Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Psychiatry > Session 02 - Affective Disorders > Flashcards

Session 02 - Affective Disorders Flashcards

1
Q

What is an affective disorder?

A

A mood disorder characterised by emotional disturbances, which results in functional impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Biological causes of affective disorders.

A

5-HT: low levels of endogenous 5-HT and Na are thought to decrease mood.

Cortisol: overactivation of the HPA axis increases both risk and persistence of low mood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Psychological causes of affective disorders.

A

Beck’s triad: negative views about the self, the world and the future seen in depression.

Attributional style: higher incidence in people who blame themselves for life events.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Social causes of affective disorders.

A

Stress: linked to negative life events, adversity and childhood stress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is depression?

A

An affective disorder characterised by low mood, leading to functional impairment and emotional distress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Core symptoms of depression.

A
  • low mood (often worst in morning)
  • anhedonia (loss of interest in activities)
  • reduced energy (fatigue)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other symptoms of depression.

A
  • less concentration / attention
  • increased guilt and unworthiness
  • changes in appetite with weight change
  • sleep disturbance (early morning waking)
  • suicidal ideation
  • psychomotor activity changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What additional symptoms may be observed in severe depression?

A

Severe depression can lead to psychotic symptoms (e.g. delusions and hallucinations).

Delusions are typically mood-congruent, including delusions of guilt, poverty, that they are dead.

Hallucinations will also usually be of defamatory voices, or the smell of rotting / decomposing flesh.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the core symptoms of depression in children?

A

Low mood or irritable mood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does depression present in the elderly?

A

Depression can present similarly to dementia, giving issues with memory.

In depression, memory loss is more rapid and causes biological symptoms. Patients are also usually aware and worried of their memory loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is depression diagnosed?

A

Patients require at least 2/3 core symptoms which last at least two weeks.

Mild = 2 core symptoms + 2 or more other symptoms.

Moderate = 2 core symptoms + 4 or more other symptoms.

Severe = 3 core symptoms + 5 or more other symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which tests can be used to objectively score depression?

A

PHQ9 is used to grade depression. It asks patients to report over the last 2 weeks how often they have been experiencing symptoms.

Mild = 5-9
Moderate = 10-14
Moderate/Severe = 15-19
Severe = >19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is depression managed?

A

Mild - guided self-help or structured group physical activity programme.

Moderate or severe - first line is CBT / IPT and SSRI (continue until well for 6 months).

If multiple treatments have failed, ECT or deep brain stimulation of subgenual cingulate cortex.

In an emergency, call the community team or Crisis Resolution and Home Treatment Team (CRHTT).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What precautions should be made when prescribing SSRIs?

A

A side effect of SSRIs is increased suicidal thoughts initially, so review within 2 weeks.

In children, avoid SSRIs and use fluoxetine first line.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the broad areas of risk to assess in a psychiatric consultation?

A
  • risk to self
  • risk from others
  • risk to others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Subdivisions of risk to self.

A
  • personal safety
  • personal health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you assess personal safety?

A

Ask the patient if they are experiencing any thoughts of. harming themselves, and whether they plan to act on these thoughts.

It is also important to ask about deliberate self-harm, which some patients may undertake not with suicidal intent but as a way of managing overwhelming and difficult emotions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What questions should you ask someone who has attempted to harm themselves?

A

Check for any delusions of control or command hallucinations.

Clarify details about the method of the attempt of self-harm / suicide.

Were any preparations made?

Did they make attempts not to be found?

Did they make a will or leave a note?

Was the attempt planned or an impulsive action?

What was their assessment of lethality?

Did alcohol play a role at all?

How do they feel about the attempt now?

Do they have any further plans to harm themselves?

Can they identify any protective factors?

Are there any risk factors in the history?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for suicide.

A
  • family history of suicide
  • precipitating triggers
  • psychosocial stressors (e.g. financial worries, housing insecurity)
  • recent losses
  • social isolation
  • early morning waking*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can you assess personal health?

A

Does the patient use alcohol or drugs as a way of managing difficult feelings or memories?

Consider personal hygiene, nutrition and safety.

Query concordance with medications and attending appointments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can you assess risk from others?

A

Consider whether there are any safeguarding concerns.

It is important to remember to ask about domestic violence and abuse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define domestic abuse.

A

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are family members or who are, or have been, intimate partners.

This includes psychological, physical, sexual, emotional and financial abuse.

It also includes ‘honour’-based violence and forced marriages.

23
Q

Asking about domestic violence.

A

It can be helpful to frame questions using statements such as “It is not uncommon for people who experience mental health difficulties to be dealing with abusive relationships. Sometimes, it can be difficult to talk about these things, so I always ask about it routinely.”

Questions to ask include:

“How are things at home?”

“Has anyone at home hurt you or threatened to hurt you?”

” Does anyone at home control or isolate you?”

“How does your partner treat you?”

“Are you having any problems with your partner?”

“Does your partner ever hurt or threaten you? Do they ever force you to do things you don’t want to do?”

“Are you able to say no to your partner?”

“How do your family treat you?”

“Does anyone in your family police your behaviour?”

24
Q

How can risk to others be assessed?

A

Ask the patient if they are having any thoughts or have made plans to harm others.

Clarify if they are experiencing command hallucinations or delusions of control.

25
Q

What is anxiety?

A

Anxiety is an unpleasant emotional state involving subjective fear, discomfort and physical symptoms.

The problem occurs when anxiety causes autonomic hyperarousal, becoming distressing and impairing function.

26
Q

Causes of anxiety.

A
  • idiopathic
  • hyperthyroidism
  • heart disease
  • drugs (e.g. salbutamol, SSRIs, caffeine, steroids)
27
Q

What is generalised anxiety disorder (GAD)?

A

Long-lasting worry that is not focused on any one object or situation.

28
Q

Diagnosis of GAD.

A

Symptoms need to be present for at least 6 months:
- insomnia
- subjective worry
- increased vigilance
- autonomic hyperactivity

29
Q

How can GAD be objectively assessed?

A

GAD-7 questionnaire.

Mild = 6-10
Moderate = 11-15
Severe = 16-21

30
Q

How is GAD managed?

A

Mild: low intensity interventions (e.g. individual guided self-help, group therapy).

If moderate/severe: CBT and SSRI (sertraline).

Acutely anxious: benzodiazepine (<4/52).

31
Q

What is panic disorder?

A

A disorder characterised by short episodes of intense anxiety, which occur unpredictably.

32
Q

Symptoms of panic disorder.

A

Acute and unpredictable:
- terror and apprehesion
- trembling
- shaking
- confusion
- dizziness
- nausea
- breathing difficulty

Attacks last a few minutes and patients often have ‘anticipatory fear’ of getting attacks.

33
Q

Management of panic disorder.

A

First line is CBT or SSRI.

If SSRI is not tolerated or no response after 3 months, offer imipramine or clomipramine.

34
Q

What are phobias?

A

Heightened fear or specific stimuli that is characterised by avoidance.

35
Q

Define agoraphobia and give the management.

A

Fear or crowded situations from which escape is difficult.

Management is CBT / SRRI.

36
Q

Define simple phobias and give the management.

A

Single isolated phobias (e.g. injection or spiders).

Management is graded exposure therapy and response prevention.

37
Q

Define separation anxiety disorder (children).

A

Fear of being apart from a caregiver.

38
Q

Define social phobia and give the management.

A

Persistent fear of social situations due to fears that they will be embarrassed.

Management - CBT (+SSRI if unresolving).

39
Q

What is bipolar disorder?

A

Characterised by recurrent episodes of altered mood and activity, involving up/downswings.

Peak age of onset is in the early 20s.

40
Q

Symptoms of bipolar disorder.

A

Patients will have episodes of depression interspersed with mania / hypomania.

41
Q

Define mania.

A

A period of elevated or irritable mood which requires 5 criteria:

1) elevated / irritable mood lasting 7 days or more.

2) has at least 3 of: less sleep, flight of ideas, lack of inhibition, high energy, grandiosity.

3) marked impairment of social functioning.

4) no psychotic symptoms in the absence of mood disturbance.

5) no organic factor causing the mania (e.g. stimulant drugs).

42
Q

Define hypomania.

A

A period of elevated or irritable mood which is usually less severe than mania, and lasts less than 7 days.

43
Q

What are the types of bipolar disorder?

A

Bipolar disorder I = mania and depression (most common).

Bipolar disorder II = hypomania and depression.

44
Q

How is bipolar disorder managed?

A

Chronic maintenance treatment.

Mood stabilising drugs:
- first line is lithium
- second line is sodium valporate, olanzapine or quetiapine

Psychological intervention to patients (CBT).

45
Q

How is acute mania treated (bipolar disorder)?

A
  • stop taking antidepressant
  • urgent referral to community mental health team
  • antipsychotic medication (olanzapine, risperidone, haloperidol, quetiapine).
46
Q

How is acute depression treated (bipolar disorder)?

A

Treat with antipsychotics alone or in combination with SSRIs.

1st line is quetiapine, olanzapine, lamotrigine, quetiapine or fluoxetine.

Do not prescribe SSRIs alone as they can precipitate mania.

47
Q

What is schizoaffective disorder?

A

An affective disorder characterised by having abnormal thought processes and unstable mood.

Diagnosis is made when a person has the symptoms of schizophrenia and a depression / bipolar, but does not meet the diagnostic criteria for either condition individually.

48
Q

Diagnosis of schizoaffective disorder.

A

Presence of psychotic symptoms for at least two weeks, without any mood symptoms.

If the patient only experiences psychosis during a mood episode, this is a mood disorder with psychotic symptoms.

If psychosis without mood symptoms - this is either schizophrenia or schizoaffective disorder.

49
Q

Management of schizoaffective disorder.

A

Bipolar type schizoaffective disorder (bipolar and schizophrenia): antipsychotics + mood-stabiliser + CBT

Depression type schizoaffective disorder (depression and schizophrenia): antipsychotics + antidepressant + CBT

50
Q

What is obsessive compulsive disorder (OCD)?

A

Characterised by the presence of obsessions and compulsions which causes distress.

51
Q

Symptoms of OCD.

A

The two main symptoms are obsessions and compulsions leading to distress.

Obsession: an unwelcome, persistent intrusive thought which is recognised as absurd (e.g. doubts, ruminations, believing they are always dirty).

Compulsion: a repetitive action that a patient performs with reluctance to neutralise an obsession (e.g. hand-washing, checking, arranging objects in a certain way).

52
Q

Types of OCD.

A

i) obsessions and compulsions (most common is hand washing concerned with contamination).

ii) checking compulsions in response to obsessional thoughts about potential harm.

iii) obsessions without compulsions (most difficult to treat).

53
Q

Diagnosis of OCD.

A

Presence of obsessions and compulsions >1 hour a day for >2 weeks.

Must cause emotional distress or interfere with activities of daily living.

54
Q

Management of OCD.

A

Mild - CBT and exposure and response prevention (ERP).

Moderate / severe - combined treatment with CBT and ERP, plus SSRI.

Year 4 - Psychiatry (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions