Anxiety & Depression

Question 1

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

Answer 1

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

Question 2

what conditions fall under the category of anxiety disorders

Answer 2

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

Question 3

what is the most common type of psychiatric disorder?

Answer 3

anxiety disorders

Question 4

what can be some organic causes of anxiety?

Answer 4

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

Question 5

fear definition

Answer 5

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

Question 6

phobia definition

Answer 6

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

Question 7

anxiety definition

Answer 7

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

Question 8

stressor-related disorder definition

Answer 8

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

Question 9

key features of generalized anxiety disorder (GAD)

Answer 9

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

Question 10

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

Answer 10

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

Question 11

prognosis of GAD

Answer 11

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

Question 12

Mental Status Exam observations in GAD

Answer 12

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

Question 13

panic attack vs panic disorder

Answer 13

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

Question 14

agoraphobia definition

Answer 14

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

Question 15

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

Answer 15

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

Question 16

risk factors for panic disorder

Answer 16

genetic
female 2x risk
increased stress
asthma

Question 17

prognosis for panic disorder

Answer 17

50% comorbidity with major depression
32% comorbidity with GAD

Question 18

what is the most common symptom associated with panic attacks?

Answer 18

palpitations

Question 19

Mental Status Examination observations in panic disorder

Answer 19

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

Question 20

what is lability

Answer 20

frequent shifts in emotional expression, unstable or quickly changing mood

Question 21

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

Answer 21

PHQ-PD 5 score of 8 or more

Question 22

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

Answer 22

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

Question 23

risk factors for “stress, not elsewhere classified”

Answer 23

life events

Question 24

adjustment disorder description

Answer 24

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

Question 25

risk factors for adjustment disorder

Answer 25

significant life events

Question 26

prognosis of adjustment disorder

Answer 26

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

Question 27

what conditions fall under the category of mood disorders

Answer 27

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

Question 28

organic causes of mood disorders

Answer 28

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

Question 29

dysphoria definition

Answer 29

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

Question 30

minor depressive episode vs major depressive episode

Answer 30

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

Question 31

another term for dysthymia

Answer 31

persistent depressive disorder

Question 32

how does persistent depressive disorder differ from major or minor depression

Answer 32

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

Question 33

symptoms of depression

Answer 33

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

Question 34

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

Answer 34

at least 2 weeks

Question 35

prognosis for minor depression

Answer 35

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

Question 36

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

Answer 36

early onset <21 years
late onset >21 years

Question 37

risk factors for persistent depressive disorder

Answer 37

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

Question 38

prognosis for persistent depressive disorder

Answer 38

45% relapse within 2 years
increased risk for suicide attempts

Question 39

what is the common term for unipolar major depression

Answer 39

major depressive disorder

Question 40

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

Answer 40

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

Question 41

prognosis for major depressive disorder

Answer 41

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

Question 42

when is the risk of recurrence in major depression the greatest

Answer 42

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

Question 43

Mental Status Exam observations in clinical depression

Answer 43

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

Question 44

clinical burnout description

Answer 44

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

Question 45

risk factors for clinical burn out

Answer 45

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

Question 46

key presenting features of clinical burn out

Answer 46

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

Question 47

prognosis for clinical burn out

Answer 47

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