Mental Health Flashcards
Adjustment Disorder
Definition: - Depression or anxiety developed in response to a stressful situation.
- Subjective distress & emotional disturbance secondary to significant life event.
Less severe form of depression without sufficient criteria for major depression Dx.
- usually no longer than 6 months.
Features:
- Interference with social functioning and performance.
- Associated with depressed mood, inability to cope or plan ahead.
Agoraphobia
Definition & Clinical features:
- Fear of being in a place they cannot escape from.
- Often manifests as fear of leaving home, entering shops, crowds and public places.
- Panic disorder is a frequent feature.
- Depression/obsessions/social phobias are also commonly present as subsidiary features.
- Behavioural avoidance
Anorexia Nervosa
Clinical features:
- Adolescent and young adult females.
- Increased prevalence in type A personalities.
- Intense fear of gaining weight or becoming fat, despite underweight status.
- Disturbance of body image, persistent lack or recognition of seriousness of low body weight with continuing behaviour directed at weight loss.
- Intentional restriction of energy intake relative to requirements
- Cold intolerance, constipation, increase lung body hair, sallow, dry scaly skin, hair loss.
Alzheimer’s Disease
Clinical Features:
- memory loss
- loss of social and occupational functioning.
- diminished executive function
- speech and motor deficits.
- personality change plus behavioural and psychological disturbance.
Bipolar affective disorder
Screening HIGH-4 H: hyperactivity, or distractibility, flight of ideas, pressured speech, racing thoughts I: insomnia and irritability G: grandiosity H: hyperhedonia, or high- risk sexual activity, shopping sprees 4: 4 days' minimum duration.
Bulimia Nervosa
Risk factors -
Female sex, Personality disorder, Body image dissatisfaction, Hx of sexual abuse, Impulsivity,
Fam Hx of alcoholism/depression/eating disorder,
Childhood overweight or obesity, Early puberty
Recurrent episodes of binge eating
- lack of sense of control - can not stop eating
Recurrent inappropriate compensatory behaviour
- Purging - Vomiting, Laxatives, Enemas
Depression and low self-esteem
Dental erosion
Parotid hypertrophy
Russell’s sign - Scaring over the dorsum of hand
Arrhythmia - Hypokalaemia, Hypomagnesaemia
Cyclothymia
Numerous mood swings
Periods of hypomanic symptoms
Alternating periods of mild to mod. depression
Symptoms present for > 2 years
Symptoms present for at least 22 months of 2 years
No Major Depressive, Manic or Mixed Episode
Delirium tremens
Hx of Alcohol use/abuse Abrupt withdrawal of alcohol Altered mental status Hallucinations - Visual and tactile Delusions Sympathetic overdrive - tremors, diaphoresis, tachycardia, anxiety, seizures
Vascular dementia
RF: age >60 years, obesity, hypertension, smoking
DM, Hypercholesterolaemia, Alcohol abuse
History of stroke / TIA Difficulty solving problems Apathy Disinhibition Slowed processing of information Retrieval memory deficit Impaired gait and balance
Lead toxicity
RFs: age 9 to 36 months, low socioeconomic status, mineral-deficient and high-fat diets, Symptoms (children) - cognitive impairment behavioural disturbance clumsiness and agitation loss of appetite constipation somnolence Symptoms (adult) cerebellar signs altered mental state seizures coma
Dysthymia (Persistent Depressive Disorder)
Depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents).
During periods of depressed mood > 2 present;
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Gambling disorder
> 4 of the following in a 12-month period
- Need to gamble with increasing amounts of money in order to achieve the desired excitement
- Is restless or irritable when attempting to cut down or stop gambling
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling
- Is often preoccupied with gambling
- Often gambles when feeling distressed
- After losing money gambling, often returns another day to get even
- Lies to conceal the extent of involvement with gambling
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
- Relies on others to provide money to relieve desperate financial situations
Major depressive disorder
RF: Older age, Recent childbirth, Stress, Trauma; Co-existing medical conditions, Personal or family hx of depression, Certain medications (e.g., corticosteroids), Female sex
Major Criteria (must have 1 major criteria)
- Depressed mood
- Anhedonia
Minor Criteria (must have 4 or more)
Weight loss or weight gain (>5% in a month)
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation (observable)
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to think or concentrate
Recurrent suicidal ideation
Alzheimers Disease
RF: age FHx Down's syndrome Cerebrovascular disease Hyperlipidaemia Clinical findings: Memory loss Disorientation Naming difficulty - objects/people Misplacing/losing items Apathy Difficulties with ADLs Prosopagnosia – impaired facial recognition Abstract thinking deficits
Generalised anxiety disorder
- 6 months of excessive pervasive worry that causes distress/impairment in functioning
- Risk factors: family history of condition, physical/emotional stressors, trauma, other MH dx, female gender
- Key psychiatric symptoms (3 out of 6 needed): Muscle tension, sleep disturbance, fatigue, restlessness, irritability, poor concentration
- ## Key physical symptoms: headaches, sweating, dizziness, nausea, tachycardia, shortness of breath, chest pain
Hoarding disorder
Persistent difficulty discarding or parting with possessions regardless of their actual value
- Difficulty in discarding item is due to perceived need to save item/distress associated with discarding them
- Accumulated possessions cause so much clutter that possessions are unable to be used as intended
- Causes impairment to functioning (social/occupation or other)
Lewy Body Dementia
Risk factors: older age
Key features: progressive cognitive decline with deficits in attention, executive function and visuospatial skills; fluctuations in mental state are prominent; visual hallucinations; depression: REM sleep disturbance - patients act out their dreams due to loss of atonia; extreme neuroloeptic sensitivity
- Late features: Memory impairment, extrapyramidal signs: Parkinsonian features of postural instability, gait difficulties, and reduced facial expression
Obsessive Compulsive Disorder
Risk factors:
family history of MH dx
Characterised by:
- unwanted, disturbing and intrusive thoughts/impulses generally seen by the patient as irrational, excessive and external to them
- repetitive behaviours and mental acts that neutralize the above and reduce emotional distress
- The above experiences must cause distress/be time consuming (greater than 1 hour per day) or interfere with normal functioning
Panic disorder
Risk factors: fam hx, young adults, female, causasian, major life events or recent trauma, comorbid with other anxiety/mood/substance use disorders, cigarette smoking and caffeine
Characterised by:
- recurring unexpected panic attacks over a 1-month period and associated worry about their recurrence or implications
- sudden onset of intense physical and cognitive symptoms of anxiety
- avoidance behaviour
- frequent co-existence of agoraphobia
Premenstrual dysphoric disorder
Risk factors: menstruating women, family history, other mood disorder
Requires at least 5 of 11 symptoms from following list during luteal phase, that must resolve soon after menses start and be absent by end of menses:
- Depressed mood, significant anxiety, affective lability, persistent anger or irritability, decreased interest in usual activities, concentration difficulty, lethargy, change in eating habits, insomnia/hypersomnia, sense of being overwhelmed, physical symptoms (headaches, bloating, weight gain, breast tenderness)
Frontotemporal Dementia
Key Features History/Exam
- Manifests as disruption in personality/social conduct/habits
- 50% display parkinsonism
- fasciculations, atrophy, hyper-reflexia, and other signs of motor neuron disease
- progressive loss of language fluency or comprehension
- development of memory impairment, disorientation, or apraxias
- age at onset peak in mid-50s
- FHx of condition
- glabellar, snout, sucking, rooting, or grasp reflex
- loss of bladder and bowel control
PTSD
exposure to a traumatic event, symptoms persists>1month after
-re-experiencing symptoms—intrusive thoughts, dreams, nightmares, flashbacks
-hyperarousal phenomena—exaggerated startle response, irritability, anger, sleep disturbance, poor concentration and memory
-avoidance and numbing—deliberate attempts to keep the traumatic event out of mind, loss of interest in activities that formerly brought enjoyment, detachment, restricted emotional responses.
depression, alcohol use issues as well
Schizophrenia
RF- FHX of condition, Substance abuse
1. hallucinations (auditory)
2. delusions (persecutory, grandiose, thought insertion/withdrawal/broadcasting)
3. Disorganized speech
4. Disorganized/catatonic behaviour
5. Negative symptoms- 5A’s: avolition, anhedonia, asocial behaviour, affective blunting, alogia
Minimum 6 months duration
Social anxiety disorder
RF- anxiety, mood, and substance-abuse, FHX+
Excessive fear of social/performance situations
Excessive concern about being criticised
Anticipatory anxiety and situational avoidance
Sympathetic NS sx- Tachycardia, hyperventilation, sweating, flushing, muscle tension
Specific Phobia
Excess/intense/disproportionate fear of specific objects or situations
Avoidance of phobic cues
anticipatory anxiety
Duration>6 months
functional impairment
Insight present in adults (not in children)
