Mental Health Flashcards
Mood vs affect?
Mood – A person’s predominant feeling at a given time (‘season’ or ‘climate’)
Affect – Involves moment to moment changes in the emotional state and the external expression of these feelings as observed by the examiner (‘day’ or ‘weather’)
Define mania
Mental illness marked by periods of great excitement or euphoria, delusions, and overactivity that lasts at least 7 days.
Define hypomania
A mild form of mania, marked by elation and hyperactivity.
Define euthymia
A normal, tranquil state/mood that is neither manic nor depressive, yet distinguishable from the state of healthy (commonly associated with bipolar disorder).
What condition is euthymia commonly associated with?
Bipolar disorder
Define subthreshold depression
Clinically relevant depressive symptoms that do not meet the criteria for a major depressive disorder.
Define major depression
Persistently depressed mood and long-term loss of pleasure of interest in life
Define mixed state
A state wherein features unique to both depression and mania occur wither simultaneously or in very short succession.
Disordered mood:
Give some red flags for mental health conditions
- Thoughts of deliberate self-harm
- Suicidal thoughts
- Previous suicide attempts
- No protective factors
- Family history of suicide
- Significant adverse life event
- Anxiety
- Loss of functioning
- Risk to self or others
- Command hallucinations
- Grandiose delusions
- Trouble with police
- Alcohol dependency
What 2 features is depression characterised by?
- Persistently low mood
- Loss of interest in everyday activities (anhedonia)
Unipolar vs bipolar?
- Unipolar – first occurrence or recurrent
- Bipolar – reoccurrences of mania and depression
In people aged 18-44, what is the leading cause of disability and premature death in the UK?
Depression
Define DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
The DSM-5 outlines the criteria for a diagnosis of depression.
What are the 2 core symptoms?
- Depressed/low mood most of day, nearly every day
- Diminished interest or pleasure in doing things (anhedonia)
The DSM-5 outlines the criteria for a diagnosis of depression.
What are some associated symptoms?
- Change in sleep – decreased (insomnia) or increased (hypersomnia)
- Change in appetite and/or weight
- Change in activity – psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of excessive or inappropriate guilt and/or worthlessness
- Concentration – diminished ability to think or concentrate, or indecisiveness
- Suicidality – thoughts or death or suicide, or has plan
Are men or women more prone to depression?
Women
Give some organic diseases that can cause low mood
- Neurological disease e.g. Parkinson’s disease, dementia, MS
- Endocrine disorder e.g. thyroid dysfunction, hypoadrenalism (e.g. Addison’s disease), hyperadrenalism (e.g. Cushing’s disease)
- Drugs e.g. steroids, isotretinoin (Roaccutane), alcohol, beta-blockers, benzodiazepines, methyldopa
- Chronic conditions e.g. diabetes, obstructive sleep apnoea, longstanding infections (e.g. mononucleosis)
- Neoplasms & cancer – pancreatic cancer is a notable example
What is bipolar affective disorder?
A mental disorder characterised by periods (2 or more) of depression and periods of elevated mood (mania).
What can a ‘manic switch’ in bipolar disorder be induced by?
A ‘manic switch’ can sometimes be induced by someone with BAD taking antidepressants to treat a depressive episode
Give some features of mania
- Elevated mood or irritability
- Impulsive & dangerous decisions with little thought for consequences
- Need for sleep often reduced
- Mood congruent delusions may be present
- Often have pressured speech and exhibit flight of ideas
What is the gold standard pharmacological medication for bipolar?
Lithium → acts as a mood stabiliser
What is generalised anxiety disorder?
Characterised by disproportionate, pervasive, uncontrollable, and widespread worry and a range of somatic, cognitive and behavioural symptoms.
What questionnaire can be used to help establish the severity of anxiety?
GAD-7 anxiety questionnaire
What is the most common psychiatric disorder?
Anxiety disorders
what age group are anxiety disorders typically seen in?
Adults between 35-55 y/o
Give some risk factors for anxiety disorders
- Female sex
- Family history of psychiatric disorders
- Childhood adversity e.g. maltreatment (sexual/physical abuse), parental problems with violence/alcoholism/drug use/mental illness, overprotective/harsh parenting, bullying
- Environmental stressors e.g. domestic violence, unemployment, low socioeconomic status, physical/emotional trauma
- Substance dependence
- Chronic/painful illness e.g. arthritis
Generalised anxiety disorder (GAD) defined and categorised by one of which two main classification systems?
- DSM-V
- ICD-10
Describe the ICD-10 classification system for anxiety
Requires symptoms to be present for most days for several months and should include elements of:
- a) Apprehension – worries about future misfortunes, feeling on edge, difficulty concentrating
- b) Motor tension – restless fidgeting, tension headaches, trembling, inability to relax
- c) Autonomic overactivity – light-headedness, sweating, tachycardia, epigastric discomfort, dizziness
Describe the DSM-V classification system for anxiety
Requires core symptoms for more days than not, which are difficult to control and present for >6 months
Give some differentials for anxiety disorder
- Acute stress disorder
- Obsessive compulsive disorder
- Panic disorder
- Post-traumatic stress disorder
- Social phobia
- Specific phobias
- Hyperthyroidism
- Alcohol withdrawal
- Cardiogenic causes
- Hypoglycaemia
Associated symptoms of anxiety?
- Psychological – fears, worry, poor concentration, irritability, depersonalisation (altered or lost sense of personal reality or identity), derealisation (surroundings feel unreal), insomnia, night terrors
- Motor – restlessness, fidgeting, feeling on edge
- Neuromuscular – tremor, tension headache, muscle ache, dizziness, tinnitus
- GI – dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loss motions
- CVS – palpitations, chest discomfort
- Respiratory – difficulty inhaling, tight/constricted chest
- GI – urinary frequency, erectile dysfunction, amenorrhoea
1st line pharmacological management of anxiety after psychoeducation/CBT etc
SSRIs
What is a pre-occupation?
A worry/nagging doubt that something has happened/likely to happen/unlikely to happen
Define a phobia
persistent and excessive fear of an object or situation
What are the most common 3 phobias?
- Planes
- Heights
- Dentists
Define an overvalued idea
An acceptable, comprehensible idea (may have an element of truth) pursued by the patient beyond the bounds of reason (belief that can be fixed but can be challenged).
E.g. a person who works at a company may rigidly maintain the idea that they are the most valuable member of the company/will save the company from ruin/will soon be made president of the company
Define an obssession
A recurring thought or repetitive behaviours that you cannot control (compulsion does NOT relieve obsession in OCD)
Define a delusion
A fixed, unshakeable belief, despite evidence to contrary, not held by others in the same culture and held with intense personal conviction and certainty.
E.g. a person believes that the government is controlling our every move via radio waves despite evidence to the contrary
