Conditions

Question 1

What classifications of bipolar are there?

Answer 1

Bipolar I – 1 or > manic episodes or mixed episodes, +/- 1 or > depressive episodes

Bipolar II – 1 or > depressive episodes with at least 1 hypomanic episode

Bipolar - Repeated episodes of hypomania or mania only are classified as bipolar.

Bipolar Affective Disorder ICD 10

Disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression).

Requires at least 2 episodes, one of which must be a hypomanic, manic or mixed episode

Question 2

What are some of the causes of mood disorders?

Answer 2

• Biological – Genetic (more in bipolar disorder), Brain illnesses, Physical Illnesses (e.g. hyperthyroidism)
• Psychological - Childhood experiences (e.g. suffering abuse), view of yourself and the world, personality traits (e.g. obsessive and dependent)
• Social - work, housing, finance, relationships, support etc.

Question 3

How is bipolar affective disorder managed?

Answer 3

• Hypo/ mania: consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
• Prophylaxis: mood stabilizer: lithium carbonate (if compliance is good, UE, ECG and T4 normal) – also teratogenic. 2nd: valproate
  
  • Check lithium levels weekly (12h post first dose) until the dose has been constant for 4 weeks, then monthly for 6 months then 3 monthly
  • Diuretics, NSAIDS, Acei all increase lithium
  • Avoid changing lithium brands
• Mx of depression: talking therapies (see above); fluoxetine is the antidepressant of choice

Question 4

What is mixed affective state?

Answer 4

This is characterised by either a mixture or a rapid alternation (usually within few hours) of hypomanic, manic and depressive symptoms

Question 5

What are the symptoms of mania?

Answer 5

• Mood: Elevated (for at least 1 week) / expansive/ irritable/ euphoria
• Cognition: grandiosity/ increased self esteem, distractibility/ poor concentration, flight of ideas/ racing thoughts, confusion, lack of insight
• Behaviour: rapid speech, hyperactivity, reduced sleep, hypersexuality, extravagance, Social inhibitions lost e.g. dangerous activities. Impaired judgement
• Psychotic symptoms: delusions and hallucinations
• Speech: increased pressure of speech

Question 6

What are the symptoms of hypomania?

Answer 6

Symptoms of Hypomania – symptoms of mania but not psychotic symptoms – decreased/ increased function for 4 days or more

Several of the following features with considerable interference with work/social activity for at least several days

• Mildly elevated, expansive or irritable mood
• Increased energy/activity
• Increased self esteem
• Sociability, talkativeness, over familiarity
• Increased sex drive
• Reduced need for sleep
• Difficulty in focussing on one task alone

Question 7

What are some of the causes of mania?

Answer 7

• Medication: steroids, illicit substances (amphetamines, cocaine, anti depressants)
• Physical: infection, stroke, neoplasm, epilepsy, MS, metabolic disturbance (hyperthyroidism)

Question 8

What are the core symptoms of depression?

Answer 8

• Continuous low mood for at least 2 weeks
• Lack of energy (fatigue)
• Lack of enjoyment/ interest; (anhedonia) – inability to enjoy any activity

Question 9

What are some of the biological symptoms of depression?

Answer 9

• Sleep changes – EMW – hypo (older adults) or hypersomnia (more common with adults)
• Appetite and weight changes – gain (atypical depression) and loss of weight (more common)
• Diurnal variation of mood – worse in morning, better by evening
• Psychomotor retardation/ agitation – not wanting to move much, prefer to stay in one place
• Loss of libido

Question 10

What are some of the cognitive symptoms of depression?

Answer 10

• LOW SELF ESTEEM – negative view of yourself and the future
• GUILT/SELF BLAME – can continue for a very long time. Can make us multiply bad feelings.
• HOPELESNESS
• HYPOCHONDRICAL THOUGHTS
• POOR CONCENTRATION/ATTENTION – ie difficult to study and get on with things. Unable to remember. Pseudodementia – depression impairing cognitive ability
• SUICIDAL THOUGHTS

Question 11

What is the diagnostic criteria of mild, moderate and severe depression?

Answer 11

• Mild – 2 core + 2 others (able to function!) – functionality is important. Get them back to what they were doing before
• Moderate – 2 core + 3 (or 4) others
• Severe – 3 core + at least 4 others
• Severe with psychotic symptoms

Question 12

How is depression managed?

Answer 12

• Mild: computerized CBT, self help, mindfulness, sleep hygiene, problem solving techniques. Only use SSRI is sx persist beyond 8 weeks
• Moderate: anti depressant and high intensity psychological intervention (8-12 sessions CBT), IAPT
• Severe depression: Includes psychotic depression. High risk of suicide. Needs rapid specialist mental health assessment, inpatient admission (using MHA if necessary), ECT

Question 13

What is psychotic depression made up of?

Answer 13

• Hallucinations (often auditory) – can be in all 5 senses
• Delusions - Hypochondriacal/ Guilt/ Nihilistic/ Persecutory

Question 14

What is post natal depression and what are some RFs?

Answer 14

• 10 – 15% of women usually within 1-2 months post partum but can appear later in some women
• Thought content may include worries about the baby’s health or her ability to cope adequately with the baby
• Risk factors – personal or family history of depression, older age, single mother, unwanted pregnancy, poor social support, previous PND

Question 15

What is the prognosis of bipolar disease?

Answer 15

• Poor prognosis suggested by :- severe episodes, early onset, cognitive deficits
• Treatment is more effective earlier in the course of illness
• 80% relapse after first episode within 5-7 years

Question 16

What are some of the factors shaping personality?

Answer 16

• Biological Genes: Temperament, physical appearance/ characteristics, IQ, disability
• Psychological Early attachment and environment, siblings, peer relationships, schooling, traumas( loss, life events)
• Social Socioeconomic status, war/ peace, social media, culture, climate, immigration.
• Personality refers to individual differences in characteristic patterns of thinking, feeling and behaving ( American Psychological Association)

Question 17

What is the description of personality disorders?

Answer 17

• Personality disorders are conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others (NHS choices)
• They are a class of mental disorders characterized by enduring maladaptive patterns of behaviour, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual’s culture. These patterns develop early, are inflexible, and are associated with significant distress or disability (APA, 2013)
• Problems are often: Persistent, Problematic, Pervasive – across different contexts

Question 18

What are the three differnent clusters of personality types?

Answer 18

• Cluster A: Paranoid, Schizoid, Schizotypal
• Cluster B: borderline, narcissistic, antisocial, histrionic
• Cluster C: Anankastic , Dependent , Anxious- Avoidant

Question 19

Describe the cluster A personality types (schizoid, schizotypal and paranoid)

Answer 19

• Paranoid: Present as suspicious and mistrustful, misinterpreting events as persecutory, bearing grudges, strong sense of personal rights.
• Schizoid: Present as detached, solitary, aloof, little interest in people and sex, indifferent, lacking close friends.
• Schizotypal: Present as eccentric, odd behaviour and thinking, unconventional beliefs

Question 20

Describe the different types of personality in cluster B? Borderline, narcisitis, histrionic, antisocial

Answer 20

• Borderline aka Emotionally unstable: Present with emotional instability, impulsivity, parasuicidal acts, chronic feelings of emptiness, intense & unstablerelationships, fear of abandonment
• Narcissistic: Present as grandiose, self – important, degrading others
• Antisocial: Present with unconcern for the feelings of others, disregard for rules, impulsivity, low tolerance to frustration, failure to take responsibility
• Histrionic: Present as theatrical, dramatic , exhibit superficial emotionality, seductiveness, suggestibility

Question 21

Describe the different types of cluster C personality types? (anakistic OCD), dependent, avoidant, anxious)

Answer 21

• Obsessive Compulsive aka Anankastic: Present as rigid, stubborn, perfectionistic, preoccupied with rules, order and routine, have a higher sense of morality. No intrusive thought.
• Dependent: Present as needing others to make decisions for them, fear abandonment, unable to cope alone, need for reassurance
• Anxious – Avoidant: Present with persistent anxiety, sensitive to rejection , tend to avoid relationships unless acceptance is guaranteed

Question 22

How do personality disorders arise?

Answer 22

‘Attachment theory’ - the emotional bond between parent and child is crucially important for the child’s survival. Experience of a consistent and responsive caregiver in childhood gives a person the sense that the world is safe and they are lovable.

There is growing evidence from neuroscience that secure attachment helps the brain develop and enables the necessary wiring and chemical connections that help babies regulate their feelings.