorexia?

A

CBT-ED
MANTRA - Maudsley anorexia nervosa treatment for adults

*children - anorexia focused family therapy

55
Q

What is refeeding syndrome?

A

Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person following a period of starvation

56
Q

What are the metabolic results in refeeding syndrome?

A

hypophosphataemia
hypokalaemia
hypomagnesaemia
abnormal fluid balance

57
Q

How would you manage refeeding syndrome?

A

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
Q

What is bulimia?

A

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
Q

What is the criteria for diagnosing bulimia?

A

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
Q

How would you manage bulimia?

A

CBT-ED

fluoxetine

61
Q

What are risk factors for suicide?

A

male

divorced, single, widowed

lack of employment

higher during spring and summer

chronic illness

history of deliberate self-harm

62
Q

Self harm more common in which sex?

A

women

63
Q

What are some questions to ask to assess severity of self-harm/suicide?

A

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
Q

What is OCD?

A

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
Q

RFs for OCD?

A

genetic disposition

Tourette’s

head injury

encephalitis

anankastic (obsessive-compulsive pd)

66
Q

Management for OCD?

A

CBT (exposure and response prevention)

Clomipramine (TCA)

SSRIs

67
Q

What is PTSD?

A

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
Q

Management of PTSD?

A

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
Q

What are is ADHD?

A

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
Q

Management of ADHD?

A

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
Q

When can postpartum psychosis occur?

A

up to 12 weeks after

after 6 weeks = lactational psychoses

risk of further episode 50%

72
Q

What are some RFs for postpartum psychoses?

A

first pregnancy

bipolar

fam hx psychoses

adoption psychoses from husband

73
Q

How does postpartum psychoses present?

A

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
Q

What are risk associated with postpartum psychoses?

A

suicide

infantcide

75
Q

How would you manage postpartum osychsoes?

A

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
Q

What is postnatal puerperal depression?

A

non-psychotic minor or major depressive disorder

develops later than psychoses or maternal blues

usually around 3rd week

77
Q

What are risk factors for puerperal depression?

A

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
Q

What scale to be used to assess puerperal depression?

A

Edinburgh Postnatal Depression Scale

79
Q

Management for postpartum psychosis?

A

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
Q

How would you differentiate Malingering and Munchausen’s?

A

Munchausen’s - PURPOSEFULLY causing symptoms - e.g. hypoglycaemia

Malingering - faking symptoms - for personal gain

81
Q

How would you differentiate Conversion disorder and Dissociative disorder?

A

Conversion - loss of function with no cause

Dissociative - similar but loss of function is non-physical e.g. loss of memory

82
Q

Anorexia features? G’s and C;s?

A 
Growth hormone
Glucose
Salivary glands
Cortisol
Cholesterol
Carotinaemia

all LOW

83
Q

When treating someone with mental health disease? What non-medical considerations to taken into account?

A 
Risk themselves
Risk to orders
Risk of exploitation
Insight? - compliance
social circumstance and support

Psychiatry (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions