Neurosies: Flashcards
Outline the features of depression:
(DEAD SWAMP): D - Depressed mood E - Energy Loss A - Anhedonia D - Death thoughts (risk)
S - Sleep disturbances W - Worthlessness/guilt A - Appetite M - Mental concentration P - Psychomotor agitation/retardation
(DEA = core symptoms
What two questionnaires are used to assess depression?
- PHQ9
- HAD score
What else would you ask about in relation to depression?
- Big life event?
- Previous manic episode
- Alcohol/drug use
- Female - ?recent childbirth
- Psychotic symtoms
What screening questions might you ask which may then prompt you to perform a screening questionnaire?
1) During the past month, have you often been bothered by feeling down, depressed or hopeless?
2) During the past month, have you often been bothered by having little pleasure in doing things?
Outline the two types of risk:
Harm to others: - Children - Driving Harm to self: - Self harm - Neglect - Suicide ideation/intent/access to means/previous attempts/regrets ect..
(NOTE: risk of self harm/suicide has no correlation to severity of depression)
Outline the classification of severity of depression:q
Core symptoms = (DEA-)
Mild depression:
- 2 core, 2 other
- Mild functional impairment
Moderate depression:
- 2 core, 3 other
- Considerable difficulty continuing with social, work, domestic activities
Severe depression:
- 3 core, 4 other
- Unlikely to be able to continue with social, work or domestic activities
- Can occur with/without psychotic symptoms
List some risk factors for suicide:
- Male
- Older
- Socially isolated
- Mental illness
- Poor physical health
What is the management for mild/subclinical depression?
- Treat anxiety
- Sleep hygiene
- CBT, exercise
What is the treatment for persistent, moderate or severe depression?
1st line - SSRI
2nd line - Swap to another SSRI
3rd line - Different class (SNRI or TCA)
Include high intensity psychological therapy: CBT, IPT, behavioural couples therapy
If severe depression is present with severe psychomotor retardation or depressive delusions/hallucinations - what therapy may be considered?
ECT
What are the symptoms of mania?
3 Sx needed (DIG FAST):
D - distractibility
I - Indiscretion
G - Grandiosity
F - Flight of Ideas
A - Activity Increase
S - Sleep Deficit
T - Talkativeness/pressure of speech
What differentiates mania from hypomania?
Full mania extra features:
- Impairment of functioning
- Psychotic features
- May require hospitalisation
- Lasts at least a week
(hypo mania only present for 4 days)
What is the management of mania?
- (remove anti-depressants)
- Mood stabiliser
- Consider anti-psychotic
Give 4 examples of mood stabilisers:
- Lithium
- Lamotrogine
- Carbamazipine
- Sodium Valporate
How does lithium work?
Inhibits cAMP production
List the SE of lithium:
(LITHIUM): L - Leukocytosis I - Insipidus (diabetes) T - Tremor (fine)/Teratogenic H - Hypothyroid I - Increased weight (U): Nausea and vomiting M - Misc. Long QT interval
What is the therapeutic interval for lithium?
0.4 - 1.0 mmol/L
What should you monitor when someone is on lithium?
Thyroid function
U+Es
List 5 features of lithium toxicity:
- Blurred vision
- D&V
- Ataxia
- Coarse tremor
- Weak muscles
Define Generalised anxiety disorder:
Excessive worry about a number of different events associated with heightened tension
List 3 risk factors for GAD:
- Female
- Genetic predisposition
- Links to child abuse and separation
Outline the management of GAD:
NICE recommends a step-wise approach:
1) Education + active monitoring
2) Low intensity psychological intervention (individual non-facilitated self-help or individual guided self-help or groups)
3) High intensity psychological interventions (CBT) or drug treatment SSRI
4) Specialist input
List 3 other neuroses apart from depression, BAD and GAD:
- Panic disorder
- PTSD
- OCD
What is the treatment for panic disorder?
- Education and monitoring
- CBT
- SSRI
What is the management for PTSD?
Mild: watch + wait
Mod: CBT + EMDR (eye movement desensitisation and reprocessing)
Severe: paroxetine (SSRI) or mirtazipine (tetracyclic AD)
What is the management for OCD?
- Education and monitoring
- CBT
- SSRI
What is the triad of PTSD?
- Hyperarousal
- Avoidance
- Flashbacks
(+/- emotional numbing)
Outline the cycle of OCD:
1) Obsessive thought
2) Anxiety
3) Compulsion
4) Temporary relief
(then back to the top)
How long does depression symptoms have to be present before a diagnosis can be made?
2 weeks
What is affect?
An immediately expressed and observed emotion (weather)
What is mood?
A sustained emotion present over a prolonged period of time that can alter an individuals perception on the world (climate)
What are the features of a Mental State Examination?
(ASEPTIC) Appearance and behaviour Speech Emotion Perception Thought Insight and judgement Cognition
What scale can be used to rate the severity of depression?
Beck Depression Inventory (BDI)
What is SAD? What can be a treatment for this?
Seasonal Affective Disorder. Phototherapy
What does augmentation mean in pharmacology?
Using two drugs to treat one condition e.g. SSRI and an antipsychotic
How long should one be prescribed antidepressants after symptoms have improved?
12 months and then slowly bring off
What reasons may someone with depression be hospitalised?
- Risk of suicide/harm to others
- self-neglect
- ECT
- treatment resistant depression (monitoring)
How many episodes of mood disturbance have to be present to diagnose BAD?
2 or more (one manic, hypomanic or mixed affective episode)
How long do manic episodes typically last?
2 weeks - 5 months
In BAD, what should be added if the patient is experiencing mod/severe depressive symptoms?
- Fluoxetine (SSRI)
- Olanzapine (atypical antipsychotic)
List 2 persistent mood disorders:
- Cyclothymia
- Dysthymia
What is cyclothymia?
Persistent instability in mood (‘mood swings’). May be treated effectively with lithium.
What is dysthymia?
Depressive neurosis - chronic depressive mood. Does not fulfil criteria for recurrent depressive disorder. Usually able to cope with basic demands of everyday life.
If severe: AD, individual psychotherapy or cognitive therapy.
When does baby blues occur and usually for how long?
Short-lived disturbance of emotions, starting 3-5/7 post-partum and lasting for 1-2/7 (not >10/7).
More common in first child or history of premenstrual tension.
What is the treatment for baby blues?
Reassurance and explanation to the mother and partner.
How long does postnatal depression typically last?
Usually self-limiting (often <1/12). Fully recovered in 1 yr.
What is puerperal psychois?
Postnatal psychosis.
What are symptoms of post-natal depression usually worse?
At night
What is the treatment for postnatal depression?
- Supportive psychotherapy
- CBT
- Social support
What is the management of PND if it last longer than 1 month?
Add antidepressant
Give 3 elements of GAD:
- Apprehension
- Motor tension
- Autonomic overactivity
What can be given for acute treatment of GAD?
Hypnotics:
- BZD
- Buspirone
- Beta-blockers
How does anxiety usually present?
When mixed with depression (most common psych. disorder in primary care.
What is a phobia?
Inappropriate situation anxiety with avoidance.
What are the 3 main groups of phobias?
- Specific
- Social
- Agoraphobia - anxiety of open spaces/going outside
What is the treatment of phobias?
Specific phobias - behavioural therapy
Agoraphobia + panic disorder/social - CBT
SSRIs - can relieve symptoms
What is maintained in OCD?
Insight into the disease
What is characterised by emotional distress and disturbance arising in a period of adaptation to a significant life change/stressful event?
Adjustment disorder (may respond to AD)
What are dissociative (conversion) disorders?
Dissociation = A disturbance in the normal integration of 2+ mental processes e.g. memory, consciousness, awareness of identity and immediate sensations, control of body movements. Conversion aspect = loss/change in bodily function, usually affecting voluntary NS; where mental stress has been converted to a physical symptoms.
What is the management of dissociative (conversion) disorders?
- Relaxation training
- Hypnosis
- Anxiolytics
- If sx not remitting - CBT/behavioural therapy
What is somatisation disorder?
Chronic syndrome of multiple physical sx not explainable medically. Poor prognosis with chronic fluctuating course.
What is hypochondriacal disorder?
Persistent belief in presence of 1+ serious physical illness despite no evidence with persistent refusal to accept advice. CBT sometimes used. Poor prognosis - chronic and fluctuating
What is persistent somatoform pain disorder (psychogenic pain)?
Preoccupation with persistent severe and distressing pain in the absence of adequate physical findings. Rx - Pain clinics, AD, CBT
