4C Psychiatry Flashcards
Psychiatric history
Pre-morbid personality = personality before current mental illness
Mental State Examination
https://geekymedics.com/wp-content/uploads/2025/02/Mental-State-Examination-MSE-OSCE-Checklist-Geeky-Medics.pdf
MHA vs MCA?
Revision - core knowledge for module
Mental Health Act (1983) - psychiatric disorders
Describe sections of MHA (detention for assessment and treatment)
90 % informal, voluntary decisions
Section 136
Police powers to remove someone from a public place and take them to a place of safety for 24 hours. Not renewable but can be extended for 12 hours.
Planned admissions:
Section 2 - assessment. Compulsory admission for up to 28 days. cannot be renewed.
section 3 - treatment. up to 6 months. can be renewed (6 months, then 1 year) entitled to 117 aftercare (council has to pay for aftercare).
Emergency admission:
Section 4 - Compulsory admission for assessment, up to 72 hours.
Section 5 - Doctors compulsory holding power of voluntary inpatients, up to 72 hours only. Must be inpatient. Cannot be extended. eg. psychotic episode
Mental Capacity Act 2005
Provides framework for decision making process in patients who lack capacity. All decision, not just medical. Capacity is time and decision specific.
Negative cognitive triad
Psychiatric history taking
NOTEPAD
Nature
Onset
Triggers
Exacerbating/relieving factors
Progression
Associated symptoms
Disability (impact)
OSCE stations
- Psychiatric history
- Risk assessment
- MSE (could be videos)
- counselling on starting SSRI
- Syringe driver px
- Breast examination
Risk assessment once - Take a psychiatric history then present a risk assessment to the examiner (beware farmer with shotgun)
Depression
Physical eg. eating
Helplessness/worthlessness
Suicidal ideation
Sleep
Anhedonia
Slow speech, thoughts
Anxiety
Physical eg. Palpitations, tingling lips and fingers, bowel habit
Sleep
Poor concentration
Panic attacks
Avoidant behaviour
Psychosis
Symptoms:
- Hallucinations
- Delusions - a fixed, false belief (can’t be persuaded)
- Thought disorder (thoughts not following a logical flow)
- Psychomotor
- Negative symptoms (withdrawal from society, become apathetic)
Auditory processing - Wernicke’s area - area active without stimulus.
Delusional disorder - symptoms?
- One or a set of delusions eg. my neighbours are spying on me
- Impacts on life
- Persists for at least 3 months
- Capgras syndrome
- Fregoli syndrome
- Erotomania: De Clerambault’s syndrome
- Othello syndrome
- Cotard’s syndrome
- Belief that a person closely related to the patient has been replaced by a DOUBLE, imposter
- Seeing your loved one in someone else - eg. Phoebe sees her mum in the cat. Fregoli = friends.
OR that several different people are in fact the same person
3.Often believe that
somebody of a
higher social class
is in love with them
Commoner in
women
They may pester
the victim with
letters/stalking
behaviour
- Morbid jealousy , delusional belief that the other person is having an affair without evidence. Homicide motive. Shakespeare play.
- Nihilistic delusion - part of them isn’t there or dead, or doesn’t exist
COTARD = GRAVEYARD
- Ekbom syndrome
- Foli-a-deux
- Grandiose delusions
- Delusional perception
- Delusions of reference
- Belief that insects are crawling under your skin
- Delusional disorder shared by two people who have strong emotional link
- Think you have special powers, can talk to God
- Give delusional meaning to a normal perception eg. the FBI are following me because I saw a yellow car.
- Belief that song lyrics, newspaper references etc are specifically directed at you
Post partum / puerperal psychosis
- Which medicines can you have when breastfeeding?
- Which can you not have when breastfeeding
Can go on to develop psychosis
- Olanzapine and quetiapine
- Clozapine
Delirium vs dementia - how to tell?
Delirium - short onset
Lewy body dementia vs Charles Bonnet syndrome
LBD - visual hallucinations that they believe are real
Charles bonnet syndrome - Visual hallucinations that they are AWARE are not real (problems with eyesight)
Schizophrenia
Onset adolescence, early adulthood.
Prodrome of more minor symptoms of anxiety and depression
Symptoms
- Delusions
- Hallucinations (usually auditory)
- Speech disorganisation (tangentiality, word sala, derailment)
- catatonia (lack of response to environment)
Treatment - Bloods
* FBC, U&Es, TFTs, LFTs, glucose, HbA1c, lipid levels, bone group
* Exclude medical causes
* Establish baseline before commencing antipsychotics
UDS
ECG
Consider CT head
Catatonic symptoms
stupor
excitement
catalepsy
stereotypy
mannerism
catalepsy vs cataplexy (sudden falling asleep)
NB. Psychological pillow (head stays up when lying down as if on invisible pillow)
Schizophrenia
Investigations?
Treatment?
Bloods
* FBC, U&Es, TFTs, LFTs, glucose, HbA1c, lipid levels, bone group
* Exclude medical causes
* Establish baseline before commencing antipsychotics
UDS
ECG
Consider CT head
Olanzapine = ‘obesapine’ (obesity common side effect)
Schizoaffective disorder
schizophrenia AND a mood disorder
Mood component ie depression or manic when unwell same as schizophrenia but
if depressive episode → add SSRI
if manic episode → add mood stabiliser eg lithium.
Personality disorder
Rule out everything else first. Try not to diagnose before age 25.
Problems in social relationships, regulation of mood, fixed and inflexible responses, perception and thoughts, abnormal behavioural pattern.
ABC = mad, bad and sad
Personality disorder - cluster A
- Paranoid
- Schizoid
- Schizotypal
‘Odd and eccentric’
- Overvalued ideas, can rationalise a bit. Thinks that police car is after them etc.
- Cold, detached, prefer to stay home, own company, niche interests. Don’t seek help. (DD= autism, but autism doesn’t have lack of interest in others)
- Peculiar ideas, beliefs, dress, magical thinking, hidden messages, odd perceptual experiences.
Personality disorder - cluster B
- EUPD/borderline. Emotionally unstable personality disorder.
- Antisocial
- Histrionic
- Narcissistic
Dramatic and emotional
- Impulsive, up and down, emotional instability. Feel numb / angry. Behaviours eg cutting.
- Aka sociopathy. Disregard for others needs and feelings, lying, stealing, aggressive/violent, law breaking. lack of remorse. Prison.
- Drama, attention seeking, talk about themselves, overly sexualised behaviour.
- Grandiosity, belief that they are more important than other people, fantasies of power and success, don’t recognise other peoples needs/feelings, envy/mean to others that are more successful.
Personality disorders - cluster C
- Avoidant
- Dependent
- Anankastic / obsessive-compulsive
Anxious and fearful
- Highly sensitive to criticism or rejection
- Depend on another, clingy, submission, tolerates abuse, difficulty disagreeing, urgent need to start new relationship
- Preoccupied with minutia, to a point that things won’t get done, desire to be in control, obsessive.
SADPERSONS scale - what are some risk factors for suicide?
Sex - Male
Age - 15-25, 59+
Depression or hopelessness
Previous attempts or psychiatric care
Excessive alcohol or drug use
Rational thinking loss
Single, widowed or divorced
Organised or serious attempt
No social support
Stated future intent
Psychiatry referrals
A&E - mental health liaison?
Crisis team - Contact within 4 hours
Urgent referrals - Contact within 72 hours
Early intervention team - psychosis
Mental health act assessment - Norfolk county council. Place of safety - A&E, Hellesdon?
IOPS - Intensive older persons service: concerns about dementia, violent
- Name 4 atypical antipsychotics?
- Name 3 typical antipsychotics?
- Olanzapine, risperidone, quetiapine, clozapine.
‘oh Olanza, wh(R)isper quietly to me and take off your clo(Z)thes’
(olanza, risper, quet, cloz)
- Typical antipsychotics = haloperidol, chlorpromazine, levomepromazine
Side effects of
1. Atypical antipsychotics?
2. Typical antipsychotics?
Atypicals = metabolic stuff, so weight gain
- (Clozapine = seizures)
Typicals = movement stuff, so parkinsonism
a mnemonic for remembering four of the atypicals that seem to come up the most (sorry if that’s inaccurate)
Both = Cardiac (Long QT), Anticholingeric (dry mouth etc)
- First line drug for PTSD?
- Venlafaxine, SNRI (after CBT, therapies not worked)
Which is which?
Flight of ideas - x is the answer they meant to give, they veer off topic but statements are related
Common in: manic illness
Clang association - jump from one thing to another that sounds the same or puns
Commonin: manic illness
Derailment - each statement they give is completely disconnected from the one before. (Knight’s move is similar but there is an obscure link between topics that makes sense to the patient).
Common in: schizophrenia
Tangentiality - similar but slower than flight of ideas
Circumstantiality - they will eventually get to the answer they were trying to give (spiral) unnecessary and excessive detail
