Psychiatry Flashcards
What is Depression?
Can be a symptom - form of sadness, not just absence of happiness.
Syndrome - constellation of symptoms and signs.
Recurrent illness - recurrent depressive disorder.
When is depression abnormal?
Persistence of symptoms.
Pervasiveness of symptoms.
Degree of impairment.
Presence of specific symptoms or signs.
What are the 3 main categories of symptoms?
Psychological - change in mood, change in thought content.
Physical - Change in bodily function.
Social - Loss of interest, withdrawal, Irritability.
When can depression be diagnosed?
Last at least 2 weeks.
No hypomanic or manic episodes in lifetime.
Not attributable to psychoactive substance use or organic mental disorder.
Need to exclude other psychotic illnesses first like schizophrenia.
Depression - somatic syndrome diagnosis
Lack of emotional reactions to events or activities that would normally produce an emotional response.
Waking 2 hours before normal time.
Depression worse in the morning.
Objective evidence of psychomotor agitation.
Loss of appetite, weight loss.
What would be diagnostic of 1.mild, 2.moderate and 3.severe depression
At least two of:
1,2,3: Depressed mood that is abnormal for most of the day almost everyday for 2 weeks.
Loss of interest or pleasure.
Decreased energy or increased fatigability.
- At least 2 additional.
- At least 4 additional.
- At least 6 additional.
e. g. loss of confidence, suicidal behaviour, agitation, sleep disturbance.
What is post-natal depression?
Increased risk of psychiatric admission in the 30 days following childbirth.
75% of women experience “blues” within 2 weeks.
What are some of the differential diagnosis of depression?
Normal reaction to life event. SAD Dysthymia Bipolar Stroke, tumour, dementia Hypothyroidism, Addison's Infections Drugs
Treatment for Depression
Antidepressants:
- Selective Serotonin Reuptake Inhibitors.
- Tricyclic antidepressants (TCAs)
- Monamine Oxidase Inhibitors
Psychological Treatments
- CBT, IPT, Individual dynamic psychotherapy, family therapy.
Physical treatments
- ECT, Psychosurgery, DBS.
What measurement tools can be used for depression?
SCID SCAN HDRS BDI-II HADS PHQ-9
What is Mania?
State of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness.
Rarely a symptom - associated with grandiose ideas, disinhibition, mental effects of stimulant drugs (AMPH, cocaine)
Pathological, inappropriate elevated mood.
How is mania classified
Hypomania - Lesser degree, mild elevation of mood, increased energy, Increased sociability, concentration reduced.
Mania - 1 week severe enough t disrupt ordinary work and activities, disinhibition, alteration of senses.
What are some mania differentials?
Mixed affective state
Schizophernia
ADHD
Drugs and Alcohol
Stroke, MS, Tumour, epilepsy, AIDS, Hyperthyroid.
How are symptoms measured?
SCID
SCAN
Young mania rating scale.
How is mania treated?
Antipsychotics - Olazapine, Risperidone.
Mood stabilisers - sodium valporate.
Lithium
ECT
What is Bipolar?
Consists of repeated (2+) episodes of depression and mania or hypomania.
(ICD-10)
Onset about 21.
What are the outcomes of major depression?
Typical episode lasts 4-6months 54% recover at 26 weeks 12% fail to recover 15% die by suicide 80% have further episodes. 2nd commonest cause of morbidity globally.
What are the outcomes of bipolar / mania?
Typical manic episode lasts 1-3 months. 60% recovered at 10 weeks 5% fail to recover 90% haver further episodes 1/3 have poor outcome 1/3 have good outcome 10% die by suicide.
What are the 3 most common mental health disorders?
Affective anxiety.
Substance misuse.
Reaction of psychological stress. (PTSD)
What are some of the affective / anxiety disorders?
Major Depressive Disorder (MDD)
Generalised Anxiety Disorder (GAD)
Panic disorder and phobic anxiety disorders
Obsessive-compulsive disorder.
What is Cognitive Behavioural therapy and what is it used for?
How our thoughts are related to our feelings and behaviour.
Particularly good for depression, anxiety, phobias, OCD, PTSD.
Short term, problem focussed, goal oriented, individual or self-help book.
What happens during CBT?
Identify thoughts, feelings and behaviours.
Assess whether thoughts are unrealistic / unhelpful.
Identify what can change.
The client then engages in the task which challenges the unrealistic or unhelpful thoughts.
What does Behavioural Activation do?
Focus on avoided activities.
- guide for activity scheduling, functional analysis of cognitive processes that involve avoidance.
Focus on what predicts and maintains an unhelpful response by various reinforces.
Client taught to analyse unintended consequences of their way of responding.
What are the different types of avoidance that can be seen in depression?
Social withdrawal - avoiding friends.
Non-social avoidance - excessive time in bed.
Cognitive avoidance - not making decisions or being serious about work.
Avoidance by distraction - comfort-eating, gambling.
Emotional avoidance - Use of alcohol or other substances.
What are the benefits of behavioural activation?
Collaborative / empathic / non judgmental.
Structured agenda- review progress.
Small changes - build to long term goals.
What is interpersonal Psychotherapy?
Treatment for depression / anxiety.
Time limited (12-16 weeks)
Focused on the present.
What events can lead to depression?
Disturbing change in or contingent with significant I-P event:
Complicated bereavement.
Dispute
Role transition
Interpersonal deficit
How does IT work in practice?
Identify the interpersonal context.
Focus on a specific area - depressive symptoms linked to interpersonal events (weekly)
Reduce depressive symptoms
Improve interpersonal functioning.
What are the 1. pros and 2. cons to IT?
- A grade evidence for treating depression.
No formal homework
Client can continue to practice skills beyond the sessions ending. - Requires a degree of ability to reflect - may be difficult for some.
Poor social networks - limited interpersonal support.