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CMS150 > Anxiety & Depression > Flashcards

Anxiety & Depression Flashcards

1
Q

what things are assessed as part of a Mental Status Exam (10)

A

appearance & behaviour
motor activity
speech
affect and mood
thought process
thought content
perception
sensorium and cognition
insight
judgement

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2
Q

what conditions fall under the category of anxiety disorders

A

generalized anxiety disorder
panic disorder
obsessive compulsive disorder
phobia-related disorders
trauma and stressor-related disorders: stress not elsewhere classified, adjustment disorder, acute stress disorder

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3
Q

what is the most common type of psychiatric disorder?

A

anxiety disorders

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4
Q

what can be some organic causes of anxiety?

A

endocrine - hyperthyroidism, pheochromocytoma, hyperparathyroidism
cardiopulmonary - heart failure, arrhythmias, asthma or COPD
neurologic - temporal lobe epilepsy or TIAs
medication - corticosteroids, cocaine, amphetamines, caffeine, withdrawal

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5
Q

fear definition

A

an emotional, physical, and behavioural response to an immediately recognizable external threat
within a normal/typical range

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6
Q

phobia definition

A

an excessive fear response to a specific object or situation that is out of proportion to the actual danger
can occur with no danger present
causes significant dysfunction due to avoidance behaviour

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7
Q

anxiety definition

A

a distressing, unpleasant emotional state of nervousness and unease
causes are less clear and timing is less tied to a threat (anticipatory, persistent, non-identifiable)
can have physical changes and behaviours similar to those caused by fear

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8
Q

stressor-related disorder definition

A

a single, discrete event or multiple events, or ongoing problems that lead to mental distress that is more intense than what is typically expected or when the person’s ability to function is significantly impaired

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9
Q

key features of generalized anxiety disorder (GAD)

A

excessive worry about everyday issues and situations almost daily for a duration of 6 months or greater with multiple somatic symptoms
present more days than not
anxiety concerning every day or routine circumstances or events, difficult to control, associated with symptoms such as restlessness, concentration problems, irritability, tension, and/or fatigue

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10
Q

what is late onset GAD?
what are the implications/prognosis

A

develops in someone who is over the age of 50
have poorer health related quality of life and poorer disease outcomes compared to those diagnosed with GAD earlier in life

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11
Q

prognosis of GAD

A

43% may develop major depression
20-25% increased risk of suicide
90% of patients with GAD have other psychiatric disorders

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12
Q

Mental Status Exam observations in GAD

A

well kempt or disheveled
psychomotor agitation
speech fast or pressured
mood described as worried, afraid, tense, exhausted, frustrated, irritable or depressed
affect may be blunt or guarded
thoughts include ruminations
difficulty concentrating
avoidance behaviours

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13
Q

panic attack vs panic disorder

A

panic attack is the onset of a discrete period of discomfort, anxiety, or fear that reaches a peak within minutes, accompanied by somatic and or cognitive symptoms
panic disorder - occurrence of repeat panic attacks followed by at least 1 month of worrying about having another panic attack or behavioural change related to the panic attacks

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14
Q

agoraphobia definition

A

an anxiety disorder/phobia with a fear of being in situations where escape may be difficult or that help won’t be available if things go wrong

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15
Q

what population is most affected by panic disorder
median age of onset?

A

median age of onset: 24 yo
it’s uncommon for individuals to develop panic disorder in their later years

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16
Q

risk factors for panic disorder

A

genetic
female 2x risk
increased stress
asthma

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17
Q

prognosis for panic disorder

A

50% comorbidity with major depression
32% comorbidity with GAD

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18
Q

what is the most common symptom associated with panic attacks?

A

palpitations

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19
Q

Mental Status Examination observations in panic disorder

A

well kempt or disheveled
psychomotor agitation
speech fast or pressured
mood described as anxious, afraid, tense, exhausted, frustrated, on edge, irritable, or depressed
may show more lability
thoughts include ruminations, extreme fear, impending doom, anticipatory anxiety about having another panic attack

20
Q

what is lability

A

frequent shifts in emotional expression, unstable or quickly changing mood

21
Q

what screening tool is the best for confidently ruling in panic disorder

A

PHQ-PD 5 score of 8 or more

22
Q

key things to know about “stress, not elsewhere classified”

A

it is not a diagnosis itself but considered a risk factor, an exacerbating factor and a treatment target
a physical or mental response to an external stressor which may be a single or repeated, short or long term occurrence
can be positive or negative

23
Q

risk factors for “stress, not elsewhere classified”

A

life events

24
Q

adjustment disorder description

A

a maladaptive emotional and/or behavioural response to an identifiable psychosocial stressor
difficulty adjusting after a stressful event at a level disproportionate to the severity or intensity of the stressor

25
Q

risk factors for adjustment disorder

A

significant life events

26
Q

prognosis of adjustment disorder

A

71% recover within 5 years
76% comorbidity with substance abuse and if this is the case, tends to have poorer outcomes

27
Q

what conditions fall under the category of mood disorders

A

depression (major depressive disorder)
bipolar disorder
adjustment disorder with depressed mood
seasonal affective disorder
premenstrual dysphoric disorder or postpartum/peripartum onset depression
substance/medication induced mood disorder
borderline personality disorder
anxiety disorders including clinical burnout and obsessive compulsive disorder

28
Q

organic causes of mood disorders

A

endocrine: hypothyroidism, Addison’s disease
neurological: multiple sclerosis, stroke, cerebral tumour

29
Q

dysphoria definition

A

a mood state associated with feelings of sadness, despair, anxiety, emptiness, discouragement, or hopelessness
having no feelings
or appearing fearful
you can have dysphoria and not have a medical condition, it is just a problem when it becomes persistent or more significant that it is clinically considered a disorder

30
Q

minor depressive episode vs major depressive episode

A

minor depressive episode is a mood syndrome with clinically significant distress and impaired functioning but with fewer symptoms (2-4) and tends to have shorter episodes, less comorbidity, fewer recurrences than major depression
major depressive episode has 5 or more symptoms and tends to have greater psychosocial and physical impairment

31
Q

another term for dysthymia

A

persistent depressive disorder

32
Q

how does persistent depressive disorder differ from major or minor depression

A

symptoms persist for 2 years or more
thought to be a lower grade but more persistent type of depression

33
Q

symptoms of depression

A

dysphoria
anergia/fatigue
anhedonia
psychomotor retardation or agitation
significant appetite or weight change
insomnia or hypersomnia
suicidality
loss of confidence, thoughts of worthlessness or hopelessness
inappropriate guilt or regret
impaired concentration or memory

34
Q

how long does someone have to be experiencing symptoms of depression for it to be considered minor depression

A

at least 2 weeks

35
Q

prognosis for minor depression

A

<20% progress to major depression
6-9x risk for having major depression
3x greater risk of suicide
30% greater risk of all-cause mortality

36
Q

early onset persistent depressive disorder (PDD) vs late onset PDD

A

early onset <21 years
late onset >21 years

37
Q

risk factors for persistent depressive disorder

A

female 2x greater risk
genetic
history of anxiety
substance use
adverse life events

38
Q

prognosis for persistent depressive disorder

A

45% relapse within 2 years
increased risk for suicide attempts

39
Q

what is the common term for unipolar major depression

A

major depressive disorder

40
Q

what ages groups seem to be most affected in major depressive disorders

A

median age of onset is 30 yo
younger adults have greater risk than older adults BUT some older adults or middle aged adults are at greater risk because of the burden of medical conditions or living in LTC homes

41
Q

prognosis for major depressive disorder

A

25x greater risk of suicide
52% increased risk of all cause mortality
some progress to schizophrenia-spectrum disorders in psychiatric setting

42
Q

when is the risk of recurrence in major depression the greatest

A

recurrence the most after 20 years (compared to 5 and 10 years) but the risk of recurrence is the greatest in the first 2 months after a major depressive episode

43
Q

Mental Status Exam observations in clinical depression

A

well kempt or disheveled
may self harm, see weight loss or gain
stooped posture
poor eye contact
psychomotor retardation, occasionally agitation
speech decreased rate and volume, monotone, paucity/poverty of speech
mood described as depressed: numb, hopeless, worthless, irritable, sad, empty
constricted, blunted or flat affect
preservations about negative themes or suicidality
delusions or hallucinations that are mood congruent

44
Q

clinical burnout description

A

a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment resulting from chronic workplace stress that hasn’t been managed well/successfully
not a mental disorder per-se, but can lead to mental health problems

45
Q

risk factors for clinical burn out

A

being employed
business start ups, especially in the first 2 years

46
Q

key presenting features of clinical burn out

A

emotional exhaustion
depersonalization - increased mental distance, reduced compassion, ore feelings of negativity or cynicism related to one’s job
lacking a sense of personal accomplishment

47
Q

prognosis for clinical burn out

A

increased risk of psychiatric conditions - especially anxiety or depression
insomnia often affects these individuals

CMS150 (6 decks)

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