Mental Health Flashcards
What is the ICD-10 definition of depression?
At least 2 of:
Persistent low mood
Anhedonia
Anergia
Present most of the time for at least 2 weeks.
What are the biological symptoms of depression?
Poor sleep (early morning waking) Reduced appetite Anergia Sexual dysfunction Tiredness
What are the psychological symptoms of depression?
Suicidal thoughts Low mood Worthlessness Hopelessness Poor concentration Guilt
How should mood symptoms be exploded?
Detail of mood: how bad, when, triggers, pattern over the day, getting worse or better?
Associated symptoms: anxiety, psychosis, elation, guilt, worthlessness, drug and alcohol
Negative cognitions: about the world, about self, about future (RISK ASSESS)
Somatic symptoms: loss of interest, early morning waking, weight, appetite
Outline the management of depression
Mild to moderate: consider watchful waiting for 2 weeks, then low intensity psychosocial interventions inc. self-help and group CBT. Consider drug treatment only in patients with a hx of moderate to severe depression, or long term subthreshold depression.
Persistent mild/moderate depression: antidepressant OR high-intensity psychological intervention
Moderate to severe depression: antidepressant AND high intensity psychological intervention.
What are the side effects of MAOIs?
Orthostatic hypotension, dry mouth, sexual dysfunction, weight gain
What are the side effects of SSRIs?
GI upset, nausea, sexual dysfunction, short term can increase anxiety, citalopram prolongs QTc, increased risk of suicide in short term, discontinuation syndrome
What are the side effects of TCAs?
Weight gain, sedation, nausea, sexual dysfunction, QTc prolongation, anticholinergic SEs
What differentials should be considered in a history of low mood?
Major depressive disorder: negative cognitions, guilt, worthlessness, hopelessness
Psychotic depression: nihilistic delusions and hallucinations
Bipolar affective disorder: past mania
Co-existent anxiety
Schizoaffective: paranoid delusions, running commentary 3rd person hallucinations
What symptoms are important to ask about in history of mania?
Elated mood Energy levels Grandiosity Restlessness Appetite Libido
REFLECT BACK TO PATIENT (examiner) THE SYMPTOMS YOU SEE
What are the 5 features of dependence on alcohol?
Compulsion - “do you have cravings?”
Control - “do you find it difficult to control your drinking?”
Withdrawal - “do you get shakes when you dont drink?”
Tolerance - “do you have to drink more?”
Primacy - “is drinking your main priority
What is the differential for psychosis?
Acute psychosis but not long enough to qualify for schizo
Schizophrenia Schizoaffective Psychotic depression Bipolar depression Delusional disorder
How long must symptoms be persisting for diagnosis of schizophrenia?
1 month period of delusions, hallucinations, disorganised speech, negative symptoms etc, associated with continuous problems over 6 month period
What is first line management of schizophrenia?
Antipsychotic + cbt
What investigations are important before starting antipsychotic medication?
Weight + waist circumference Pulse and BP Blood glucose (ideally fasting) Lipids LFTs FBC Prolactin level ECG and/or cardiac risk assessment!!!!
Which antipsychotic is most likely to cause hyperprolactinaemia?
Risperidone
Which antipsychotic causes most weight gain/
Olanzapine + clozapine
Which antipsychotic has least SEs?
Aripiprazole
Which antipsychotic is most likely to cause orthostatic hypotension?
Quetiapine
What are the SEs of atypical antipsychotics?
Weight gain + metabolic syndrome Hyperprolactinaemia Sedation Dry mouth Postural hypotension
What are the SEs of typical antipsychotics?
QTc prolongation
EPSEs (Parkinsonism, dystonia, akithasia, tardive dyskinesia)
What are the SEs of clozapine?
Postural hypotension, agranulocytosis, weight gain, deranged LFTs
What are the characteristic features of Alzheimer’s disease?
Medial temporal lobe neurofibrillary tangles, amyloid plaques and neuron loss
Memory loss (short term and names first), later can cause behavioural abnormalities and cognitive impairment)
Slowly progressive
What are the characteristic features of vascular dementia?
Stepwise progression
Executive functions such as planning tend to be more affected than memory
What are the characteristic features of Lewy-body dementia?
Parkinsonism
Progressive cognitive decline with prominent executive and visuospatial impairment
Lewy bodies (alpha synnuclein proteins) in the brain
REM sleep disorder, parkinsonism, visual hallucinations
Fairly rapidly progressive
What are the characteristic features of frontotemporal dementia?
Change in personality and social behaviour, or primary aphasia
What are the 7 As of dementia?
Anosognosia - lack of insight
Amnesia - loss of memory
Apathy - lack of interest
Agnosia - unable to recognise objects using the senses
Aphasia - loss of language
Apraxia - loss of coordination and difficulty with ADLs
Altered impressions - misinterpretation of sense information
What drugs are used in dementia - example of each class with SEs, MoA and which dementias they are useful in.
AChE inhibitors - rivastigmine, donepazil and galantamine. SEs include CARDIAC ARRHYTHMIAS, nausea, vomiting, headaches, insomnia. Can be used for Alzheimer’s or Parkinson’s (rivastigmine)
Memantine - glutamate antagonist, used in Alzheimers
What is the differential for suspected dementia?
V - stroke, subdural haematoma
I - Cerebral abscess, meningitis, encephalitis, UTI, chest infection
T - head injury, pain causing delirium
A - autoimmune encephalitis, SLE
M - Cushing’s, thyroidism, hypercalcaemia, hypo-glycaemia
I - Drug side effects
N - brain mets or primary
C - Down’s
D - Alzheimers, CJD, MSA, PSP
F - Depression (pseudodementia)
What are the counselling points for lithium?
Exact mechanism unknown
Tablet, capsule or liquid taken once per day
Take it lifelong usually
Takes 1-2 weeks to begin working
Need FBC, U+Es, TFTs, bHCG in women, ECG. Check litium level every week until stable for 4 weeks, then 3 monthly. TFTs, U+Es and Ca every 6 months
SEs: GI (abdo pain + nausea, metallic taste), fine tremor, diabetes insipidus (polydipsia, polyuria, weight gain). In overdose, D+V, dizziness, ataxia, worsening tremor, drowsiness + restlessness).
