RICK ALLEN

Mental Health Quiz

List the Six Stages of Behavioural Change Pre-contemplation, Contemplation, Preparation,

Action, Maintenance, RelapseWhat strategies can the treating Doctor

utilise to motivate a patient between Contemplation, Preparation and Action? Decisional balance (Pro’s and con’s), ID high risk

situations, plan, goal setting…What are some strategies to be used with a

patient who has relapsed? ID why and use it as a learning tool.

List the DSM IV criteria for Major Depressive Disorder 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

What does Alexithymia mean? No words for feelings

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

Define Adjustment Disorder An abnormal emotional response to an event

Define Dysthymia Chronic, low grade dysphoria

What are the four elements comprising the clinical depression model and what are they about? Dynamic – Attachment. Forms basis of success or failure in a

child. Cognitive – Core beliefs. Developed in childhood, maintains more

than initiates depression Psychosocial – Life events and their meaning to the pt. Biological

What effect does depression have on a pt. w chronic disease? Incr. mortalitiy, morbidity, perceived pain, func disability, hospital

visits, hospital stay length, depressive Sx. and wish to die in palliative setting. Dec. Tx. adherence.

What treatment strategies are used to combat the endogenous vs. exogenous causes of depression? Endogenous (10% of pt.) = issue with neurotransmitter drugs Exogenous (90% of pt.) = CBT

List some RF for Mania ♀, age (late 20’s), ↓ SES, FHx (genetic – neurotransmitter

abnormalities?), childhood abuse, adverse life events, lack of confiding relationship, ↓ sleep (manic), substance abuse (manic)

What is the DSM IV criteria for Bipolar disorder? 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

What is… Bipolar I

Episodes of mania with potentially depressive episodes Bipolar II

Episodes of hypomania with …. What is hypomania

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

Rapid cycling bipolar 4+ episodes a year of depression, mania or hypomania

over 12mths Mixed bipolar

Simultaneous or quick succession (over 1hr) Cyclothymic

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

When assessing a suicide attempt, what information should you garner? Details of the attempt Ongoing risk (present) Screen for mental illness Mental state Collateral Psych opinion and history

What are some RF associated with suicide attempts? Demographic: sex, age (25-34, >75), ATSI, low SES,

rural, single Illness: previous self harm, mood/anxiety/personality

disorders, subs. Abuse, chronicDefine self harm

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

What is the aim of CBT? To logically challenge the false beliefs of the patient.

Explain the ABC paradigm that CBT aims to address A: the event the individual is exposed to B: the thoughts, beliefs and self-verbalisations the ind. engages in

response to A C: the emotional and behavioural response to B

Describe a mechanism of addiction Learned behaviour: habit; operant (consequence) vs classical (Pavlov)

conditioning Pharmacological: dependence, reward circuits Underlying co-morbidity: self medication Social context: peer pressure, availability, perceived legality

Pharmacological Tx for… Alcohol

Naltrexone (opiate antagonist), Acamprosate, Benzo’s, Thiamine Benzo’s

None. Slow withdrawal Cocaine

Symptomatic. Risperidone for paranoia??? Opiates

Naloxone, methadone, buprenorphine, α-2 adrenergic agonists

When estimating a pt.s level of conciousness, what does AVPU stand for? Alert, Voice, Pain, Unresponsive

What is the aim of a mental status exam? Provide a snapshot in time of a pt’s psychological and

behavioural well beingWhat elements is it comprised of?

Appearance and behaviour, Speech, Affect, Mood, Thought, Perception, Cognitive func., Insight and judgement

What is affect? The moment-to-moment emotion observed

Roughly what is the lifetime risk in Aus for MDD and Bipolar I MDD Male = 11.6%, Female = 17.9%, Bipolar = 1.34%

What aspects of a manic pt. may require them to be involuntarily admitted? Poor insight, unpredictable, danger to themselves or others

Define substance abuse Self administration of any substance for non-medical

purposes with harmful effects One or more of

Recurrent use and failure to perform/fulfil role or obligations Recurrent use when physically hazardous Recurrent substance related legal problems Continued use despite persistent/recurrent

social/interpersonal problems

Define dependence Three or more of the following over 12mths

Increased tolerance Repeated withdrawal syndromes Taken over longer periods in larger amounts than initially

intended Persistent desire to cut down with unsuccessful attempts Increased time spent getting, using or recovering from

substance Continued use despite physical or psych issues

List the DSM IV criteria for schizophrenia Psychotic Sx. for >1mth Significant impaired psychosocial function >6mths of continuous signs of illness Absence of a prominent mood disorder or an organic brain syn. Be mindful of a pervasive developmental disorder

Define Schizophreniform disorder Sx. of schizophrenia with disruption for <6mths

Define Schizoaffective disorder Elevated/depressed mood alternating/concurrent w Sx of

schizophreniaWhat are psychotic Sx?

Delusions, hallucinations, disorganised speech, disorganised thought/behaviour, catatonia, negative symptoms

List some prodromal signs and symptoms of schizophrenia Anxious, suspicious, unkempt, progressive social withdrawal,

decreased social interactions, increased attention to the internal

List the DSM IV criteria for schizophrenia Psychotic Sx. for >1mth Significant impaired psychosocial function >6mths of continuous signs of illness Absence of a prominent mood disorder or an organic brain syn. Be mindful of a pervasive developmental disorder

Define Schizophreniform disorder Sx. of schizophrenia with disruption for <6mths

Define Schizoaffective disorder Elevated/depressed mood alternating/concurrent w Sx of

schizophreniaWhat are psychotic Sx?

Delusions, hallucinations, disorganised speech, disorganised thought/behaviour, catatonia, negative symptoms

List some prodromal signs and symptoms of schizophrenia Anxious, suspicious, unkempt, progressive social withdrawal,

decreased social interactions, increased attention to the internal

List what are referred to as negative symptoms Things that are ‘taken away/missing’

Alogia (speech poverty) Amotivation/avolition Social withdrawal Blunted affect/ decreased emotional expression Abstract thought

And positive symptoms… ‘Added symptoms’

Delusions, hallucinations, catatonia, thought disorder.

Explain catatonia Bizarre posturing or mannerisms,

disorganised/purposeless/disinhibited behaviour.Describe the cognitive changes observed in a

schizophrenic patient while suffering the condition and following effective treatment During: decreased memory, attention and general

intelligence. After: intelligence does not reach levels prior to illness.

Provide some epidemiological info regarding schizophrenia ♂ vs ♀ and age peak

♂ > ♀ ♂ 18-25 y.o. ♀ 25-35y.o.

What brain changes are observed in the schizophrenic pt? Increased ventricle size Increased extracerebral space Decreased hippocampus Decreased gray matter (dendritic and axonal branch pruning)

In a thought disorder, what is meant by derailment? No logical link b/n ideas expressed. Subject shifting.

And neologisms? Create new words that have no meaning to anyone else.

Explain the MOA of the anxiolytic benzodiazepine Binds to an accessory/regulatory site on GABAa, acting

allosterically to increase GABA affinity at the receptor. This potentiates the opening of the channel for lower levels of

GABA. It is NOT a GABA agonist Results in Cl influx into cell hyperpolarisation harder to reach

AP threshold.

Effects? Anxiolysis, sedation, muscle relaxant, anticonvulsant, anterograde

amnesia.

SE? Impaired co-ordination and cognition, increasing tolerance and

dependence, acute toxicity/OD or enhancement with alcohol/barbituates resp depression

Does the medium-duration Temazopam have an active metabolite? No

Which antidepressant is most effective at combating severe depression? TCA’s. Will let SNaRI pass too.

What is their MOA and what is their use limited by? Variable inhibition of NET and SERT b/n drugs SE and serious acute toxicity in OD (arrythmia, seizure, mania) SE= Antimuscarinic, sedation, postural hypotension and wt ↑

Which antidepressants can cause serotonin syndrome and what symptoms are observed with this condition? SSRI, + MAO-I. SNaRI Agitation, confusion, diaphoresis, diarrhoea, tachycardia, HTN,

mydriasis, tremor, hyperthermia, hyper-reflexia, clonus

Provide the names of two typical and atypical antipsychotics Typical: chlorpromazine. Haloperidol Atypical: Clozapine, risperidone

In what ways do typical and atypical antipsychotics differ? Typicals block D2 receptors to a greater degree. Atypicals also

block serotonin receptors. Atypicals are less likely to cause EPSE, but morelikely to cause

metabolic SE Atypicals are as effective at treating psychosis, but also treat

negative Sx.

List the four signs comprising EPSE Acute dystonia, akathisia, Parkinsonian Sx, Tardive dyskinesia

Why, if clozapine is the gold standard for antipsychotics, is it used as a last-line treatment? SE of agranulocytosis, therefore requiring constant monitoring

What is the MOA of the mood stabiliser Sodium Valproate? Inhibits Na channels increased GABA in the brain

T/F – Sodium Valproate stabilises all mood issues? F

Why F? It only controls mania

What is the MOA of lithium? Who knows…but it’s the gold standard!

For funnsies, write a generic MSE for A patient with schizophrenia A patient with MDD A patient with bipolar I