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Flashcards in Psychiatry Deck (96)
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1

What are the core features/symptoms of depression?

Low mood
Anergia
Anhedonia

2

List aetiology/risk factors for depression

Genetics, family history
Stressful events/life
Alcohol/drug use
Chronic disease
Steroid use, Cushing's syndrome (HPA disruption)

3

List additional symptoms and signs of depression (not core features)

Negative thoughts and speech
Insomnia, early morning wakening
Reduced appetite
Weight loss
Loss of libido
Inattention, poor concentration
Thought poverty, low pressure of speech
Reduced facial expressions
Limited body language

4

What is the criteria for mild-mod depression?

2/3 core symptoms + 4 additional symptoms

5

What is the criteria for severe depression?

3/3 core symptoms + 5 additional symptoms

6

What investigations would you order for suspected depression?

Largely clinical diagnosis based on history and mental state
Thyroid function test
Inflammatory markers
CT/MRI brain

7

List drug classes and examples of drugs used in depression

SSRI (fluoxetine, citalopram, sertraline, paroxetine)
TCA (amitryptiline, clomipramine, imipramine)
MAOi (phenelzine, moclobemide)
SNRI (venlafaxine, duloxetine)
NASSA (mirtazepine)
Anticonvulsants/mood stabilisers (lamotrigine, lithium, sodium valproate)

8

What are some notable side effects of SSRI?

GI upset
Short-term anxiety/suicidal ideation
Sexual dysfunction
Hyponatraemia

9

What are some notable side effects of TCA?

Sedation
Anticholinergic side effects (dry mouth, dizziness, blurred vision, urinary retention, constipation)

10

What are some notable side effects of MAOi?

Hypertensive crisis
Postural hypotension
Drowsiness
Insomnia
Nausea, constipation
Reaction with tyramine foods

11

What factors influence suicidal thoughts/intent/behaviour?

Male
Older
Living alone
Recent traumatic event
Unemployment, financial struggle
Major psych illness
Alcohol/drugs addiction
Family problems

12

What factors influence self harm?

Female
Young
Social issues
Personality disorder
Alcohol abuse
Arguments
Stress
Child abuse

13

Define bipolar disorder

2 or more episodes of mood and behaviour disturbance involving hypomania/mania and depressive phases

14

What are the three types/classifications of bipolar disorder?

I: manic episode + previous hypomanic-depressive episodes
II: 2 or more hypomanic-depressive episodes (no mania)
III: drug-induced hypomania-depression

15

What is the difference in duration between hypomania and mania?

Hypomania lasts 4 consecutive days
Mania lasts 7 consecutive days

16

List aetiology/risk factors for bipolar disorder

Genetics, family history
Infections
Hyperthyroidism
SLE
Stroke
Recreational drugs (amphetamines, cocaine, cimetidine, steroids, levodopa)

17

List clinical features of bipolar disorder

Elated mood, euphoria
Usually depression occupies longer phases
Overactivity
Restlessness
Racing thoughts
High pressure speech
Irritability
Grandiose delusions
Flight of ideas
Inattention, insomnia
Increased libido
Irresponsible, reckless behaviour
Psychosis more associated with mania

18

Outline treatment of acute mania/hypomania

Antipsychotic (aripiprazole, olanzapine)_
Detention may be necessary
Mood-stabiliser (valproate)

19

Which drug is used for bipolar disorder treatment?

Lithium
May use lamotrigine/valproate if ineffective/intolerable

20

List aetiology/risk factors for anorexia nervosa

Genetics, family history
Down-regulated HPA
Childhood problems
EUPD
Social/cultural/occupational factors

21

What are the specific criteria for diagnosing anorexia nervosa?

Body weight less than 85% expected or BMI less than 17.5
Fear of being fat even when underweight
Purging/vomiting behaviour to lose weight
Endocrine disturbance

22

List clinical features of anorexia

Cold sensitivity
Fatigue
Impaired cognition
Constipation
Osteoporosis
Dizziness
Fullness after eating
Autonomic upset
Reduced libido, amenorrhoea

23

What questions would you particularly ask for investigating anorexia?

Sick because you feel full?
Control over eating?
One stone loss in 3 months?
Fat belief when others say you're thin?
Food dominates your life?
(SCOFF)

24

What are the specific criteria for diagnosing bulimia nervosa?

BMI less than 17.5
Recurrent binge-eating behaviour
Preoccupation with weight
Purging mechanisms to overcome fatness

25

List clinical features of bulimia nervosa

Storage of food
Eating large quantities
Vomiting, calluses on hands (Russell's sign)
Tetanic muscles
Swollen salivary glands
Endocrine disturbance

26

Outline treatment for eating disorders

CBT, family therapy
Diet management, food diary
Treat complications
OCP can boost oestrogen
SSRI may help

27

List clinical features of generalised anxiety disorder

Psychological: worry, panic, irritability, reduced concentration, restlessness, distractability
CNS: numbness, tingling, fatigue, insomnia, dizziness, headache, tremor
Autonomic: palpitations, chest pain, hyperventilation, xerostomia, nausea, vomit
"lump in throat" "butterflies" "ringing" nail-biting thumb-sucking

28

What is the duration of symptoms for diagnosis of generalised anxiety disorder?

6 months or more

29

Outline non-pharmacological treatment of generalised anxiety disorder

Lifestyle - exercise, relaxation, meditation, avoid caffeine and anxiogens
CBT, mindfulness
Graded exposure desensitisation
Hypnosis

30

Outline pharmacological treatment of generalised anxiety disorder

Anxiolytics (diazepam for less than 6 weeks)
SSRI (fluoxetine)
Pregabalin
Paroxetine for social anxiety
Venlafaxine