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Year 2 - Theme 3 > Affective disorders - clinical aspects > Flashcards

Affective disorders - clinical aspects Flashcards

1
Q

What is psychopathology

A
  • Abnormal experience, cognition and behaviour
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2
Q

What is descriptive psychopathology

A
  • describes and categorizes the abnormal experiences as reported by the patient and observed in behaviour
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3
Q

Classification of descriptive psychopathology

A
  • Observation of behaviour

- Phenomenology

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4
Q

What is phenomenology

A
  • Emphatic assessment of subjective experience
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5
Q

Standard sets of criteria used to classify al psychiatric disorders

A
  • The diagnostic and statistical manual for mental disorders(DSM)
    • The international classification of diseases(ICD)
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6
Q

Psychiatric examination

A

· Presenting symptoms and their chronology
· The psychiatric history
· Mental state examination
· Diagnosis

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7
Q

MDE - Appearance and behaviour

A
  • clothing, posture, gestures, gaze, attitude towards examiner, motor retardation, agitation (hand wringing, hair pulling), stooped posture, downcast gaze, catatonic features
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8
Q

MDE - Speech

A
  • Decreased rate and volume, delayed response, spontaneity
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9
Q

MDE - Mood, affect

A
  • Depression, anhedonia, reactivity of mood, anxiety, panic
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10
Q

MDE - Expression

A
  • Mood congruence
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11
Q

MDE - Thoughts

A

Form (thought blocking, slow flow of thoughts, associations maintained); Content (poverty of contents, non-delusional ruminations about loss, death, suicide,etc.); mood-congruent delusions (guilt, punishment)

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12
Q

MDE - Perception

A
  • Mood congruent hallucinations(rare)
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13
Q

MDE - Cognition

A
  • Oriented to person, place and time, memory and concentration impairment
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14
Q

MDE - Judgement and insight

A
  • Excessive, or poor
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15
Q

The affective episodes

A
  • Major depressive episode
  • Manic episode
  • Hypomanic episode
  • Mixed affective episode
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16
Q

Symptoms of depression

A 
· Depression of mood
	· Anhedonia
	· Psychomotor retardation
	· Agitation / restlessness
	· Anxiety / preoccupation
	· Diurnal variation of mood
	· Insomnia
	· Feelings of guilt , self-reproach worthlessness
	· Somatic symptoms
	· Hypochondriasis
	· Weight loss
	· Suicidal thoughts
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17
Q

Major depressive episode - DSM V criteria

A

Five of more symptoms during 2 weeks period:

  1. Depressed mood most of the day, nearly every day
  2. Diminished interest or pleasure
  3. Weight loss / weight gain or appetite decrease / increase
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent suicidal ideation or a suicide attempt/plan
18
Q

What do symptoms of major depressive episode - DSM V criteria cause

A
  • Symptoms must cause clinically significant distress or functional impairment and are not attributable to the physiological effects of a substance or to another medical condition
19
Q

Melancholic features of major depressive episode - DSM V criteria

A

Loss of pleasure in all, or almost all, activities
Lack of reactivity to usually pleasurable stimuli
Profound despondency, despair, empty mood
Depression regularly worse in the morning
Early-morning awakening
Marked psychomotor agitation or retardation
Significant anorexia or weight loss
Excessive or inappropriate guilt

20
Q

Features of atypical depression

A

• Mood reactivity
and
• Significant weight gain or increase in appetite
• Hypersomnia
• Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
• interpersonal rejection sensitivity

21
Q

Features of the manic episode - DSM V diagnosis

A
  • abnormally and persistently elevated, expansive, or irritable mood
  • For a period lasting at least one week and present most of the day, nearly every day:
  • abnormally and persistently increased activity or energy
22
Q

Indicative symptoms of the manic episode - DSM V diagnosis

A
  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 racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity or psychomotor agitation
  7. Excessive involvement in high risk activities
23
Q

Effect of manic episode on functional capabilities

A
  • The mood disturbance is sufficiently severe to cause marked functional impairment or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
  • The episode is not attributable to the physiological effects of a substance or to another medical condition.
  • Can be associated to psychotic symptoms such as delusions and hallucinations
24
Q

Features of the hypomanic episode - DSM V diagnosis

A

For a period lasting at least 4 days and present most of the day, nearly every day:
• abnormally and persistently elevated, expansive, or irritable mood
• abnormally and persistently increased activity or energy

25
Q

Symptoms of the hypomanic episode - DSM v diagnosis

A
  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 racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity or psychomotor agitation
  7. Excessive involvement in high risk activities
26
Q

Effect of a hypomanic episode - DSM V diagnosis on functional capabilities

A
  • The episode is not severe enough to cause marked functional impairment or to necessitate hospitalization
  • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
  • The disturbance in mood and the change in functioning are observable by others.
  • The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment).
27
Q

Features that may be associated to both depression and mania

A
  • Anxiety
  • Restlessness, tension, worry, anticipatory anxiety, fear of losing control
  • Psychotic symptoms
  • Delusions and hallucinations, mood congruent or incongruent
  • Catatonia
28
Q

Features of mixed affective episodes

A
  • Full criteria met for either (hypo)manic or depressive episode, and
  • at least 3 symptoms of the opposite polarity are present
29
Q

MDD effect in terms of gender

A
  • Affects females more than males
30
Q

Age of onset for MDD

A
  • 25-35 years(but can be at any age)
31
Q

Prevalence of MDD

A
  • 1 in 5 lifetime prevalence
32
Q

What percentage of MDD patients die by suicide

A
  • 8-19%
33
Q

DSM V diagnosis of bipolar classification

A
  • Bipolar disorder I

- Bipolar disorder II

34
Q

Feature of bipolar disorder I

A
  • At least one manic episode
35
Q

Features of bipolar disorder II

A
  • At least one hypomanic episode

- At least one major depressive episode

36
Q

Peak age onset for bipolar disorder

A
  • 15-24 years old
37
Q

Prevalence of bipolar disorder

A
  • 0.6-2.4%
38
Q

Genetic effect - bipolar disorder

A
  • Familial aggregation(10 times higher risk in 1st degree relatives)
39
Q

Effect of bipolar disorder on men and women

A
  • Both affected equally
40
Q

General features of bipolar disorder

A
  • Highly recurrent

* May have progressive course

41
Q

Suicide rate comparison - bipolar disorder and general population

A
  • Rate of suicide > 20 times higher than general population

* 30%-50% of patients attempt suicide

Year 2 - Theme 3 (9 decks)

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