affective disorders and self harm Flashcards
define euthymic
normal mood
define hyperthymic
elevated mood
define cyclothymic
variable mood
define anhedonia
loss of enjoyment or pleasure
define stupor
the lack of critical mental function and a level of consciousness
patient only responds to intense stimuli e.g. pain
what are tactile hallucinations
the feeling of things crawling on the skin
name some risk factors for depression
alcohol/drugs, abuse, unemployment, previous diagnosis, chronic disease, urban population
what is cotard’s syndrome
delusion in which people believe they are dead, do not exist, are putrefying or have lost their blood or internal organs
what is somatic depression
marked loss of interest, lack of emotional response, waking in the morning, depression worse in the morning, loss of appetite, loss of libido
clinical presentation of atypical depression
mood reactivity, weight gain or increase in appetite, hypersomnia, leaden paralysis
what is leaden paralysis
heavy, leaden feeling in arms or legs
classic presentation of depression
triad of anhedonia, anergia and amotivation
MSE: speech in depression
reduced rate, lower pitch, reduced volume and intonation
depression questionnaire used in primary care
PHQ-9
depression questionnaire used in secondary care
HAD
medical management pathway for depression
1st line - SSRI (sertraline)
2nd line - switch SSRI
3rd line - SNRI, tricyclic
when does bipolar disorder usually present
late teens - early 20s
what is bipolar 1
at least one manic episode with or without a history of major depressive episodes
what is bipolar 2
one or more major depressive episode and at least one hypomanic episode, but NO evidence of mania
clinical presentation of a hypomanic episode
persistent - lasting several days
elevation of mood, irritability, activity
increased talkativeness, racing thoughts, decreased need for sleep
how does a manic episode differ from a hypomanic episode
lasts at least one week, impulsive or reckless behaviour, flight of ideas
what MUST be ruled out before a diagnosis of bipolar disorder is made
substance misuse
first line management of an acute manic episode in bipolar
atypical antipsychotic
olanzapine, risperidone, quetiapine
what can be used for symptom control of an acute manic episode
benzodiazepines
first line management of an acute bipolar depression
atypical antipsychotic
why should antidepressants be avoided in bipolar depression
can cause rapid cycling mood
gold standard for bipolar maintenance and what should be added on depending on type
LITHIUM
+ valproate if primarily manic
+ lamotrigine if primarily depressed
pathophysiology of self harm
promotes the release of endorphins - brings temporary distress reduction
what is another name for postpartum psychosis
puerperal psychosis
when does postpartum psychosis usually present
2-4 weeks postpartum
risk factors for postpartum psychosis
family history, first pregnancy, C-section, perinatal death, history of mental illness, previous episode
what is capgras delusion
belief by the patient that the close person is replaced by an imposter who looks physically the same
first line management of postpartum psychosis
antipsychotic
which antipsychotics are safe to take while breastfeeding
olanzapine and quetiapine
what is postnatal depression
depression that develops up to a year after the birth of a baby
risk factors for postnatal depression
family history, complicated pregnancy/traumatic birth, history of abuse, lack of support
name some transient causes of confusion
delirium, post-ictal, migraines, delirium tremens
name some enduring causes of confusion
TBI, dementia, alcohol related
what is the most common neuropsychiatric complication of stroke
post-stroke depression
