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47 Cards in this Set
- Front
- Back
Explain the depression symptom mnemonic SADAFACES
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Sleep disorder
Anhedonia Dysphoria Appetitte gain/loss Fatigue Anxiety/agitation Concentration and memory problems Esteem issues Sexual dysfunction/suicidal behaviour (ideation, parasuicide, suicide) |
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List the risk factors for suicide
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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 |
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What childhood factors contribute to depression
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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 |
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List social factors that contribute to depression
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Unemployment
Life events (divorce, death) Domestic violemce Lack of social support Chronic medical condition |
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What personality factors contribute to depression
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Neuroticism
Dependency Self criticism Introversion |
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Briefly describe the aetiologies of depression
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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 |
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What is the diagnostic scale commonly used for depression and list 5 of the 17 diagnostic criteria
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Hamilton Depression Rating Scale
Depressive mood Sleep disorder Suicidality Fatigue disturbing work and activities Agitation |
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What is the reason for the relatively high prevalence of depression
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It is generally a lifelong illness with a recurring relapse rate
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Based on the severity of depression obtained from the Hamilton Depression Rating Scale, what is the likely course of treatment
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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 |
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What are the broad goals and anatomical targets of CBT
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Problematic emotions (limbic system - amygdala)
Problem solving, coping skills (pre-frontal cortex) |
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List the 6 forms of mood disorder
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Depression
Cyclothymia Bipolar Dysthymia Adjustment disorder Mood disorder associated with a chronic illness |
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What are the 9 risk factors for mood disorder
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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) |
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Define adjustment disorder with depression
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Sadness, lack of concentration, worry, anxiety causing significant social impairment as a result of a stressor within the last 3 months
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Define a manic episode
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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 |
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How is hypomania different from mania
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1) Less severe manifestations
2) Minimal social impairment 3) No psychosis 4) No hospitalisation |
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What are the 5 classifications of bipolar
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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 |
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What are Ddx's of mania
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1) Stimulants: amphetamines
2) Sympathomimetics 3) Metabolic: hyperthyroidism, Wilson's 4) Neurological: CVA, trauma, Huntington's) |
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List the DSM IV criteria for Major Depressive Disorder
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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 |
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List some RF for depression
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Youth (<21)
Cumulative stressful events Single (widowed, divorced…) Low SES Perceived lack of social support Past psychiatric history History of substance abuse |
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Define Dysthymia
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Chronic, low grade dysphoria
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What are the four elements comprising the clinical depression model and what are they about?
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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 |
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What effect does depression have on a pt. w chronic disease?
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Incr. mortalitiy, morbidity, perceived pain, func disability, hospital visits, hospital stay length, depressive Sx. and wish to die in palliative setting. Dec. Tx. adherence.
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What treatment strategies are used to combat the endogenous vs. exogenous causes of depression?
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Endogenous (10% of pt.) = issue with neurotransmitter -> drugs
Exogenous (90% of pt.) = CBT |
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List some RF for Mania
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♀, age (late 20’s), ↓ SES, FHx (genetic – neurotransmitter abnormalities?), childhood abuse, adverse life events, lack of confiding relationship, ↓ sleep (manic), substance abuse (manic)
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What is the DSM IV criteria for Bipolar disorder?
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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) |
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What is…
Bipolar I |
Episodes of mania with potentially depressive episodes
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What is…
Bipolar II |
Episodes of hypomania with depression
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What is hypomania
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>4d, 3/7 of criteria, Not severe enough to cause disability, handicap or require hospitalisation.
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Rapid cycling bipolar
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4+ episodes a year of depression, mania or hypomania over 12mths
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Mixed bipolar
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Simultaneous or quick succession (over 1hr)
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Cyclothymic
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Chronic low grade mood cycling for >2yrs (hypomania and low grade depression)
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When assessing a suicide attempt, what information should you garner?
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Details of the attempt
Ongoing risk (present) Screen for mental illness Mental state Collateral Psych opinion and history |
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What are some RF associated with suicide attempts?
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Demographic: sex, age (25-34, >75), ATSI, low SES, rural, single
Illness: previous self harm, mood/anxiety/personality disorders, subs. Abuse, chronic |
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Define self harm
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Any behaviour involving deliberate infliction of pain or injury to oneslf.
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What is the aim of CBT?
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To logically challenge the false beliefs of the patient.
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What are the recurrence rates for MDD
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1 episode 50%
3 episodes 90% |
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What other comorbidies may present with MDD and need to be assesses
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Psychotic symptoms (delusions, hallucinations)
Panic, anxiety Eating disorder Substance abuse, alcoholism Axis 2 Cognitive decline, dementia |
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How can undoing influence post natal depression
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Undoing, for instance, poor upbringing by a mother can raise expectations, setting up for exhaustion, failure, guilt, anxiety and depression
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What are the differentials for post partum depression
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Adjustment disorder
Hypothyroidism Substance abuse PP psychosis |
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What are the differences between repression, suppression and dissociation
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Dissociation is an unconscious detachment from reality
Repression is unconscious exclusion of pleasurable impulses Suppression means deliberately not thinking about certain things |
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What is the effect of regression in response to crisis
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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)
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When is grief pathological
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•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 |
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What are the psychiatric and organic differentials for mania
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Schizophrenia
Personality disorder (Cluster A) CNS infections, tumours Hyperthyroidism Drugs (CNS stimulants) |
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Describe dysthymic disorder
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Depressed mood lasting most of the day on most days over 2 years
Poor concentration Poor appetite Low energy, lack of motivation No suicidality |
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What are the risk factors for dysthymic syndrome
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Female < 64
Concurrent anxiety or borderline personality disorder Substance abuse Low SES |
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How can you differentiate grief from depression
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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. |
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Differentiate post-partum blues, psychoses and depression. How could both depression and psychosis increase risk to the baby
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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) |