Q. WHAT DO YOU UNDERSTAND BY THE TERM “MELANCHOLIC DEPRESSION”?
Anhedonia
Retarded or agitated
Anorexia
Non-reactive Mood
Guilty ruminations
Diurnal mood variation
Distinct quality of mood
Q. WHAT DO YOU UNDERSTAND BY THE TERM “DYSTHYMIC DISORDER”?
Most days for 2 years depressed mood for most of the day.
Never absent for >2/12
Q. WHAT DO YOU UNDERSTAND BY THE TERM “DOUBLE DEPRESSION”?
People with dysthymic disorder who occasionally lapse into a MDE, then when MDE resolves return to chronic dysthymic state
Q. WHAT DO YOU UNDERSTAND BY THE TERM “BIPOLAR MOOD DISORDER”?
BPAD I – 1 or more manic / mixed episodes with or w/o MDE.
BPAD II – at least 1 MDE and at least 1 hypomanic episode, no past manic / mixed episodes.
Q. WHAT DO YOU UNDERSTAND BY THE TERM “BIPOLAR SPECTRUM DISORDER”?
Does not meet DSM-IV criteria for BPAD I or II but exhibit cyclothymia (cyclical changes in mood).
Q. WHAT DO YOU UNDERSTAND BY THE TERM “SCHIZOAFFECTIVE DISORDER”?
Psychotic symptoms for the majority of 1/12
AND at least 1 MDE, manic / mixed episode
MUST have had psychotic symptoms present for at least 2 weeks w/o prominent mood Sx
Q. WHAT DO YOU UNDERSTAND BY THE TERM “MANIA”?
>1/52 abnormally elevated, expansive or irritated mood
Distractibility
Indiscretion
Grandiosity
Flight of Ideas
Activity Increased
Sleep (decreased need for)
Talkativeness (pressured speech)
Q. WHAT DO YOU UNDERSTAND BY THE TERM “HYPOMANIA”?
As mania BUT is NOT severe enough to cause a marked impairment in social or occupational functioning
Q. WHAT DO YOU UNDERSTAND BY THE TERM “PSYCHOTIC DEPRESSION”?
One of the most SEVERE forms of depression in which person experiences psychotic symptoms (usually paranoid / mood-congruent delusions & hallucinations)
Q. WHAT DO YOU UNDERSTAND BY THE TERM “MOOD CONGRUENT DELUSIONS”?
Delusional content is consistent with mood.
e.g. Depressed “world is ending”
Manic “possess magical talents or abilities”
Q. WHAT ARE THE RISK FACTORS FOR SUICIDE?
Sex male
Age 15-24, 75-84
Depression (45-70% of all attempts)
Previous attempts
Ethanol abuse
Relationship issues
Social support lacking
Organized plan
No spouse
Sickness
Psychosis with demand hallucinations
Hopelessness a better indicator of suicide than mood
Q. WHAT ARE THE SYMPTOMS ASSOCIATED WITH SUICIDE?
Hopelessness
Anhedonia
Severe anxiety, panic attacks
Sleep disturbances
Impaired concentration
Psychomotor agitation
Q. HOW DO YOU ASSESS SUICIDAL INTENT?
Risk factors
Onset
Precipitating, aggravating, relieving factors
Frequency of thoughts
How much control of thoughts
What keeps them alive
Q. HOW DO YOU ASSESS SUICIDAL LETHALITY?
Access to means e.g. firearms, hanging, gases, drugs
Funeral plans
Practiced suicide
Changed life-insurance / will
Given away possessions
Q. HOW DO YOU MANAGE THE SUICIDAL PATIENT?
<3 RF consider sending home with family.
>3 RF hospitalize
1. Make the patient feel safe
2. OACIS, case notes & collateral Hx to determine previous Mental Illness.
3. If attempt has been made, attend to medical consequences
4. Define stressors
5. Arrange inpatient treatment +/- detainment
6. Suicide is a Sx of mental illness, treat underlying illness & Sx will resolve.
Q. NAME 4 CURRENT ANTIPSYCHOTIC MEDICATIONS + COMMONLY USED DOSAGES.
Risperidone (2-8mg)
Quietapine (300-900mg)
Olanzapine (10-20mg)
Clozapine (200-600mg)
Q. NAME 3 COMMON LONG LASTING ANTIPSYCHOTIC DEPOT INJECTIONS + COMMONLY USED DOSAGES.
Haloperidol decanoate (25-300mg 4 wkly)
Risperidone (25-50mg 2 weekly)
Zuclopenthixol decanoate (200-400mg 4 weekly)
Q. MENTION THE IMMEDIATE ACTING DEPOT INJECTION + DOSAGES.
Zuclopenthixol acetate (acuphase) (50-150mg) every 2-3 days max. 4 doses
Q. NAME COMMON SIDE-EFFECTS OF ANTIPSYCHOTIC MEDICATION.
Cognitive deficits accompanying depression or other psych illness. Usually resolve with Rx, but risk of progressing to real dementia esp. w/o Rx
Q. WHAT MEDICATIONS CAN BE USED AS AN ADJUNCT THERAPY IN ALCOHOL DEPENDENCE?
Disulfiram – Inhibits metabolism of EtOH in liver -> excess acetaldehyde
Naltrexone – mu opioid antagonist reduces pleasure effect of alcohol
Acamprosate – Modulation of glutamate & GABA NT system
Q. WHAT DO YOU UNDERSTAND BY THE TERMS TRANSFERENCE & COUNTER-TRANSFERENCE?
Transference: Phenomenon where a patient’s perceptions, feelings, behaviour towards the therapist are subconsciously influenced by their past relationships & experiences.
Counter-transference: Phenomenon where the therapists perceptions, feelings and behaviours towards the patient are influenced by previous experiences with patients (in response to patient’s transference)
Q. HOW CAN TRANSFERENCE AND COUNTER-TRANSFERENCE AFFECT CLINICAL PRACTICE?
Can undermine therapeutic process
Cloud clinical judgment
Therapist must remain non-judgmental and assume an empathetic & professional stance.
Q. WHAT IS CBT?
Combines cognitive and behaviour therapies to teach the patient to weaken connections between thinking patterns, habitual behaviours and mood and anxiety problems.
Protection