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Phase 3a Psych > Depression, Self harm + suicide, Bipolar > Flashcards

Depression, Self harm + suicide, Bipolar Flashcards

1
Q

what is the ratio of F:M with depression?
who is more suicidal?

A

F>M (2:1)
Males

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1
Q

what is the definition of depression?

A

2+ weeks of anhedonia (loss of interest in things prev interested in), low mood and low energy most days

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2
Q

what are some bio-psycho-social risk factors for depression?

A

Bio: chronic pain, post partum, steroid use, Low T4

Psycho: Trauma, low esteem, abuse

Social: Bereavement, divorce, very stressed

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3
Q

what are the 2 hypothesis of depression?
explain them?

A

stress - vulnerability = diff ppl = diff thresholds

Monoamine hypothesis = low DA, serotonin, NAd

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4
Q

Sx of depression Acronym?

A

SIGE CAPS

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5
Q

SIGE CAPS?

A

Suicidality/self harm
Interest Low
Guilt + worthlessness
Energy low

Concentration Low
Appetite low
Psychomotor retardation
Sleep low

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6
Q

what are the Sx in atypical depression?
Tx?

A

high appetite, sleep + mood may be okay on good occasions, catatonia, VERY SENSITIVE
Tx: CBT + MAOI/SSRI

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7
Q

what bloods would we do for depression?

A

FBC, U+E, TFT, Prolactin, syphillis serology, B12 + Folate

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8
Q

what 4 questionnaires are done?

A

PHQ9
HADS
BDI - II
Edinburgh

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9
Q

PHQ9 (scores and levels?)
HADS
BDI-II
Edinburgh
Used in?

A

PHQ9 - used in community
0-4 = none, 5-9 = mild, 10-14 = mod, 15+ = severe

HADS (only hospital use) - anxiety and depression

BDI-II (Beck depression inventory - self reporting)

Edinburgh (post natal depression)

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10
Q

What is the criteria for:
subclinical
Mild
moderate
severe

A

subclinical = 4 or less SIGECAPS

Mild = 5 or more SIGECAPS + little functional impairment

Moderate = 5 or more SIGECAPS + marked functional impairment

severe = 5 or more SIGECAPS + marked functional impairment +/- psychosis

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11
Q

Tx for mild depression?

A
  1. CBT (group/individual) + advice 12-16 weeks
  2. SSRI (can give first if want Tx)
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12
Q

Mod/severe depression Tx?
Refractory/severe Tx?

A

SSRI + high intensity CBT
Can consider ECT

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13
Q

IAPT referral for what?
what does IAPT stand for?

A

Improving access to psychological therapies
NHS initiative for mild-moderate depression

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14
Q

Non pharmacological Tx for depression?

A

CBT
IPT (interpersonal)
Psychodynamic therapy

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15
Q

seasonal affective disorder
describe its nature and time its worse?
Tx?

A

Recurrent
winter
Tx= light therapy, SSRI

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16
Q

what is dysthymia?
Tx?

A

Subclinical depression for 2+ years
Tx = low intensity CBT

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17
Q

what can depression also cause to happen?

A

pseudo dementia

18
Q

how can we tell the different between dementia and pseudo dementia?

A

‘I don’t know’ answers but normal MSE

19
Q

what does self harm consist of?

A

cutting, head banging

20
Q

RF for self harm?

A

LGBTQ, female, EUPD, depression, bereavement, trauma/abuse

21
Q

what does suicide consist of? ways?

A

cutting
ligatures
overdose
jumping from height

22
Q

RF for suicide acronym?

A

SAD PERSONS

23
Q

What does SAD PERSONS Stand for?

A

Sex Male
Age old + teens
Depressed
PHx parasuicide
EtOH (alcohol)
Rational loss (psychotic)
Social support low
Organised plan
Non married
Sick chronic illness

24
Q

what increases risk of reoccurrence of suicide attempt?

A

makes conscious effort NOT to be found
leaves note
plans death
NO regret afterwards

25
Q

What is bipolar affective disorder (BAD) ?

A

extremes of mania and depression

26
Q

what are the 3 types of BAD?

A

Bipolar 1
Bipolar 2
Cyclothymia

27
Q

what is bipolar 1?

A

Alternating mania and depression with or without a depressive episode
Psychotic, No insight, grandiosity

28
Q

what is bipolar 2?

A

Alternating hypomania and depression
With a depressive episode
no psychosis, mild insight, no grandiosity

29
Q

what is cyclothymia?

A

alternating hypomania and subclinical depression

30
Q

what is rapid cycling?

A

4+ manic episodes in a year

31
Q

what are the 2 hypotheses of BAD?

A

Impaired cortical regulation
DA hypothesis (high DA in reward pathway)

32
Q

RF for BAD?

A

family Hx 1st degree
stress
abuse/trauma
substance abuse
~24y

33
Q

what can precipitate mania?

A

benzos
SSRIs
Alcohol
LSD

34
Q

what are the symptoms of mania acronym and time length?

A

7+ days of IDIG FAST
SIGNS OF PSYCHOSIS AND FUNCTION POOR

35
Q

what does IDIG FAST stand for?

A

Irritability
Distractable
Insomnia
Grandiose delusions
Flight of ideas
Activity high
Speech high
Thoughtless - high risk
+/- Hallucinations

36
Q

what are the Sx of hypomania? time and signs?

A

4+ days of
good mood,
mild distractibility,
low sleep and food need,
no grandiosity,
talkative and mildly reckless
No hallucination
NOT PSYCHOTIC AND FUNCTIONING WELL

37
Q

What is the Dx of bipolar?

A

depression bloods
clinical Dx

38
Q

Tx of BAD acutely in mania?
biopsychosocial model

A

antipsychotics
(and stop SSRI if taking for depression)
consider InPx in bipolar 1
CMHT, Crisis team, CBT

39
Q

Tx of BAD long term?
monitoring?

A

Lithium
monitor serum Li 12h post dose, weekly till stable then 3 monthly

40
Q

what do we need to look out for with lithium?

A

LITHIUM CON and Silent SE

41
Q

what GP referral is done in mania and hypomania?

A

mania = urgent cmht
hypomania = routine cmht

42
Q

what Tx for depressive episodes?

A

antipsychotics
fluoxetine + olanzipine

43
Q

in a manic episode, if on SSRI?

A

taper and discontinue

Phase 3a Psych (11 decks)

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