Depression and disorders

Question 1

Components of mental state examination (MSE)

Answer 1

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

Question 2

key things to look for in MSE

Answer 2

low mood
poor self care
reduced eye contact
flattened affect
monotonous speech

Question 3

Psychotic depression

Answer 3

mood congruent psychotic symptoms e.g. nihilistic delusions, delusions of guilt, Cotard’s syndrome

Question 4

Cotard’s syndrome

Answer 4

False belief that you or your body parts are dead, dying, or don’t exist. AKA walking corpse syndrome

Question 5

Psychiatric history and risk assessment

Answer 5

Explore previous treatments, hospital admissions, past medical history, family history, time
Explore risk to self, others and from others

Question 6

Antidepressants and bipolar disorders

Answer 6

Ineffective in acute bipolar depression
can cause acute manic/hypomanic episodes
can cause more mood episodes in rapid cycling cases

Question 7

Personality disorders

Answer 7

Maladaptivepatterns of behaviour, cognition, and inner experience. Develop early, associated with significant stress or disability.

Question 8

Paranoid disorder

Answer 8

pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.

Question 9

Schizoid disorder

Answer 9

lack of interest and detachment from social relationships, apathy, and restricted emotional expression.

Question 10

Schizotypal disorder

Answer 10

extreme discomfort interacting socially, and distorted cognition and perceptions

Question 11

Antisocial disorder

Answer 11

pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behaviour.

Question 12

Borderline disorder

Answer 12

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

Question 13

Histrionic disorder

Answer 13

pervasive pattern ofattention-seekingbehaviour and excessive emotions.

Question 14

Narcissistic disorder

Answer 14

pervasive pattern ofgrandiosity, need for admiration, and a perceived or real lack of empathy.

Question 15

Avoidant disorder

Answer 15

pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation

Question 16

Dependent disorder

Answer 16

pervasive psychological need to be cared for by other people.

Question 17

Obsessive-compulsive personality disorder (NOT OCD)

Answer 17

rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships

Question 18

Bipolar affective disorder (BPAD) VS Borderline personality disorder (BPD)

Answer 18

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

Question 19

BPAD vs Schizoaffective disorder (Schzd)

Answer 19

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)

Question 20

BPAD vs ADHD

Answer 20

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

Question 21

Organic causes of mood disorders

Answer 21

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

Question 22

Vascular depression (subcortical ischaemic depression)
organic cause of depression 1

Answer 22

White matter hyperintensities (lesions) cause cognitive decline lead to increased vulnerability to stressors

Question 23

What should you aim to treat in vascular depression?

Answer 23

Risk factors - diabetes, hypertension, smoking/alcohol

Question 24

Poststroke depression
organic cause of depression 2

Answer 24

Lesions in frontal lobe or basal ganglia can increase chance of depression. More frontal lesions causes more severe symptoms - retardation in thinking and behaviour

Question 25

Iatrogenic causes of mood disorders

Answer 25

Medications - bblockers, steroids, ab, statins, E3, opiates, statins

Question 26

Treatment for bipolar vs unipolar depression.

Answer 26

Bipolar - mood stabilisers
Unipolar - antidepressants