Mental state exam

What are types of anxiety disorders?

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, <2w; +/- psychosis

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%