Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialties > Psych Written - Mood & Anxiety > Flashcards

Psych Written - Mood & Anxiety Flashcards

1
Q

Specific antidepressant indications

A

Biological Sx e.g., lack of appetite, insomnia - Mirtazapine

Child/adolescent - Fluoxetine

IHD or other co-morbidity - Sertraline

Severe episode - paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of Severe psychotic depression

A

Delusions:
Nihilistic delusions - excessive guilty, punishment
Coutard syndrome - belief they are dead/ rotting

Hallucinations:
auditory - (2nd version usually) cries or screams for help, derogatory voices
visual - demons, ghosts, punishers
olfactory - faeces, rotting flesh

Catatonia & functional incapacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Core depression sx

A

Low mood
Anhedonia
Anergia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient Health Questionnaire (PHQ) - 9 Scoring

A 
Minimal 1-4
Mild 5-9
Moderate 10-14
Moderately severe 15-19
Severe 20-27
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hospital Anxiety & Depression scale (HADS) Scoring

A

Normal 0-7
Mild 8-10
Moderate 11-14
Severe 15-21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Criteria for admission or urgent referral to HTT (in depression)

A 
Self-neglect
Active suicidal ideas or plans
Risk to others
Poor social support
Psychotic Sx
Severe agitation
Lack of insight
Treatment resistant depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antidepressant medication approach

A

1st = SSRI

  • e.g. sertraline, citalopram
  • 2x trials before moving to next step

2nd = taper down SSRI + switch to SNRI

  • e.g. venlafaxine, duloxetine
  • NOTE: will not see effect until max dose reached

3rd = augment Tx

  • antipsychotic e.g. quetiapine
  • Lithium
  • alternative antidepressant e.g. mirtazapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ICD-10 Criteria for Bipolar Affective Disorder

A

2 or more episodes

  • 1 must be manic associated (manic / hypomanic), the other can be depressive
  • mania must last ~ 4 months
  • depression lasts ~6 months
  • complete recovery between episodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bipolar types

A

Type 1 = manic interspersed with depressive

Type 2 = recurrent depressive episodes, less prominent hypomanic episodes

Rapid cycling = 4+ episodes per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mania - definition

A

Distinct period of abnormally & persistently elevated, expansive or irritable mood

with 3 characteristics of mania

for at least 7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Features of mania (MMSE)

A

Appearance & behaviour:

  • excitable, easily distracted
  • inappropriate clothing - flashy/extravagant
  • catatonic stupor (Extreme cases)

Speech:

  • pressures
  • mutism (extreme cases, unusual)

Mood (& affect)

  • increased self esteem
  • labile mood
  • irritable
  • loss of inhibition

Thought:

  • flight of ideas
  • racing thoughts

Perception

  • Schneider’s 1st rank Sx
  • grandiose delusions
  • paranoia

Insight: minimal - reckless behaviour

Cognition: no change

Risk

  • suicidal ideation
  • disinhibition –> sexual, financial exploitation from others
  • aggression to others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hypomania - definition

A

> 3 characteristic sx of mania

lasting 4+ days

Does NOT impair occupational/social functioning

No psychotic sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ix to consider in suspected BPAD

A

Collateral Hx!
Young Mania rating scale

Physical exam

Urine drug screen
Bloods - FBC, TSH, U&E, LFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of first presentation ?BPAD

A

Refer to secondary care - cannot diagnose in GP!

  • mania or severe depression –> urgent to CMHT / HTT / admission to ward
  • hypomania –> routine referral to CMHT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute Mania Biological Management

A

Taper off & stop any antidepressant e.g. SSRI
Consider sedation e.g. clonazepam

If no existing Tx = stabilise

  • 1st line = antipsychotic e.g. olanzapine
  • 2nd line = switch antipsychotic e.g. haloperidol, quetiapine, risperidone
  • 3rd line = + lithium or sodium valproate

Already on Tx = optimise

  • check compliance
  • check lithium levels
  • add atypical antipsychotic

+ ECT if unresponsive to Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute Depression (in BPAD) Biological Management

A

Not already on Tx:

  • 1st line = fluoxetine + olanzapine OR quetiapine only
  • 2nd line = olanzapine or lamotrigine only

On lithium:

  • check plasma lithium + increase dose if needed
  • if at max lithium level = Tx as above

On sodium valproate:

  • check levels + increase dose if needed
  • max tolerated dose / top of therapeutic range = Tx as above

+ R/v within 4 weeks of resolution

17
Q

Long term biological management of BPAD

A

1st line = lithium

  • monitor for toxicity
  • can take up to 5 weeks to titrate

Not effective = + Sodium valproate

Not tolerated = switch to sodium valproate ONLY or Olanzapine ONLY

Co-existing depression = antidepressant only if mood stabiliser also given

  • 1st line = fluoxetine + olanzapine
  • 2nd line = quetiapine only
  • 3rd line = olanzapine ONLY or lamotrigine ONLY
18
Q

Psychological management of BPAD

A

Offered after resolution of acute episode

Mainly CBT

  • identify relapse indicators
  • establish relapse prevention strategies

Psychodynamic psychotherapy if mood stable

19
Q

DSM-V Definition of Generalised Anxiety Disorder

A

Excessive & uncontrolled worry

present for most days over 6 months

NOT triggered by specific stimulus (and disproportionate to any inherent risk)

that causes distress or imppairment

And is NOT due to other mental health disorder substance abuse or medical condition

20
Q

Presentation of GAD

A

At least 3 of:

  • restlessness / nervousness
  • irritability
  • muscle tension
  • poor concentration
  • sleep disturbance & fatigue
  • coping mechanisms e.g. EtOH, substance
21
Q

GAD-7 Scoring

A

Mild - 5
Moderate = 10
Severe = 15

22
Q

Biological management of GAD

A

Education & Psych considered earlier in Tx.

1st line = SSRI

  • NICE - sertraline
  • licensed - paroxetine

2nd line = switch SSRI after 8 weeks

3rd line = venlafaxine extended release formulation

Adjuncts:

  • pregabalin
  • quetiapine (unclicensed)
  • propanolol
23
Q

Guidance for giving Benzodiazpines in GAD

A

Avoid if possible

Better for short term situations e.g. flight, blood test

Max duration of tx = 2-4 weeks (psych and physiological dependence)

Lorazepam = worst withdrawal risk as shortest half life

24
Q

Agoraphobia definition

A

Cluster of phobias relating to being in situations where escape might be difficult or that help won’t be available if things go wrong

Often open or confined spaces

Central fear = inability to escape to safe place –> urge to return home to safety

25
Q

Presentation / criteria for Agoraphobia

A

Anxiety in at least 2 of:

  • crowds
  • public places
  • travelling away from home
  • travelling alone

Avoidance of phobic situation - prominent
Housebound / dependent on others
Panic attacks - common
Psych or autonomic Sx

26
Q

Social phobia definition

A

Marked fear of being the focus of attention, behaving in a way that will be humiliating or of scrutiny/criticism from others

Causing avoidance of social situations

27
Q

Tx of Panic disorder

A

Education, reassurance, self-help

CBT & Relaxation training e.g., breathing techniques
- Via Referral to IAPT psychological service through GP

+/- SSRI e.g., Citalopram or Venlafaxine (modified release) - esp if co-morbid depression

Switch to TCA e.g., imipramine after 12 weeks if no response

NICE: Benzos NOT recommended due to risk of tolerance & dependence

28
Q

Management of phobias

A

Education, re-assurance, self help

Exposure & response prevention therapy

  • gradual approach to threat/phobia
  • allows desensitisation

CBT

  • explore likelihood & impact of anticipated catastrophe
  • improve self confidence

Medication

  • antidepressants e.g. Sertraline, Venlafaxine
  • beta blockers (symptomatic)
  • BDZ (short term stressful events only)
29
Q

OCD Tx

A

CBT - including ERP

SSRI (high dose) e.g. fluoxetine, sertraline
- after 12 weeks, switch SSRI OR…

Clomipramine (TCA)

Psychosurgery (anterior cingulotomy) - rare, done if comorbid tics

30
Q

How long should SSRI be continued in OCD?

A

12 months - to prevent relapse

31
Q

Tx of acute stress reaction?

A

Self limiting - supportive only

32
Q

Tx for PTSD

A

CBT - trauma focused, EMDR
Mitrazapine, SSRI, Venlafaxine

MDMA trials?

Specialties (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions