Cliical Depressionm

Question 1

Elements of mental state exam

Answer 1

appearance and behaviour, speech, mood/affect, thought, perceptions, cognition, insight

Question 2

Thought I’d split into

Answer 2

Thought form and thought content

Question 3

Thought form and thought content

Answer 3

form → logical connection, easy to follow

content → beliefs, anhedonia, possible psychotic symptoms

Question 4

what does psychotic depression involve?

Answer 4

mood congruent psychotic symptoms/delusions

Question 5

extra elements of psychiatric history?

Answer 5

forensic history, personal history esp when doing full clerking, risk assessment

Question 6

elements of risk assessment?

Answer 6

To self to others from others

Question 7

what is the therapeutic relevance in distinguishing bw bipolar/unipolar?

Answer 7

antidepressants largely ineffective in acute bipolar depression

can cause acute hypomanic/manic episodes

lead to more mood episodes in rapid-cycling cases

Question 8

common symptoms between bipolar affective disorder and borderline personality disorder?

Answer 8

rapid mood changes, unstable interpersonal relationships, impulsive sexual behaviour, suicidality

Question 9

symptoms unique to BPAD?

Answer 9

episodic, high heritability, grandiosity, mood states less dependent on environment

Question 10

symptoms unique to BPD?

Answer 10

quicker mood changes, poor self image, fear of abandonment, feelings of emptiness, history of trauma/disrupted attachment, self harm

Question 11

difference in symptoms between BPAD and schizoaffective disorder?

Answer 11

schizoaffective disorder → more prominent thought disorganisation, paranoid delusions

hallucinations/delusions rarely chronic in BPAD, residual symptoms more likely in schizoaffective

Question 12

What distinguishes BPAD and ADHD

Answer 12

BPAD not necessarily present in childhood, episodic, recurrent depressive episodes, amphetamines worsen mania

Question 13

Common symptoms between BPAD and ADHD

Answer 13

hyperactivity, impulsivity, impaired concentration, impairment of executive function, abnormal STM

Question 14

Pseudo dementia

Answer 14

Due to low mood,develop issues in cognition but thus reverses if you treat depression

Question 15

Antidepressants common side effects

Answer 15

Increased anxiety/agitation
Insomnia/headaches
Suicidal ideations

Question 16

Forensic history

Answer 16

Offending as youth?
Arrests/cautions/probation
Substance misuse

Question 17

Personal history

Answer 17

Birth and early development
Education
Schooling
Employment
Psychosexual history
Premorbid personality (how do your friends describe you)

Question 18

Organic/iatrogenic causes

Answer 18

Endocrine eg cushings/addisons
Systemic eg viral infections,sle
Deficiencies eg b12 or folic acid
Neurological eg MS,Alzheimer’s
Medications eg steroids,beta blockers

Question 19

Other organic causes

Answer 19

Vascular depression due to white matter hypersensitivity,these can impact cognitive function making the individual more prone to stressors,treat vascular risk such as diabetes/hypertension

Postroke depression can cause retardation in thinking and behavior,lesions I’m the left frontal love and basal ganglia can cause depression with the tendency that the more frontal the lesions the more severe

Question 20

Cluster A differentials

Answer 20

Paranoid-irrational suspicion and mistrust of others interpreting motivations as malevolent

Schizotypal-extreme discomfort interacting socially and distorted cognition and perception

Schizoid-lack of interest and detachment from social relations,apathy and restricted emotional expression

Question 21

Cluster b

Answer 21

Antisocial-pervasive pattern of disregard and violation of rights of others,lack of empathy,bloated self image,manipulative and impulsive

Borderline-pervasive pattern of abrupt mood swings,instability in relationships,self image,identity behavior leading to self harm and impulsivity

Histrionic-pervasive pattern of attention seeking behaviour and excessive emotions

Narcissistic-pattern of grandiosity need for admiration and lack of empathy

Question 22

Cluster c

Answer 22

Avoidant-social inhibition and extreme sensitivity to negative evaluation

Dependant-need to be cared for by other people

Obsessive compulsive personality disorder-conformity to rules,perfectionism,control to the point of satisfaction and exclusion of leisurely activity and friendship