Psych: Conditions

Question 1

Depressive disorder clinical features?

Answer 1

(3 main symptoms)
Low mood
Anhedonia
Low energy

(Other symptoms)
Decreased appetite 
Decreased libido
Insomnia/ hypersomnia
Decreased concentration
Decreased Self-esteem
Ideas of guilt/worthlessness
Thoughts of self harm

(The severity: Mild, moderate, severe depends on)
Number of symptoms
Severity of symptoms
Degree of associated distress
Impact on daily life
Presence of psychotic features (labelled severe in this case)

Question 2

Depressive disorder: How is it diagnosed?

Answer 2

-One of the core symptoms for greater than 3 weeks
Classified like this:
- (First episode/Recurrent) Mild (+-somatic symptoms)/ Moderate (+-somatic symptoms)/ Severe (+- psychotic symptoms).

Question 3

Depressive disorder: What is the management?

Answer 3

In all severities:
--Treat comorbid physical illness
--Treat substance misuse problems
Mild:
--Cognitive behavioural therapy
--Self help groups
--Structured physical activity groups
Moderate:
--Individual CBT
--Antidepressant medication
--Interpersonal therapy
Severe:
--ECT if oral intake poor
--Admission or crisis team referal
--Antipsychotics if indicated

Question 4

Core features of Schizophrenia?

Answer 4

• (Positive symptoms)
• -Delusions
• -Hallucinations (Visual + auditory)
• -Thought disorder (insertion, withdrawal, broadcast)
• -Sense of being controlled (passivity)
• (Negative symptoms)
• -Loss of motivation
• -Loss of affect variation (“blunting”)
• -Paucity of thought
• -Loosening of association

Question 5

Schizophrenia subtypes?

Answer 5

• Paranoid schizophrenia
• Hebephrenic schizophrenia
• Catatonic schizophrenia
• Undifferentiated schizophrenia
• Post-schizophrenic depression
• Residual schizophrenia
• Simple schizophrenia

Question 6

Schizophrenia management?

Answer 6

• First psychotic episode
• -Start on a SGA antipsychotic (eg olanzapine, amisulpride, risperidone, quetiapine, clozapine)
• -Use a long acting benzodiazepine (eg diazepam)
• Long term management
• -establish minimal effective dose of anti-psychotics
• -Switch to FGAs if indicated (eg chlorpromazine)
• -Manage comorbidities, and side effects of anti-psychotics (eg EPSE; dystonia)
• -Give depot injection (eg Olanzapine pamoate)

Question 7

Differentials relating to Schizophrenia?

Answer 7

• Organic: physical causes of psychosis (eg substance misuse)
• Acute and transient psychotic episode: resolves completely w/i few months, can be stress related

• Mood disorder: depression and mania, if severe enough, produce psychotic symptoms. Find out chronology of Sx. 

• Schizoaffective disorder: is diagnosed if both schizophrenic and affective symptoms develop together and are roughly evenly balanced, to the extent that one set of symptoms cannot be said to be more important than the other
• Persistent delusional disorder: describes delusions with few if any hallucinations. 

• Schizotypal disorder: lifelong state of eccentricity with abnormal thoughts