Affective Disorder Flashcards
Describe the MSE
A: apperance - apparent age, height weight and manner of dress and grooming. Colourful clothing may suggest mania where as an unkempt individual may be shizophrenic
Behaviour: Observations of specific abnormal movements as well as more general observations of the patient’s level of activity and arousal and observations of the patient eye contact and gait. CHoreform athetoid movement may indicate underlying neuro disorder, tremor or dystonia may indicate antipsychotic medications side effect
Speech: Loudness, rhtyhm prosody, intonation, pitch atricualtion, quantity rate spontaneity and latency of speech.
Emotion
- Mood: patients own word to describe mood
- affect labelling the apparent emotion conveyed by the persons non verbal behaviour, and also by using the parametes of appropriateness, intensity range reactivity and mobility
Perception
-Hallucination: sensory pereception in the absence of any external stimulus and is experienced in external or objective space (i.e experienced by the subject as real)
-Illusion is defined as a false sensory perception in the presnece of an external stimulus - a distortion of a sensory experience
-Psuedohallucination is experienced in internal or subjective space (voices in my head)
Visual hallucinations are gnerally suggesitve of organic conditions such as epilepsy where as auditory hallcuinations are typical of psychosis
Thought
#Process - quantity temp and form. Thought blocking, tangential thinking, deraliment of thought
#Content:
-Delusions: three essential qualtiies: it can be defined as a false unshakeable idea or belief that is
1) out of keeping with the patients educationl culture and social background
2) held with extraordinary conviction and subjective certanity
3)core feature of psychotic disorders
Insight/Judgemnt:
- Insight: persons understanding of his or her metnal illness
- Judgment referes to the patients capacity to make sound reasoned and responsible decisions.
Cognition
- Alertness
- orientation
Discuss precipitants of depressive episodes
Genetics
- Previous trauma
- Childhood factors
- social supports
- cultural issues
- physical factors
- stress
- adverse life events
- Carers oft those with chronic illness are at risk
Depression associated with physical illness may be
- a direct effect (hypothyroidism)
- A reaction to illness (chronic pain)
- a side effect of treatment (steroids)
Discuss Major Depressive disorders
Bimodal distribution of onset
-early 20s
-in 50s
Women affected twice as often as men
Diagnosis
- signs and symptoms need to be present for at least 2 weeks
- Symptoma in at least 5 of the following 9 catefories with at least one of the symptoms either depressed mood od loss of interest or prleasure
1) depressed mood most of the day every day
2) diminished interest in activities
3) Sleep disorder
4) significant (>5% in a month) weight loss whilst not dieting
5) poor concentration
6) guild/worthlessness
7) psychomotor changes
8) fatigue
9) recurrent thought of death or suidice
Must lead to distress or fucntional impairment Must not be a direct effect of -substance use -medical condition -bereavement
10 year conversion rate to BPD type2 is 9%
Describe minor depressive disorder
2-4 of the symptoms for major depressive disorder with the same other stipulations
Present for at least 2 weeks
can only be made in patients wihtout a history of
-major depression
-dysthymia
-bipolar
-psychotic disorders
Progresses to major depression within a year in 25% of cases
Describe dysthymic disorder
Sad mood for more days than not
accompanied by another 2 symptoms of major depressive disorder
duration of at least 2 years
Discuss management options for affective disorders
Mild
-CBT
Moderate
- pharm
- CBT
Severe
-Pharm
CBT
EST
Discuss risk factors to suicide
DEMOGRAPHIC
- Male gender (OR 2.6)
- indigenous
- in custody
PSYCHIATRIC DIAGNOSIS (OR 3.5)
- present in 90% of completed suicide
- depression
- psychosis
- Anxiety disorder
OTHER
- Substance abuse
- availability of effective means
- social isolation
- previous self herm
- Experiences of adveristy
- Sexual abuse
- Conflicts with sexual identidy
- Stressful events precede suicide in msot cases
- recent disruption of a personal relationship
- recent hospitailisation for mental llness
- antidepressant use in patients <25 years of age
Discuss lethality factors for suicide
High risk in the immediaet term (IPMO)
- Intention
- Plan
- Motivation
- Opportunity
Discuss the SAD PERSON’S INDEX
- Sex M>F
- AGE >45 or <19
- Depression
- Previous attemtps
- Ethanol
- R loss of rationality
- Spouse absent orpresent
- Organised plan
- No Support
- Sickness
0+4 - low risk discharge with follow-up
5-6 moderate risk consider hospitalisation
7-10 high risk
Poor sensitivity and specificity 50% sens and 63% specific
Discuss bipolar disorder, classifications
Life time prevalance 1.6%
Strong genetic element
Bipolar 1
- At least one lifetime episode of mania and usually (but not necessarily) epsiodes of depression
- may also include episodes of hypomania
Bipolar 2
- Episodes of both hypomania and depression
- no manic episodes
- more common in females
- cyclothymic disorder
Discuss natural history of bipolar disease
Onset most commonly in early 20s
Patients experience episodes of mania, hypomania, depressed or mixed
-depression/mania 3:!
-first depressive episodes usually preceds manic/hypomanic episode
-each episode last approximately 3-6 months
-shares many characteristics with major depression but episodes of hypomania and mania are distintinctive
Describe Manic episodes
Distinct period of abnormally and persistently elevated expansive or irritable mood lasting at least a week
3 symptoms out of 7 present to significant degree
1) inflated self esteem or grandiosity
2) decreased need for sleep
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility
6) increase in goal directed activity
7) excessive involvement in pleasurable activities that have protentional for painful consequences
Other features
- disturbance is sufficiently severe to cause marked impairment in fucntioning
- not due to effects of substance or medical condition
Compare and contrast mania from hypomania
Hypomania
-clinical features of mania
-episodes of at least several days induration
no marked functional impairment psychotic features or hospitalization
-psychosis never present
-functioning improved or mildly impaired
-lasting weeks
Mania
- psychosis often present
- functioning markedly impaired
- hospitalisation required
- duration months
Discuss management of Bipolar
Acute mania in the ED should be initially managed with orals - olanzapine 10mg
-halo or droperidol are alternatives
Long term lithium is the mainstay of treatment
-high rates of non compliacne
Some newer treatments involve
- carbamexapine
- valproate
- atypical antipsychotics
Compare and contrast drug induced psychosis from shizophrenia
Drug induced
- Speed – sudden
- usually in 20s
- usually less than a week folowing acute use up to 6 months with chronic
- history of mental heath may be absent
- agitation and violence common
- auditory hallucinations rare
- paranoia vommon
- delusions uncommon and variable
- affect appropriate
- thought blocking rare
Shizo
- Speed – slow
- usually in teens
- more than 6 months
- present unless first episode
- agitation and violence less common
- auditory hallucinations common
- paranoia common
- delusions common
- affect blunted
- thought blocking common