Mental Health - Mood Disorders

Front 1

Explain the depression symptom mnemonic SADAFACES

Back 1

Sleep disorder
Anhedonia
Dysphoria
Appetitte gain/loss
Fatigue
Anxiety/agitation
Concentration and memory problems
Esteem issues
Sexual dysfunction/suicidal behaviour (ideation, parasuicide, suicide)

Front 2

List the risk factors for suicide

Back 2

1) MDD
2) family history of suicidal behaviour
3) past attempts
4) lack of social support
5) gender: males complete suicide
6) recent loss
7) alcohol or drug abuse

Front 3

What childhood factors contribute to depression

Back 3

1) Deviant relationship with parents-> anxiety, fearfulness
2) Formation of core beliefs
3) Development of schema based on core beliefs of learned helplessness, self-defeating attitudes, belief in failure

Front 4

List social factors that contribute to depression

Back 4

Unemployment
Life events (divorce, death)
Domestic violemce
Lack of social support
Chronic medical condition

Front 5

What personality factors contribute to depression

Back 5

Neuroticism
Dependency
Self criticism
Introversion

Front 6

Briefly describe the aetiologies of depression

Back 6

1) Genetics: serotonin transporter polymorphisms
2) Stressors: bereavement, illness, lack of social or family support, adverse life events
3) Neuroendoctine: low levels of cortisol, testosterone, menopause, PMS, OCs
4) Child-parent relations: low parental involvement, overprotectiveness, abuse, neglect
5) Vascular lesions: CAD, stroke, vascular dementia
6) Neurodegenerative diseases: Parkinson's, Altzheimer's, alcoholism

Front 7

What is the diagnostic scale commonly used for depression and list 5 of the 17 diagnostic criteria

Back 7

Hamilton Depression Rating Scale
Depressive mood
Sleep disorder
Suicidality
Fatigue disturbing work and activities
Agitation

Front 8

What is the reason for the relatively high prevalence of depression

Back 8

It is generally a lifelong illness with a recurring relapse rate

Front 9

Based on the severity of depression obtained from the Hamilton Depression Rating Scale, what is the likely course of treatment

Back 9

Mild: either psychotherapy (CBT) alone or combined with an SSRI
Moderate: pharmacological therapy based on the type of depression
Severe: pharmacotherapy (including antipsychotics) or ECT

Front 10

What are the broad goals and anatomical targets of CBT

Back 10

Problematic emotions (limbic system - amygdala)
Problem solving, coping skills (pre-frontal cortex)

Front 11

List the 6 forms of mood disorder

Back 11

Depression
Cyclothymia
Bipolar
Dysthymia
Adjustment disorder
Mood disorder associated with a chronic illness

Front 12

What are the 9 risk factors for mood disorder

Back 12

Gender
Age (peaks late 20's)
Child abuse
Family Hx of depression
Social isolation
Low socioeconomic status
Adverse life events
Sleep deprivation (can trigger mania)

Front 13

Define adjustment disorder with depression

Back 13

Sadness, lack of concentration, worry, anxiety causing significant social impairment as a result of a stressor within the last 3 months

Front 14

Define a manic episode

Back 14

Showing 4 of the following symptoms that cause significant social impairment and usually requires hospitalisation, especially if experiencing psychosis:
1) grandiosity
2) pressured speech
3) Goal directed behaviour
4) Flight of ideas
5) Distractability
6) Agitation
7) Decreased sleep

Front 15

How is hypomania different from mania

Back 15

1) Less severe manifestations
2) Minimal social impairment
3) No psychosis
4) No hospitalisation

Front 16

What are the 5 classifications of bipolar

Back 16

1) Bipolar I: depression and mania
2) Bipolar II: depression and hypomania
3) Rapid cycling bipolar: more than 4/year cycles of depression and mania
4) Cyclothymia: 2 years of cycling of low grade mood swings between hypomania and low mood that doesn't meet classification of depression

Front 17

What are Ddx's of mania

Back 17

1) Stimulants: amphetamines
2) Sympathomimetics
3) Metabolic: hyperthyroidism, Wilson's
4) Neurological: CVA, trauma, Huntington's)

Front 18

List the DSM IV criteria for Major Depressive Disorder

Back 18

5 or more of the following over a 2 week period
At least one of: Dysphoria or Anhedonia, plus
Wt. loss/gain and appetite change
Insomnia/hypersomnia
psychomotor agitation/retardation
fatigue/loss of energy
↓ self esteem (worthlessness, guilt)
↓ conc. rr indecisiveness
recurrent thoughts of death or suicide

Front 19

List some RF for depression

Back 19

Youth (<21)
Cumulative stressful events
Single (widowed, divorced…)
Low SES
Perceived lack of social support
Past psychiatric history
History of substance abuse

Front 20

Define Dysthymia

Back 20

Chronic, low grade dysphoria

Front 21

What are the four elements comprising the clinical depression model and what are they about?

Back 21

Dynamic – Attachment. Forms basis of success or failure in a child.
Cognitive – Core beliefs. Developed in childhood, maintains more that initiates depression
Psychosocial – Life events and their meaning to the pt.
Biological

Front 22

What effect does depression have on a pt. w chronic disease?

Back 22

Incr. mortalitiy, morbidity, perceived pain, func disability, hospital visits, hospital stay length, depressive Sx. and wish to die in palliative setting. Dec. Tx. adherence.

Front 23

What treatment strategies are used to combat the endogenous vs. exogenous causes of depression?

Back 23

Endogenous (10% of pt.) = issue with neurotransmitter -> drugs
Exogenous (90% of pt.) = CBT

Front 24

List some RF for Mania

Back 24

♀, age (late 20’s), ↓ SES, FHx (genetic – neurotransmitter abnormalities?), childhood abuse, adverse life events, lack of confiding relationship, ↓ sleep (manic), substance abuse (manic)

Front 25

What is the DSM IV criteria for Bipolar disorder?

Back 25

1 or more manic episodes, define as 4/7 of the following for >1wk
Inflated self esteem/grandiosity
Decreased need for sleep
Increased talkativeness/ Pressure of speech
Racing thoughts/ Flight of ideas (+ connection, - goal)
Distractibility
Increased activity/psychomotor agitation
Excessive involvement in goal orientated activities with massive potential for painful consequences (money, sex…)
No organic cause
Not a mixed episode (fulfils both manic and depressive criteria for one week)

Front 26

What is…
Bipolar I

Back 26

Episodes of mania with potentially depressive episodes

Front 27

What is…
Bipolar II

Back 27

Episodes of hypomania with depression

Front 28

What is hypomania

Back 28

>4d, 3/7 of criteria, Not severe enough to cause disability, handicap or require hospitalisation.

Front 29

Rapid cycling bipolar

Back 29

4+ episodes a year of depression, mania or hypomania over 12mths

Front 30

Mixed bipolar

Back 30

Simultaneous or quick succession (over 1hr)

Front 31

Cyclothymic

Back 31

Chronic low grade mood cycling for >2yrs (hypomania and low grade depression)

Front 32

When assessing a suicide attempt, what information should you garner?

Back 32

Details of the attempt
Ongoing risk (present)
Screen for mental illness
Mental state
Collateral
Psych opinion and history

Front 33

What are some RF associated with suicide attempts?

Back 33

Demographic: sex, age (25-34, >75), ATSI, low SES, rural, single
Illness: previous self harm, mood/anxiety/personality disorders, subs. Abuse, chronic

Front 34

Define self harm

Back 34

Any behaviour involving deliberate infliction of pain or injury to oneslf.

Front 35

What is the aim of CBT?

Back 35

To logically challenge the false beliefs of the patient.

Front 36

What are the recurrence rates for MDD

Back 36

1 episode 50%
3 episodes 90%

Front 37

What other comorbidies may present with MDD and need to be assesses

Back 37

Psychotic symptoms (delusions, hallucinations)
Panic, anxiety
Eating disorder
Substance abuse, alcoholism
Axis 2
Cognitive decline, dementia

Front 38

How can undoing influence post natal depression

Back 38

Undoing, for instance, poor upbringing by a mother can raise expectations, setting up for exhaustion, failure, guilt, anxiety and depression

Front 39

What are the differentials for post partum depression

Back 39

Adjustment disorder
Hypothyroidism
Substance abuse
PP psychosis

Front 40

What are the differences between repression, suppression and dissociation

Back 40

Dissociation is an unconscious detachment from reality
Repression is unconscious exclusion of pleasurable impulses
Suppression means deliberately not thinking about certain things

Front 41

What is the effect of regression in response to crisis

Back 41

Regression towards a more immature defence mechanism based on the principle of mounting tension to plateau of disorganisation. Primitive and neurotic defence mechanisms include dissociation, schizoid fantasy, hypochondriasis, somatisisation, repression, acting out (particularly anger)

Front 42

When is grief pathological

Back 42

•Acute form lasting more than 6 months
•Inability to return to work after 2 weeks
•Suicide attempt
•Social isolation
•Denial of reality of death
•Hostility towards those associated with the death
•Anxiety/hypochondriasis

Front 43

What are the psychiatric and organic differentials for mania

Back 43

Schizophrenia
Personality disorder (Cluster A)
CNS infections, tumours
Hyperthyroidism
Drugs (CNS stimulants)

Front 44

Describe dysthymic disorder

Back 44

Depressed mood lasting most of the day on most days over 2 years
Poor concentration
Poor appetite
Low energy, lack of motivation
No suicidality

Front 45

What are the risk factors for dysthymic syndrome

Back 45

Female < 64
Concurrent anxiety or borderline personality disorder
Substance abuse
Low SES

Front 46

How can you differentiate grief from depression

Back 46

Grief lasts up to 12 months, waxes and wanes and you return to premorbid level of functioning. If intense grief lasts beyond 2 months then this is complicated grief.
If depression develops, the symptoms are unremitting (every day) and level of functioning remains diminished without return to premorbid level.

Front 47

Differentiate post-partum blues, psychoses and depression. How could both depression and psychosis increase risk to the baby

Back 47

All can begin within a month
Baby blues: immediate to 2 weeks at the most
Psychosis and depression begin within a month and continue indefinitely. Psychosis is usually with the first baby, depression is more common with subsequent babies.
Risk: both can injure or kill their babies (one for psychotic reasons, the other to prevent perceived suffering in a "bad" world. Neglect in both cases can do the same)