Affective and Psychotic Disorders, Schizophrenia and Personality Disorders

Question 1

which common mental disorders fall under the bracket of affective disorders?

Answer 1

depression
mania
bipolar disorder

Question 2

what kind of mental disorder are depression and mania?

Answer 2

mood disorders

Question 3

in which three spheres do depressive symptoms be categorised?

Answer 3

psychological
physical
social

Question 4

what type of psychological changes can occur in depression? give examples of symptoms

Answer 4

change in mood: anxiety, low mood, bewilderment

change in thought content: guilt, hopeless, worthless

Question 5

what type of physical changes can occur in depression? give examples of symptoms

Answer 5

change in bodily function: disturbed sleep, loss of appetite, loss of libido, weight loss, pain
change in psychomotor function: agitation or retardation

Question 6

name a few depressive symptoms which may occur in the social sphere

Answer 6

anhedonia
isolation/withdrawal
loss of confidence
lack of concentration
apathy
irritability

Question 7

which classification is commonly used to differentiate between mild, moderate and severe depression?

Answer 7

ICD-10 classification

Question 8

in general terms, how are mild, moderate and severe depression differentiated?

Answer 8

by the number of symptoms presented (eg mild 4 symptoms, moderate 6+ symptoms, severe 8+ symptoms)

Question 9

what are the main three symptoms which should always be found to diagnose any severity of depression?

Answer 9

• low mood for 2+ weeks
• fatigue/low energy
• anhedonia

Question 10

if a patient presents with depression, but also describes a manic episode, how does that affect the diagnosis of depression?

Answer 10

the manic episode in someone with depression with point towards bipolar disorder rather than simply depression

Question 11

what symptoms could signify that a patient is severely depressed rather than moderate or mild?

Answer 11

psychotic symptoms

catatonia/stupor

Question 12

how can somatic syndrome be different from depression?

Answer 12

it doesn’t always present with low mood, but may have a cluster of other symptoms associated with depression

Question 13

what percentage of women get post partum “blues” and post partum depression?

Answer 13

post partum blues - 75%

post partum depression - 10%

Question 14

what is the incidence of postpartum psychosis?

Answer 14

1 in 500 women

Question 15

define dysthymia and cyclothymia respectively

Answer 15

dysthymia - mild, chronic form of depression

cyclothymia - mild form of bipolar disorder

Question 16

what is the average age of diagnosis for depression and bipolar disorder respectively?

Answer 16

depression - late 20’s (27)

bipolar disorder - early 20’s (21)

Question 17

are females or males more likely to present with depression?

Answer 17

incidence is the same for males and females

Question 18

how many episodes of mania are necessary to diagnose bipolar disorder?

Answer 18

one episode of mania is sufficient

Question 19

name a few possible signs of mania

Answer 19

pressured speech
grandiosity
disinhibition
increased libido
overfamiliarity
reduced sleep
irritability
elated mood
increased spending

Question 20

what are the main screening tools used for affective disorders?

Answer 20

SCAN

SCID

Question 21

how likely are patients with an affective disorder to have further episodes in the future?

Answer 21

> 80% likelihood

Question 22

how many patients with an affective disorder die by suicide on average?

Answer 22

10-15%

Question 23

how many patients with an affective disorder recover after the first episode?

Answer 23

50-60%

Question 24

how is hypomania different from mania?

Answer 24

symptoms not as severe

doesn’t present with psychosis

Question 25

how many episodes of mania and depression are needed to diagnose bipolar affective disorder?

Answer 25

2+ episodes

Question 26

name a few common mental disorders that can be treated with psychological therapies

Answer 26

``` depression anxiety OCD panic/phobia disorders alcohol/drug/tobacco abuse PTSD ```

Question 27

name the four psychological therapies that can be used in certain mental disorders

Answer 27

``` cognitive behavioural therapy (CBT) interpersonal psychotherapy (IPT) behavioural activation (BA) motivational interviewing (MI) ```

Question 28

give a brief description of the uses and strategy of cognitive behavioural therapy

Answer 28

CBT can be used for affective disorders, panic/phobia disorders and PTSD. it aims to help the patient understand the link between their thoughts, feelings and behaviours following certain events

Question 29

give a brief description of the uses and strategy of behavioural activation

Answer 29

BA can be used for depression. it focuses on helping patients plan and carry out activities they have avoided

Question 30

give a brief description of the uses and strategy of motivational interviewing

Answer 30

MI can be used in addictive disorders. it aims to help the patient go through the process of considering, planning and acting to stop their addiction

Question 31

give a brief description of the uses and strategy of interpersonal psychotherapy

Answer 31

IPT can be used in depression and anxiety, and it aims to help patients reflect on the correlation between interpersonal events and their feelings/mood

Question 32

what is the definition of psychosis?

Answer 32

inability to distinguish symptoms of hallucinations, delusions and thought disorders from reality

Question 33

which are the main diseases which can present with psychosis?

Answer 33

delirium schizophrenia severe depression with psychotic symptoms mania with psychotic symptoms

Question 34

define a delusion

Answer 34

a delusion is a false, unsheakable belief not in keeping with social or cultural background

Question 35

define a hallucination

Answer 35

a hallucination is an uncontrolled, real perception of a non-existent stimulus in the external space

Question 36

how long do symptoms need to be present for someone to be diagnosed with schizophrenia?

Answer 36

one month at least

Question 37

name a few symptoms which can lead to a diagnosis of schizophrenia

Answer 37

- hallucinations - delusions - thought disorder - speech disorder/neologisms - catatonic behaviour - negative symptoms

Question 38

name a few positive symptoms found in schizophrenia

Answer 38

hallucinations delusions thought disorder

Question 39

name a few negative symptoms found in schizophrenia

Answer 39

apathy anhedonia lack of emotions

Question 40

name a few generic factors which may be involved in schizophrenia

Answer 40

biological (neurochemistry, genetics) psychological (family, events) social (migration, drugs)

Question 41

which neurotransmitters are thought to play a part in schizophrenia?

Answer 41

dopamine serotonin GABA glutamate

Question 42

what is the incidence of schizophrenia?

Answer 42

1% of population

Question 43

what is the gender incidence of schizophrenia?

Answer 43

males = females

Question 44

what is the age range for diagnosis of schizophrenia?

Answer 44

15-35

Question 45

how long should patients stay on antipsychotic medication after an episode of psychosis?

Answer 45

18 months to 2 years

Question 46

name a few factors which may improve a prognosis of schizophrenia

Answer 46

``` no family history sudden onset stable family/friends relationships stable emotions prompt treatment ```

Question 47

name a few factors which can worsen a prognosis of schizophrenia

Answer 47

``` family history (twins especially) slow insidious onset substance abuse unstable social circumstances early onset ```

Question 48

what is schizoaffective disorder?

Answer 48

it's a combination of psychotic symptoms (eg hallucinations, delusions or thought disorder) with either depressed or manic features

Question 49

can patients with severe anxiety/depression drive?

Answer 49

if mild/moderate with no significant impairment - yes | if severe/psychotic - no

Question 50

in the GP setting, how often should patients be followed up after being put on antidepressants?

Answer 50

if high risk/under 30 - see after a week and frequently after that until no longer high risk. otherwise, every 2 weeks for 3 months then taper off