Mental Health

Question 1

Mood vs affect?

Answer 1

Mood – A person’s predominant feeling at a given time (‘season’ or ‘climate’)

Affect – Involves moment to moment changes in the emotional state and the external expression of these feelings as observed by the examiner (‘day’ or ‘weather’)

Question 2

Define mania

Answer 2

Mental illness marked by periods of great excitement or euphoria, delusions, and overactivity that lasts at least 7 days.

Question 3

Define hypomania

Answer 3

A mild form of mania, marked by elation and hyperactivity.

Question 4

Define euthymia

Answer 4

A normal, tranquil state/mood that is neither manic nor depressive, yet distinguishable from the state of healthy (commonly associated with bipolar disorder).

Question 5

What condition is euthymia commonly associated with?

Answer 5

Bipolar disorder

Question 6

Define subthreshold depression

Answer 6

Clinically relevant depressive symptoms that do not meet the criteria for a major depressive disorder.

Question 7

Define major depression

Answer 7

Persistently depressed mood and long-term loss of pleasure of interest in life

Question 8

Define mixed state

Answer 8

A state wherein features unique to both depression and mania occur wither simultaneously or in very short succession.

Question 9

Disordered mood:

Answer 9

Question 10

Give some red flags for mental health conditions

Answer 10

• Thoughts of deliberate self-harm
• Suicidal thoughts
• Previous suicide attempts
• No protective factors
• Family history of suicide
• Significant adverse life event
• Anxiety
• Loss of functioning
• Risk to self or others
• Command hallucinations
• Grandiose delusions
• Trouble with police
• Alcohol dependency

Question 11

What 2 features is depression characterised by?

Answer 11

1. Persistently low mood
2. Loss of interest in everyday activities (anhedonia)

Question 12

Unipolar vs bipolar?

Answer 12

• Unipolar – first occurrence or recurrent
• Bipolar – reoccurrences of mania and depression

Question 13

In people aged 18-44, what is the leading cause of disability and premature death in the UK?

Answer 13

Depression

Question 14

Define DSM-5

Answer 14

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Question 15

The DSM-5 outlines the criteria for a diagnosis of depression.

What are the 2 core symptoms?

Answer 15

1. Depressed/low mood most of day, nearly every day
2. Diminished interest or pleasure in doing things (anhedonia)

Question 16

The DSM-5 outlines the criteria for a diagnosis of depression.

What are some associated symptoms?

Answer 16

• Change in sleep – decreased (insomnia) or increased (hypersomnia)
• Change in appetite and/or weight
• Change in activity – psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of excessive or inappropriate guilt and/or worthlessness
• Concentration – diminished ability to think or concentrate, or indecisiveness
• Suicidality – thoughts or death or suicide, or has plan

Question 17

Are men or women more prone to depression?

Answer 17

Women

Question 18

Give some organic diseases that can cause low mood

Answer 18

• Neurological disease e.g. Parkinson’s disease, dementia, MS
• Endocrine disorder e.g. thyroid dysfunction, hypoadrenalism (e.g. Addison’s disease), hyperadrenalism (e.g. Cushing’s disease)
• Drugs e.g. steroids, isotretinoin (Roaccutane), alcohol, beta-blockers, benzodiazepines, methyldopa
• Chronic conditions e.g. diabetes, obstructive sleep apnoea, longstanding infections (e.g. mononucleosis)
• Neoplasms & cancer – pancreatic cancer is a notable example

Question 19

What is bipolar affective disorder?

Answer 19

A mental disorder characterised by periods (2 or more) of depression and periods of elevated mood (mania).

Question 20

What can a ‘manic switch’ in bipolar disorder be induced by?

Answer 20

A ‘manic switch’ can sometimes be induced by someone with BAD taking antidepressants to treat a depressive episode

Question 21

Give some features of mania

Answer 21

• Elevated mood or irritability
• Impulsive & dangerous decisions with little thought for consequences
• Need for sleep often reduced
• Mood congruent delusions may be present
• Often have pressured speech and exhibit flight of ideas

Question 22

What is the gold standard pharmacological medication for bipolar?

Answer 22

Lithium → acts as a mood stabiliser

Question 23

What is generalised anxiety disorder?

Answer 23

Characterised by disproportionate, pervasive, uncontrollable, and widespread worry and a range of somatic, cognitive and behavioural symptoms.

Question 24

What questionnaire can be used to help establish the severity of anxiety?

Answer 24

GAD-7 anxiety questionnaire

Question 25

What is the most common psychiatric disorder?

Answer 25

Anxiety disorders

Question 26

what age group are anxiety disorders typically seen in?

Answer 26

Adults between 35-55 y/o

Question 27

Give some risk factors for anxiety disorders

Answer 27

* Female sex * Family history of psychiatric disorders * Childhood adversity e.g. maltreatment (sexual/physical abuse), parental problems with violence/alcoholism/drug use/mental illness, overprotective/harsh parenting, bullying * Environmental stressors e.g. domestic violence, unemployment, low socioeconomic status, physical/emotional trauma * Substance dependence * Chronic/painful illness e.g. arthritis

Question 28

Generalised anxiety disorder (GAD) defined and categorised by one of **which** two main classification systems?

Answer 28

1. DSM-V 2. ICD-10

Question 29

Describe the ICD-10 classification system for anxiety

Answer 29

Requires symptoms to be present for **most** **days** for **several** **months** and should include elements of: * a) **Apprehension** – worries about future misfortunes, feeling on edge, difficulty concentrating * b) **Motor tension** – restless fidgeting, tension headaches, trembling, inability to relax * c) **Autonomic overactivity** – light-headedness, sweating, tachycardia, epigastric discomfort, dizziness

Question 30

Describe the DSM-V classification system for anxiety

Answer 30

Requires core symptoms for **more days than not,** which are difficult to control and present for \>6 months

Question 31

Give some differentials for anxiety disorder

Answer 31

* Acute stress disorder * Obsessive compulsive disorder * Panic disorder * Post-traumatic stress disorder * Social phobia * Specific phobias * Hyperthyroidism * Alcohol withdrawal * Cardiogenic causes * Hypoglycaemia

Question 32

Associated symptoms of anxiety?

Answer 32

* Psychological – fears, worry, poor concentration, irritability, depersonalisation (altered or lost sense of personal reality or identity), derealisation (surroundings feel unreal), insomnia, night terrors * Motor – restlessness, fidgeting, feeling on edge * Neuromuscular – tremor, tension headache, muscle ache, dizziness, tinnitus * GI – dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loss motions * CVS – palpitations, chest discomfort * Respiratory – difficulty inhaling, tight/constricted chest * GI – urinary frequency, erectile dysfunction, amenorrhoea

Question 33

1st line pharmacological management of anxiety after psychoeducation/CBT etc

Answer 33

SSRIs

Question 34

What is a **pre-occupation**?

Answer 34

A **worry/nagging doubt** that something has happened/likely to happen/unlikely to happen

Question 35

Define a phobia

Answer 35

persistent and excessive fear of an object or situation

Question 36

What are the most common 3 phobias?

Answer 36

1. Planes 2. Heights 3. Dentists

Question 37

Define an overvalued idea

Answer 37

An **acceptable**, **comprehensible** idea (may have an element of truth) pursued by the patient **beyond the bounds of reason** (belief that can be fixed but can be challenged). E.g. a person who works at a company may rigidly maintain the idea that they are the most **valuable** member of the company/will save the company from ruin/will soon be made president of the company

Question 38

Define an obssession

Answer 38

A recurring thought or repetitive behaviours that you cannot control (compulsion does NOT relieve obsession in OCD)

Question 39

Define a delusion

Answer 39

A **fixed**, **unshakeable** belief, despite **evidence to contrary**, not held by others in the same culture and held with intense personal conviction and certainty. E.g. a person believes that the government is controlling our every move via radio waves despite evidence to the contrary