Psychiatry: The Main Ones Flashcards
What is major depressive disorder ? characterised by what (3) ? leading to what ? (2)
characterised by persistent low mood, loss of interest + enjoyment and low energy
=> social + occupational dysfunction
What Pneumonic can be used for major depressive disorder presentation ?
SIGECAPS
(SIG E-CAPS, like the doctors used to write on prescriptions or something)
What does SIGECAPS stand for ? what condition associated with ?
major depressive disorder: depressed mood PLUS
- Sleep (disrupt amount + quality, difficulty falling and staying asleep)
- Interest (anhedonia, things that used to bring joy don’t anymore)
- Guilt ( thoughts fixate on guilt, worthlessness, hopelessness)
- Energy (depleted, can’t get out of bed)
- Concentration (reduced)
- Appetite (mostly decreased (food is unappetising/tastless/cardboard) => weight loss)
- Psychomotor retardation (general slowing of speech + paschal movements)
- Suicide
How many criteria are required for major depressive disorder diagnosis ? one of which two symptoms are required ? how long symptoms around for ?
if not depressive mood or anhedonia => not depression
- >5/9 criteria
- > 2 weeks
(two blue weeks)
what is the suicide risk in major depressive disorder ?
5% suicide risk
What is the most common psychiatric disorder ?
major depressive disorder
(mixed anxiety + depression)
percentage of ppl who experience major depressive disorder ?
> 20% experience depressive ep in lifetime
major depressive disorder RF: sex ? age ?
- F twice as likely as M
- first onset usually <25 or >65
Without treatment, how long does depressive ep usually last ? how likely to return ?
depressive ep lasts 6-12 months then return to euthymia
- then 50% chance of another recurring
major depressive disorder:
With treatment, how long does remission take ?
usually less than 3 months
overall major depressive disorder management ? (3)
depends on mild/mod/severe
- Psychotherapy (CBT)
- Medication: Antidepressants, antipsychotics
- ECT
(don’t forget biopsychosocial approach)
How does CBT work ?
focuses on connections between thoughts feelings + behaviour
- break out of cycle
what scale is used to assess for severity of depression ? what are the categories and values for them ?
‘less severe’ depression: PHQ-9 score of < 16
‘more severe’ depression: PHQ-9 score of ≥ 16
name some antidepressant options (drug class + examples)
- how effective are they for major depressive disorder ?
SSRI (citalopram, fluoxetine, sertraline)
SNRI (duloxetine)
Dopamine reuptake inhibitor (buproprium)
- 1/3 remission, 1/3 response, 1/3 resistant
when would you consider ECT in major depressive disorder ? when consider first line ?
- If antidepressant resistant, ineffective (2 antidepressant have been trailed and failed)
- Consider first line in Px with life threatening depression (psychotic, suicidal, catatonia)
Describe the monitoring in antidepressant use for major depressive disorder ? how long use the meds for ?
monitor after 2 weeks
- continue treatment 6 months after remission
how do you stop SSRIs ?
gradually reduce SSRI dose over 4 weeks
which antidepressant should be used in kids/adolescents ?
fluoxetine (SSRI)
What depressive subtypes are there ?
- Melancholia
- atypical
- Postpartum
- Seasonal
- Psychotic
What is atypical depression ? describe presentation ?
which drug used for it ?
ate-typical
- depressed person but with mood reactivity became happy + ate food + gained weight so limbs feel heavy + sensitive to refection
-Tx: MAOIs
What is psychotic depression ?
paranoia/hallucinations + SIGECAP
what is dysthymia ? how long symptoms ?
persistent depressant disorder (chronic, not episodic)
- but it is sub-syndromal (<5/9) but still struggles with low mood >2 yrs
what is double depression ?
dysthymia + major depressive disorder
(generally low mood with additional episode depressive episodes)
What is mania ?
characterised by excessive elevated mood + energy (plus goal directed activity)
what is bipolar disorder ? causes what ?
chronic mental illness with alternating periods of abnormal mood elevation + depression with change or impaired function
what are the two main features to a manic episode ?
- elevated mood
- increased goal driven activity
describe the mood changes in mania ?
- elevated (like a million bucks/euphoria)
- non-reactive (just like in depression)
- can also be expressed as irritability of hostility (or alternating)
what pneumonic can be used for bipolar presentation ?
DIGFAST
what does DIGFAST stand for ? what condition is this associated with ? describe a bit of each
bipolar: elevated mood + activiy PLUS DIGFAST
- Distractability (trouble staying on topic, finishing sentence)
- Impulsivity (pleasure seeking activities: sex, drug use, opening mon mon)
- Grandiosity (inflated self esteem)
- Flight of idea
- Activity (increased energy + activity)
- Sleep (decrease need for sleep)
- Talkativeness (pressured speech)
describe the though content and though process in a manic Px ?
thought content: grandiosity (inflated self esteem)
thought process: flight of idea
what is required for bipolar diagnosis ? requirements
- duration of symptoms ?
elevated mood +
3/7 DIGFAST (1 of which must be increased goal directed activity)
- present for >1 week
How long to manic eps last if untreated ? if treated ?
manic ep lasts 3-6 months
- with treatment can be stopped in days/weeks
bipolar prevalence ? average age of onset ? M:F ?
- 1% lifetime prevalence
- Equal in men and women
- Most ppl develop in late teens/early 20s
what is the risk another mood episode in bipolar after the first ?
> 90%
(compared to 50% in depression)
What is the overall management of bipolar ?
usually always meds (mood stabilisers)
- mood stabilisers
- anticonvulsants
- Antipsychotics
when is lithium used in bipolar management ?
usually long term management
- helpful with mani + depressive episodes
(but only reaches therapeutic range after 3-4 days - benzos + AP act quicker)
when are anticonvulsants used in mania ? give examples and when used ?
- mania (sodium valproate, carbamazepine)
- Depression (lamotrigine)
when might antipsychotics be used in bipolar management ?
- faster at treating mania than mood stabilisers
- might be used in combo or instead of mood stabiliser in long term management
Name the 5 mood disorders ?
- Dysthymia
- Cyclothymia
- Depressive mood disorder
- Bipolar II
- Bipolar I
what different types of bipolar disorders are there ? (4)
type I
type II
cyclothymia
mixed state
what is bipolar type I ?
episodes of mania alternating with eps of depression
(only need 1 manic ep to be diagnosed bipolar I)
what is bipolar type II ?
characters by eps of hypomania (rather than mania) + depression
what is hypomania ? how long ?
milder symptoms of mania that is no imparting unction but still disturbance to mood
- 4 or more days
what is cyclothymia ? how long ?
hypomania (not quite mania) + dysthymia (not quite depression)
- must have features for 2 yrs
- bipolars version of depressions dysthymia
what is mixed state bipolar ? why is this dangerous ?
mani + depressed at same time
- low mood/worthlessness/anhedonia plus increased goal driven activity => increased suicide risk
acute management of an agitated manic Px ?which drugs ?
- tranquil environment + de-esclation techniques
- Rapid acting tranquillisation (voluntary - oral olanzapine or oral lorazepam) (involuntary: IM olanzipine or IM lorazepam)
acute management of manic Px ? (no agitation)
- discontinue antidepressant
- Antipsychotic or mood stabilsiter (sodium valproate, lithium, olanzipine)
long term bipolar management ?
mood stabilster/antipsychotic
- depressive ep: addition of antidepressant (fluoxetine)
(but be careful to no cause manic ep)
What is schizophrenia ?
- Severe mental illness characterised by psychotic symptoms (hallucinations, delusions and thought disorder)
- Affect ability to differentiate what is and isn’t real => alter mood, thoughts, perception, belief + behaviour => distressed and fearful, agitated
psychosis ?
abnormal mental state where someone is unable to distinguish what is real + not
Schizophrenia RF ? (4)
- Genetic component
- Child abuse
- Cannabis use
- Increasing paternal age
What is primary psychosis ?
psychosis not attributed to another medial condition
(like is schizophrenia)
What 2 groups are schizophrenia symptoms split into ? describe each category a bit ? give examples
- positive: present in schizo but not most ppl (hallucinations, delusions, thought disorder)
- Negative: Not present in schizo that suavely are for most ppl
what acronym can be used for schizophrenia symptoms ? what does it stand for ?
HD BS Network (Radio spread news of fake BS that feels v real to patient)
- Hallucinaitons
- Delusions
- Behaviour (disorg)
- Speech (disorg)
- Negative Sx
what diagnostic criteria needed for schizophrenia diagnosis ? how many symptoms for how long ?
need >2 symptoms for at least 6 months
(at least 1 +ve symptom)
what is a hallucination ?
perceptions in absence of stimulus (any of the five senses)