Psychiatry Flashcards
What are the 3 core symptoms of depression
Low mood
Anhedonia
Low energy levels
Cognitive symptoms of depression
Low mood Feelings of guilt Feelings of uselessness Feelings of worthlessness Suicidal thoughts Poor concentration Mood congruent hallucinations and delusions
Functional symptoms of depression
Early morning waking - 2 hours before their normal time
Difficulty getting to sleep, waking up multiple times during the night
(Diurnal variation of symptoms - worse in early morning and late at night)
Weight loss - loss of appetite, nausea
Weight gain - comfort eating
Decreased libido
Slow thoughts/actions
Agitated/fidgety
Memory problems
Diagnostic criteria of depression
1 core symptoms + 3 others
3 others = mild
4-5 others = moderate
7+ others = severe
What does melancholia mean
Emotional numbness
Medications that increase the risk of depression
Steroids Beta blockers Statins Oral contraceptive Isotretinoin
Risk factors for depression
FH Female Stress/trauma Substance abuse Previous psychiatric diagnosis Chronic disease Unemployed Single Post-natal
Differentials for depression
Hypothyroidism
Bipolar disorder
Parkinson’s disease
Addison’s disease
Depression screening questionnaire
PHQ-9
What is bipolar I disorder
One or more manic episodes (lasting 1+ weeks) with or without major depressive episodes
What is bipolar II disorder
One episode of hypomania and one major depressive episode but no episodes of mania
What is rapid cycling in bipolar
4+ manic/hypomanic/major depressive episodes per year
What is cyclothymia
Persistent manic/depressive mood swings over the course of 2 years, which are not sufficiently severe to justify a diagnosis of bipolar disorder
How long do you have to allow before seeing beneficial effects of SSRIs
4-6 weeks
Common initial side effects of SSRIs
Dry mouth Mild nausea GI upset Sexual dysfunction Drowsiness
Side effects of tricyclic antidepressants
Dry mouth Blurred vision Constipation Urinary retention Sweating Dizziness Drowsiness
Venlafaxine and Duloxetine belong to which class of antidepressants
SNRIs
What are the 10 main symptoms of depression and how long do you need to have had symptoms for
At least 2 over a 2 week period
- Persistent low mood
- Anhedonia
- Fatigue/low energy
- Disturbed sleep
- Poor concentration/indecisiveness
- Low self-confidence
- Poor/increased appetite
- Suicidal thoughts or acts
- Agitation or slowing of movement
- Guilt or self-blame
What are the main differences between a manic and hypomanic episode
Manic lasts at least 1 week
Hypomanic lasts at least 4 days
Manic results in significant dysfunction (work/school), requires hospitalisation (risk to self or others), or has psychotic features. Whereas hypomanic doesnt result in significant dysfunction, hospitalisation or psychotic features
Features of mania and hypomania
Increased goal directed activity - sexually, work, socially
Psychomotor agitation
Increased talkativeness/pressure of speech
Flight of ideas or racing thoughts
Loss of social inhibition, socially inappropriate and reckless behaviour, aggressive/hostile
Decreased need for sleep
Overconfidence
Easily distracted
What is dysthymia
A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder
Describe how acute stress reactions present
Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.
Typical symptoms of PTSD
Flashbacks Dreams/nightmares Persisting background sense of emotional blunting Social detachment Anhedonia Avoidance of triggers
What is the difference between somatoform/somatisation disorders and hyochondriacal disorder
Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.
Describe how acute stress reactions present
Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.
Typical symptoms of PTSD
Flashbacks Dreams/nightmares Persisting background sense of emotional blunting Social detachment Anhedonia Avoidance of triggers
What is the difference between somatoform/somatisation disorders and hyochondriacal disorder
Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.
5 screening questions for eating disorders
Sick? - do you make yourself sick after meals Control? - do you feel you've lost control over how much you eat One stone (in 3 months)? Fat? - do you believe yourself to be fat when others say you are thin Food? - would you say food dominates your life
Differentials for eating disorders
Anxiety/depression/stress Malignancy Addison's disease Chronic infection Malabsorption syndrome Drug/alcohol dependency
Physical effects of an eating disorder
Tooth damage due to acid Cold Bradycardic Think hair Think skin Amenorrheic
Differentials for anxiety
OCD Hyperthyroidism Psychotic illness Substance abuse Substance withdrawal Phaeochromocytoma
What are Schneider’s first rank symptoms of schizophrenia
Thought echo Thought insertion/withdrawal Thought broadcasting 3rd person auditory hallucinations Delusional perceptions Passivity/somatic passivity - belief that movements/emotions/thoughts are being controlled
What are the positive symptoms of schizophrenia
Delusions
Hallucinations
Thought disorders
Schneider’s first rank symptoms
What are the negative symptoms of schizophrenia
Decline in normal function Affective blunting - lack of facial expression, flat voice, lack of eye contact Social isolation/withdrawal Anhedonia Poverty of speech Avolition - lack of motivation Apathy Poor self-care
What are delusions
Fixed beliefs that are not reality based and cannot be explained as part of the patients cultural background
Types of delusions
Persecution Reference Grandeur Control - includes thought broadcasting, insertion, withdrawal Nihilistic
What is the difference between thought disorders and delusions
Formal thought disorder refers to an impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language. Whereas delusions reflect abnormal thought content, formal thought disorder indicates a disturbance of the organization and expression of thought
Types of auditory hallucinations
Commands
Derogatory
Conversing
Running commentry
Drug-induced psychosis usually causes which type of hallucination
Tactile
Types of formal thought disorder
Tangentiality/flight of thought Derailment/knights move thinking Word salad - no connection between words Incongruent affect Circumstantiality Pressured speech Distractible speech - cant maintain attention, distracted by irrelevant things Perseveration Neologisms - new word or new meaning to an existing word that is only apparent to them
Describe the prodromal period before schizophrenia
Before disease develops tendency as a child to be withdrawn, have loss of interest, self-neglect, depression.anxiety, brief psychotic episodes
Periods of stress/intense emotion/significant event can trigger schizophrenia in a susceptible individual
What drug class is used to treat schizophrenia
Dopamine (D2) receptor antagonists
Examples of typical antipsychotics
Haloperidol Chlorpromazine Promethazine Flupenthixol Decanoate (IM)
Side effects of typical antipsychotics
Extrapyramidal - parkinsonism, akathisia, dytonia, dyskinesia
Hyperprolactinaemia - sexual dysfunction, osteoprosis, amenorrhea, galactorrhea, gynaecomastia, hypogonadism
Metabolic - weight gain, T2DM risk, hyperlipidaemia, metabolic syndrome
Anticholinergic - tachycardia, blurred vision, dry mouth, constipation, urinary retention
Neuro - seizures, neuroleptic malignant syndrome
Increased QT interval
Examples of atypical antipsychotics
Clozapine Olanzapine Quetiapine Risperidone Amisulpride
Life threatening potential side effect of Clozapine
Agranulocytosis
Organic causes of psychosis
Dementia Temporal lobe epilepsy Infection - encephalitis, AIDS Brain injury Brain tumour Huntington's disease Low B12 Cushings High dose steroids SLE Thyroid disease
What are the 5 main differentials of psychosis
Schizophrenia
Drug induced/withdrawal
Severe depression (psychosis would be mood congruent)
Manic phase of bipolar disorder (psychosis would be mood congruent)
Dementia
Describe section 2 of the mental health act
Allows for assessment +/- treatment
Lasts 28 days
AMHP (approved mental health practitioner) activates it
2 doctors need to approve it, one of whom needs to be section 12 approved
Describe section 4 of the mental health act
Allows emergency admission for assessment
Lasts 72 hours
AMHP or nearest relative can activate it
One doctor needed to approve it
Describe section 3 of the mental health act
Allows treatment for up to 6 months
Treatment for 1st 3 months then need consent or 2nd opinion application by AMHP or NR, needs 2drs approval
