depression tutorial

Question 1

Why important to make distinction between bipolar and unipolar depression?

Answer 1

antidepressants appear to be ineffective in acute bipolar depression & prophylaxis, can cause acute manic/hypomanic episodes, worsen long-term course of bipolar especially in those with rapid-cycling courses where they lead to more mood episodes & depressive states

Question 2

What are personality disorders?

Answer 2

• Maladaptive patterns of behaviour, cognition and inner experience, exhibited across many contexts & deviating from those accepted by their culture.
• Patterns develop early, are inflexible and associated with significant distress & disability

Question 3

What are in cluster A personality disorders?

Answer 3

Paranoid, schizoid, schizotypal

Question 4

What is paranoid personality disorder?

Answer 4

Irrational suspicion and mistrust in people, interpreting their motivations as malevolant

Question 5

What is schizoid personality disorder?

Answer 5

Lack of interest & detachment from social relationships, apathy & restricted emotional expression

Question 6

What is schizotypal personality disorder?

Answer 6

Extreme discomfort interacting socially and distorted cognition & perceptions

Question 7

What are cluster B personality disorders?

Answer 7

Antisocial, borderline, histrionic, narcissistic

Question 8

What is antisocial personality disorder?

Answer 8

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

Question 9

What is borderline personality disorder?

Answer 9

Pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity and behaviour and affect, often leading to self-harm and impulsivity

Question 10

What is histrionic personality disorder?

Answer 10

Pervasive pattern of attention seeking behaviour & excessive emotions

Question 11

What is narcissistic personality disorder?

Answer 11

Pervasive patterns of grandiosity, need for admiration and perceived or real lack of empathy

Question 12

What are cluster C personality disorders?

Answer 12

Avoidant, dependent, obsessive compulsive

Question 13

What is avoidant personality disorder?

Answer 13

Feelings of social inhibition & inadequacy, extreme sensitivity to negative evaluation

Question 14

What is dependent personality disorder?

Answer 14

Psychological need to be cared for by others

Question 15

What is obsessive compulsive personality disorder? Is it the same as obsessive compulsive disorder?

Answer 15

Rigid conformity to rules, perfectionism, and control to point of satisfaction & exclusion of leisurely activities and friendships.
Distinct form obsessive compulsive disorder

Question 16

What is the similarity/difference between bipolar affective disorder BPAD and borderline personiality disorder?

Answer 16

• Both have rapid mood swings, unstable relationships, sexual behaviour and suicidality.
• BPAD runs in family and has grandiosity.
• Borderline personality disorder has poor self image, fear of abandonment and feelings of emptiness

Question 17

Differences between BPAD and schizophrenia?

Answer 17

• BPAD can have hallucinations too, cognitive impairment, depression and negative symptoms.
• Schizoaffective shares symptoms of both.
• Schizophrenia more chronic delusions/hallucinations, in BPAD more episodic.

Question 18

Differences between BPAD and attention deficit disorder ADD?

Answer 18

• Both have impaired concentration, impaired executive function, abnormal working & short term memory.
• BPAD has heritability, recurrent depressive episodes.
• Amphetamines worsen mania

Question 19

What are bipolar and psychiatric comborbidities?

Answer 19

Increased risk of any anxiety disorder and substance use disorder

Question 20

What are other causes of depressive symptoms?

Answer 20

1. endocrine (hyper/hypothyroidism, hyper/hypoparathyroidism, adrenocorticism, hypoglycaemia, cushings, addisons)
2. systemic - infections, viral, SLE, HIV, pancreatitis, cancers (Cytokines released )
3. deficiencies - vitamin B12 or folic acid
4. neurological - MS, alz, parkinsons
5. medications: beta blockers, steroids, anti-parkinsonians, anti-cholingerics (IBS meds), antibiotics, statins, oestrogens, opiate pain killers, acne meds
6. vascular depression (late life depression ) associated with white matter hyperintesnities that can impact cognitive function making vulnerable to stressors (treat vascular risk)
7. post-stroke depression - can be persistent, retardation in thinking, lesions in left frontal lobe or basal ganglia. (the more frontal the lesion more severe the symptoms)