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Mental Health Flashcards

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1
Q

Bipolar disorder - epi

A

• 6th leading cause of disability in the developed world for people aged 19-45 years
• 60% of diagnosis occurs before the age of 20 years
• M = F
• Hard to diagnose considering that the onset of depression usually occurs first

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2
Q

Bipolar disorder - definition

A

• Chronic mood disorder characterised by episodes of abnormally elevated/irritable mood (mania) and
depressive episodes

• Manic episodes = abnormally elevated, expansive or irritable mood, lasting for at least 1 week
• Hypomania = distinct period of elevated mood lasting for 4 days. Not as severe as mania

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3
Q

Bipolar disorder - aetiology and RF

A

Unknown. Multifactorial
• Risk factors:
⁃ Young age of onset < 20 years
⁃ Family Hx
⁃ Previous Hx of depression
⁃ Substance abuse
⁃ Stressful life events
⁃ Anxiety disorder

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4
Q

bipolar disorder - classification

A

• Bipolar disorder, type I
⁃ At least 1 manic, major depressive or mixed episode in the past

• Bipolar disorder, type II
⁃ Never had a full manic episode
⁃ At least 1 hypomanic episode or 1 major depressive episode

• Rapid-cycling Bipolar Disorder
⁃ 4 or more affective episodes per year – (15%)

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5
Q

bipolar disorder - clinical features

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6
Q

Bipolar disorder Rx

A
  1. 1st Line = Lithium
    ⁃ Indications is Rx for acutely manic or hypomanic states and prevention of further mania
    ⁃ Anti-depressant features
  2. Antipsychotics – olanzapine or aripiprazole
    ⁃ Can also be used as 1st line Rx if Lithium is not suitable. Anti-manic affects
  3. Other mood stabilisers:
    ⁃ Valproate and Carbamazopine - as adjuncts
    ⁃ Lamotragine (1st line if depression is predominant feature)
  4. Anti-depressants – Should be avoided as they can precipitate mania. SSRIs are drug of choice if required

NOTE
Lithium Toxicity:
• Lithium is usually well-tolerated, however it has a narrow therapeutic window. Also alters thyroid function
• Mild-moderate = polyuria, polydipsia, weight gain, oedema, diarrhoea, nausea, vomiting, muscle weakness,
drowsiness, apathy, ataxia
• Severe = increased muscle tone, hyper-reflexia, myoclonic jerks, tremor, dysarthria, seizure, psychosis, coma

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7
Q

BIPOLAR DISORDER - COMPLICATIONS AND PROGNOSIS

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8
Q

Borderline personality disorder definition

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9
Q

Borderline Personality Disorder - epidemiology

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10
Q

Borderline Personality Disorder - aetiology and pathophysiology

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11
Q

Classification of Personality Disorders

A

Classification of Personality Disorders:
• Cluster A - Odd/Eccentric
• Cluster B - Dramatic (including BPD)
• Cluster C - Anxious/fearful

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12
Q

Boderline personality disorder - clinical features

A

Any 4 of the following is diagnostic:
1. Fears of abandonment
2. Patterns of unstable, intense interpersonal relationships. Idealisation and devaluation
⁃ Presence of “black-white” thinking or “splitting” – all good or all bad
3. Identity disturbance
4. Impulsivity
⁃ In at least 2 areas e.g. spending, sex, substance abuse, reckless driving, binge eating
5. Recurrent suicidal behaviour, gestures, threats, self-mutilating behaviour
6. Affect instability - alternating throughout the day
7. Chronic feelings of emptiness
8. Inappropriate or intense anger
9. Transient, stress-related paranoid ideations

Suicide
⁃ Recurrent suicidal threats, gestures and attempts (so common it constitutes diagnostic criteria)
⁃ Deliberate Self-harm = Intentional, non-fatal self injury e.g. cutting, scratching, burning, poisoning
etc.
⁃ Common reason for ED presentations in people with BPD
⁃ Reasons:
⁃ Often not to commit suicide but to attempt to feel better
⁃ Externalise or show mental pain in a physical way
⁃ Feel pain to overcome pyschological pain and distress
⁃ Gain a sense of control or overcome a feeling of numbness

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13
Q

Borderline Personality Disorder - diagnosis and DDx

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14
Q

Borderline Personality Disorder - management and prognosis

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15
Q

major depressive disorder - definition, epi

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16
Q

Major Depressive Disorder - aetiology

A

• Complex and poorly understood
• Genetics - highly heritable (3x risk for 1° relative)
• Stressful life events, personality and gender may play a role

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17
Q

Major Depressive Disorder - pathophys

A

•Abnormal concentration of neurotransmitters
⁃ ↓ levels of 5HT, NE or DA or ↓ number of receptors
⁃ ↓DA –> Concentration & motivation problems
⁃ ↓5HT –> Fatigue and hypersomnia

• Dysregulation of the HPA axis
⁃ Stress response –> ↑CRH –> ↑ACTH and cortisol
⁃ Excess cortisol is toxic to the hippocampus

• Trophic effects:
⁃ ↓ levels of Brain-derived Neurotrophic factor
⁃ Neuronal loss at pre-frontal cortex, hippocampus and ↑ ventricle size
⁃ Stress and cortisol also decrease BDNF levels

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18
Q

Major depressive disorder - RF

A

Risk Factors:
• Age > 65
• Female
• Personal or FHx of depression/suicide
• Post-partum
• Drugs such as corticosteroids, OCP,
propranolol
• Physical disease (esp. chronic disease)
• Abuse
• Substance abuse
• Stressful life events

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19
Q

Major Depressive Disorder - clinical features

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20
Q

Major Depressive Disorder - investigations

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21
Q

Major Depressive Disorder- complications and prognosis

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22
Q

Major Depressive Disorder - management

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23
Q

PTSD - defintion

A

Definition:
• An anxiety disorder that develops after a traumatic life-threatening experience, characterised by reexperiencing (the event), hyper-arousal, avoidance and numbing

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24
Q

PTSD - risk factors

A

Risk Factors:
• Previous psychiatric Hx
• Lower intelligence
• Female gender
• Prior exposure to trauma

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25
PTSD - aetiology
Aetiology: 1. Multifactorial. 2. Stress–vulnerability model ⁃> Not all people that experience trauma develop PTSD, therefore must be also vulnerability such as poor coping mechanisms or lack of social support 3. Requires a external trigger such as: ⁃ Violence or military action ⁃ Physical and sexual abuse, rape ⁃ Disaster ⁃ People who have experienced threats to their own life ⁃ OR perception of trauma
26
PTSD - classification
Acute stress disorder (symptoms present for < 1 month) Vs. PTSD (symptoms present > 1 month) • Acute PTSD – duration of symptoms < 3 months • Chronic PTSD – duration of symptoms > 3 months • Delayed onset – symptom onset > 6 months after the event
27
PTSD clinical features
28
PTSD - DDx, Rx, co morbidities
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PTSD - aetiological and maintaining factors in panic disorder
30
Schizophrenia definition
Definition: • A mental illness characterised by a co-occurrence of at least two of the following symptoms: ⁃ Delusions ⁃ Hallucinations ⁃ Disorganised speech ⁃ Disorganised/catatonic behaviour ⁃ Negative symptoms (affect flattening, avolition, anhedonia, attention deficit, impoverishment of speech/language) • At least one of the symptoms must be a positive symptom
31
Schizophrenia epi
Epidemiology: • Prevalence = 0.5-1% of the population • Age of onset is < 25 years for males and < 35 years for females ⁃ Earlier the onset, worse the prognosis • Males > females
32
Schizophrenia aetiology
Aetiology: • Multifactorial disease • Genetics - Hx of the disorder in the family • Developmental - neuronal pruning • Stress diathesis model: ⁃ A person with a specific vulnerability that encounters stressful events --> symptoms • Risk factors: ⁃ Family Hx ⁃ Substance use ⁃ Psychological stresses ⁃ Child abuse ⁃ Winter birth
33
Structural Changes of the Schizophrenic brain
Structural Changes of the Schizophrenic brain: • Enlargement of the ventricles • Increased grey matter loss • Excessive neuronal pruning • Less branching of neurons
34
schizophrenia pathophysiology
35
schizophrenia clinical features
36
Schizophrenia management
37
schizophrenia: complications and prognosis
Complications: • Antipsychotic side effects (akathesia, postural hypotension, dystonia, parkinsonism) • Suicidal tendencies • Substance abuse - 30-50% • Metabolic abnormalities 2° to antipsychotics - weight gain, metabolic syndrome (medium) Prognosis: • Poor, even with Rx some pts are still symptomatic. Males have worse prognosis due earlier onset • Lower life expectancy due to co-morbidities • Suicide (10%) • Job + Supportive Family (single most important factors) for better outcomes
38
NSW mental health act - aims
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Involuntary admission
40
NSW mental health act - Magistrates Decisions
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NSW Mental Health Act - Community Rx orders
42
define postnatal depression
Postnatal depression = Major depressive disorder that develops within 4 weeks of giving birth
43
Epidemiology of postnatal depression
• Affects 1 in 8 women (~13%) • 50% of all episodes begin in the antenatal period • Baby “blues” ⁃ Common experience and refers to a mild and transient mood disturbance that occurs in the first few days after delivery ⁃ Estimated that 50-80% of women experience this to some extent ⁃ Peak onset is day 4-5 post delivery ⁃ Usually resolves by day 10 and does not require specific Rx. Reassurance
44
Aetiology of postnatal depression
Aetiology: • Poorly understood. Multifactorial. ⁃ Genetics ⁃ Psychological factors (support, life events, abuse, low income), ⁃ Psychiatric illness or personality disorder ⁃ Environmental - sleep deprivation ⁃ Hormonal Risk Factors: • Hx of depressed mood, depression or anxiety • Recent stressful event • Poor social support • Discontinuation of psychological Rx • Sleep deprivation • Genetic susceptibility • Violence by partner during pregnancy
45
classification of postnatal depression
1. Minor mood disturbance (“baby blues”) 2. Postnatal depression 3. Postnatal psychosis - psychiatric emergency ⁃ Core features include acute onset of manic, mixed or depressive psychosis immediately in the postnatal period
46
clinical features of postnatal depression
47
Management of postnatal depression
Management: • Psychological: (mild-mod depression) ⁃ CBT and IPT (interpersonal psychotherapy) • Pharmacological: ⁃ Important to discuss risk vs. benefits of therapy including implications on breast feeding ⁃ Rx psychological disease takes higher priority than breastfeeding ⁃ Similar Rx regime as major depressive disorder
48
complications of postnatal depression
Complications: • Impaired bonding with infant, neglect, suicide (short-term low)
49
prognosis of postnatal depression
Prognosis: • Episodes of postnatal depression last ~ 3-6 months on average • Few remain depressed passed 1 year • Future episodes depends on future life events, patient psychological and biological factors
50
postnatal depression Screening – Edinburgh Postnatal Depression Scale:
51
risk assessment - harm to self vs others
52
risk assessment - why assess risk?
53
risk and the mental health act
54
MSE and risk assessment
55
Psych Drug classification in pregnancy
56
risk vs benefit of Psychiatric Drugs in Pregnancy/Breastfeeding
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Psychiatric Drugs in Pregnancy
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General principles of prescribing (psych drugs) during pregnancy
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Psych drugs in breastfeeding
60
general principles of prescribing (psych drugs) during breastfeeding
61
Define substance use
62
Epi of substance use
Epidemiology: • High prevalence – Up to 8% of the population in the US and 40% of inpatients • Under-recognised • Affects all races, ages and socio-economic backgrounds
63
Classification of Substances involved in Addiction + clinical features
64
Ix of substance use
Ix: • Urine drug screen (toxicology screen) • FBC, UECs, LFTs • Screen for HIV (consent), Hep B, Hep C & syphilis
65
clinical features of substance abuse table
66
Substance Use Assessment

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