Psychiatry Flashcards
What are the two core symptoms of depression?
Persistent sadness/low mood
Loss of interest or pleasure in most activities (anhedonia)
What are the other symptoms (not core symptoms) associated with depression?
Fatigue/loss of energy, worthlessness/excessive or inappropriate guilt, recurrent thoughts of death/suicidal ideation, diminished ability to think/concentrate, psychomotor agitation/retardation, changes in appetite or weight loss
How do you classify depression into less severe and more severe?
Less severe - PHQ-9 score <16
More severe - PHQ-9 score 16 and above
What are the risk factors for developing depression?
Female, past history of depression, other mental health problems, physical illness, psychosocial problems, hormonal imbalances
What is the first line management for someone with less severe depression>
CBT or other psychological intervention
Antidepressants are not recommended initially
What is the management of someone with more severe depression?
Offer psychological interventions and antidepressant therapy
What is the difference between type 1 and type 2 bipolar?
Type 1 = mania
Type 2 = hypomania
Both have major depressive episodes
What is cyclothymia?
Less severe version of bipolar in which there is hypomania and periods of low mood
What are the core features of mania?
Hyperactivity, elevated mood, irritability
What features are present in those with mania?
Irritability, euphoria, grandiose ideas, flight of ideas, poor concentration, lack of insight, rapid speech, decreased sleep, recklessness, delusions and hallucinations
What is required to diagnose someone with bipolar?
Needs to be at least two episodes in which a person’s mood and activity levels are signifiacntly disturbed (one of which has to be mania/hypomania)
What’s the difference between mania and hypomania?
In hypomania there are no psychotic symptoms, less associated dysfunction (compared to mania), hypomania lasts only 7-10 days
What medications are used during acute manic episodes?
If 1st episode = antipsychotics such as haloperidol, olanzapine are used
If already on antipsychotic then dose should be increased to maximum tolerated dose (+ another antipsychotic if required)
What medications can be used to prevent manic/depressive episodes in those with bipolar?
1st line = lithium (+valproate if ineffective)
What’s the difference between baby blues and post-partum depression?
In baby blues symptoms are usually mild and resolve within 2 weeks of delivery, no treatment is required
What are the risk factors for developing post-partum depression?
Previous history of mental health problems, psychological disturbance during pregnancy, poor social support, poor relationship with partner, recent major life event
How is post-partum depression managed for mild-to-moderate and moderate-to-severe?
Mild = facilitated self-help strategies
Mild (but previous history of severe depression) = consider SSRI - sertraline or paroxetine safest in breastfeeding)
Severe = consider high intensity CBT +/- antidepressant
What are the risk factors for developing post-partum psychosis?
Past history of postpartum psychosis, past history of bipolar disorder, family history of bipolar or postpartum psychosis
What are the features of post-partum psychosis?
Can be depressive or manic in nature, may be delusions, hallucinations and have beliefs about the baby
How is post-partum psychosis managed?
Admission onto a specialist mother and baby unit
Mood stabilising or antipsychotics drugs are usually used
What are the risk factors for developing schizophrenia?
Early use of cannabis, cocaine and amphetamines, family history, social isolation, abnormal family interactions
What are the 4 1st rank symptoms of schizphrenia?
Thought alienation (loss of sense that thoughts are their own)
Passivity phenomena (thoughts, actions or feeling as being manufactured against their will by someone else)
3rd person auditory hallucinations - someone is talking about them/thought echo
Delusional perception - delusional idea in response to a stimulus
What are the 2nd rank symptoms of schizophrenia?
Delusions, 2nd person auditory hallucinations (someone commanding you to do something), hallucinations in other modalities, thought disorder, catatonic behaviour
What is required to diagnose someone with schizophrenia?
Requires symptoms for around 6 months and symptoms to be present much of the time with marked impairment in functioning
1 1st rank symptom or 2 2nd rank symptoms
What medications can cause drug induced psychosis?
Muscle relaxants, antihistamines, antidepressants, parkinson medications, corticosteroids, stimulants
What investigations need to be done in someone presenting with schizophrenia symptoms?
LFTs and FBC to rule out alcohol abuse
Serological tests for syphilis
Urine screen for signs of drug abuse
What is the management of someone with schizophrenia?
Antipsychotics continued for 1-2 years after initial event before gradually reducing dose with plan to stop
Atypical antipsychotics are 1st line
What is schizoaffective disorder?
Features of schizophrenia + mood disorder such as depression or bipolar
What is the management of someone with schizoaffective disorder?
Antipsychotics, mood stabilisers used if bipolar type, psychological treatments
What are the risk factors for anxiety?
Genetic, stress, life events, 34-54, being divorced, living alone, single parent
What is required to diagnose anxiety?
Excessive anxiety any worry occurring more days than not for at least 6 months, difficult to control the worry
+ associated with fatigue, restlessness, difficulty concentrating, irritability, muscle tension
+ physical symptoms
How is anxiety managed?
Sleep hygiene, regular exercise, meditation, CBT, SSRIs
1: self help
2: CBT or SSRI
3: refer for specialist assessment
In those who cannot tolerate SSRIs venlafaxine or pregabalin can be considered
What is a panic disorder?
Panic attacks associated with >1 month duration of anxiety about recurrence or attacks/consequences of attacks
Often co-exists with agoraphobia or social anxiety
What is the management for panic disorders?
Avoid anxiety producing substances like caffeine, exclude alcohol or drug misuse, CBT, SSRIs
What is a complex phobia?
Develop during adulthood, associated with deep-rooted fear or anxiety about a particular situation/circumstance
Common examples: social phobia and agoraphobia
What is the management for complex phobias?
Counselling, psychotherapy, CBT
Sometimes SSRIs or beta blockers can be prescribed to help people cope
What are obsessions and compulsions?
Obsession = unwanted intrusive thought, image or urge that repeatedly enters the person’s mind
Compulsions = repetitive behaviours or mental acts that the person feels driven to perform
What is the diagnostic criteria for OCD?
Either obsession or compulsions present on most days for a period of at least 2 weeks - repetitive and unpleasant, cause distress, unable to resist them, interfere with functioning
What is the management for OCD?
1st line = CBT including exposure and response prevention
2nd line = SSRI
If severe they get both
Clomipramine (TCA) is also used as alternative to SSRI
How is PTSD diagnosed?
Symptoms need to persist for 4 weeks after event (if not it is acute stress disorder)
What are the risk factors for PTSD?
Life threatening events, asylum seekers, first responders, military, previous psychiatric disorders, female
What are the symptoms of PTSD?
Re-experiencing (recurrent and intrusive)
Avoidance and overthinking relating to the event
Hyperarousal (being concerned about imminent danger) or emotional numbing
Chronic stress reactions
What is the management for severe PTSD?
1st line = Trauma focused CBT should be offered including EMDR
2nd line = SSRI/SNRI
What is somatisation disorder?
Multiple physical symptoms present for at least 2 years e.g. headaches, tiredness, chest pain
What is hypochondirasis?
Persistent belief in presence of an underlying serious disease e.g. thinking they have cancer
What is conversion disorder?
Loss of motor or sensory function which suggest serious neurological disease
Usually develops quickly in response to a stressful situation