Affective Disorder Flashcards

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1
Q

Describe the MSE

A

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
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2
Q

Discuss precipitants of depressive episodes

A

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)
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3
Q

Discuss Major Depressive disorders

A

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%

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4
Q

Describe minor depressive disorder

A

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

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5
Q

Describe dysthymic disorder

A

Sad mood for more days than not
accompanied by another 2 symptoms of major depressive disorder
duration of at least 2 years

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6
Q

Discuss management options for affective disorders

A

Mild
-CBT

Moderate

  • pharm
  • CBT

Severe
-Pharm
CBT
EST

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7
Q

Discuss risk factors to suicide

A

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
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8
Q

Discuss lethality factors for suicide

A

High risk in the immediaet term (IPMO)

  • Intention
  • Plan
  • Motivation
  • Opportunity
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9
Q

Discuss the SAD PERSON’S INDEX

A
  • 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

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10
Q

Discuss bipolar disorder, classifications

A

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
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11
Q

Discuss natural history of bipolar disease

A

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

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12
Q

Describe Manic episodes

A

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
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13
Q

Compare and contrast mania from hypomania

A

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
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14
Q

Discuss management of Bipolar

A

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
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15
Q

Compare and contrast drug induced psychosis from shizophrenia

A

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
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