psych Flashcards
what questionnaire can be used to screen for depression?
PHQ-9
HAD
Beck’s
what is sub-threshold depression ?
fewer than 5 symptoms
what are the key symptoms of depression?
low mood
anhedonia
fatigue/lack of energy
what are some of the symptoms of depression
low mood anhedonia fatigue weight change decreased concentration decreased libido agitation disturbed sleep retardation thoughts of death and suicide
what are some psychotic symptoms of sever depression?
delusions of poverty guilt personal inadequacy responsibility for worlds events hallucinations - usually auditory olfactory hallucinations - bad smells visual hallucinations - tormentors catatonic behaviour
what factors increase risk of depression?
fam history
chronic illness
adverse life events
what are the different types presentations of depression?
without somatic symptoms with somatic symptoms with psychotic symptoms atypical seasonal affective
what is the initial management for sub-threshold depression?
educate on sleep hygiene
active monitoring
low intensity psychosocial interventions (CCBT, provision of written materials, physical activity programmes
when should you consider drug treatment for persistent sub-threshold or mild/moderate depression?
if the have a past history of moderate or severe depression
if the symptoms of threshold depression have lasted for more than 2 years
if the symptoms of sub-threshold or mild have persisted after other interventions
what is the third step of depression management?
for persistent sub-threshold symptoms or mild/moderate depression with inadequate response to initial interventions and moderate and severe depression.
The options are an antidepressant or a high intensity psychological intervention (CBT, IPT, couple therapy)
Combination of CBT and medication
what is step 4 of depression management?
for severe and complex depression - risk to life, refer to specialist mental health team
impatient care and crisis resolution and home treatment crisis team
what is the first line drug for depression?
SSRI’s (fluoxetine, sertraline, paroxetine, citalopram)
what are the second line drug treatments for depression?
TCA’s (amitriptyline, clomipramine)
MAOIs (phenelzine, tranylcyromine)
SNRIs (venlafaxine, duloxetine)
SARIs - trazodone
What is bipolar?
chronic mental health disorder characterised by periods of mania/hypomania alongside periods of depression
what is the ICD-10 diagnostic criteria for bipolar?
at least 2 episodes, one must be hypomanic, manic or mixed
what is the DSM-V criteria for bipolar?
occurrence of at least one manic episode. thus by definition any previously well person experiencing their first episode of mania would be classified as bipolar
Type 1 - mania and depression
Type 2 - hypomania and depression
what are the symptoms of a manic episode?
distinct period of abnormally/persistently elevated moof for at least one week plus at least 3 characteristic symptoms:
- energy - over reactivity, pressure of speech, flight of ideas, racing thoughts, decreased sleep.
- self esteem - over optimistic ideation, grandiosity, decreased social inhibition
- distractibility
- inappropriate behaviour - without considering consequences, reckless with money, inappropriate sexual encounters
- disruption of work, family and social life
- psychotic symptoms - grandiose ideas +/- delusions related to identity or role, persecutory delusions, incomprehensible speech, violent behaviour, catatonic behaviour (manic stupor), lack of insight.
what are the symptoms of a hypomanic episode?
elevated mood plus at least 3 other symptoms lasting for more than 4 days:
- increased energy, decreased need for sleep, increased sociable and talkative, increased feelings of self esteem, increased sex drive and easily distracted.
Does not interfere with social or occupational function. They have no delusions or hallucinations
What is the acute management for bipolar
admit if severe - may be due to impaired judgment, high risk of suicide/homicide, severe psychotic, depressive, rapid cycling or catatonic symptoms.
Stop drugs that may be causing mania
give antipsychotic meds for mania and if the are in low mood give anti-depression
what is the first, second and third line treatment for someone having an acute manic episode?
1st line - antipsychotic - haloperidol, olanzapine quetiapine or risperidone
2nd line - increase dose of AP, or use a mood stabiliser (lithium)
3rd line - valproate
what is the first and second line drug treatments for bipolar depression?
1st line - fluoxetine combined with olanzapine or quetiapine.
2nd line - if unresponsive to first line consider lamotrigine
what is the intermediate management of bipolar?
monitor psych status, drug side effects, compliance and therapeutic levels of mood stabilisers
make sure to identify and address significant episodes early.
what is the long term management of bipolar?
1str line - lithium
2nd line - carbamazepine
what are the causes/risks of schizophrenia?
genetic - lifetime risk is increased 10% for first degree relatives - associated with DISC1 gene
substance misuse hostile family adverse life events social disadvantage Caribbean have highest rates