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Year 5 Psych > Affective and Anxiety Disorders > Flashcards

Affective and Anxiety Disorders Flashcards

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1
Q

Risk Factors for suicide completion (scale)

A 
"SADPERSONS"
Sex (male)
Age (15-25 and >59)
Depression
Previous attempt
Excess ethanol or substance abuse
Rational thinking loss
Sickness
Organized plan
No spouse
Social support lacking

NB: in US, access to firearms is the biggest risk factor

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2
Q

Biological aspect to depression

A

Neurochemical and endocrine theories.
E.g. 5HT, NE, Da all decreased; stress increases cortisol which decreases neurotrophin level expression and damages hippocampal neurons

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3
Q

Psychosocial aspect to depression

A 
Childhood adverse events
Vulnerability reduces resilience (e.g. unemployment, lack support)
Life events
Substance misuse
Beck's triad
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4
Q

Beck’s triad (depression)

A

Worthlessness (self)
Helplessness (world)
Hopelessness (future)

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5
Q

Seasonal Affective Disorder

A

Depression with a seasonal pattern, often in winter

Tx: light therapy, CBT, anti-depressants

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6
Q

Atypical depression

A

Retain mood reactivity.

May have increased sleep and eating

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7
Q

Agitated depression

A

Depression with psychomotor agitation rather than retardation

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8
Q

MSE: Depression

A

A: signs neglect, dehydration, look miserable, disinterested, movements may indicate anxiety, poor eye contact, tearful,
S: Slow, quiet.
M: Restricted range of affect
P: in very severe, may have visuals of evil images, auditory hallucinations with unpleasant voices. Delusions-guilt, nihilistic (nothingness), persecutory
T: worthlessness, helplessness, hopelessness. Suicidal thoughts
C: psychomotor retardation or slowing of thoughts/speech can mimic cognitive impairment

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9
Q

Ddx-depression

A

Physical: hypothyroidism, head injury, cancer, quiet delirium, meds
Adjustment disorder (follows life event)
Bereavement (up to 6/12)
Chronic schizophrenia (blunted affect)
Bipolar disorder (always ask about periods energy–antidepressants dangerous if bipolar)
Postnatal blues/depression
Sementia
Dysthymia

Often co-morbid with panic dosorder, agoraphobia, OCD, eating/personality disorders

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10
Q

Depression criteria

A

5/9 of following for at least two weeks:
(“SIG E CAPS”)

Sleep (decreased, early morning awakening)
Interest decrease (anhedonia)
Guilt
Energy decrease
Concentration decrease
Appetite change
Psychomotor retardation or agitation
Suicidal ideation
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11
Q

Ix-depression

A

TFT
FBC
Glucose/HbA1c
Beck Depression Inventory or Hospital Anxiety and Depression Scale

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12
Q

Treatment of subclinical depression

A

Watch and wait (F/U in 2/52)
Sleep hygiene advice
Information about depression (what to look out for)

If persistent-written/web-based/standalone CBT materials +/- therapist
Schedule activities that help engage in behaviours that increase energy levels and develop interests/achievement
Group-based CBT
Exercise

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13
Q

Side effects of antidepressants

A

D&V, weight change (gain), blurred vision, anxiety, agitation, insomnia, tremor….

Contraindicated in bipolar
Affected by P450 inducers/inhibitors

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14
Q

When to refer depressed pt to secondary care

A

High suicide risk
Severe depression
Unresponsive to tx

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15
Q

Bipolar-definition

A

Requires two episodes, one of which must be hypomanic, manic, or mixed.
Recovery usually complete between two episodes

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16
Q

Biological and social factors in bipolar

A

Bio:
Genetic: 1st degree relative increases risk 7x.
Increased E, NE, Da, 5HT –> mania

Social:
Stressful life events….PREGNANCY

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17
Q

Mania definition

A

Lasts at least one week, disturbs occupational/social functioning

"DIG FAST"
Distractibility
Irritability
Grandiosity
Flight of ideas
Agitation/aggression
Speech-pressured
Talkative

May have psychotic symtpoms

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18
Q

Type I bipolar

A

Manic episodes interspersed with depressive episodes

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19
Q

Type II bipolar

A

Mainly recurrent depressive episodes, less prominent hypomanic episodes

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20
Q

Rapid cycling bipolar

A

Four or more affective episodes in a year
Women
Valproate

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21
Q

When to admit bipolar pt

A

High risk suicide/homicide
Severe psychotic/manic/depressive symptoms
Severe cylcing
Catatonic symptoms

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22
Q

Biological tx in bipolar

A

Lithium first line. Takes 2/52 to work so add benzo or antipsych in meantime
Valproate, benzos, carbamazepine
Severe behavioral disorder: haloperidol, clonazepam
If acute manic episode (severe/life-threatening): ECT

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23
Q

Psychosocial tx in bipolar

A 
Psychoeducation
CBT
interpersonal and social rhythm therapy
Family therapy
Support groups
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24
Q

OCD-definition

Plus definitions obsessions and compulsions

A

Anxiety-producing obsessions which they try to relieve with rituals (compulsions)

Obsessions: involuntary thoughts, images, or impulses that are recurrent/intrusive, enter mind against conscious resistance, and pt recognizes obsessions product of owns mind even though involuntary and often repugnant

Compulsiosn-repetitive metntal operations or physical acts. Feel compelled to perform, and done to relieve anxiety through belief they will prevent dreaded event

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25
OCD-biological aspects
Genetic risk Neuro: basal ganglia implicated NTs: 5HT dysregulation
26
OCD-psychosocial
Anankastic personality traits (rigidity, orderliness) Stress may precipitate Young age
27
Body dysmorphic disorder
Preoccupation with imagined defect in appearance. | Time consuming behaviors (e.g. mirror gazing, excessive camouflaging techniques, skin picking, reassurance-seeking)
28
Anankastic personality disorder
Aka obsessive compulsive personality disorder | Rigidity of thinking, perfectionism, orderliness, moralistic preoccupation with rules, tendency to hoard
29
Tx-OCD
CBT incl exposure therapy and relapse prevention Behavioral therapy-response prevention Psychotherapy SSRIs high dose for at least 12/52 (escitalopram, fluoxetine, sertraline, paroxetine) Clomipramine if above SSRIs don't work Antipsychotics if psychotic features, tics, or schizotypal traits (risperidone) ECT if suicidal or severely incapacitated
30
Biological aspect to personality disorders
Henetic inheritance Hx depression, EtOH dependence Some NT disturbances or EEG findings (psychopathy)
31
Psychosocial causes of personality disorders
Cognitive and psychoanalytic theroeis: expectations tend to be fulfilled (open and confident people receive more friendly responses) Maladaptive schema-formed in childhood Narcissistic and borderline personalities display primitive defense mechs (splitting, projection, fantasizing, reaction formation) Childhood temperament Childhood experience ("people feel lovable because they were first loved")
32
Clusters of personality disorders
"Weird, wild, and worried" A (weird): odd/eccentric, paranoid, schizoid B (wild): dramatic, erratic, emotional, histrionic, emotionally unstable, dissocial C: (worried): anxious/fearful, anankastic, anxious/avoidant, dependent
33
Paranoid personality disorder
Unforgiving, suspicious, possessive/jealous of partners, excessive self-importance, conspiracy theories.
34
Schizoid personality disorder
"All alone" Anhedonic, limited emotional range, little sexual interest, apparent indifference to praise/criticism, normal social conventions ignored, excessive fantasy world/introspection "Schizoids avoid"--just not really into being around others
35
Dissocial personality disorder
FIGHTS Can't maintain relationships, irresponsible, guitless, heartless, always someone else's fault Evidence childhood conduct disorder
36
Emotionally unstable
Affective instability Explosive behavior, impulsive, outburts of anger, unable to plan/consider consequences Borderline type-self-image unclear, chronic empty feelings, abandonment fears, suicide attempts and self harm Impulsive type-lack impulse control, outburt of threat/violence, sensitivity to being thwarted/criticized
37
Histrionic personality disorder
Attention seeking, concerned with appearance, theatrical, open to suggestion, racy/seductive, shallow affect Manipulative behavior
38
Avoidant personality disorder
Avoid social contact--would like to be around people, but anxious Doesn't get involved unless sure of acceptance
39
Dependent personality disorder
Subordinate, undemanding, feels helpless when alone Fears abandonment, encourages others to make decisions, reassurance needed Clinging, excess need for care
40
Anorexia nervosa-definition
Morbid fear of gaining weight, deliberate weight loss, distorted body image, amenorrhea, BMI
41
Biological aspects to anorexia nervosa
Genetic NTs: 5HT Hypothalamic dysfunction Neuro: pseudoatrophy with sulcal widening and ventricular enlargement
42
Psychosocial aspects to anorexia nervosa
Parental overprotectiveness, weak generational boundaries, lack of conflict resolution, rigidity. Escape from problems in adolescence Culture: Westerns "ideal body" is unusually thin Past exposure to dieting behavior (childhood obesity, parental obesity) Childhood feeding difficulties, picky eating, childhood perfectionism, OCD, negative self-evaluation
43
Complications anorexia nervosa
Highest mortality of psychiatric illnesses (including depression) CVS: arrhythmias, cardiomyopathy, long QT, signif bradycardia. Common cause of death Endo/GI: hypokalemia, hyponatremia, hypoglycemia, hypothermia, hypercortisolemia, amenorrhea, delayed puberty, osteoporosis Repro: decreased fertility Neuro: peripheral neuropathy, loss brain volume Etc etc. NB REFEEDING SYNDROME. If re-feed too quickly, electrolyte disturbances (K) and then death by arrhythmia
44
Subtypes of anorexia
``` Restricting type (restrict calories) Binge and purge type ``` NB: binge and purge may resemble bulimia, but MAIN DIFFERENTIATOR is the weight: anorexics are underweight, bulimics are normal or overweight
45
Tx-anorexia nervosa
Biological: fluoxetine Psycho: family therapy, CBT, nutritional education, psychodynamic psychotherapy Social: interpersonal therapy
46
Bulimia nervosa
Binging and excessive preoccupation with control of body weight. Binges followed by compensatory behavior, e.g. vomiting, fasting, excessive exercise
47
Etiology bulimia
Similar to anorexia Genetics Hx dieting, negative self-evaluation, parental obesity, weight-related criticism, EtOH and substance misuse, depression
48
Complications bulimia
Dental erosion and caries Electrolyte disturbances: arrhythmias, metalbolic acidosis if laxative use, alkalosis if vomiting, ulcers, pancreatitis, constipation/steatorrhea
49
Tx-bulimia
Bio: fluoxetine, medical stabilization Psycho: CBT, self-help Social: support groups
50
SCOFF questionnaire
Screening for anorexia nervosa and bulimia. 1. Do you make yourself SICK because you feel uncomfortably full? 2. Do you worry you have lost CONTROL over how much you eat? 3. Have you recently lost mrore than ONE stone in a 3-mo period? 4. Do you believe yourself to be FAT when others say you are thin? 5. Would you say that FOOD dominates your life?
51
Psychosocial causes anxiety
Childhood adversity Life events can trigger Classical conditioning Negative reinforcement (e.g. running away relieves anxiety) Cognitive theories: worrying thoughts repeated automatically which induce and maintain worry response Attachment theory: insecure styles of attachment to parents become anxious adults
52
Sxs anxiety
Fear, poor concentration, irritability, depersonalization/derealization, insomnia, night tremors Restlessness, fidgeting, feeling on edge Trembling, tension HA, muscle aches Dry mouth, difficulty swallowing, nausea, loose/frequent motions Erectile dysfunction, amenorrhea, urinary frequency Tight chest, palpitations
53
Generalized anxiety disorder
Not associated with specific external threat. Excessive worry or apprehension about many normal life events >6/12 Has at least one sxs of autonomic arousal (e.g. tachy, sweating, shaking, dry mouth)
54
Agoraphobia
Fear of being unable to escape into a safe place (e.g. home) May manifest in open spaces that are difficult to leave without attracting attention 95% have current or past dx of panic disorder
55
Social phobia
Fear of being criticized or scrutinized; worry that they will be embarrassed in public. Will tolerate anonymous crowd (unlike agorophobics) but small groups are intimidating. Self-medication with alcohol or drugs =avoidance and perpetuates problem
56
Panic disorder
Episodic anxiety attacks, not restricted to certain situations or objective danger. May have fear of having further attachs Panic can persist until pts receive reassurance or reverts to "safety behaviors" e.g. calling ambulance, taking aspirin Pts may think they are dying, having MI, or going mad which can further increase anxiety levels
57
Acute stress reaction
1-3 days | Anxious but may seem dazed, may have amnesia, depersonalization, derealization
58
PTSD
Persistent flashbacks, vivid memories, recurring dreams Actual or preferred avoidance of circumstances remembling or associated with stressor Inability to recall, partially or completely, some important aspects or period exposure to stressor
59
Adjustment disorder
60
Grief reaction
Anger, guilt, self-blame, searching and pining (vivid dreams dead person being alive, pseudohallucinations), sadness and despair, acceptance
61
Tx-GAD
Buspirone for psych sxs BDZ for somatic sxs CBT
62
Tx-agoraphobia
Antidepressants Beta blockers CBT
63
Tx-panic disorder
SSRIs CBT Psychodynamic psychotherapy
64
Tx-PTSD
Trauma-focused CBT and EMDR (eye movement desensitization and reprocessing) Sleep disturbance: mirtazapine Anxiety/hyperarousal: BDZ
65
Tx-adjustment disorder
Antidepressants, anxiolytics, or hypnotics Supportive psychotherapy, practical support Verbalization of feelings prevents maladaptive behavior

Year 5 Psych (5 decks)

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