Exam Flashcards
Core symptoms of depression (3)
Low mood, anhedonia, anergia
Additional depression symptoms (7)
Biological- poor sleep, early wakening,appetite changes
Poor concentration and memory
Feelings of guilt, hopelessness about future
Suicidality/self harm
Obsessions e.g. death
Delusions (e.g. of sin, guilt)
Hallucinations (second person auditory is most common)
What does a depression diagnosis consist of?
Two core symptoms plus others 4 = mild 6 = moderate 8 = severe (also take into account the level of functional impairment)
What is dysthmia?
Chronic sub-threshold depressive state of greater than two years duration
Signs/symptoms of mania (6)
Elevated mood Irritability Disinhibition Overactivity Decreased need for sleep Psychotic features e.g. delusions, hallucinations
Definition of bipolar affective disorder
Two or more episodes of mania +/-depression
How are mania and hypomania distinguished?
In hypomania there are no psychotic features
What is cyclothymia?
Persistent mood instability
Treatment of acute mania (3)
Atypical antipsychotics e.g. olanzapine FIRST CHOICE
Benzodiazepines
Sodium valproate
Prophylaxis of mania (3)
Lithium 1st line
Anticonvulsants (sodium valproate, lamotrigine, carbamezapine)
Atypical antipsychotics
Features of thought a) flow [5] b) content [3] in mania
a) flight of ideas, loosening of associations, pressured speech, neologisms, circumstantiality
b) delusions e.g. religious, grandiose, persecutory; obsessions; ideas of reference
Treatment of
a) mild to moderate depression
b) moderate to severe depression
a) CBT; relaxation therapy; consider antidepressants if persisting, patient has a history of severe depression
b) antidepressants + high intensity psychological treatment (CBT or interpersonal therapy)
When should an urgent psychiatric referral be made in depression?(3)
Active suicidal ideas or plans
Putting themselves or others at risk
Evidence of self neglect
Antidepressant treatment
a) first-line
b) when there is no response/partial response at 2-4 weeks
a) SSRI such as citalopram
b) other SSRI; mirtazapine; tricyclic
When should tricyclics be avoided?
When there is a risk of overdose
How long should treatment continue for after remission, and how long should doses be reduced over
At least six months
Doses should be reduced over 4 weeks, although fluoxetine can be withdrawn faster
When should SSRIs be prescribed with caution?
Epileptics- lowers the seizure threshold
Peptic ulcer disease
Young people
Important drug interactions of SSRIs (5)
QT prolonging drugs
Monoamine oxidase inhibitors
Triptans
NSAIDS- if given with SSRI, co-prescribe PPI
Warfarin/heparin/aspirin- avoid SSRI, give mirtazapine
Physical symptoms of anxiety (7)
Sweating, chills Trembling, shaking Throat lump Palpitations Chest pain/discomfort Nausea/GI upset Dry mouth
Cognitive symptoms of anxiety (5)
Fear of losing control Derrealisation Depersonalisation Hyper-vigilance Meta-worry
Definition of generalised anxiety disorder
anxiety that is:
not restricted to particular circumstances
persistent (most days for 6 months)
causing significant distress/functional impairment
Common co-morbidities in anxiety (3)
Depression
Substance abuse
Other anxiety disorders e.g.PTSD
What is social anxiety disorder characterised by
Persistent fear of situations where the patient is exposed to unfamilial people, or scrutiny by others
Psychological measures for anxiety treatment (2)
CBT
Relaxation therapy
Pharmacological measures for anxiety treatment (4)
Benzodiazepines
SSRIs (sertraline is 1st line)
Buspirone (5HT-1A agonist)
Beta blockers (somatic symptoms)
Problems with benzodiazepines in anxiety management (3)
Paradoxical aggression
Anterograde amnesia
Tolerance/dependence
What are
a) obsessions
b) compulsions
a) stereotyped, purposeless, egodystonic words/phrases that enter the patients mind
b) senseless repeated rituals
Common
a) obsessions [3]
b) compulsions [3]
in OCD
a) contamination, order/symmetry, fear of harm e.g. locking doors
b) cleaning, hoarding, checking
Rating scale used in obsessive compulsive disorder to assess functional impact
Yale-Brown Obsessive Compulsive scale
First line treatment in mild-moderate functional impairment for OCD
Low intensity psychological intervention e.g. CBT, exposure and response prevention treatment
Treatment for moderate-severe functional impairment in OCD
High intensity CBT+ERP
+- SSRI
