Learning objectives from tutorials Flashcards
Meanings of the term depression
Symptom - an emotion within the range of normal experience
Syndrome - a constellation of symptoms and signs
Illness - “recurrent depressive disorder”
Describe the symptoms of depressive syndrome
Low mood
Anhedonia - complete inability to feel pleasure
Low energy
Poor appetite Poor sleep Poor concentration Reduced libido Tearfulness Negative thoughts Suicidal thoughts
May have psychotic symptoms
Describe the features of depressive syndrome which may be seen on a mental state examination
Appearance - poor self care, reduced facial movement
Behaviour - psychomotor retardation or agitation
Mood - subjective and objectively depressed, reduced range and intensity of affects
Speech - slow, quiet, monotonous
Thought form - thoughts may be slowed
Thought content - negative, guilty or suicidal; depressive delusions if psychotic
Abnormal perceptions - possible auditory hallucinations if psychotic; reduced eye contact
Insight - usually present
Cognition - not usually impaired
Describe the complications of depression
Suicide
Psychosis
Social and occupational dysfunction - unemployment or problems at work, family and relationship problems, social isolation
What is the minimum length of time antidepressants should be continued after eliciting a response
6 months
Should be continued for 6-12 months; can be continued long term if chronic depression, or as prophylaxis where depressive episodes have been frequent or severe, psychotic or involved in a single suicide attempt
Give an example of a biological treatment for depression
Antidepressants
SSRI
MOA
TCA
Electro-convulsive therapy
Give a psychological treatment for depression
Cognitive behavioural therapy
Interpersonal psychotherapy
Give a social treatment for depression
No specific treatments but modification of lifestyle factors may be helpful
Describe the symptoms of a manic episode
Abnormally elevated or irritable mood associated with increased energy and activity, increased talkativeness, inflated self esteem, decreased need for sleep, increased libido, overspending, reckless behaviour, racing thoughts IN A SYNDROMAL PATTERN
May include psychotic symptoms
Describe features seen in mania with psychotic symptoms
Speech can show flight of ideas - thoughts jumping from topic to topic
Delusions - usually grandiose
Hallucinations - usually second person auditory
Define the criteria for bipolar affective disorder
Repeated episodes of mania and depression
At least 2 episodes of mania or one episode of mania and one episode of depression
Those who only have mania are rare but are classed as having bi-polar
The basic treatment modality for acute mania
Benzodiazepines/sedation - to calm patient down and re-instate normal sleep pattern
Antipsychotics - have sedative and mood-stabilising properties, as well as reducing any psychotic symptoms
Consider stopping any Antidepressants as these can worsen or induce mania but may be appropriate if have worked in the past
Mood stabilisers - lithium, anticonvulsants
Basic treatment modalities used in adolescent psychiatry
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Issues of consent in the assessment and treatment of young people
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Clinical features OD anorexia nervosa
1) primary psychological disturbance - patient has dread of being overweight and imposes a new target weight - often associated with disturbance of perception
2) patient restricts food intake and uses other methods to reduce weight (self-induced vomiting, diuretics, laxatives, xs exercise)
3) BMI
Clinical features of bulimia nervosa
Episodes of binge eating - feeling of loss of control
General pre-occupation with eating
Attempts to compensate for weight gain by restricting food intake between binges (self induced vomiting, diuretics, laxatives appetite suppressants, or xs exercise
A fear of being overweight
Associated features and complications of eating disorders
Lanugo hair - fine, downy hair seen in malnourished
Russel’s sign - calluses on knuckles or back of hands due to repeated self induced vomiting
Erosion of tooth enamel
Loss of secondary sexual characteristics
Vitamin deficiency states, peripheral neuropathy
Electrolyte imbalances - due to malnutrition or vomiting
Hypotension, bradycardia
Suicide and self harm are more common
Death is due to complications - malnutrition, electrolyte distubrance, ruptured oesophagus or cardiac failure
Management of eating disorders
Dietary support and re-feeding if dangerously low weight
CBT orientated therapy with dieticians
Family therapy/intervention with the family
SSRI can help with bulimia but there isn’t an evidence basis for their use in adolescents and they are not useful in anorexia
Describe key aspects of assessment and management after attempted suicide
Assessment by a special trained staff member with ready access to psychiatric opinion
Identify any psychiatric disorder and offer referral to local mental health services for treatment
Consider the need for in-patient psychiatric care
Involvement of other relevant agencies - social services, family, school
Develop a safety plan - practical measures such as removing means to attempt suicide again (by locking medicines away) and identify person they can contact if they feel suicidal again
Mental state examination components
Appearance and behaviour
Mood - subjective, objective, affect
Speech
Thought form Thought content (delusions, suicidal intent)
Abnormal perceptions
Insight
Cognition
Differential diagnosis for presentations of disturbed or antisocial behaviour
Conduct disorder
Oppositional defiant disorder
ADHD
Depression
Basic management of common psychiatric conditions presenting with disturbed behaviour
Family education Parent management training Family therapy Educational support Anger management for the child Treat comorbid problems, e.g. ADHD
Mental health disposals available to the court
Assessment order Treatment order Committal to hospital Interim compulsion order Restriction order (can only be used with compulsion order and when there is significant risk to the public)
What are the possible civil provisions
Emergency detention certificate
Short term detention certificate
Compulsory treatment order
Emergency detention certificate
Any registered medical practitioner
Lasts for a maximum of 72 hours
Patient must be likely to have a mental disorder
Patients decision making ability is significantly impaired
Significant risk to health, safety or welfare, or to safety of others
No alternative to treatment in hospital and required urgently
Short term detention impractical
Short term detention certificate
Applied by approved medical practitioner (AMP) with mental health officer (MHO) consent
Patient has mental disorder
Patients ability to make decisions about the provision of medical treatment is significantly impaired as a result of that mental disorder
It is necessary to detain the patient in hospital for the purpose of determining what medical treatment should be given to the patient or to give them medical treatment
Significant risk to health, safety and welfare of patient or others
Lasts 28 days from day admitted to hospital
Compulsory treatment order
Granted by mental health tribunal and lasts up to 6 months
Must have mental disorder
Medical treatment available to prevent mental disorder worsening or to alleviate effects
Significant risk to health, safety or welfare, or to safety of others
Significant impairment in decision making ability
Treatment cannot be provided informally
Describe the features of chronic alcohol misuse which may be seen on a mental state exam
Appearance Behaviour Mood - subjective, objective, affect Perception Insight
Screening tools regarding alcohol
FAST (how often had >X drinks on one occasion, how often forget things, how often have failed what expected of you, has anyone ever been concerned) score 3+ = hazardous level
CAGE (have you ever felt you should CUT down, have people ANNOYED you by criticising your drinking, have you ever felt GUILTY about your drinking, have you ever had a drink first thing in the morning (EYE OPENER) 4 = alcoholism
Define delusion
A fixed belief, held despite rational argument or evidence to the contrary
