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(psych) depression Flashcards

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1
Q

what are the symptoms of depression categorised into?

A

core symptoms
biological symptoms
psychological symptoms

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2
Q

what are the core symptoms of depression?

A

low mood (mood may be worse in the morning)

anergia (loss of energy)

anhedonia (loss of enjoyment)

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3
Q

what are the biological symptoms of depression?

A

impaired sleep

lack of appetite

low libido

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4
Q

what are the psychological symptoms of depression?

A

suicidal thoughts

feelings of guilt and remorse

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5
Q

what is a mental state examination?

A

a structured way of observing and describing a patient’s current state of mind using a variety of domains

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6
Q

what are the components of a mental state examination?

A

appearance and behaviour

speech

mood and affect

thought

perception

cognition

insight

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7
Q

what is the purpose of a mental state examination?

A

obtains a description of the patient’s mental state, which when combined with the psychiatric history, allows the clinician to make an accurate diagnosis

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8
Q

how do you begin a mental state examination?

A

(wash hands and don PPE if required)

introduce yourself (name and role)

confirm patient identity

gain consent = ‘are you happy/alright to talk to me about how you been recently?’

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9
Q

how do you assess appearance in an MSE?

A

distinguishing features (e.g. self-harm)

clothing

personal hygiene

objects

weight

stigmata of disease (e.g. jaundice)

= provides an insight into the patient’s mental state

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10
Q

how do you assess behaviour in an MSE?

A

engagement and rapport

eye contact

facial expressions

body language

psychomotor activity (psychomotor retardation, restlessness)

abnormal movements (tremors, tics, lip smacking)

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11
Q

how do you assess speech in an MSE?

A

rate (slow/pressurised)

quantity (minimal/excessive)

tone (motononous/tremuolous)

volume

fluency and rhythm (stuttering, stammering/slurred)

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12
Q

define mood

A

represents a patient’s predominant subjective internal state at any one time as described by them

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13
Q

define affect

A

represents an immediately expressed and observed emotion

i.e. facial expression, overall demeanour

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14
Q

differentiate between mood and affect

A

mood refers to the predominant internal state of a patient described by them themselves

affect refers to the immediately expressed and observed emotion

= affect is what you observe BUT mood is what the patient tells you

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15
Q

how do you assess mood in an MSE?

A

ask questions such as:

how are you feeling?
what is your current mood?
have you been feeling low/depressed recently?

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16
Q

how do you assess affect in an MSE?

A

observe a patient’s facial expressions and overall demeanour

assess:
apparent emotion

range/mobility of affect (fixed/restricted/labile)

intensity of affect (heightened/blunted)

congruency of affect (congruent/incongruent)

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17
Q

what is incongruent affect?

A

when a patient’s affect does not align with the content of their thoughts (i.e. laughing when sharing distressing thoughts)

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18
Q

how is thought assessed in an MSE?

A

assessed in three aspects: form, content and possession

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19
Q

what is thought form?

A

the processing and organisation of thoughts

asses:
1) speed of thoughts

2) flow and coherence of thoughts (flight of ideas, thought blocking, tangential/circumstantial thoughts)

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20
Q

what is thought content?

A

delusions

obsessions

compulsions

overvalued ideas

suicidal/homicidal thoughts

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21
Q

what is thought possession?

A

thought insertion
thought withdrawal
thought broadcasting

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22
Q

what is perception?

A

the interpretation of sensory information to understand the world around us

(abnormalities in perception are a feature of severe mental health conditions)

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23
Q

how is perception assessed in an MSE?

A

assess for the presence of:

hallucinations
pseudo-hallucinations
illusions
depersonalisation
derealisation
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24
Q

how is cognition assessed in an MSE?

A

assess:

whether they are orientated in time, place and person

attention span and concentration levels

short term memory

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25
how can cognition be formally assessed?
separate tests (e.g. Addenbrooke's cognitive exam III, MMSE etc)
26
what is insight in the context of an MSE?
the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal
27
how is insight assessed in an MSE?
ask questions such as: do you think you have a problem at the moment? do you feel you need help with your problem? what do you think is causing the problem?
28
apart from an MSE, what other information would a clinical like to know about a patient?
!!! suicide risk !!! history of presenting complaint past psychiatric AND past medical history family history drug history (+ allergies and side effects) social history (substance abuse, lifestyle factors, sexual health)
29
what must you ALWAYS remember to also do when taking a psychiatric history?
(sensitively) ask about suicide risk screening for and and asking about suicide does not increase the risk of attempting it (!!!)
30
what do you want to know in terms of the history of the presenting complaint?
1) explore core, biological and psychological symptoms in more detail 2) (ODPARA - non-pain related) Onset of symptoms (insidous/acute) Duration of episodes (diurnal?) Progression of symptoms Aggravating factors (psychosocial stressors?) Relieving factors (medication?) Associated psychiatric disorders (bipolar disorder, schizophrenia, OCD etc)
31
what do you want to know in terms of the past psychiatric history?
previous episodes of depression? how were they resolved? previous conditions previous treatments previous admissions under the MHA or informal collateral history
32
what do you want to know in terms of the past medical history?
any existing medical conditions that can cause a mental disturbance via physiological mechanisms (e.g. hypothyroidism can cause depression) allergies + side effects to medications
33
what do you want to know in terms of the family history?
any mental illness? who e.g. first degree relative? what are the family relationships like?
34
what do you want to know in terms of the drug history?
any prescribed medication? any over-the-counter medication? (if yes, then note name, when, dose, frequency, duration, outcome, side effects, route and form)
35
what do you want to know in terms of the social history?
general social situation: living situation, accommodation, who is at home/personal support network, help with ADLs alcohol use/misuse recreational drug use smoking
36
which types of history can also be taken during a full psychiatric history?
forensic history = arrests/cautions/MHA admissions/incarcerations etc AND collateral history = from a family member or friend or associate to corroborate the information given by the patient AND personal history = birth, early life, school, qualifications, employment, psychosexual history, premorbid personality
37
what is a forensic history?
history of the patient's criminal offences i.e. arrests, cautions, incarcerations, probations, MHA admissions etc
38
what is a collateral history?
a history taken from a family member, friend or an individual close to the patient useful when = cannot fully believe the information given by the patient OR when patient has memory loss/impaired cognition
39
what is a personal history and why is it important?
history of the patient's birth, early life, school qualifications, employment, premorbid personality etc = can help work out triggers/causes of the mental health condition that the patient presents with
40
which risk assessments must be carried out in a full psychiatric history?
``` risk to self: current suicide risk previous suicide attempt(s) self-harm self-neglect ``` risk to others: thoughts/plans to harm others? risk from others: vulnerability to exploitation
41
differentiate between unipolar and bipolar depression
unipolar depression = several depressive symptoms (extremely low mood) bipolar depression = several depressive + also manic symptoms (alternating between periods of extremely low mood with extremely euphoric/irritable mood)
42
how do antidepressants affect unipolar and bipolar depression?
antidepressants are linked to an increase in manic/hypomanic episodes in bipolar depression + also mostly ineffective in acute bipolar depression compared to unipolar depression
43
what can antidepressant cause in bipolar depression?
can cause hypomanic or manic episodes (or more mood episodes) worsening the long-term course of bipolar depression
44
what are personality disorders (PD)?
maladaptive patterns of behaviour and cognition, deviating from those accepted by the individual's culture (develop early + inflexible + associated with significant distress or disability)
45
define paranoid personality disorder
pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
46
define schizoid personality disorder
lack of interest and detachment from social relationships, apathy, and restricted emotional expression
47
define schizotypal personality disorder
extreme discomfort interacting socially, and distorted cognition and perceptions
48
define antisocial personality disorder
pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behaviour
49
define borderline personality disorder
pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behavior and affect, often leading to self-harm and impulsivity
50
define histrionic personality disorder
pervasive pattern of attention-seeking behaviour and excessive emotions
51
define narcissistic personality disorder
pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy
52
define avoidant personality disorder
pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
53
define dependent personality disorder
pervasive psychological need to be cared for by other people
54
what is obsessive-compulsive personality disorder?
rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships
55
what are the 10 personality disorders listed in DSM-5?
cluster A = paranoid PD schizoid PD schizotypal PD ``` cluster B = antisocial PD borderline PD histrionic PD narcissistic PD ``` cluster C = avoidant PD dependent PD obsessive-compulsive PD
56
what does cluster A of personality disorders in DSM-5 incorporate?
paranoid personality disorder schizoid personality disorder schizotypal personality disorder
57
what does cluster B of personality disorders in DSM-5 incorporate?
antisocial personality disorder borderline personality disorder histrionic personality disorder narcissistic personality disorder
58
what does cluster C of personality disorders in DSM-5 incorporate?
avoidant personality disorder dependent personality disorder obsessive-compulsive personality disorder
59
what is bipolar affective disorder?
i.e. manic depression wide mood alterations with periods of depression and periods of mania
60
compare BPAD (bipolar affective disorder) and schizophrenia
both have - hallucinations - cognitive impairment - depression and negative symptoms of schizophrenia (apathy, anergia, social isolation) but BPAD = episodic hallucinations and delusions and schizophrenia = chronic hallucinations and deluions
61
compare BPAD (bipolar affective disorder) and ADD (attention deficit disorder)
both have - impaired concentration - impaired executive function - abnormal working and short term memory but BPAD = high heritability, recurrent depressive episodes
62
what is attention deficit disorder?
basically ADHD (attention-deficit hyperactivity disorder) but with predominantly inattentive presentation
63
what does bipolar disorder commonly present with?
commonly w anxiety disorders OR substance use disorders
64
what are some organic causes of depression?
endocrine (hyper/hypothyroidism, hyper/hypoparathyroidism, hypoglycaemia, Cushing's, Addisons's) infections (viral, SLE, HIV) deficiencies (vvit B12 or folate) neurological (Alzheimer's, MS, Parkinson's) medications
65
what are some organic causes of depression?
endocrine (hyper/hypothyroidism, hyper/hypoparathyroidism, hypoglycaemia, Cushing's, Addisons's) infections (viral, SLE, HIV) deficiencies (vvit B12 or folate) neurological (Alzheimer's, MS, Parkinson's) medications (steroids, beta-blockers, opiate painkillers, statins, antibiotics etc) vascular depression post-stroke depression
66
what is vascular depression?
due to white matter hyperintensities that can impact cognitive function need to minimise vascular risk factors (diabetes, hypertension, smoking, alcohol)
67
what is post-stroke depression?
lesions in the left frontal lobe or basal ganglia = apt to cause depression retardation in thinking and behaiour

brs (phase 1b) (71 decks)

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