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)
what are the most common hallucinations in schizophrenia ? describe more
most often auditory
- often distressing 3rd person commentary (that is clearly coming form outside of their head)
if a patient is responding to their hallucinations, what is this called ?
responding to internal stimuli
What is a delusion ?
fixed false belief (outside cultural norms)
- Cant be shaken and is so clearly incorrect
describe the delusions associated with schizophrenia ?
- tend to be paranoid + persecutory in nature
- Though broadcasting/withdrawal/insertion
- delusions of control
What can show you that a patient has disorganised thought ? (2) give examples (5)
- disorganised behaviour and disorganised speech
- neologisms, word salad, tangentially, derailment, circumstantiality
Name the negative symptoms associated with schizophrenia ?
5As
- Affect (blunted)
- Ambililance (can’t make decisions)
- Alogia (struggle with speech)
- Anhedonia
- Asociality
what is brief psychotic disorder ?
if psychotic symptoms last <1 month
if HD BS network symptoms last 1-6 months, what is this ?
schizophreniform disorder
What is delusional disorder ?
ppl develop delusions but no other +ve or -ve symptoms
(can still impact life)
Schizophrenia epi - prevelance ? M:F ? age of onset ?
0.5 - 1%
M>F (M present earlier of often worse)
age of onset about 25 yrs
without treatment, how long can sypomt son psychosis last ?
may persist for yrs
schizophrenia disease coarse ? how likely to repeat ?
life long pattern of acute symptomatic exacerbations on top of progressive functional deterioration (different to mood disorder where function stays same between eps)
- after first exacerbation => >90% chance repeat
schizophrenia overall management ?
Medications (antipsychotics) plus psychotherapy (this alone is not sufficient - like in bipolar)
what medications used in schizophrenia ? type of drug ?
antipsychotics (block dopamine NT) => psychotic symptoms resolved in days/weeks
- more effective at reduced +ve symptoms but not so much -ve
acute manamgnet of psychotic patient ?
if immediate risk to self: tranquillise
- up titrate antipsychotic
long term management of schizophrenia ? 1st, 2nd, 3 rd line
1st: continue oral non-clozapine antipsychotic (continue for 2 yrs)
2nd: other non-clozapine
3rd: clozapine
What is schizoaffective disorder ?
Schizo (psychotic), affective (mood)
- A disorder with features of both schizophrenia and affective disorders e.g., depression, bipolar
- (often misdiagnosed - 6 months later + don’t meet criteria)
What acronym can be used for shozoaffective disorder ? what does it stand for ? expand
schizo-detective disorder => HATS
- Half the time must be spent with mood symptoms (or more, majority)
- Alone (psychotic symptoms also occur alone without mood symptoms)
- Together (psychotic + mood symptoms most occur other at some point)
- Substances (rule out any substance are causing symptoms)
What conditions is schizoaffective disorder often mistaken with ? which criteria does this not fill ?
- Bipolar with psychotic manic ep (does not it A criteria of HATS)
- Dug induced psychosis (does not fit S criteria of HATS)
- Schizophrenia (schizophrenia can present with -ve symptoms which gets confused for affective disorder)
schizoaffective disorder management ?
same as schizophrenia and also treatment manic or depressive symptoms as in bipolar
Name some delusional subtypes ? (3) most common ?
- erotomania:
- persecutory (most common)
- jealous (orthella syndrome)
what is ertonmania ?
delusional subtype
- ertomania: Px believes that someone important is secretly in love with them => contact that person/ dangerous/assaultative behaviour
What is persecutory delusion ?
delusional subtype
- persecutory (most common): Px is convinced other are attempting to do them harm
What is jealous delusion? also known as ?
- jealous (orthella syndrome): Px believes spouse or pattern has been unfaithful => collect evidence or restrict partner movement
What is personality ?
how someone acts, thins + feels when interacting with the world
what kind of general traits cause personality disorders ? description of the traits (3)
- inflexible
- Disabling
- Extreme
what do personality disorders lead to ?
- Stress
- Diability
- Dysfunction
What are cluster A personality disorders ? way to remember them ? acronym ?
Cluster A (weird ones)
(PaSS - to the party)
- Paranoid
- Schizoid
- Schizotypal
What are cluster B personality disorders ? way to remember them ? acronym ?
Cluster B (wild ones)
(BANHed - form the party)
- Borderline
- Antisocial
- Narcissitstic
- Histrionic
What are cluster C personality disorders ? way to remember them ? acronym ?
Cluster C (worried)
(Dead On Arrival - cos they bring sad vibes)
- Dependant
- Obsessive compulsion
- Avoidant
what is the general management for personality disorders ?
psychotherapy
what is Paranoid personality disorder ?
which cluster ?
tend to believe what ?
leads to what ?
paranoid PD (cluster A): persistant pattern of fear, mistrust + suspiciousness
- Tend to believe that others are dicing or exploiting them => tend not to confide in other due to fear of being betrayed
- Can lead to social isolation (cos they think everyone is out to get them)
what is schizoid personality disorder ?
which cluster ?
tend to do what ?
indifference to what ?
Schizoid - they avoid (cluster A)
- persistent lack of interest in social relationsships
- preference for solitary activities, disinterest in seeking new relationships
- difficultying experiencing pleasure
- indifference to praise/criticism (v unlike cluster B)
- alone + aloof
what is schizotypal personality disorder ?
which cluster ?
tend to believe what ?
leads to what ?
schizotypal (cluster A)
- presence of odd beliefs relating to other ppl
- Ideas of reference + delusions
- Difficulty relating to there ppl (=> loneliness + isolation)
- 1/3 will progress to schizophrenia diagnosis
Why is cluster B personality disorders known as the wild cluster ?
due to the emotional instability (high neuroticism)
- stem from intense desire to be loved
overal cluster B emotions ? traits ?
- Sadness, dissatisfaction, anger, irritability, emptiness
- Low self esteem, unstable sense of identity, extreme sensitive to criticism or rejection
Describe the overall severity and M/F split to the cluster B personality disorders ?
extreme: borderline, antisocial
mild: histrionic, narcissistic
M: antisocial, narcissistic
F: borderline, histrionic
what is narcissistic personality disorder ?
which cluster ?
tend to believe what ?
leads to what ?
Narcissistic (cluster B): mainly Men
- Inflated sense of self importance, boasting
- Believe to be superior, sense of self entitlement, arrogance
- Inability to empathise with others
- High emotional reactivity when not centre of attention or receive criticism
what is histrionic personality disorder ?
which cluster ?
tend to believe what ?
leads to what ?
Histrionic (cluster B): mainly women
- pattern of excessive or exaggerated behaviours, need to be centre of attantion
- seducative of provocative behaviours, theatrical speech, unstable affect
what are the 9 key criteria for BPD? what acronym ? explain them a bit
I DESPAIR
- Identity (unstable => inconsistent sense of self => purposelessness)
- Dysphoria (chronic emptiness feeling)
- Emotional instability (strong and fluctuating emotions)
- Self harm + suicide (often cutting, chronically suicidal)
- Psychoti/dissociative (hallucinations, delusions, paranoia)
- Anger/hostility (externalise or internalise)
- Impulsivity (substance abuse, unsafe sex)
- Relationships (short lived relationships pattern)
how many BDP symptoms required for diagnosis ?
> 5 / 9 IDESPAIR symptoms for diagnosis
BDP epidemiology ? prevalence ? M:F ? presentation age ?
- 5-10%
- first meet criteria in adolescence
- M=F
describe BPD disease course ?
not neesarrily life long
- difficulty keeping a job
BPD treatment ?
- DBT: teaching skills (mindfulness, emotional regulation) that target core patterns of disorder
- diagnose the patient + educate them about the condition
What is antisocial personality disorder ? what cluster ? generally
ASPD - cluster B
- persistent behaviour that threatens safety of others
- purposeful deception, aggression, violence
ASPD presentation ? due to what ?
due to low conscientiousness (plus emotional instability, sensitive to rejection + impulsivity)
- criminality
- impulsivity
- disregard for safety
- lying
- agression and violence
- some feel remorse for actions
when to ASPD symptoms first present ? and when diagnosed ?
symptoms bein in childhood but can only be diagnosed as an adult
ASPD epi ? where is it most prevalent ?
5% (up to 50% in prison)
peak in adolescentsA
ASPD treatment
quite a tricky one
- sometimes psychotherapy has some positive effects
What is dependant personality disorder ? what cluster ? general
dependant PD - cluster C
- over reliance on other ppl in multiple areas of life
- feel unable to live life on their own (responsibilities, decisions, projects)
what is obsessive compluscei PD ? what cluster ? describe features
OCPD - Cluster C
- need for things to be net + orderly at all times
- perfectionism (able to completes tasks unless completely perfect)
- rigidity
- unwillingness to change or throw things out
OCPD managmnet ?
CBT is seen to be effective
what is avoid bat PD ? what cluster ? descried features
Avoidant PD - Cluster C
- chronic avoidance bt still desire human contact (difference to schizoid)
- a bit like social anxiety disorder: avoidance of social engagements, constant worry of being rejected, a view of oneself as inferior
avoidant PD treatment ?
similar to social anxiety disorder
- SSRIs
- CBT
What are the main types of anxiety disorders ? (6)
- GAD
- Phobias
- Panic disorder
- Social anxiety disorders
- OCD
- PTSD
What 3 symptoms do all phobias have in common?
- Anxiety restricted to the phobia
- Significant autonomic symptoms (increased breathing, Changes with HR, sweating)
- Avoidance
What is agoraphobia?
Fear of marketplace (fears of leaving home, shops, crowds, open places, public transport)
How is agoraphobia different to social phobia?
- Social phobia is fear of scrutiny of other people => avoidance of social situation
- Agoraphobia is fear of crowded spaces => anxiety + autonomic symptoms => avoidance
When do phobias tend to arrive?
childhood
What is panic disorder ?
recurrent attacks intense mental + physical discomfort from overreaction of fear response
- not restriciotn to any situation of circumstance (unlike phobias)
Dominant symptoms of panic disorder?
- Autonomic symptoms (crecendo => fear of dying => avoidance): sweating, trembling, increased HR, dizziness, nausea, chest pain, sob
- also symptoms of derealisation/depersonalisation
acute and long term management of panic attacks and panic disorder ?
acute: bensodiazepines
- Long term: CBT +/- SSRIs
What are anxiety disorders ? affects in what ways (3) ?
unpleasant mental state where you worry about future possbailties of anger
- physiological, psychological, behavioural
acute and chronic sx of an anxiety disorder ?
acute: sweating, trembling, high HR, dizziness, nausea, fear of dying, chest pain, sob
- chronic: muscel tension, irritability, sleep difficulting, low energy , restlessness, inattention
what is Generalised anxiety disorder ?
(excessive + generalised anxiety most days for > 6 months)
- Free floating anxiety
- Chronic, excessive worry for at least six months that causes distress or impairment
- Avoidance isn’t as common as anxiety is not related to specific circumstance
GAD treatment ?
(without will last for years)
- CBT +/- SSRI
Phobias management ?
exposure therapy
(meds not so useful)
What is social anxiety disorder ?
anxiety related to the possibility of judgement or rejection => avoidance
What aerological factors precipitate anxiety disorders ?
- genetic vulnerability => reduced regulation of neurochemistry => affect seritonergic function
- environmental factor triggers initial episode => cognitive reconditioning perpetuates pathological anxiety state
Explain benzodiazepine usage in anxiety disorders
- highly effective in acute anxiety
- negative: highly addictive, tolerance (efficacy reduces after a couple weeks)
What is OCD ? 3 main components ?
(its in the name)
obsessions + complussions that leads to dysfunction + distress
- Obsessive thoughts
- (and/or) Compulsions
- Disorder
Describe the obsessions and obsessive thoughts associated with OCD ? (7)
- Intrusive (enter suddenly)
- mind based (recognised that come form own mind - different from schizophrenia)
- unwanted - try to ignore
- resistant
- distressing (fear of causing harm to someone)
- egodystonic (discordant with self)
- recurrent
describe the compulsions associated with OCD ?
specific behaviours that reduce the distress causes by obsessions (calm-pulsions)
- neutralising behaviours that clam intense feelings of anxiety that obsessions bring
- Not enjoyable and does result in completion of a task
What makes OCD a disorder ?
relief brought by the compulsions is only temporary => endless loop (=> time consuming) => affect work, social life
OCD epi. prevelance? M:F ? age of onset ?
1% prevelance
- M=F
- onset during childhood/adoeschecne
- non-episodic
OCD diagnostic criteria ?
obsessions +/or compulsions that cause marked distress + time consuming (>1hr/day)
OCD Mx ? first and second line ?
- psychotherapy: Exposure + response prevention (ERP): increase time between obsession + compulsion
- 2nd line: medications: SSRI (clomipramine)
What is PTSD ? characterised by ? (3)
A disorder that may develop following a traumatic event characteristised by
- re-experiencing
- hyperarousal
- avoidance
What is a traumatic event ?
violent of life threatening (=> feelings of fear/helplessness)
- can be acute or chronic trauma
What does re-experiencing the event mean in terms of PTSD ?
flashbacks or nightmares (sudden + unexpected re-expericing episodes of trauma)
- often caused by exposure to a trigger
What is hyperarousal in terms of PTSD ?
- autonomic hyperarousal + hypervigilence
(eventually becomes persistent + generalised) - State of alert, easily startled
PTSD diagnostic criteria ?
re-experiencing, hyperarousal + avoidance following traumatic event => long lasting distress (for more than 1 month)
PTSD epi. prevelance ? F:M ?
3% prevelance
- F>M (x2)
PTSD Mx ? (3) nightmares?
most effective: trauma focused CBT of EMDR (+/- andidepressant (SSRI))
- prozasin (to help with nightmares)
What is acute stress disorder ? how different to PTSD ?
differentiated by time frame
- Sx occurring immediately after traumatic event (PTSD is only after 1 month of Sx)
what is complex PTSD ? usually caused by ?
usually caused by chronic trauma during neuro dev years (child abuse)
- reexperiencing, hyperarousal + avoidance following traumatic even => long lasting distress (same as PTSD) PLUS
- emotions dysregulation
- negative self concept
- interpersonally difficulteis
