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Year 4 - Pysch > Affective disorder > Flashcards

Affective disorder Flashcards

1
Q

definition of bipolar affective disorder according to ICD-10

A

2x episodes of depression + 1 episode of mania or hypomania

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2
Q

what is the risk of having bipolar affective disorder

A

lifetime risk of 1 %

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3
Q

RF for bipolar affective disorder

A

all race and sexes are affected equally

higher socio-economic classes

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4
Q

what is the mean age of onset for BAD

A

21

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5
Q

what age of onset of BAD would warren investigations

A

> 50 due to the possibility of organic disease

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6
Q

aetiology of BAD

A

genetic

  • strongest genetic link in all affective disorders - polygenic
  • if first degree relatives have BAD then 10% lifetime risk of having BAD

neurochemical abnor

  • monoamine hypothesis - mania result from increased levels noradrenaline, serotonin and dopamine
  • stimulating drugs - cocaine and amphetamines can exacerbate mania

other neuro abnor

  • ventricular enlargement
  • structural abno in pre-frontal cortex, striatum, amygdala

environmental factors

  • life event
  • severe stress
  • disruption in daily rountine/circadian rhythm may provoke first episode onset
  • seasonal - spring, summer, postpartum period
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7
Q

clinical features of BAD

A

2 + episodes of depression + 1 episode of mania/hypomania

manic episodes usually start abruptly, last approx 4 months

depressive episdoes last approx 6 months

frequency and severity of episodes are variable

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8
Q

what is rapid cycling in BAD

A

rapid cyclin = 4+ episodes mania, hypomania and/or depression in 1 yr

more common in female

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9
Q

what is the finding of MSE of mania

A

A/B - dressed in colour clothing, unusual haphazard combination clothing with inappropriate accessories
- hyperactive behaviour, may appear entertaining, charming, flirtatious, assertive, aggressive and irritable

S - pressued, difficult to interrupt, neologisms (words that do not make any sense), clang association(words linked together if they sound similar to one another

M/A - tpyically euphoric, optimistics, self-confident, grandiose or irritable, tearful, rapid unexpected shift from one to another

T - Percussed to speak and tangential

T - flight of ideas, unrealistic plans (which acts on but unfinished), engage in risky, pleasable activity eg spending a lot of money, risky sexual behaviour, harming oneself or others, get into troublems with police

P - can have psychotic symptoms depending on severity - hallucinations, delusion (often delusion grandeur)

I - poor concentration is poor but intact memory

I - poo insight

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10
Q

what is the acronym used in MSE

A

All Sane Men Think That Pizza Is Italian

Appearance/behavior 
Speech 
Mood/Affect 
Thought content 
Thought Form/possession
Perception (hallucination)
IQ 
Insight
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11
Q

what is cyclothymia

A

mild chronic BAD

fluctuating numerous episodes of mild elevation and depressive symptoms not severe enough or prolonged to reach criteral BAD

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12
Q

what are the different suib-group of BIpolar disorder according to ICD-10

A

hypomania
mania without psychotic symptoms
mania with psychotic symptoms

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13
Q

what is the definition of hypomania according to ICD-10

A

lesser degree mania, abnor of mood and behaviour that are too persistent and marked for Cyclothymia but not accompanied by hallucinations or delusions

does not lead to significant disruption to work and social life

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14
Q

what is the definition of mania without psychotic symptoms according to ICD-10

A

mood elevation out of keeping with individuals circumstances

elation, inc energy, over-activity, pressure on speech, dec need sleep, poor concentration, marked distractibility, inflated self-esteem

perceptual disorder - appreciation colour, preoccupation with fine details of surface, subjective hyperacusis (heightened hearing)

risk behaviour/reckless behaviour

some manic episode mood irritable and suspicious

episode > 1 wk, severe enough to disrupt ordinary work and social activity

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15
Q

what is the definition of mania with psychotic symptoms according to ICD-10

A

in addition to mania without psychotic symptoms, delusion (grandiose) or hallucination (voice directly speaking to pt)

the excitement, excessive motor activity and flight of ideas are so severe that pt unable to communicate properly

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16
Q

what is BAD I

A

at least 1 manic or mixed episode

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17
Q

What is BAD II

A

never had a full manic episode, at least 1 hypomanic episodes and at least 1 major depressive episode

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18
Q

DDx for BAD

A 
mixed affective states 
schizoaffective disorder 
schizophrenia 
cyclothymic disorder 
ADHD 
drug-induced

organic brain disease

  • frontal lobe disease
  • hyperthyroidism
  • Cushing
  • SLE
  • sleep deprivation
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19
Q

treatment for acute manic episode

A

admission to hospital to reduce stimulation and control symptoms asap

mood stabiliser, antipsychotics and benzodiazepines

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20
Q

Investigation for BAD

A

full psych history

collateral history form family/carer to have a fuller picture about the patient

full physical exam to exclude any organic disease 
- CT/MRI head 
- TFT 
- baseline blood test 
baseline ECG
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21
Q

Treatment of BAD

A

• Acute mania should be admitted to hospital to reduce stimulation and control of symptoms asap
• If agitation = IM Benzodiazepine
• No agitation + mild = oral mono therapy - mood stabiliser/atypical antipsychotic
• No agitation + moderate = oral mood stabiliser +/- atypical antipsychotic
• Acute depressive = mood stabiliser +/- atypical antipsychotic +/- antidepressants
• Maintenance treatment - after stabilisation
o if predominately mania symptoms = mood stabiliser/atypical antipsychotic + psychosocial intervention
o If predominately depressive symptoms = lamotrigine + psychosocial intervention
o If both = lithium or valproate semisodium + psychosocial intervention

22
Q

what are the different types of psychological treatments

A

what type is patient dependent

supportive - where patient might just want explanation and reassurance

counselling - explanation, reassurance, support, goal oriented, identification and resolution current life difficulties

exploratory psychotherapy - CBT and psychodynamic psychotherapy

23
Q

what is CBT

A

cognitive behavior therapy

focused on here and now

pt and trained therapist develop shared understandings of person current problems and try to understand them in terms of their thoughts

identification realistic, time limited goals of cognitive and behavioural strategies

24
Q

how is CBT done

A

can be one on one or small group generally need 10-20 sessions

may involve cognitive training, graded exposure to anxiety provoking situations

25
Q

what is the selection criteria for CBT

A

psychological mindedness

adequate ego strength

able to form and maintain relationships

motivated for insight and change

able to tolerate change and degree frustration

26
Q

what is psychodynamic psychotheraoy

A

aims to bring unconscious feelings to surface so can be felt and understood

focuses on present and past/childhood experiences

27
Q

what is a primary mood disorder

A

one that does not result from another medical/psychiatric condition

28
Q

what is a secondary mood disorder

A

one that does result from another medical/psychiatric condition

29
Q

what is dysthymia

A

it is a state of low mood, that is usually insidious in onset and lasts for at least 2 years

30
Q

what is the ICD classification of depression

A

mild
moderate
severe
psychotic

31
Q

what is the DSM V classification of depression

A

major depressive disorder/episode

however, some will suffer depressive symptoms but not meeting the criteria for depression therefore, they have dysthymia

32
Q

epidemiology of depression

A

life-time risk of 15%

F:M - 2:1

33
Q

what is the peak prevalence of depression in male

A

old age

34
Q

what is the peak prevalence in female

A

middle age

35
Q

what is the most suitable model for aetiology of depression?

A

biopsychosocial model

36
Q

what is the biological cause to depression

A

1) genetics - 1st degree relative affected - 15% risk inc
2) neurochemical abnormalities - monoamine hypothesis - depletion monoamine neurotransmitter eg noradrenaline, serotonin, dopamine, revised hypothesis –> no depletion of monoamine receptors but due to change in receptors function
3) other neurological abnor - enlarged lateral ventricles, loss volume in frontal and temporla lobes
4) endocrine abnor - raised cortisol in 50% of depressed patients, distrubance to the hypothalamic pituitary dadrenal axis, Cushings, addison, hypothyroidism, hyperparathyroidism
5) organic causes - stokre, AD, PD, Huntingtons, MS, epilepsy
6) environmental factors - early adverse life event, excess adverse life events, seasonal affective disorder - all of which will cause a change to the HPA axis and pre-dispose to stress and hence depression

37
Q

what is the psychological aetiology of depression

A

Bowlby’s theory - depression results from maternal deprivation

Freud’s theory - loss of the loved object and mixed feelings of love and hatred

Beck cognitive theory - a triad of -ve appraisal of self, present and future - think guilt (past), self-worthless (present), hopelessness (future)

38
Q

what is the social aetiology of depression

A

lower socioeconomic status - social causation (stress associated with such problem leads to depression)

39
Q

what are the 3 core symptoms of the depression

A

low mood
loss of interest and enjoyment - anhedonia
fatigability - loss of energy

40
Q

what are some of the psychological symptoms of depression?

A

poor concentration
poor self esteem
guilt
pessimism

41
Q

what are the somatic symptoms of depression?

A 
sleep disturbance 
early morning waking 
moring depression (diurnal variation of mood) 
loss of appetite and weight loss 
loss of libido 
anhedonia 
agitation
42
Q

what is depression stupor

A

a state of extreme apathy or lethargy –> ECT needed

43
Q

what is the mild episode of depression according to ICD-10

A

> 2 cor symptoms + 2 other symptoms (4 in total) for > 2 weeks

44
Q

what is the moderate episode of depression according to ICD-10

A

> 2 core symptoms + 3 other symptoms (5 in total) for > 2 weeks

45
Q

what is the severe episode of depression according to ICD-10

A

considerable distress and agitation. loss of self-esteem, feeling of uselessness and guilt are prominent

a number of somatic symptoms are present

v.high risk of suicide and pyschotic symptoms maybe present

46
Q

what is psychotic depression according to ICD-10

A

it is depression with psychotic symptoms eg hallucinations, delusions, psychomotor retardation

again v/high risk of suicide

47
Q

what is the definition of depression according to DSM-V

A

a total of 5 symptoms (one must low mood/anhedonia)

symptoms must be present > 2 weeks

48
Q

what are some of the investigations for depression

A 
FBC - anaemia 
CRP - infection causing delirium 
TFT - hypothyrodism 
Vit B12 +folate - rule out anaemia 
toxicology screen 
dexmathasone suppression test - addison's/cushing's disease
49
Q

DDX for depression

A

any organic problems
hypothyroidism
addison’s/cushings’

practically any other psychiatric conditions since they have some sort depressive symptoms

50
Q

management of depression

A

biological - antidepressants –> lithium –> ECT

psycholgical - CBT, supprot

Socia

Year 4 - Pysch (6 decks)

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