mood disorders tutorial Flashcards
psychiatric history, MSE, distinguishing differentials
What are the core symptoms of depression
anhedonia
anergia
low mood
how do we organise important depression sympotms?
in triads, there is biological sympotm triad: libido, apetite, sleep
core symptom triad —
cognitive sympotm triad- thoughts on oneself, the future and the world
what duration do the symptoms need to have for depression?
at least two weeks with most days during these times having the symptoms
what are the main aspects of psych history
1) history of presenting complaint,
2) past psych history,
3) medical history to treat these things,
unique 4) substance misuse history,
unique 5) forensic history,
6) family history,
unique 7) personal history, -growing up ect.
questions for presenting complaint, what is the difference with past psych history qs
all questions relevant to p.c. even if they touch on subject of other conditions it will be only if the other conditions are relevant to the p.c./ its about the present moment vs in past psych hist- you ask about OTHER psych conditions they have or other episodes.- PAST
onset - acute or insidious (gradual)
duration
diurnal variation
Suicidal ideation/plans/intent
Thoughts/acts of self-harm
Exacerbating and relieving factors: are they taking medication and is it helping? Psychosocial stressors/support?
Relevant physical health conditions: e.g. hypothyroidism, anaemia, Cushing’s, chronic pain (may be CAUSING or DRIVING depression)
in what history section do you consider collateral history?
past psych history
types of qs in past psych hist— for more like this go to ppt bc its copy paste
Previous episodes? How long did they last?
Did previous episode(s) resolve with or without treatment?
History of any other mental illness? – Important to rule out manic episodes
Previous admissions? (informal versus under the mental health act)
Collateral history (important if patient is being guarded/poor historian)
Medical notes if available
Previous self-harm or suicide attempts
what does a risk assessment assess?
harm to self, others or from others (if they are particularly vulnerable bc of their psych diagnosis)
how to distinguish between BPD (borderline personality disorder) and BPAD (bipolar affective disorder
BPAD mood changes over days/ weeks rather than BPD: hours/ days
BPAD - grandiosity VS BPD- feelings of emptiness, low self esteem, fear of abandonment, Hx self harm
BPAD- MORE HERITABILITY
environment influence: BAPD less affected by env + BPD Hx of trauma/ disrupted attachment
what are common things between BPAD BPD
Suicidality
rapid mood changes
unstable interpersonal relationships
impulsive sexual relationships
commmon between BPAD and schitzoaffective disorder
both can present with changes in mood symptoms and psychosis
what are the differences between schitzoaffective disorder and BPAD
with schizoaffective disorder theres more 1) disorganisation of thought,
2) paranoid delusional beliefs and
3) a) auditory hallucnations, also
b) episodic hallucinations are more likely to be a long term/ residual symptom
common points between BPAD and ADHD
hyperactivity
impulsivity
impaired concentration
impaired executive function
abnormal working and short term memory
what are the unique features of BPAD that distinguish it from ADHD
not necessarily present in childhood
episodic
family history more relevant cz»_space;> heritability
reccurrent depressive episodes
amphetamines worsen mania
what is a type of differentials we should always consider for patients presenting with mood disorder symptoms?
organic/ iatrogenic causes
organic causes categories to think about when mood disorder symptoms
endocrine
systemic
deficiencies
neurological (++ poststroke depression)
++
vascular depression
what are some endocrine causes
hyper hypothyroidism and parathyroidism
hypoglycaemia
cushings and addisons )hyper and hypoadrenals)
what are some systemic causes and why do systemic causes cause depression
infection, systemic lupus erythematosus, HIV infection, cancers, Cytokines manifested in systemic diseases are considered to be a cause of depression]
what are some deficiencies that can cause mood disorders
b12, folic acid
neurological causes of mood disorders
MS alzheimers, parkinsons
iatrogenic causes of miid disorders
beta blockers, steroids, anti- Parkinsons, some antibiotics (eg ciprofloxacin) statins, oestrogen, opiates, acne meds
what is another name for vascular depression
subcortical ischaemic depression
what abnormal FINDING is vascular depression associated with and why does that process increase risk to mood disorders
white matter hyperintensities, because they impact on cognitive function making the individual more vulnerable to stressors
(CHAT GPT) White matter hyperintensities (WMHs) are areas of abnormal signal intensity seen on magnetic resonance imaging (MRI) scans of the brain
what risk factors should be adressed in vascular depression
smoking and alchohol
what is the presentation (roughly) of poststroke depression
retardation in thinking and behaviour is prominent
damage to which brain regions during stroke are responsible for post stroke depression and what is the location/ severity trend
lesions in the left frontal lobe or basal ganglia are apt to cause depression
with the tendency that the more frontal the lesion the more severe the symptoms
