Psychiatry Flashcards
What are the three core symptoms of depression?
Low mood
Anergia (loss of energy)
Anhedonia (loss of pleasure)
What are other symptoms of depression?
Change in sleep Change in appetite Weight loss Change in libido Diurnal mood variation Agitation Loss of confidence Loss of concentration Guilt Hopelessness Suicidal ideation Reduced self esteem
Define paranoid
Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges
Define schizoid
Emotionally ‘cold’, lacks interest in others, rich fantasy world
Define schizotypal
Extreme social discomfort, distorted cognitions and perceptions
Define antisocial
Criminals, aggressive, lack of empathy, impulsive, lack of guilt, manipulative
Define borderline
Mood swings, self-harm and impulsivity, self-image problems, often history of abuse
Define histrionic
Attention seeking behaviour and excessive emotions
Define narcissistic
Grandiosity, need for admiration and a perceived lack of empathy
Define dependent
Passive, clingy, need to be cared for by other people, feels helpless when not in relationship
Define avoidant
Social inhibition and inadequacy, extreme sensitivity to negative evaluation
Define obsessive compulsive (anankastic)
Worries and doubts, perfectionism, sensitive to criticism, pedantry
Difference between avoidant and schizoid?
Schizoid VOLUNTARILY withdraw from social situations
Criteria for mild, moderate and severe depression
Mild: 2 core + 2 others
Moderate: 2 core + 3-4 others
Severe: 3 core + 4+ others
Risk factors for depression
Genetic
Childhood experiences
Social circumstances
Assessment for depression
PHQ-9
HADs
Management for depression
1st line: SSRI - sertraline, citalopram, fluoxetine
2nd line: alternate SSRI
3rd line: Mirtazapine, SNRI - venlafxine/duloxetine
Define baby blues
Common transient
3-7 days after birth - may last 2 weeks
Tearful, anxious and irritable
Tx: Reassurance and support
Define post-natal depression
10% of all women
Start within a month and peaks at 3 months
Tx: Reassurance and support
CBT, SSRIs - sertraline
Define puerperal psychosis
Rare
2-3 weeks after birth - risk to mother and baby
Severe mood swings and disordered perception - psychosis
Hospital admission
Mood stabiliser, antidepressant, ECT
Psychotic symptoms - antipsychotics/long-acting benzodiazepine
First rank symptoms for Schizophrenia
Hallucinations - 3rd person
Delusional perception
Thought disorders - withdrawal, insertion, broadcasting
Passivity phenomena
Management for schizophrenia
1st line: 2nd generation antipsychotics - risperidone, olanzapine, quetiapine, paliperidone, arirpiprazole
2nd line: 1st generation antipsychotics - haloperidol, chlorpromazine
3rd line: Clozapine
Side effects of 1st generation anti-psychotics
extrapyramidal side effects
Dystonia
Dyskinesia
Akasthesia
Parkinsonism
Side effects of 2nd generation anti-psychotics
Weight gain Diabetes Hyperglycaemia Dyslipidaemia Stroke Drowsiness
Side effects of clozapine
Agranulocytosis Reduced seizure threshold Myocarditis Weight gain Neutropenia Parkinson's
Treatment for dystonia
Procycladine
Treatment for dyskinesia
Tetrabenazine
Treatment for Parkinsonism
Procyladine
Treatment for akasthesia
Propanolol +/- cyproheptadine
Define schizoaffective disorder
Confusion and affective mood disorder
Pt experiences both symptoms of a mood disorder (mania or depression) and schizophrenia (hallucinations/delusions) at the same time
Tx: Antipsychotic and mood stabiliser
Define generalised anxiety disorder (GAD)
Anxiety that is generalised + persistent. ‘Excessive worry’ + feelings of apprehension about every day events/problems
Risk factors for generalised anxiety disorder
35-54 years old
Female > Male
Divorced/separated
Live alone/lone parent
Clinical features for generalised anxiety disorder
Restlessness Irritability Easily fatigued Difficulty concentrating Muscle tension Sleep disturbance
Other features of generalised anxiety disorder
Heart palpitations Increased HR Sweating Dry mouth Insomnia Difficulty breathing Chest pain Nausea and vomiting Numbness Dizzy Depersonalisation Fear of dying
Management for generalised anxiety disorder
Exercise Meditation Relaxation techniques CBT Behavioural therapy SSRI - first line Benzodiazepine (Addictive) Propanolol - for somatic symptoms such as tremor and sweating
Define PTSD
Severe psychological disturbance following a traumatic event. Characterised by involuntary re-experiencing elements of the event
Causes of PTSD
Fear response
Neurophysical changes
Genetic
Reduced hippocampal volume
Risk factors for PTSD
low education lower social class female Previous family history Previous traumatic events
Symptoms for PTSD
Flashblacks, nightmares
Avoidance
Hypervilgilance
Emotional numbing
Treatment for PTSD
CBT
Eye movement desensitisation and reprocessing (EMDR)
Sertraline and mirtazapine
