Depression and disorders Flashcards
Components of mental state examination (MSE)
Appearance and behaviour - eye contact, poor self care, psychomotor retardation
Speech - reduced vol/rate, monotone
Mood/affect - reduced emotional range, tearful
Thought - anhedonia, biological symptoms,
Perceptions - hallucinations, objective responses
Cognitions - confusional state, pseudodementia caused by low mood in older adults
Insight - recognising risk to others as well as self
key things to look for in MSE
low mood
poor self care
reduced eye contact
flattened affect
monotonous speech
Psychotic depression
mood congruent psychotic symptoms e.g. nihilistic delusions, delusions of guilt, Cotard’s syndrome
Cotard’s syndrome
False belief that you or your body parts are dead, dying, or don’t exist. AKA walking corpse syndrome
Psychiatric history and risk assessment
Explore previous treatments, hospital admissions, past medical history, family history, time
Explore risk to self, others and from others
Antidepressants and bipolar disorders
Ineffective in acute bipolar depression
can cause acute manic/hypomanic episodes
can cause more mood episodes in rapid cycling cases
Personality disorders
Maladaptivepatterns of behaviour, cognition, and inner experience. Develop early, associated with significant stress or disability.
Paranoid disorder
pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.
Schizoid disorder
lack of interest and detachment from social relationships, apathy, and restricted emotional expression.
Schizotypal disorder
extreme discomfort interacting socially, and distorted cognition and perceptions
Antisocial disorder
pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behaviour.
Borderline disorder
pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behavior andaffect, often leading to self-harm and impulsivity
Histrionic disorder
pervasive pattern ofattention-seekingbehaviour and excessive emotions.
Narcissistic disorder
pervasive pattern ofgrandiosity, need for admiration, and a perceived or real lack of empathy.
Avoidant disorder
pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
Dependent disorder
pervasive psychological need to be cared for by other people.
Obsessive-compulsive personality disorder (NOT OCD)
rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships
Bipolar affective disorder (BPAD) VS Borderline personality disorder (BPD)
BPAD - Episodic, Runs in family, Grandiosity
Mood states typically less affected by environment
BPD - Mood changes over course of hours/days rather than days/weeks
Poor self image, Feelings of emptiness, Fear of abandonment, Hx of self-harm, Hx of trauma/disrupted attachment
Rapid mood changes
Unstable interpersonal relationships
Impulsive sexual behaviour
Suicidality
BPAD vs Schizoaffective disorder (Schzd)
BPAD - Episodic delusions/hallucinations (rarely chronic)
Schzd - Episodic delusions/hallucinations (residual symptoms more likely)
More prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations
Both can both can present with psychosis and mood symptoms (both depression and mania)
BPAD vs ADHD
BPAD - Not necessarily present in childhood, Episodic, Family history, Recurrent depressive episodes
Amphetamines worsen mania
Hyperactivity
Impulsivity
Impaired concentration
Impairment of executive function
Abnormal working and short term memory
Organic causes of mood disorders
Endocrine - thyroidism, pth-ism, cushings, addisons, hypoglycaemia
Systemic - viral infections, SLE, HIV, cancer (cytokines released can cause depression)
Deficiencies in B12/folic acid
Neurological - MS, alzheimers, parkinsons
Vascular depression (subcortical ischaemic depression)
organic cause of depression 1
White matter hyperintensities (lesions) cause cognitive decline lead to increased vulnerability to stressors
What should you aim to treat in vascular depression?
Risk factors - diabetes, hypertension, smoking/alcohol
Poststroke depression
organic cause of depression 2
Lesions in frontal lobe or basal ganglia can increase chance of depression. More frontal lesions causes more severe symptoms - retardation in thinking and behaviour
Iatrogenic causes of mood disorders
Medications - bblockers, steroids, ab, statins, E3, opiates, statins
Treatment for bipolar vs unipolar depression.
Bipolar - mood stabilisers
Unipolar - antidepressants
