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Year 5 Psych > Affective and Anxiety Disorders > Flashcards

Affective and Anxiety Disorders Flashcards

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1
Q

Risk Factors for suicide completion (scale)

A 
"SADPERSONS"
Sex (male)
Age (15-25 and >59)
Depression
Previous attempt
Excess ethanol or substance abuse
Rational thinking loss
Sickness
Organized plan
No spouse
Social support lacking

NB: in US, access to firearms is the biggest risk factor

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2
Q

Biological aspect to depression

A

Neurochemical and endocrine theories.
E.g. 5HT, NE, Da all decreased; stress increases cortisol which decreases neurotrophin level expression and damages hippocampal neurons

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3
Q

Psychosocial aspect to depression

A 
Childhood adverse events
Vulnerability reduces resilience (e.g. unemployment, lack support)
Life events
Substance misuse
Beck's triad
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4
Q

Beck’s triad (depression)

A

Worthlessness (self)
Helplessness (world)
Hopelessness (future)

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5
Q

Seasonal Affective Disorder

A

Depression with a seasonal pattern, often in winter

Tx: light therapy, CBT, anti-depressants

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6
Q

Atypical depression

A

Retain mood reactivity.

May have increased sleep and eating

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7
Q

Agitated depression

A

Depression with psychomotor agitation rather than retardation

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8
Q

MSE: Depression

A

A: signs neglect, dehydration, look miserable, disinterested, movements may indicate anxiety, poor eye contact, tearful,
S: Slow, quiet.
M: Restricted range of affect
P: in very severe, may have visuals of evil images, auditory hallucinations with unpleasant voices. Delusions-guilt, nihilistic (nothingness), persecutory
T: worthlessness, helplessness, hopelessness. Suicidal thoughts
C: psychomotor retardation or slowing of thoughts/speech can mimic cognitive impairment

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9
Q

Ddx-depression

A

Physical: hypothyroidism, head injury, cancer, quiet delirium, meds
Adjustment disorder (follows life event)
Bereavement (up to 6/12)
Chronic schizophrenia (blunted affect)
Bipolar disorder (always ask about periods energy–antidepressants dangerous if bipolar)
Postnatal blues/depression
Sementia
Dysthymia

Often co-morbid with panic dosorder, agoraphobia, OCD, eating/personality disorders

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10
Q

Depression criteria

A

5/9 of following for at least two weeks:
(“SIG E CAPS”)

Sleep (decreased, early morning awakening)
Interest decrease (anhedonia)
Guilt
Energy decrease
Concentration decrease
Appetite change
Psychomotor retardation or agitation
Suicidal ideation
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11
Q

Ix-depression

A

TFT
FBC
Glucose/HbA1c
Beck Depression Inventory or Hospital Anxiety and Depression Scale

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12
Q

Treatment of subclinical depression

A

Watch and wait (F/U in 2/52)
Sleep hygiene advice
Information about depression (what to look out for)

If persistent-written/web-based/standalone CBT materials +/- therapist
Schedule activities that help engage in behaviours that increase energy levels and develop interests/achievement
Group-based CBT
Exercise

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13
Q

Side effects of antidepressants

A

D&V, weight change (gain), blurred vision, anxiety, agitation, insomnia, tremor….

Contraindicated in bipolar
Affected by P450 inducers/inhibitors

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14
Q

When to refer depressed pt to secondary care

A

High suicide risk
Severe depression
Unresponsive to tx

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15
Q

Bipolar-definition

A

Requires two episodes, one of which must be hypomanic, manic, or mixed.
Recovery usually complete between two episodes

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16
Q

Biological and social factors in bipolar

A

Bio:
Genetic: 1st degree relative increases risk 7x.
Increased E, NE, Da, 5HT –> mania

Social:
Stressful life events….PREGNANCY

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17
Q

Mania definition

A

Lasts at least one week, disturbs occupational/social functioning

"DIG FAST"
Distractibility
Irritability
Grandiosity
Flight of ideas
Agitation/aggression
Speech-pressured
Talkative

May have psychotic symtpoms

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18
Q

Type I bipolar

A

Manic episodes interspersed with depressive episodes

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19
Q

Type II bipolar

A

Mainly recurrent depressive episodes, less prominent hypomanic episodes

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20
Q

Rapid cycling bipolar

A

Four or more affective episodes in a year
Women
Valproate

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21
Q

When to admit bipolar pt

A

High risk suicide/homicide
Severe psychotic/manic/depressive symptoms
Severe cylcing
Catatonic symptoms

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22
Q

Biological tx in bipolar

A

Lithium first line. Takes 2/52 to work so add benzo or antipsych in meantime
Valproate, benzos, carbamazepine
Severe behavioral disorder: haloperidol, clonazepam
If acute manic episode (severe/life-threatening): ECT

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23
Q

Psychosocial tx in bipolar

A 
Psychoeducation
CBT
interpersonal and social rhythm therapy
Family therapy
Support groups
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24
Q

OCD-definition

Plus definitions obsessions and compulsions

A

Anxiety-producing obsessions which they try to relieve with rituals (compulsions)

Obsessions: involuntary thoughts, images, or impulses that are recurrent/intrusive, enter mind against conscious resistance, and pt recognizes obsessions product of owns mind even though involuntary and often repugnant

Compulsiosn-repetitive metntal operations or physical acts. Feel compelled to perform, and done to relieve anxiety through belief they will prevent dreaded event

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25
Q

OCD-biological aspects

A

Genetic risk
Neuro: basal ganglia implicated
NTs: 5HT dysregulation

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26
Q

OCD-psychosocial

A

Anankastic personality traits (rigidity, orderliness)
Stress may precipitate
Young age

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27
Q

Body dysmorphic disorder

A

Preoccupation with imagined defect in appearance.

Time consuming behaviors (e.g. mirror gazing, excessive camouflaging techniques, skin picking, reassurance-seeking)

28
Q

Anankastic personality disorder

A

Aka obsessive compulsive personality disorder

Rigidity of thinking, perfectionism, orderliness, moralistic preoccupation with rules, tendency to hoard

29
Q

Tx-OCD

A

CBT incl exposure therapy and relapse prevention
Behavioral therapy-response prevention
Psychotherapy
SSRIs high dose for at least 12/52 (escitalopram, fluoxetine, sertraline, paroxetine)
Clomipramine if above SSRIs don’t work
Antipsychotics if psychotic features, tics, or schizotypal traits (risperidone)
ECT if suicidal or severely incapacitated

30
Q

Biological aspect to personality disorders

A

Henetic inheritance
Hx depression, EtOH dependence
Some NT disturbances or EEG findings (psychopathy)

31
Q

Psychosocial causes of personality disorders

A

Cognitive and psychoanalytic theroeis: expectations tend to be fulfilled (open and confident people receive more friendly responses)
Maladaptive schema-formed in childhood
Narcissistic and borderline personalities display primitive defense mechs (splitting, projection, fantasizing, reaction formation)
Childhood temperament
Childhood experience (“people feel lovable because they were first loved”)

32
Q

Clusters of personality disorders

A

“Weird, wild, and worried”
A (weird): odd/eccentric, paranoid, schizoid
B (wild): dramatic, erratic, emotional, histrionic, emotionally unstable, dissocial
C: (worried): anxious/fearful, anankastic, anxious/avoidant, dependent

33
Q

Paranoid personality disorder

A

Unforgiving, suspicious, possessive/jealous of partners, excessive self-importance, conspiracy theories.

34
Q

Schizoid personality disorder

A

“All alone”
Anhedonic, limited emotional range, little sexual interest, apparent indifference to praise/criticism, normal social conventions ignored, excessive fantasy world/introspection

“Schizoids avoid”–just not really into being around others

35
Q

Dissocial personality disorder

A

FIGHTS
Can’t maintain relationships, irresponsible, guitless, heartless, always someone else’s fault
Evidence childhood conduct disorder

36
Q

Emotionally unstable

A

Affective instability
Explosive behavior, impulsive, outburts of anger, unable to plan/consider consequences

Borderline type-self-image unclear, chronic empty feelings, abandonment fears, suicide attempts and self harm

Impulsive type-lack impulse control, outburt of threat/violence, sensitivity to being thwarted/criticized

37
Q

Histrionic personality disorder

A

Attention seeking, concerned with appearance, theatrical, open to suggestion, racy/seductive, shallow affect
Manipulative behavior

38
Q

Avoidant personality disorder

A

Avoid social contact–would like to be around people, but anxious
Doesn’t get involved unless sure of acceptance

39
Q

Dependent personality disorder

A

Subordinate, undemanding, feels helpless when alone
Fears abandonment, encourages others to make decisions, reassurance needed
Clinging, excess need for care

40
Q

Anorexia nervosa-definition

A

Morbid fear of gaining weight, deliberate weight loss, distorted body image, amenorrhea, BMI

41
Q

Biological aspects to anorexia nervosa

A

Genetic
NTs: 5HT
Hypothalamic dysfunction
Neuro: pseudoatrophy with sulcal widening and ventricular enlargement

42
Q

Psychosocial aspects to anorexia nervosa

A

Parental overprotectiveness, weak generational boundaries, lack of conflict resolution, rigidity.
Escape from problems in adolescence
Culture: Westerns “ideal body” is unusually thin
Past exposure to dieting behavior (childhood obesity, parental obesity)
Childhood feeding difficulties, picky eating, childhood perfectionism, OCD, negative self-evaluation

43
Q

Complications anorexia nervosa

A

Highest mortality of psychiatric illnesses (including depression)

CVS: arrhythmias, cardiomyopathy, long QT, signif bradycardia. Common cause of death

Endo/GI: hypokalemia, hyponatremia, hypoglycemia, hypothermia, hypercortisolemia, amenorrhea, delayed puberty, osteoporosis

Repro: decreased fertility
Neuro: peripheral neuropathy, loss brain volume

Etc etc.

NB REFEEDING SYNDROME. If re-feed too quickly, electrolyte disturbances (K) and then death by arrhythmia

44
Q

Subtypes of anorexia

A 
Restricting type (restrict calories)
Binge and purge type

NB: binge and purge may resemble bulimia, but MAIN DIFFERENTIATOR is the weight: anorexics are underweight, bulimics are normal or overweight

45
Q

Tx-anorexia nervosa

A

Biological: fluoxetine
Psycho: family therapy, CBT, nutritional education, psychodynamic psychotherapy
Social: interpersonal therapy

46
Q

Bulimia nervosa

A

Binging and excessive preoccupation with control of body weight. Binges followed by compensatory behavior, e.g. vomiting, fasting, excessive exercise

47
Q

Etiology bulimia

A

Similar to anorexia
Genetics
Hx dieting, negative self-evaluation, parental obesity, weight-related criticism, EtOH and substance misuse, depression

48
Q

Complications bulimia

A

Dental erosion and caries
Electrolyte disturbances: arrhythmias, metalbolic acidosis if laxative use, alkalosis if vomiting, ulcers, pancreatitis, constipation/steatorrhea

49
Q

Tx-bulimia

A

Bio: fluoxetine, medical stabilization
Psycho: CBT, self-help
Social: support groups

50
Q

SCOFF questionnaire

A

Screening for anorexia nervosa and bulimia.

  1. Do you make yourself SICK because you feel uncomfortably full?
  2. Do you worry you have lost CONTROL over how much you eat?
  3. Have you recently lost mrore than ONE stone in a 3-mo period?
  4. Do you believe yourself to be FAT when others say you are thin?
  5. Would you say that FOOD dominates your life?
51
Q

Psychosocial causes anxiety

A

Childhood adversity
Life events can trigger
Classical conditioning
Negative reinforcement (e.g. running away relieves anxiety)
Cognitive theories: worrying thoughts repeated automatically which induce and maintain worry response
Attachment theory: insecure styles of attachment to parents become anxious adults

52
Q

Sxs anxiety

A

Fear, poor concentration, irritability, depersonalization/derealization, insomnia, night tremors
Restlessness, fidgeting, feeling on edge
Trembling, tension HA, muscle aches
Dry mouth, difficulty swallowing, nausea, loose/frequent motions
Erectile dysfunction, amenorrhea, urinary frequency
Tight chest, palpitations

53
Q

Generalized anxiety disorder

A

Not associated with specific external threat. Excessive worry or apprehension about many normal life events
>6/12
Has at least one sxs of autonomic arousal (e.g. tachy, sweating, shaking, dry mouth)

54
Q

Agoraphobia

A

Fear of being unable to escape into a safe place (e.g. home)
May manifest in open spaces that are difficult to leave without attracting attention
95% have current or past dx of panic disorder

55
Q

Social phobia

A

Fear of being criticized or scrutinized; worry that they will be embarrassed in public. Will tolerate anonymous crowd (unlike agorophobics) but small groups are intimidating.
Self-medication with alcohol or drugs =avoidance and perpetuates problem

56
Q

Panic disorder

A

Episodic anxiety attacks, not restricted to certain situations or objective danger.
May have fear of having further attachs
Panic can persist until pts receive reassurance or reverts to “safety behaviors” e.g. calling ambulance, taking aspirin

Pts may think they are dying, having MI, or going mad which can further increase anxiety levels

57
Q

Acute stress reaction

A

1-3 days

Anxious but may seem dazed, may have amnesia, depersonalization, derealization

58
Q

PTSD

A

Persistent flashbacks, vivid memories, recurring dreams
Actual or preferred avoidance of circumstances remembling or associated with stressor
Inability to recall, partially or completely, some important aspects or period exposure to stressor

59
Q

Adjustment disorder

A
60
Q

Grief reaction

A

Anger, guilt, self-blame, searching and pining (vivid dreams dead person being alive, pseudohallucinations), sadness and despair, acceptance

61
Q

Tx-GAD

A

Buspirone for psych sxs
BDZ for somatic sxs
CBT

62
Q

Tx-agoraphobia

A

Antidepressants
Beta blockers
CBT

63
Q

Tx-panic disorder

A

SSRIs
CBT
Psychodynamic psychotherapy

64
Q

Tx-PTSD

A

Trauma-focused CBT and EMDR (eye movement desensitization and reprocessing)

Sleep disturbance: mirtazapine
Anxiety/hyperarousal: BDZ

65
Q

Tx-adjustment disorder

A

Antidepressants, anxiolytics, or hypnotics
Supportive psychotherapy, practical support

Verbalization of feelings prevents maladaptive behavior

Year 5 Psych (5 decks)

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