BAP guidlines; diagnosis and treatment Flashcards
Significant anxiety symptoms, impaired function with a history of trauma and flashbacks?
PTSD
Significant anxiety symptoms, impaired function with obsessions +/- compulsions
OCD
Significant anxiety symptoms, impaired function with uncontrollable worry about several areas
GAD
Significant anxiety symptoms, impaired function with intermittent panic/anxiety attacks due to a fear of social scrutiny?
Social phobia
Significant anxiety symptoms, impaired function with intermittent panic/anxiety attacks due to a discrete object/ situation?
Specific phobia
Significant anxiety symptoms, impaired function with intermittent panic/anxiety attacks which is uncued/spontaneous?
Panic disorder
Management of GAS?
CBT
Pharmacological: SSRI, duloxetine, pregabalin, quetiapine and benzodiazepines
Difference between management of GAD and panic disorder?
Can consider TCA in panic disorder
Consider anticonvulsants; gabapentin and sodium valproate
Which medications should be avoided in panic disorder?
Propranolol
Buspirone
Bupropion
Added treatment in OCD management?
Clomipramine
Psychological: exposure therapy, CBT
Indication for antidepressant use?
Moderate or severe depression in adults irrespective of environmental factors and depression symptoms profile
Depression of any severity that has persisted for more than 2 years
Short term in mild/mod depression
When should ECT be considered as a 1st line?
Major depression in urgent and emergent situations such as: depressive stupor, high risk of suicide, extreme levels of distress, poor fluid intake
Symptoms of depression
Depressed mood
Loss of interest in activities
Significant wt loss
Insomnia or hypersomnia
Fatigue or energy loss
Feeling of worthlessness or inappropriate guilt
Recurrent thoughts of death or suicidal ideation
Symptoms causing significant reduced functionality
Choice of antidepressant?
SSRI (better cardiac profile and MUCH less dangerous in overdose)
Mirtazapine if sedation and weight gain desired
SNRIs
Mania in bipolar disorder?
Dopamine antagonist antipsychotics
Valproate
Lithium
Depression in bipolar disorder?
Quetiapine
Olanzapine +/- fluoxetine
Antidepressants
Lamotrigine
Long term maintenance of bipolar disorder?
Lithium (mania, depresino, suicide)
Valproate and dopamine antagonists ( mainly mania)
Lamotrigine (mainly depression)
What is PTSD?
Delayed or protracted response to stressful event of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone
Sy of PTSD?
Flashbacks Nightmares Numbness and emotional blunting Detachment from people Anhedonia Avoidance of activities reminiscent of trauma Autonomic hyperarousal; hypervigilance, enhanced startle reaction, insomnia Anxiety and depression
Hypomania
Persistent mild elevation of mood, increased energy and activity
Usually marked feelings of well-being and both physical and mental efficient
Increased sociability, talkativeness and over familiarity
Increased sexual energy
Decreased need for sleep
Irritability
Do you get hallucinations or delusions in hypomania?
No
What delusions and hallucinations tend to accompany mania?
Grandiose delusions
Hallucinations; voices speaking directly to patient
Tends to be mood congruent
What is cyclothymia?
Persistent instability of mood which are not sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder
What is dysthymia?
Chronic depressed mood, lasting several years which is not sufficiently severe to justify a diagnosis of depressive disorder
Mild depressive disorder?
2 or 3 biological symptoms
Still functioning
Mod depressive disorder
4 or more biological symptoms
Great difficulty in continuing with ordinary activities
Severe depressive disorder?
Several of biological symptoms are marked and distressing; typically loss of self-esteem and ideas of worthlessness and guilt
Suicidal thoughts common
Anorexia nervosa?
Deliberate weight loss, induced and sustained by the patient Dread of fatness Undernutrition BMI of less than 17.5 Restricted dietary choice Excessive exercise Induced vomiting and purgation Use of depressants and diuretics
Bulimia nervosa
Repeated bouts of overeating and an excessive preoccupation with control of body weight leading to a pattern of overeating followed by vomiting or use of laxatives
Core symptoms of depression?
Depressed mood
Reduced enjoyment or interest
Decreased energy
Additional symptoms of depression
Loss of confidence Guilt Suicidal ideas or behaviours Poor concentration Agitation/ retardation Sleep disturbance Changes in appetite
Threshold for moderate depression?
2 core
4 others
6 in total
Threshold for severe depression
All 3 core symptoms
5 others
8 in total
Atypical depression
Mood reactivity (mood brightens in response to positive events)
2 or more:
Weight gain
Hypersomnia
LEaden paralysis
Long-standing pattern of interpersonal rejection sensitivity
Cotard’s syndrome
Subtype of psychotic depression
Nihilistic delusions
5 Rs of depression?
Response Remission Relapse Recovery Recurrence
Bipolar 1
Mania
Depressive
Bipolar 2
Hypomania
Depressive episode
Hypomanic symptoms
Inc activity or phsical restlessness Increased talkativeness Difficulty in concentration or distractibility Dec sleep Inc sexual energy Mild spending sprees At least 4 days STILL FUNCTIONING
Manic episode
At least 1 week Inc activity Inc talkativeness Flight of ideas Loss of social inhibitions Dec sleep Grandiose delusions Distractibility or constant changes in activity or plans Reckless behaviour Marked sexual energy or sexual indiscretions NOT FUNCTIONING PSYCHOSIS
