Psych - mood, anxiety and eating disorders Flashcards by Eilidh Edmiston

what is the criteria for depression

last >2 wks
no hypomanic or manic symptoms
interfere with normal function

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what are the symptoms of depression? how many must you have?

2 of:
Depressed mood to an abnormal degree present for most of the day, every day >2 weeks
Loss of interest/pleasure in activities
Decreased energy or increased fatigability

at least 4 of:
loss of confidence or self esteem
unreasonable feelings of self-reproach or excessive and unreasonable guilt
recurrent thoughts of death or suicide, or any suicidal behaviour
complaints or evidence of diminished ability to think or concentrate
sleep disturbance of any type
change in appetite with corresponding weight change

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what are the symptoms of atypical depression

mood reactivity
2 or more of:

 significant weight gain or increase in appetite
 hypersomnia
 leaden paralysis = heavy, leaden feelings in arms or legs
 long-standing pattern of interpersonal rejection sensitivity (that results in significant social or occupational impairment

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what are the symptoms of psychotic depression

occasionally paranoid, hypochondriacal, or ‘mood-congruent’

cotard’s syndrome = extreme nihilistic delusions

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what is classed as moderate depression

2 core symptoms + 4 additional

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what is classed as severe depression

all 3 core symptoms + 5 additional

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what is the treatment of mild depression

CBT

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what is the medical treatment of the 1st episode of depression

continue antidepressants for 6 months after full recovery

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what is the medical treatment of the <1st episode of depression

continue antidepressants for 1-2 yrs after full recovery

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what is bipolar disorder

2 or more episodes in which the patient’s mood and activity levels are significantly disturbed

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what are the types of bipolar

I = mania + depression (classic)
II = hypomania + depression (more common)
III = hypomanic episode following use of antidepressants for depression

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what are the symptoms of a hypomanic episode

mood is elevated for at least 4 consecutive days

3 of the following:
 increased activity or physical restlessness;
 increased talkativeness;
 difficulty in concentration or distractibility;
 decreased need for sleep;
 increased sexual energy;
 mild spending sprees, or other types of reckless or irresponsible behaviour;

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what are the symptoms of a manic episode

mood is predominately elevated sustained for at least 1 week

3 of the following:
 Increased activity or physical restlessness;
 Increased talkativeness (‘pressure of speech’);
 Flight of ideas or the subjective experience of thoughts racing;
 Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances; Disinhibition
 Decreased need for sleep;
 Inflated self-esteem or grandiosity;
 Distractibility or constant changes in activity or plans;
 Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving;
 Marked sexual energy or sexual indiscretions.

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what is the treatment for acute mania/hypomania

stop antidepressants
max antimanic dose if on maintenance
antipsychotics

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what is the 1st line antipsychotic for acute mania/hypomania/ depression

olanzapine, quetiapine, risperidone

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what is the treatment for acute depression

antipsychotics

antidepressant + antimanic

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what is the long-term maintenance of bipolar disorder

lithium = gold standard
valproate = primarily manic
lamotrigine = primarily depression

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what is the non-pharmalogical treatment of mood disorders

ECT
CBT
interpersonal therapy

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what are the contraindications to ECT

MI within 3 months
recent cerebrovascular accident
intracranial mass
phaeochromocytoma

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what are the side effects of ECT

headache, short-term memory loss

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when is ECT commonly used

recurrent depression without psychosis

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what does ECT do? how is it given?

achieves a seizure lasting 15-20sec

usually 2x a week bilaterally

what is anorexia nervosa

deliberate weight loss that is induced and sustained by the patient

what are the symptoms of anorexia nervosa

self-induced weight loss
body image disturbance
BMI 17.5 or less
amenorrhoea

what is bulimia nervosa

repeated bouts of overeating an excessive preoccupation with control body weight leading to a pattern of overeating followed by vomiting/purging

what are the symptoms of bulimia nervosa

persistent preoccupation with eating | binges and attempts to counter effects of binges

what are the physical signs of bulimia nervosa

calluses on knuckles = Russell's signs parotid hypertrophy dental caries

what are the physical signs of anorexia nervosa

``` muscle wasting hair loss, lunar hair cold, blue peripheries dry skin hypercarotenaemic = jaundice-like yellowing of skin (palms and soles) ```

what are the complications of bulimia nervosa

``` oesophageal reflux oesophageal tears/rupture hypokalaemia subconjuctival haemorrhage seizures - metabolic abnormalities ```

what is the cause of refeeding syndrome

depletion of already inadequate stores of nutrients which are quickly used up as body starts to repair itself

what is an anxiety disorder

anxiety that is more extreme than normal causing significant distress and impairment of functions

what is generalised anxiety disorder

this is generalised and persistent but not restricted to any particular environment

what is the criteria for generalised anxiety disorder

long-lasting = most days for at least 6 months not controllable causing significant distress/impairment in function

what are the symptoms of generalised anxiety disorder

``` Persistent nervousness/restlessness/keyed up/on edge Trembling/Muscular tensions Sweating Palpitations Light-headedness/dizziness Epigastric discomfort Sleep disturbance ```

what is the treatment of generalised anxiety disorder

CBT SSRIs/SNRs pregablin

what is the first line antidepressants used in generalised anxiety disorder

fluoxetine and sertaline

what is panic disorder

recurrent attacks of severe anxiety which is not restricted to a particular situation

what is the symptoms of panic disorder

anxiety symptoms secondary fear of dying/losing control/going mad +/- agoraphobia

what is the treatment of panic disorder

CBT | SSRIs/SNRs/tricyclics

what is a specific phobia

marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object/situation

what are the symptoms of a specific phobia

Exposure to phobic stimulus provokes immediate anxiety response akin to panic attack Recognition that fear is excessive or unreasonable Avoidance of phobic situation Normal functioning is impaired by the avoidance, anxious anticipation, or distress

what is the treatment of  a specific phobia

behaviour therapy = exposure, add CBT if needed | SSRIs/SNRIs if needed

what is social phobia? what is it also known as?

aka social anxiety disorder persistent fear of one or more social/performance situations in which the person is exposed unfamiliar people or possible scrutiny by others

what are the symptoms of social phobia

blushing or shaking fear of vomiting urgency or fear of micturition or defaecation exposure to the feared situation provokes anxiety which may lead to a panic attack behaviour inhibition

what is OCD

recurrent obsessional thoughts and/or compulsive acts

describe obsessional thoughts in OCD

Ideas, images or impulses entering the mind in a stereotyped way Recognised as the patient’s own thoughts But unpleasant, resisted and ego-dystonic

describe compulsive acts in OCD

``` Repeated rituals or stereotyped behaviours Not enjoyable or functional Often viewed as “neutralising” Recognised as pointless Resistance may diminish over time ```

what is the diagnostic criteria of OCD

obsessional symptoms/compulsive acts must be present for most days for at least 2 weeks AND must cause distress and interfere with activities

what is PTSD

a delayed or protracted response to a stressful event or situation of an threatening/catastrophic nature

what is the diagnostic criteria for PTSD

``` duration of 1 month traumatic event distress and impairment in functioning 1 or more intrusive symptoms 3 or more avoidance symptoms 2 or more increased arousal symptoms ```

what are the intrusive symptoms of PTSD

recurrent distressing recollections nightmares flashbacks physiological reactions

what are the avoidance symptoms of PTSD

``` avoidance of thinking about/talking about event avoidance of reminders loss of interest in activities amnesia of trauma detachment/numbing ```

what are the increased arousal symptoms of PTSD

``` sleep disturbance irritability/anger concentration difficulties hyper vigilance exaggerated startle response ```