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Depresssoin, Bipolar, Psychoses Flashcards

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1
Q

What are the core Sx of depression

A

Low mood
Loss of energy
Loss of pleasure (anhedonia)

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2
Q

Sx other than core in depression

A

Sleep, appetite, libido, concentration, confidence, guild, hopelessness, suicidal

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3
Q

How to define mild / moderate depression

A

Mild - 2 core + 2
Moderate - 2 core + 3-4 others
Severe - 3 core + 4 others

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4
Q

What is the leading cause of maternal death post partum

A

Suicide - post natal depression

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5
Q

What is bi polar

A

Depression + hypo/mania

Rapid cycling

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6
Q

Define bipolar 1 ? 2?

A

1- at least two episodes of mania or mania and depression - depressive episodes last longer
2- Many episodes of depression with only hypomania

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7
Q

How does a manic person appear ? What signs? What is hypomania?

A

Cheerful and euphoric, grandiose - may be irritable -> anger
Insight impaired, pressure of speech, impaired the judgement and risk taking

Hypomania - mania to lesser extent

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8
Q

Risks with schizophrenia ?

A

Life expectancy 25 years less, Suicide, cvd, resp, infection

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9
Q

What do people with schizophrenia experience?

A

Hallucinations and delusions

Disordered thinking

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10
Q

Negative and positive Sx of schizophrenia ?

A

N - Ahendonia, loss of sleep, motivation, communication, self neglect
P- Hallucinations, delusions, passivity phenomena, thought alienation, lack of insight

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11
Q

Differentiate between mania and hypomania?

A

Psychotic symptoms

Auditory hallucinations / delusions of grandiose

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12
Q

Investigations in pt with psychotic Sx

A

Bloods - U&Es, LFT, Ca, FBC, glucose
Radiological - CT/MRI if suggested neurological abnormality
Urine - Drugs (stimulants / canabis) / culture for infection
EEG

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13
Q

When would you do an EEG in psychotic Sx

A

If Hx of seizure / temporal lobe epilepsy

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14
Q

What additional blood tests could you do in pt with psychotic if suggested?

A

PTH, tumour markers, cortisol, Thyroid, UDRC (syphilis)

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15
Q

What special investigations could you do in pt with psychotic Sx if the Hx indicated?

A

Cushings - 24hr cortisol
Phaochromocytoma - 24hr catecholamine
Carcinoid syndrome - 24hr 5-HIAA

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16
Q

What causes the Sx of Cushing’s syndrome

A

High levels of cortisol

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17
Q

Sx of cushings

A

Weight gain, thinning / easy bruising skin, stretch marks, round face, muscle weekness, loss of libido

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18
Q

When does Cushing’s syndrome usually occur?

A

Tx with corticosteroids

Tumour

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19
Q

What is a phaochromocytoma

A

Tumour of adrenal glands

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20
Q

Usual presentation of phaeochromocytoma

A

Sx come in unpredictable sudden attacks that last a few minutes - hour

Sever headache
Sweating
Palpitations

(Many other … irritable, anxious, weight loss, drowsy, tremors, SOB, othostatic hypotension)

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21
Q

Which inherited genetic disorders are linked to phaeochromocytoma?

A

Multiple endocrine neoplasia
Von hipped Lindau
Neurofibromatosis type 1

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22
Q

What is a carcinoid tumour ?

A

Tumour which produces hormones

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23
Q

Sx of carcinoid tumour ?

A

Depends where it is
Bowel - abdo pain, GI Sx, bleeding
Lunch - cough / haemoptsis / SOB / pain

Common are - diarrhoea, abdo pain, loss of appetite
Flushing of skin
Tachycardia , SOB, wheezing

Tend to come on unexpectedly as tumour produces Sx

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24
Q

Usual onset presentation of schitzophreia

A

80% get prodromal Sx

20% acute onset

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25
Q

When is the first episode of schitz usually ? What are common early signs?

A

Late adolescence / early adulthood - THEY LACK INSIGHT

Noticeable withdrawn / bizarre behaviour / personality change
Failure to achieve academic potential
Self harm / suicide attempt
Complain to council they can hear neighbours
Via criminal justice system

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26
Q

Issues with young adults / adolescents and schitz

A

Lack of compliance
Drug alcohol
Life stressors

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27
Q

2 options to treat acute psychosis ?

A

Start second gen Eg Olanzapine, risperidone (Can add a benzodiazepine)

Low potency 1st gen Eg chloropromazine and titrate up

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28
Q

Why do you not use chlorpromazine over 600mg

A

Little additional antipsychotic effect but still increases sedation

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29
Q

Patient develops ESPEs after antipsychotics what should you give?

A

Procyclidine (antimuscarinic)

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30
Q

What co morbidity s very common with schitz ?

A

Depression in 70%

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31
Q

Management of psychosis after discharge

A

Continue antipsychotic medication at lowest possible dose
Psychological - Family therapy / compliance therapy
Social - community psychiatric nurses

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32
Q

Common side effects of antipsychotics

A

Sedation
Weight gain
ESPEs
Postural hypotension

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33
Q

How to avoid sedation with antipsychotics

A

Avoid - chlorpromazine / promazine

Prescribe eg risperidone / amisulphide / haloperidol

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34
Q

How to avoid weight gain with antipsychotics?

A

Avoid phenothiazine , olanzapine, clozapine

Prescribe haloperidol, fluphenazine

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35
Q

Avoid ESPEs

A

Prescribe 2nd gen

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36
Q

Avoid postural hypotension in antipsychotics ?

A

Avoid phenothiazine

Prescribe haloperidol, amusulphide, trifluperazine

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37
Q

Before using clozapine in treatment resistant schitz what should you do?

A

Clarify diagnosis
Stop any substance misuse
Stop non compliance Eg could use depot

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38
Q

Eg of drugs used for antipsychotic depot? When is depot useful ? How long do they last ?

A

Risperidone, olanzapine
Non compliance / failure to respond
Release over 1-4 weeks

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39
Q

What is schitzoaffective disorder ? How do you treat it?

A

Schitz and affective Sx present NOT due to substance misuse or medical disorder
Same as schitz but also manic /depressive for bipolar

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40
Q

Do you get delusions and hallucinations in schitzotypal disorder ? Explain it simply? Treatment?

A

No
‘Partial’ expression of schitz phenotype
Risperidone / CBT

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41
Q

What is schitzophreniform disorder ? Treatment?

A

Schitz lasting >1 - <6 months

Same as acute schitz

42
Q

What is delusional disorder?

A

Delusions without hallucinations

No thought disorder / mood disorder / flattening of affect

43
Q

Management of delusional disorder

A

Separation - from source of delusional ideas
Pharmacological - Eg Antipsychotics, Benzodiazapines, SSRIs
Psychological

44
Q

Medication to treat post psychotic depression?

A

Lowest possible antipsychotic with an antidepressant

45
Q

What is induced delusional disorder? Management?

A

Where an individual adopts delusions of another ( could be 2 healthy people developing same delusion)

Separation , psychological, pharmacological

46
Q

How long do Sx need to be present for depressive illness ?

A

> 2weeks

47
Q

Disturbed sleep in depression ?

A

Insomnia (with early morning waking 2-3 hrs)

Hypersomnia

48
Q

What is seen in severe depression?>

A

Psychotic Sx - delusions / hallucinations, catatonic psychomotor

49
Q

Core Sx of depression

A

Depressed mood
Anhedonia
Lack of energy

50
Q

Non core Sx of depression

A

Weight change , disturbed sleep, psychomotor agitation / retardation, feelings of worthlessness/guilt/suicide, loss of libido

51
Q

What are the semantic Sx of depression ?

A

Flattened emotions, diurninal variation, anhedonia, appetite / weight / libido, psychomotor

52
Q

What is non-melancholic depression

A

Absence of psychotic / somantic Sx

53
Q

2 types of non melancholic depression

A

Irritable / hostile - younger, Hx of acting out, poor responses to antidepressants

Anxious - Shy + withdrawn “always a worrier” - increased drug / alcohol, better response to antidepressants

54
Q

What is melancholic depression

A

Has somantic Sx - especially psychomotor disturbance

55
Q

What is psychomotor disturbance ? Egs

A

Purposeless motions / restlessness

Eg biting nails, wringing hands

56
Q

1st 2nd 3rd line treatment for depressive illness without psychotic features ?

A 
Bio
1 - antidepressant (if CI -> CBT ) 
2 - try different antidepressant 
       (Partial responders could add lithium)
3- ECT

Psycho - CBT, psychoeducation

Socio - family or carer support, employment, education

MILD - watch and wait, IAPT
MOD - SSRI and IAPT
SEVERE - admission to ward, ECT

57
Q

When could ECT be first line in depression without psychotic features ?

A

If severe biological features / high risk of self harm

58
Q

1st and 2nd line treatment for depression with psychotic features?

A

1 - ECT

2 - Antidepressant + antipsychotic

59
Q

What is an atypical depressive episode? Sx? Management?

A

Mood is depressed but able to enjoy some activities but not to ‘normal levels’
Hypersomnia, hyperphagia, heaviness in limbs

SSRI / Phenelzine (MOAI) / other antidepressant

60
Q

Management of seasonal affective disorder?

A

Light therapy through winter

Antidepressants

61
Q

What is dysthymia ? Other name? Management?

A

Chronic low grade depressive Sx
Persistent depressive disorder
SSRIs / CBT

62
Q

Tricyclics pros and cons ?

A

May be more effective in severe depression

Toxicity in OD - may slow cardiac conduction / reduce seizure threshold

63
Q

What is cyclothymic disorder?

A

Like bi polar with chronic mood fluctuations >2years with episodes of depression and hypomania but with insufficient severity to meet diagnosis of bipolar affective

64
Q

What is bipolar 1 ?

A

One or more MANIC episodes and usually one or more depressive

65
Q

What is bipolar II ?

A

Recurrent major Depressive and hypomanic episodes

66
Q

Features of bipolar

A 
Decreased social inhibition 
Often lacks insight 
Psychomotor activity 
Optimism 
Self esteem 
Rapid thinking (pressured speech / flight of ideas ) 
Grandiose
67
Q

How long does a manic / depressive episode usually last ?

A

Manic -3-6 months

Depressive - 6-12months

68
Q

DDs of bipolar

A

Substance abuse Eg cocaine
Mood abnormalities from endocrine - Cushings / steroid induced psychosis
Schitzophrenia - both can get delusions, psychomotor activity, hallucinations
Personality disorders
ADHD

69
Q

Risk factors for bipolar ?

A

Strong genetic component
Prolonged stressors during childhood
Sleep disturbance

70
Q

Physiology in bipolar

A

Hypothalamic-pituitary-adrenal (HPA) axis - decreased feedback / hypothalamus
Small prefrontal lobes and increased globes pallidus / amydala

71
Q

Treatment of a manic episode? 2nd line?

A

Haloperidol / olanzapine / risperidone

2 - add lithium / valproate

72
Q

Short term management of behavioural disturbance in manic ? Rapid tranquillisation ?

A

Benzodiazepines

Lorazepam / antipsychotic

73
Q

Issue with antidepressants in depressive strange of bipolar? How do you avoid this?

A

May precipitate manic phase

Prescribe with anti manic / mood stabiliser

74
Q

Management of bipolar affective ? Most effective? What needs to be monitored ?

A

Bio - lithium (most effective)

Psych - CBT, psychoeducation

Socio - family or carer support, employment, education

Weight / CV

75
Q

Which mood stabilisers are particular teratogenic ?

A

Valproate / lithium (Epstein’s anomaly) - Don’t use if potential of child bearing

76
Q

Syndrome when the Pt thinks someone known to them has been replaced by an imposter

A

Capgras syndrome

77
Q

What is fregoli syndrome? Usual cause? Management?

A

Stangers Eg Doctor/nurse are the Pts persecutors in disguise
Schitz, affective disorder, dementia
-> treat underlying cause

78
Q

What is it called when a patient believes insects are colonising their body? Usually found in? Management?

A

Delusional parisitosis
Schitz / depression
Antipsychotics

79
Q

What is shared delusional disorder also called? What is it ? Commonly found in? Management?

A

Folie à Deux
Delusional belief shared by 2 people where only 1 has a psychotic illness
(Psychotic individual tends to be more intelligent / dominating influence)
Usually in schitz

Treat - schitz
-period of separation -> supportive / family therapy

80
Q

What is erotomania also called? What is it? Often found in? Management? What is the increased risk in men?

A

De clerambault’s syndrome
Belief that someone (usually high social status) is in love with them
-> make advances & can become angry when rejected

Found in affective (manic), schitz, women

Men have more forensic risk

Manage - hospitalisation (could be under MHA) to avoid harassment / injury

81
Q

What is othello syndrome? When is it often found? What are the risks?

A

Pt convinced partner is unfaithful -> tries to produce evidence

Long term alcohol abuse, dementia, schitz, cocaine, dopamine agonists in Parkinson’s

Violence / separation -> may need to hospitalise
Tends to reoccur

82
Q

What is cotards syndome ? Where is it found? Management?

A

Nihilistic delusions where pt believes part of their body is decaying / doesn’t exist
They may believe they are dead / unable to die

Psychotic depression

ECT - due to severity

83
Q

Other name for factitious disorder ? What is it? What is often seen? Management? DDs ? When is it by proxy

A

Munchausen’s syndrome
Deliberately faked symptoms Eg abdo pain / hallucinations
Present to different hospitals / have different aliases
Seen in severe personality disorders

Manage - confront without rejection

DD- somatisation / dissociative disorders (Sx not continuously produced)

By proxy - parent fakes illness in child

84
Q

What is couvard syndrome?

A

Expectant men experiencing Sx of pregnancy
Eg Abdo pain / swelling, Nausea / vomiting

Often reoccurs in subsequent pregnancies

85
Q

What are the Sx of ganser’s syndrome ? Possible cause? Prognosis ? DD?

A

Approximate inconsistent answers to simple questions Eg 2+2 = 5 , what colour is snow? -> green
Clouding of consciousness
True / pseudohallucinations
Somatic Sx

Underlying depressive disorder -> treat

Often spontaneous improvement with amnesia of abnormal behaviour

Munchausens

86
Q

Can you use 2 antipsychotics concordantly ?

A

No

87
Q

What things should you monitor 4-6 weeks after commencing antipsychotics ?

A

Effectiveness, side effects, physical health, weight , lipid / glucose, ECG

88
Q

What ECG change often in antipsychotics

A

Prolonged QT

89
Q

Risk of what condition during treatment of schitz ? After treatment finishes?

A

Depression

Relapse

90
Q

What psychological therapies in schitz

A

Individualised CBT
Family therapy
Art therapy
Self help groups / forums

91
Q

Parts of CBT for schitz

A

Learn how to manage hallucinations and not be scared
Challenge delusional beliefs
Coping strategies Eg music / tell voices to go away

92
Q

What is family therapy good for in schitz? Art therapy?

A

Fam - reduce excessive emotion

Art - reduce negative Sx

93
Q

What social support do schitz really need

A

Help return to work/ study -> increase self esteem / quality of life
May need impatient / community support if residual negative Sx

94
Q

What needs to be managed at all severities of depression

A

Treat co-morbid physical illness

Treat substance misuse problems

95
Q

1st / second line for mild depression

A

1- exercise groups, guided self help, computerised CBT

2- Individual CBT / IPT, behavioural couples therapy

96
Q

1st / 2nd line for moderate / none responsive mild depression

A

1- psychological w/antidepressants -> continue for 6/12 after improvement
2- combine antidepressant with lithium / atypical antipsychotic / another antidepressant

97
Q

Management of severe depression

A

ECT

98
Q

What risks do you need to assess in a psychotic patient

A

Suicide
Violence
Victimisation
Adherence / leaving treatment early

99
Q

What risks for suicide in a psychotic patient

A

Male, single, unemployed, chronic illness
Previous attempts, paranoid illness, high IQ, depression, substance abuse, insight
High premorbid psychosocial functioning with high expectations of future

100
Q

Which psychotic patients are of a high risk of violence in the community? Inpatient?

A

Male, young, hx of untreated illness

Substance abuse, previous Hx, mania, antisocial personality, hostility, suspicious, agitated, thought disturbance

101
Q

Who is at risk of leaving treatment early in psychosis?

A

Young, male. Schitz, formal admission, suicidal, mania, paranoia, substance use, hx of re admissions

102
Q

How to avoid victimisation after admission ?

A

Try to avoid admission if possible and ensure staffing levels are sufficient for adequate monitoring and care

Psych (14 decks)

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