Mental state exam

What are types of anxiety disorders?

Panic disorder
Agoraphobia
Specific phobias
GAD
OCD

What are symptoms of anxiety disorder?

1. Recurrent panic attacks

2. Psychological: derealisation/depersonalisation, fear of losing control, dying

3. Not secondary- no stimulus, starts randomly

4. Persistent worry about having another attack Phobic avoidance

What are symptoms of panic attacks?

palpitations, tremor, sweating, chest pain, nausea

How prevalent is panic disorder?

1.5-3.7% prevalence

What is agoraphobia?

Fear of crowds
Anxiety and panic symptoms associated with places or situations

What are symptoms of Agoraphobia?

Escape may be difficult/embarrassing
Crowds, public places, travelling alone
Avoidance

What is the prevalence of Agoraphobia?

Prevalence 2.8-5.8%

Who classically presents with agoraphobia?

30-40 year old women

What are symptoms of specific phobias?

• Recurrent/excessive/unreasonable symptoms of anxiety

• Autonomic

• Psychological

• Anticipated presence of specific feared object/activity Spiders, snakes, heights etc

What is the prevalence of specific phobias?

Lifetime prevalence 12.5%

What is generalised anxiety disorder (GAD)?

Anxious about everything. E.g. I have to do the dishes then cook etc.

Free-floating anxiety

What are symptoms of GAD?

• Excessive worry

• Generalised, free-floating, persistent anxiety

• Apprehension about everyday events/problems

• muscle and psychic tension

• Significant distress/functional impairment

• Sleeping issues

What is the prevalence of GAD?

Prevalence 2.5-6.4%

What is over compulsive disorder?

Continuous thoughts that can't be forgot through ditraction.

What are obsessions?

Idea, image or impulse
Recognised as own
Repetitive, intrusive, distressing

What are compulsions?

Unnecessary/purposeless action
Avoids occurrence of adverse event
Relieves anxiety (in short term!)

What is the prevalence of OCD?

Prevalence 0.5-3%

What is an example of mood disorders?

Bipolar disorder

Symptoms of mood disorders?

Depressive episode
Manic/hypomanic episode

What are symptoms of depressive episode?

• Core symptoms: depressed mood, anergia, anhedonia

• Biological symptoms: disturbed sleep, diminished appetite, reduced concentration

• Psychological symptoms: reduced self-esteem, self-confidence; ideas of guilt/unworthiness; bleak view of future; ideas/acts of self-harm/suicide

What are the ICD-10 criteria to diagnose a depressive episode?

-Mild: two core plus two others, not intense, 2w
-Mod: two core plus 3-4 others, marked intensity
-Severe: three core plus four others; severe intensity,

What is the prevalence of depressive episode?

Lifetime prevalence 10-20%

What are symptoms of a manic episode?

Increased energy (overactivity, reduced sleep)
Formal thought disorder (pressured speech, flight of ideas)
Increased self esteem: grandiosity, disinhibition., over-familiarity
Reduced attention
Consequential behaviours (schemes, spending, sexual encounters)
Psychotic symptoms

What are the ICD-10 criteria to diagnose a manic episode?

Abnormally and persistently elevated/expansive/irritable mood with 3+ symptoms; 1w duration; significant impairment of functioning

What the criteria for a hypomanic episode?

Three or more symptoms over at least 4d

What does hypomanic episode NOT cause?

Not severe enough to:
Interfere with social/occupational functioning
Require admission to hospital
Include psychotic features

What the criteria for a bipolar affective disorder (BPAD)?

2+ episodes, one of which must be manic/hypomanic or mixed; complete recovery between episodes

What is the prevalence of BPAD?

Prevalence 1%

What is BPAD I?

Mania

What is BPAD II?

Hypomania

What are examples of psychotic disorders?

Schizophrenia
Delusional disorder

What is the ICD criteria to diagnose scz?

At least one of:
Thought echo/insertion/withdrawal/broadcast
Delusions of control/passivity and delusional perception
Auditory hallucinations (3rd person, running commentary
Implausible delusions

Or at least two of:
Persistent hallucinations with non-affective delusions
Breaks in train of thought
Catatonic behaviour
Apathy/blunting
Loss of interest/social withdrawal

For at least 1mo

What is the incidence of scz?

15 new cases per 100 000 population

What is the prevalence of scz?

1%

What are not present in delusional disorders?

Non-bizarre delusions
No hallucinations/thought disorder/mood disorder/flattening of affect

How long should symptoms last for diagnosis of delusional disorder?

> 1 month

What is the prevalence of delusional disorder?

Prevalence 0.025-0.03%