psych vol 2 Flashcards
depression definition, key points diagnosis.
episodic mood disorder. depression + anhedonia for at least 2 weeks.
3 core features- presistent low mood
anhedonia (inability to experiance pleasure from activities prev found enjoyable)
reduced energy.
for diagnosis need 2 core + at least one other symptom (mod is 2, severe is all 3 core + 4 other)
risk factors for depression + epidaemiology
genetics, early onset anxiety, pmh of depression, personality (neuroticism, perfectionings, blame onself)
substance abuse
- adversity (trauma, stress, education)
chromasone 3 and 10 polymorphisms
Epi:
more common in females
very very common
leading cause of disability and death in 18-44 (suicide is more common in males)
theories of depression
monoamine theory- reducing in the amount in the brain causes depression- some evidence for + against
neuroendocrine hypothesis- increaced amounts of cortisol cause depression.
cognative- Becks cognative triad The self- i am to blame
the world- is unfair
the future- hopeless
investigation of depression and menegement
Ix: “during the last month have you been bothered by feeling down, depresed or hopeless?”
“during the last month have you often been bothered by having little interes or pleasure in doing things?” — if yes to either do mental health assessment (risk as of self harm inc in this)
Mx: anti depressants take 6 weeks to have effect.
1st line- CBT (if indicated)
2nd- SSRI
3rd line –> SNRI, bupropion, mirtazapine, TCA + MOA inhibitors.
if suicidal- add lithium
psychostimulatns for acutely dyeing people.
breifly what is serotonin syndrome
triad
autonimic- fever, sweat, rigors, tachy, diarrhoea
cognitive- headache, agitation, confusion
neuro- tremor, hyper reflexia, myoclonus
MX; ABC
stop offending
treat symptomatically.
definition and overview of perinatal mental health
any mental health issues during pregnancy or the year after pregnancy.
post natal blues affects more than 50% of women in 1st week after birth.
- significant hormonal and lifestyle changes + sleep depravation.
gen mild and ease within 2 weeks of delivery.
give some insight into the more serious perinatal mental health conditions
post natal depression- occuring around 3/12 after birth. Rx like normal depression. must be present for 2 weeks or more to be diagnosied
purperic psychosis- onset between two to three weeks after delivery. Women experience full psychotic symptoms—- need urgent assessment.
Rx: Admission to the mother and baby unit
Cognitive behavioural therapy
Medications (antidepressants, antipsychotics or mood stabilisers)
Electroconvulsive therapy (ECT)
discuss acute stress disorder, inc charicteristics, frequency, risk factors etc
relatively new condition (1994)
occurs no less than 3 days and no more than 4 weeks after a traumatic event.
if longer than 4 weeks may meet criteria for PTSD.
24% at one week, 11-40% at week 2. 1-11% go on to develop PTSD
Risk factors- no specific for ASR but for PTSD
Pretrauma- female, intellectual disabillity
education (lack)
hx of traumatic events / psych disorder
genetics
Peritrauma-
severity
assult
rape
physical injury
Post trauma:
tacychardia
socioeconomic status
pain severity
ICU
brain injury
dissociative symptoms
disabililty
subsequent life events
pathophysiology of acute stress reaction + acute stress disorder criteria for diagnosis
generally unsure, but pavlovian training and then extinction of this is the prime hypothesis
e.g - explosion at night- when night comes again people expect explosion, gradually through experaincing nights without explosion the symptoms reduce.
criteria
intrusion (repetative game themes in kids, dreams, flasbacks)
negative mood
dissociative symptoms
avoidance
arousal (inability to sleep, rage, distractability)
no other investigation or leb test etc.
management of acute stress reaction
make safe
support emotionally
practical support (e.g poliece dealings)
follow up for at least 6/12
evaluate for suicide risk.
trauma focused CBT- education around trauma psychology
exposure therapy is also an option in some situs but obviously not all.
limited evidence for pharmacology.
definition of anxiety disorders + overview of the condition. Diff diagnosis and meds that could trigger it.
excessive anxt or worry for more days than its not, for 6 months or more.
assoc with 3 or more of the following
restlessness
fatigue
difficult concentrating/ mind going blank
irritability
muscle tension
sleep disturbance
DD: hyper thyroid, cardiac, med induced anxiety, copd, pheochromocytoma
meds that could trigger : salbutamol, theophylline, steds, antidepressants, caffiene.
management of anxiety disorder + risk factors for it + diagnosis
step 1: education and active monitoring
2: low intensity psych intervention (self help)
3: high intensity psych interventions (e.g CBT) or drug
4: highly specialist input.
drug Rx: SSRI, buspirone, beta blockers, benzoz
Rf:
family history of anxiety, physical or emotional stress, history of trauma (phys, emotional, sexual)
diagnosis of anxiety: clinical, but want to rule of the DD if strong suspicion.
panic disorder overview and mechanisms of symptoms
disorder= recurrent attacks not due to substance misuse, medical conditions, or other psychiatric disorder.
an attack =a period of intense fear characterised by several symptoms
develop rapidly and peak within 10 mins. usually last 20-30 mins. - can be spontaneous or situational.
sympathetic overdrive- tachycardia, hyperventilation, sweating.
hyper vent = loss of Co2 + alkylosis –> constriction of cerebral arteries –> light headedness
crop in Ca2+ due to alkylosis –> tingling + paraesthesia
treatment of panic disorder and clinical features of a panic attack.
self help/ CBT
if CBT fails- antidepressants (SSRI)
if no response after 12/52 - imipramine or clomipramine
benzos for short term only.
(STUDENTS FEAR 3C’s)
Sweating
trembling
unsteadiness
derealisation
Elevated Hr
Nausea
tingling
shortness of breath
FEAR (dying, going crazy etc)
Chest pain
Choking
Chills.
risk factors for panic disorder, diagnosis
1st degree relative history
18-39
female
white and native American
major life events
comorbid (anxiety, substance use, mood disorder), asthma, ciggies, caffeine.
diagnosis- clinical with heedance to differentials.
what are obsessions and compulsions and how do they tie together in ocd
obsessions –>unwanted disturbing and intrusive thoughts, images, or impulses. recognised as excessive or irrational, pts often try to resist them. recognised as the individuals own thoughts.
compulsions –> repetitive stereotyped behaviour + mental acts which neutralise obsessions and reduce emotional distress, usually recognised as pointless, repeated attempts are made to resist.
in OCD these end up being time consuming and cause distress or difficulty functioning.
affects 2% of the population.
risk factors, diagnostic factors and investigations for OCD
family history, PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection)
male, schizotypal personality disorder, tic disorder, brain structural abnormality.
diagnosis: presence of risk factors, obsessions and compulsions, sensory phenomena
no initial test, but can use structured clinical interview or yale-bown obsessive-compulsive scale.
treatment of OCD
patient should try and resist ritual, they reinforce the behaviours for short term relief.
done by functional impairment
mild- Brief CBT
Moderate- choice between CBT and medication - anxiolytics not recommended in the long term but can be used in short
Severe- Combines SSRI + full course CBT.
Clomipramine if 2 SSRI fail
mental health specialist referral.
post traumatic stress disorder definition
develops within 6 months of experiencing trauma or.
4 symptoms- intrusion, avoidance, negative cognition and mood, alterations in arousal and reactivity
these symptoms must persist for more than 1 month and cause functional impairment for diagnosis to be made.
key diagnostic factors, risk factors and investigations of PTSD
diagnostic factors: exposure to trauma, intrusion, avoidance, negative alteration in cognitions, arousal + reactivity
risk factors: exposure to significant stressor
Ix: PTSD checklist for DSM-5 / other trauma screening questionnaire.
management of PTSD
if less than 3 months and mild moderate- active management
if severe or longer than 3 months - trauma focused cognitive behavioural therapy
if CBT not effective consider SSRI but not so great. if they don’t work consider venlafaxine (SNRI)
can consider eye movement desensitisation and reprocessing.
