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Flashcards in The major disorders and their physical treatments Deck (81):

What is clinical depression?

Low mood accompanied with sleep difficulty, change in appetite, hopelessness, pessimism or thought of suicide


Why is major depression so often missed?

[1] lack of knowledge [2] preoccupation with physical disease [3] stigma [4] underrated severity


What are the different ways depression can be classified?

[1] mild/moderate/severe [2] with/without biological features [3] with/without hallucinations or delusions [4] with/without manic episodes


What are the differential diagnosis of depression?

Bipolar disorder; substance-induced mood disorder; schizophrenia; dementia


What are some potential causes of depression?

Genetics; biochemistry; endocrinology; stressful events; freudian reasons; vulnerability factors


How can endocrinology affect depression?

Cortisol suppression is abnormal in approx. 30%


What are the vulnerability factors that may lead to depression?

Physical illness, pain and lack of intimate relationships may allow depression to arise and be perpetuated


How would you manage depression in the presence of biological features or stressful life events?

Antidepressants - particularly if symptoms are severe.


Who is likely to benefit from antidepressant drugs?

S - suicide plans
U - unexplained feelings of guilt or worthlessness
I - inability to function
C - concentration impaired
I - impaired appetite
D - decreased sleep
E - energy low, or unaccountable fatigue


What are some of the reasons that people may commit suicide?

[1] keeping honour and autonomy, avoiding shame [2] avoiding something ghastly [3] controlling change in families [4] communicating important messages


How would you help a suicide survivor?

Assessment; discussion with the family; facilitating the patient's understanding of their predicament; prevention; follow-up


What are the three periods of time you would assess in a suicide survivor?

The day it happened, the previous months and the persons family and personal history.


What would you want to find out about the suicide event?

What happened that day? Were things normal to start with? when did the feelings and events leading up to the act start? was there any last act? what happened after the event?


What would you want to find out about the months before the suicide attempt?

how things have been over the preceding months? might the attempt have been made at any time over the last months? what relationships were important over this time?


What is a summary of the questions you should ask with an attempted suicide?

Any plan? What? When? Where? Are the means available? Ever tried before? How seriously? Preparations?


What are the main risk factors of death from a suicide attempt?

Male, older, unemployed, with prolonged psychiatric or painful illness, drug abuse


How do tricyclic and related antidepressant drugs work?

They improve mood and increase synaptic availability of norepinephrine or 5-HT.


Give some examples of sedative antidepressants?

amitriptyline; deothiepin; doxepin; trimipramine


Give some examples of non-sedative antidepressants?

clomipramine; imipramine; lofepramine; nortriptyline; protriptyline


What are some tricyclic side effects?

convulsions (dose related), arrhythmias, and heart block and anticholinergic effects


Are there are drug interactions to be aware of with tricyclics?

The pill may reduce the effect of tricyclics. The effect of some hypotensives may be reduced.


How do SSRI's work?

5-HT (serotonin) re-uptake inhibition. Serotoninergic system dysfunction is a feature of drug-free depressed people


What are the advantages of using SSRIs?

Less toxic in overdose and less sedating


What are the disadvantages of SSRIs?

approx. 30 times the price of tricyclics


What are the side-effects of SSRIs?

Nausea, dry mouth, blurred vision, seizures and anorgasmia


At what period of time is the suicide risk highest when taking SSRIs?

Suicide risk is greater earlier on


Name some examples of SSRIs?

Sertraline, fluoxetine, fluvoxamine maleata, paraxeti9ne


What are some contraindicated SSRI medications?

MAOI, sumatriptan, Lithium, theophylline, haloperidol, beta blockers, warfarin


What is anxiety neurosis?

Neurosis refers to maladaptive psychological symptoms not due to organic causes or psychosis, and usually precipitated by stress.


What are the symptoms of anxiety neurosis?

Apart from free-floating anxiety and depression, such symptoms are fatigue, insomnia, irritability, worry, obsessions, compulsions, poor copncentration, hyperventilation, sweating, palpitations, difficulty getting to sleep, bet-wetting.


What are the types of anxiety?

generalised anxiety disorder, panic disorder, somple phobia, PTSD, social phobia, OCD.


What are the possible causes of anxiety?

Stress, life events, intrapsychic theories.


What are the different aspects of treating anxiety?

symptom control, graded exposure, anxiolytics, progressive relaxation training.


What does symptom control in anxiety treatment involve?

Simple listening is a potent way of reducing anxiety. Reassure the patient that their symptoms are not from a physical disease.


What does graded exposure in anxiety treatment involve?

Graded exposure to the anxiety-provoking stimulus is a well-validated therapy.


Name some examples of anxiolytics?

Diazempam, benzodiazepam


What are phobic disorders?

These involve symptoms of anxiety occurring in specific situations only and leading to their avoidance.


What is obsessive compulsive disorder?

Compulsions are senseless, repeated rituals. Obsessions are sterotyped, purposeless words or phrases that come into the mind. They are perceived by the patient as nonsensical.


How does the patient feel about their obsessions in OCD?

They are often resisted by the patient, but if long-standing, the patient may have given up resisting them.


What are some examples of common OCD obsessions?

Cleaning, counting and dressing rituals.


What is the pathophysiology of OCD?

Positron emission tomography reveals increased blood flow to the orbitofrontal cortex, and reduced blood flow to the caudate nucleus.


How do you treat OCD?

Behavioural therapy, clomipramine and SSRIs can help.


What is depersonalisation?

An unpleasant state of disturbed perception in which objects (e.g.body parts) are experienced as being changed (e.g. made of cotton wool), becoming unreal, remote, or automatised.


Is depersonalisation a feature of psychosis?

No, because there is insight into its subjective nature, and it is not a feature of psychosis?


What are some symptoms of stress?

insomnia, sleep-walking, intrusive thoughts, dyspepsia, chest pain, faintin g, palpitations, transitory hypertension, hyperventilation


What are the biological consequences of stress?

Depression, increased weight, BP and alcohol intake; peptic ulcers; IBS and migraine


Give some examples of ways people relieve stress?

Smoking, alcohol and chattering. Exercise, singing, progressive relaxation or counselling


What are some symptoms of PTSD?

Anxiety, depression, obsessive recall, alcohol abuse, irritability, bed wetting. Symptoms may be swift or take years to come to light.


In what population is anorexia most common?

Mainly teenage girls, the prevalence is higher in upper socio-economic classes.


What are the four diagnostic criteria of anorexia?

[1] the person chooses nopt to eat, leading to potentially dangerous weight loss interfering with normal functioning. [2] intense fear of becoming obese [3] disturbance of weight proportion [4] amenorrhoea over 3 consecutive cycles absent.


What are the symptoms of anorexia?

Attaching excessive importance to weight reduction, excessive exercise, patient sees self-worth as being embodied in her shape and weight.


What are some physical complications of weight reduction?

Sensitivity to cold, constipation, amenorrhoea, faints, weakness, fatigue, low BP, low potassium, low glucose


What are the diagnostic criteria of bulimia?

Recurrent episodes of binge eating accompanied with lack of feeling of control; regular mechanisms to overcome the fattening effects of binges; body weight higher than required for the diagnosis of anorexia.


What are some physical complications of bulimia?

stomach rupture, haematemesis and metabolic complications following excessive vomiting. There may be painless enlargement of the salivary glands, tetany and seizures, along with Russell's sign


What is Russell's sign in regards to bulimia?

Calluses form on the back of the hand, following its repeated abrasion against incisors during inducement of vomiting.


How does schizophrenia present?

A common mental disorder which typically presents in adulthood with delusions, hallucinations, and disordered thoughts. There is a more chronic picture of withdrawal, apathy, emotional blunting and slowness of thought


How does the brain change physically with schizophrenia?

There are subtle changes (missing glutamate receptors) affecting the hippocampus and temporal lobe, the cerebral ventricles are also enlarged.


What are the first rank symptoms of schizophrenia?

Thought insertion, thought broadcasting, thought withdrawal, passivity feelings, hearing voices, hallucinations


Give an example of thought insertion

'Someone is putting thoughts into my head'


Give an example of thought broadcasting

'People hear my thoughts as they occur'


Give an example of thought withdrawal

'Thoughts are being taken out of my head'


Give an example of passivity feelings

'Someone is controlling my thoughts and movements; I'm their robot'


What are the most frequent symptoms of schizophrenia?

Lack of insight, auditory hallucinations, suspiciousness, flatness, voices speaking to patient


What are the most frequent behaviours of schizophrenia?

Social withdrawal, underactivity, lack of conversation, few leisure interests, slowness,


What factors create a better prognosis for schizophrenia?

Sudden onset, no negative symptoms and a supportive home


What would you use to treat the acute symptoms of schizophrenia?

Neuroleptics, e.g. chlorpromazine reduce hallucinations and delusions within 3 weeks


What advice would you give to the family of schizophrenic?

Aim to create a stress-free environment. Relatives need to be neither critical nor overprotective


How can schizophrenic patients practically alter their lifestyle to treat their condition?

Changing the focus of attention; relaxation techniques; modifying exacerbating behaviours


What is the definition of tolerance?

A drug's early effects are later achievable only by suing higher doses


What is the definition of withdrawal syndrome?

The physical effects experienced when a tolerance-inducing drug is withdrawn.


What is the definition of dependence?

Conly continued doses prevent physical or psychological withdrawal


What are the physical symptoms of drug withdrawal?

Dilated pupils, D&V, tachycardia, sweating, cramps and piloerection


What are the physiological symptoms of drug withdrawal?

Restlessness and craving when the drug is withdrawn.


When would you suspect drug addiction?

[1] convictions for crime, to buy drugs [2] any odd behaviour (with visual hallucinations, elation or mania) [3] unexplained nasal discharge [4] scars of injections [5] repeated requests for opiates


How would you counsel parents about how they can counsel their children?

[1] agree a plan together [2] accept the chid [3] find out the child's attitudes on different drugs [4] speak to younger siblings so they know how to say no if offered


What is psychopathy?

A persistent personality disorder characterised by antisocial behaviour, inability to make loving relationships and lack of guilt. Typically the patient is impulsive, and regards his closest associates without affection.


What are the causes of psychopathy?

Brain, damage, social factors, parental psychiatric illness or laxity have been suggested, but none is pre-eminent.


How would you treat psychopathy?

It can be problematic as patients are seldom in a frame of mind which is likely to promote change. Peer group pressure may be a motivating force. It is rarely wise to use drugs, but SSRIs may be beneficial if they are aggressive.


What is an obsessional personality?

The rigid, obstinate bigot who is preoccupied with unimportant details


What is a histrionic personality?

The self-centred, sexually provocative (but frigid) person who enjoys (but does not feel) angry scenes


Name some types of drugs that have withdrawal symptoms?

Benzodiazepines, monoamine oxidase inhibitors and tricyclic drugs