Core Conditions

Question 1

What are some psychological features of anxiety disorders?

Answer 1

• Spectrum of feelings from mild unease to terror
• Anticipatory anxiety - Worries or foreboding
• Situational or exposure-based anxiety
• May be free-floating and generalised
• May be randomly experienced as a ‘panic attack’
• Specific to specific stimuli - things or situations – phobias
• Fear of dying - Fear of losing control - Fear of madness
• Derealisation or depersonalisation
• May be experienced as repetitive intrusive thoughts or images - Obsessions
• May need to take certain actions to attempt reduction of anxiety - Compulsions

Question 2

What are some somatic features of anxiety disorders?

Answer 2

• Muscular tension
• Sweating
• Trembling
• Palpitations
• Chest pain or abdominal pain
• Choking sensations or difficulty breathing
• Dizziness or feeling faint

Question 3

What are some functional impairment features of anxiety disorders?

Answer 3

• Disruption to normal levels of Functioning

Question 4

Epidemiology of anxiety disorders

Answer 4

• 25% of adults will experience an anxiety disorder at some point in their lives
• Most commonly adults between 35-55¹
• In any given week 8/100 people have mixed anxiety/depression in UK²
• In 2020, 37% of population reported high anxiety levels
• Incidence of anxiety in over 75s in 2020 was twice as high as 16-24s, previously always lower³

Question 5

Epidemiology of unipolar depression

Answer 5

• Incidence 4.4% in UK (4.5% worldwide)
• Leading cause of disability and premature death in people aged 18-44¹
• 1 in 5 adults experienced some form of depression from January to March 2021 in the UK – double that pre-Covid
• Increased to 1 in 3 for those in financial difficulty
• 43% women age 16-29 experienced symptoms of depression, 26% of men of same age
• 39% of disabled adults compared to 13% none disabled²

Question 6

What are some behavioural/psychological features of depression?

Answer 6

• Low mood
• Loss of interest and enjoyment
• Reduced energy or lack of motivation
• Poor concentration
• Low self-esteem/self-confidence
• Ideas of guilt
• Feelings of worthlessness
• Pessimistic view of the future
• Hopelessness
• Thoughts or acts of self-harm or suicide
• Irritability
• Indecisiveness
• Increased worries or anxieties
• Social isolation
• Reckless behaviours
• Disruption to normal levels of functioning
• +/- psychotic symptoms – nihilistic delusions
• +/- stupor – mute and unresponsive but conscious
• Disturbed sleep (initial insomnia - early morning waking )
• Poor appetite
• Motor retardation
• Constipation
• Heightened experience of pain
• Loss of libido
• Menstrual cycle changes

Question 7

What are some functional impairment features of depression?

Answer 7

• Disruption to normal levels of Functioning

Question 8

Epidemiology of bipolar disorder

Answer 8

• More common at younger age groups – 3.4% of 16-24s compared to 0.4% of 65-74s
• Globally, 18^th highest health condition in number of years lived with disability¹
• 25-56% of people with bipolar disorder will attempt suicide at least once in their lifetime
• 50% risk of recurrence within 12 months of an episode
• 2/100 lifetime prevalence²

Question 9

What is mania? (& features)

Answer 9

• Elevated mood•Increased energy
• Feelings of well-being
• Inflated self-esteem - grandiosity
• Over-optimism
• Increased sociability
• Overfamiliarity
• Increased libido
• Decreased need for sleep
• Irritability
• Conceit and boorish behaviour
• Impairment of concentration and attention
• Pressure of speech
• Flight of ideas
• Disinhibition
• Reckless behaviours – financial / sexual / physical risk / +/- self-neglect
• Disruption to normal levels of functioning
• +/- delusions (grandiose or persecutory)
• +/- hallucinations

Question 10

Epidemiology of psychosis

Answer 10

• Cannabis use has a 40% increased risk of psychotic illness
• Migration increase risk of psychotic illness 3x
• Parent with schizophrenia increases risk to child by 7.5x
• In 2014 0.5% of people >16yrs had a diagnosis of a psychotic disorder
• 80% show some response to treatment in the first year
• 20% will have no further episode within 5 years
• About 15% have treatment resistant psychosis two years after their acute episode¹

Question 11

What is schizophrenia? & features

Answer 11

• Disorder of possession of thought
  
  • Thought echo
  • Thought insertion
  • Thought withdrawal
  • Thought broadcasting
• Disorder of Content of Thought
  
  • Delusions – Unusual / Bizarre beliefs not in keeping with Culture/Religion - Many different forms: - Persecutory – Grandiose – External Control/Influence - Reference
• Disorder of Perceptions
  
  • Hallucinations – often third-person auditory, but any sensory modality
• Motor abnormalities
  
  • Catatonic behaviours (e.g. negativism, posturing, waxy flexibility, stupor, mutism)
• Emotional and Social Behaviour Abnormalities
  
  • Apathy
  • Blunting of emotional responses (affect)
  • Social withdrawal
  • Poor concentration
• Disruption to normal levels of functioning

Features

• Disorder of Form or Process of thinking
  
  • Loosening of associations – derailment – knights move
  • Circumstantiality
  • Concreteness – literal interpretation
  • Incoherence – word salad
  • Flight of ideas
  • Thought block
  • Neologisms