What are some of the symptoms of depression
- Loss of interest/motivation (core)
- Low mood (core)
- Fatigue/lack of energy (core)
- Weight loss/loss of appetite
- Slow thought process/ movements
- Suicidal thoughts
- Feelings of worthlessness/ guilt
- Early waking/ difficulty sleeping
- Dec. concentration
- Dec. sexual drive
- Irritability
What are the ICD10 criteria for depressive episodes
Mild depressive episode
- Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities.
Moderate depressive episode
- Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.
Severe depressive episode without psychotic symptoms
- An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of “somatic” symptoms are usually present.
Severe depressive episode with psychotic symptoms
- An episode of depression as described in severe without, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent.
How might you manage depression
- RISK ASSESMENT
- CBT
- Lifestyle change/ group therapies
- SSRI
- Tricyclic antidepressants
- May need to add in anti-psychotics/mood stabilisers
What are some of the general symptoms of anxiety
- Tremor
- Light headed
- Dizziness
- Chest pain
- Palpitations
- SOB
- Sweating
- Tension
What are the ICD10 subtypes of anxiety
- Generalised anxiety disorder
- Mixed anxiety and depressive disorder
- Panic disorder
- Agoraphobia
- Social isolation
- Specific (isolated) phobias
What characterises generalised anxiety disorder
- Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances
What characterises Panic disorder
- Severe/recurrent panic attacks
- Sudden onset palpitations, chest pain, fear of dying, heavy breathing
What characterises Agoraphobia
- Fear of leaving house, entering shops, crowds, traveling on public transport/planes
- Can have panic attacks associated with fears
- Will avoid triggering their fears (leaving house etc.)
What characterises Social isolation
- Fear of scrutiny causing avoidance of social situations
- Presents with blushing, tremor, Urinary frequency , nausea
- May progress to panic attacks
What characterises specific (isolated) phobias
- Panic attack or anxiety symptoms triggered by a specific trigger
- Eg. animal, heights, blood
What are some of the signs of mania
- Flight of ideas
- Hyperactivity
- Hypersexuality
- Grandiose delusions
- Rapid speech
- Poor concentration
- Dec. sleep
- Euphoria
- Irritability
What are the ICD10 categories of mania
Hypomania
- Persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency
Mania without psychotic symptoms
- Mood is elevated out of keeping with the patient’s circumstances and may vary from carefree joviality to almost uncontrollable excitement
Mania with psychotic symptoms
- In addition to the clinical picture described in mania without, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present
How might you treat an episode of mania acutely
- Risk assessment
- Mood stabiliser - Sodium valproate/lithium
and/or - Antipsychotic - Olanzapine/ haloperidol/ risperidone
What are the types of bipolar defined by ICD10
Bipolar 1
- At least one manic episode and an episode of depression of any severity
Bipolar 2
- At least one episode of severe depression and an episode of hypomania
How might you treat Bipolar
- Treat any manic or depressive episode using antipsychotic/antidepressant
- Lithium (req. monitoring) 1st line for preventing relapse
- Can add Sodium valproate/carbamazepine
- Or can add atypical antipsychotic eg. Risperidone or olanzapine to Lithium or Valproate
- CBT/group/talking therapies
What is Emotionally unstable personality disorder
- Split into Borderline and impulsive types
- Both have tendencies to act impulsively without consideration of others, liable to outbursts and Can be argumentative and cause conflict
Borderline - Self-image issues, Unstable relationships, tendency to self-destructive behaviour/ suicidality
Impulsive - Lack of impulse control, emotional outbreaks
How might emotionally unstable personality disorder present
- Suicide attempt
- Poor relationships/lonely
- Self-harm/poor eating
- Repeated crises
- Addiction/ drug/alcohol misuse
How might you treat emotionally unstable personality disorder
- Specialist referral
- Dialectal behaviour therapy
- Inpatient support schemes
- Drug treatment to manage comorbid depression/ calm impulsiveness/aggression
What is psychosis
- A severe mental disorder in which thoughts are so impaired that contact is lost with external reality
What are the symptoms of psychosis
- Hallucinations
- Delusions
- Disturbed/confused thoughts
What are some common causes of psychosis
- Schizophrenia
- Bipolar
- Severe anxiety/depression
- Medication
- Worsening medical condition
- Recreational drugs
What are the first rank symptoms of schizophrenia
- Auditory hallucinations
- Somatic hallucinations
- DELUSIONS OF THOUGHT INTERFERENCE
- PASSIVITY PHENOMENON OR DELUSIONS OF CONTROL
What are the core symptoms of schizophrenia
Positive - Hallucinations - Delusions - Disorganised speech - Catatonic behaviour Negative - Diminished emotional expression - Social withdrawal - Decreased interest/concentration
What are the types of schizophrenia according to ICD10
Paranoid schizophrenia
- Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances.
Hebephrenic schizophrenia
- A form of schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. The mood is shallow and inappropriate, thought is disorganized, and speech is incoherent. There is a tendency to social isolation.
Catatonic schizophrenia
- Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition.
