affective disorders and self harm

Question 1

define euthymic

Answer 1

normal mood

Question 2

define hyperthymic

Answer 2

elevated mood

Question 3

define cyclothymic

Answer 3

variable mood

Question 4

define anhedonia

Answer 4

loss of enjoyment or pleasure

Question 5

define stupor

Answer 5

the lack of critical mental function and a level of consciousness
patient only responds to intense stimuli e.g. pain

Question 6

what are tactile hallucinations

Answer 6

the feeling of things crawling on the skin

Question 7

name some risk factors for depression

Answer 7

alcohol/drugs, abuse, unemployment, previous diagnosis, chronic disease, urban population

Question 8

what is cotard’s syndrome

Answer 8

delusion in which people believe they are dead, do not exist, are putrefying or have lost their blood or internal organs

Question 9

what is somatic depression

Answer 9

marked loss of interest, lack of emotional response, waking in the morning, depression worse in the morning, loss of appetite, loss of libido

Question 10

clinical presentation of atypical depression

Answer 10

mood reactivity, weight gain or increase in appetite, hypersomnia, leaden paralysis

Question 11

what is leaden paralysis

Answer 11

heavy, leaden feeling in arms or legs

Question 12

classic presentation of depression

Answer 12

triad of anhedonia, anergia and amotivation

Question 13

MSE: speech in depression

Answer 13

reduced rate, lower pitch, reduced volume and intonation

Question 14

depression questionnaire used in primary care

Answer 14

PHQ-9

Question 15

depression questionnaire used in secondary care

Answer 15

HAD

Question 16

medical management pathway for depression

Answer 16

1st line - SSRI (sertraline)
2nd line - switch SSRI
3rd line - SNRI, tricyclic

Question 17

when does bipolar disorder usually present

Answer 17

late teens - early 20s

Question 18

what is bipolar 1

Answer 18

at least one manic episode with or without a history of major depressive episodes

Question 19

what is bipolar 2

Answer 19

one or more major depressive episode and at least one hypomanic episode, but NO evidence of mania

Question 20

clinical presentation of a hypomanic episode

Answer 20

persistent - lasting several days
elevation of mood, irritability, activity
increased talkativeness, racing thoughts, decreased need for sleep

Question 21

how does a manic episode differ from a hypomanic episode

Answer 21

lasts at least one week, impulsive or reckless behaviour, flight of ideas

Question 22

what MUST be ruled out before a diagnosis of bipolar disorder is made

Answer 22

substance misuse

Question 23

first line management of an acute manic episode in bipolar

Answer 23

atypical antipsychotic
olanzapine, risperidone, quetiapine

Question 24

what can be used for symptom control of an acute manic episode

Answer 24

benzodiazepines

Question 25

first line management of an acute bipolar depression

Answer 25

atypical antipsychotic

Question 26

why should antidepressants be avoided in bipolar depression

Answer 26

can cause rapid cycling mood

Question 27

gold standard for bipolar maintenance and what should be added on depending on type

Answer 27

LITHIUM + valproate if primarily manic + lamotrigine if primarily depressed

Question 28

pathophysiology of self harm

Answer 28

promotes the release of endorphins - brings temporary distress reduction

Question 29

what is another name for postpartum psychosis

Answer 29

puerperal psychosis

Question 30

when does postpartum psychosis usually present

Answer 30

2-4 weeks postpartum

Question 31

risk factors for postpartum psychosis

Answer 31

family history, first pregnancy, C-section, perinatal death, history of mental illness, previous episode

Question 32

what is capgras delusion

Answer 32

belief by the patient that the close person is replaced by an imposter who looks physically the same

Question 33

first line management of postpartum psychosis

Answer 33

antipsychotic

Question 34

which antipsychotics are safe to take while breastfeeding

Answer 34

olanzapine and quetiapine

Question 35

what is postnatal depression

Answer 35

depression that develops up to a year after the birth of a baby

Question 36

risk factors for postnatal depression

Answer 36

family history, complicated pregnancy/traumatic birth, history of abuse, lack of support

Question 37

name some transient causes of confusion

Answer 37

delirium, post-ictal, migraines, delirium tremens

Question 38

name some enduring causes of confusion

Answer 38

TBI, dementia, alcohol related

Question 39

what is the most common neuropsychiatric complication of stroke

Answer 39

post-stroke depression