Cliical Depressionm Flashcards
Elements of mental state exam
appearance and behaviour, speech, mood/affect, thought, perceptions, cognition, insight
Thought I’d split into
Thought form and thought content
Thought form and thought content
form → logical connection, easy to follow
content → beliefs, anhedonia, possible psychotic symptoms
what does psychotic depression involve?
mood congruent psychotic symptoms/delusions
extra elements of psychiatric history?
forensic history, personal history esp when doing full clerking, risk assessment
elements of risk assessment?
To self to others from others
what is the therapeutic relevance in distinguishing bw bipolar/unipolar?
antidepressants largely ineffective in acute bipolar depression
can cause acute hypomanic/manic episodes
lead to more mood episodes in rapid-cycling cases
common symptoms between bipolar affective disorder and borderline personality disorder?
rapid mood changes, unstable interpersonal relationships, impulsive sexual behaviour, suicidality
symptoms unique to BPAD?
episodic, high heritability, grandiosity, mood states less dependent on environment
symptoms unique to BPD?
quicker mood changes, poor self image, fear of abandonment, feelings of emptiness, history of trauma/disrupted attachment, self harm
difference in symptoms between BPAD and schizoaffective disorder?
schizoaffective disorder → more prominent thought disorganisation, paranoid delusions
hallucinations/delusions rarely chronic in BPAD, residual symptoms more likely in schizoaffective
What distinguishes BPAD and ADHD
BPAD not necessarily present in childhood, episodic, recurrent depressive episodes, amphetamines worsen mania
Common symptoms between BPAD and ADHD
hyperactivity, impulsivity, impaired concentration, impairment of executive function, abnormal STM
Pseudo dementia
Due to low mood,develop issues in cognition but thus reverses if you treat depression
Antidepressants common side effects
Increased anxiety/agitation
Insomnia/headaches
Suicidal ideations
Forensic history
Offending as youth?
Arrests/cautions/probation
Substance misuse
Personal history
Birth and early development
Education
Schooling
Employment
Psychosexual history
Premorbid personality (how do your friends describe you)
Organic/iatrogenic causes
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
Other organic causes
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
Cluster A differentials
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
Cluster b
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
Cluster c
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
Depression triads
Core symptoms are anergia anhedoina and low mood
Biological symptoms are libido sleep and appetite
Cognitive symptoms are the world oneself and the future
How else can depression present
Psychotic depression
Look for mood congruent symptoms eg nihilistic delusions,delusions of guilts and cotards syndrome (believing your organs aren’t real)
