Psychiatry Flashcards
Major depression DSM V criteria
Symptoms almost every day, for at least two weeks;
>=5 of the following:
- Depressed mood lasting for most of the day
- Sleep disturbance (insomnia or hypersomnia)
- Loss of interest or anhedonia
- Feelings of worthlessness or guilt
- Fatigue or loss of energy
- Diminished concentration or ability to make decisions
- Significant change in weight (not associated with dieting) or appetite
- Psychomotor changes (agitation or retardation)
- Recurrent suicidal ideation or thoughts of death
At least one of the symptoms must be depressed mood or anhedonia.
Clinically significant distress or impaired functioning
DSM V criteria for manic episode
> =3 of the following:
- Increased goal-directed activity (sexually, at work, and/or socially ) or psychomotor agitation
- Increased talkativeness or pressure to keep talking
- Flight of ideas or racing thoughts
- Excessive involvement in risky activities that can potentially lead to negative consequences (e.g., compulsive shopping, indiscreet sexual behavior, impulsive financial investments)
- Decreased need for sleep
- Heightened self-esteem or grandiosity
- Distractibility
Definition of manic and hypomanic episode
Abnormally and persistently elevated, expansive or irritable mood alonside increased goal-directed behaviour, activity or energy that are unattributable to an organic psychic disorder or psychotropic substances
Manic: most of the day for at least >=7 consecutive days
Hypomanic: most of the day for >=4 consecutive days
Manic: significant professional/social dysfunction, patient requires hospitalisation or psychotic features may be present
Bipolar I and II definition
Bipolar I disorder: >=1 confirmed episode of mania
Bipolar II disorder: >=1 confirmed episode of hypomania and >=1 major depressive episode and absence of any manic episodes
Treatment of bipolar disorder (acute, maintenance)
Acute: resolution of mania and psychosis (if present)
mild to moderate: monotherapy with lithium, valproic acid, atypical antipsychotics (olanzapine, quetiapine)
severe: combination therapy: mood stabiliser (lithium or valproic acid) plus antipsychotic (quietiapine, risperidone, haloperidol)
Acute depression: atypical antipsychotics plus mood stabiliser
Maintenance: prevention of manic episodes, reduction of suicide risk, improvement in social functioning
Commonly used: lithium (preferred) - monitor serum levels, Valproic acid, lamotrigine. Carbamazepine
For refractory: Mood stabiliser plus atypical antipsychotic
Avoid prescribing antidepressants before initiating therapy with mood stabilisers, as antidepressants can precipitate a manic episode. Can prescribe after initiating mood stabilisers.
Definition schizophrenia
Schizophrenia is a psychiatric disorder characterized by psychotic symptoms (e.g., hallucinations), negative symptoms (e.g., decreased expressiveness), and cognitive impairment (e.g., lack of executive function).
DSM V criteria schizophrenia
At least two of the following symptoms must be present, with at least one of these from the first three symptoms listed:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
The above symptoms persist for ≥ 1 month.
There are continuous cognitive or affective disturbances for ≥ 6 months.
Symptoms must cause social, occupational, or personal functional impairment lasting ≥ 6 months.
Definition schizoaffective disorder
A psychiatric disorder characterized by the presence of psychosis (hallucinations, delusions, and ego disturbances), intermittently accompanied by manic or depressive symptoms. By definition, the psychotic symptoms must be more dominant than the mood symptoms and psychosis must have been present for at least 2 weeks in the absence of any mood disturbance.
Definition schizophreniform disorder
A psychiatric disorder characterized by symptoms of schizophrenia (e.g., delusions, hallucinations, disorganized speech, and/or negative symptoms) that impair social, occupational, and personal functioning. Symptoms last between 1-6 months.
Initial first line treatment for schizophrenia
Antipsychotics - risperidone, aripiprazole, quetiapine
