B PSYCH TO DO Flashcards
1
Q
DEPRESSION
What are the biological causes of depression?
A
- Personal/FHx + genetics
- Personality traits (dependent, anxious, avoidant)
- Physical illness (hypothyroid, anaemia, childbirth)
- Iatrogenic (beta-blockers, steroids, substance misuse)
2
Q
SCHIZOPHRENIA
What is schizophrenia?
A
- Splitting or dissociation of thoughts, loss of contact with reality
3
Q
SCHIZOPHRENIA
What is the neurotransmitter hypothesis in schizophrenia?
A
- Excess dopamine + overactivity in mesolimbic tract = +ve Sx
- Lack of dopamine + underactivity in mesocortical tracts = -ve Sx
- Overactivity of dopamine, serotonin, noradrenaline + underactivity of glutamate + GABA
4
Q
SCHIZOPHRENIA
What are the first rank symptoms of schizophrenia?
What is the relevance?
A
- Delusional perceptions
- Auditory hallucinations (3 types)
- Thought alienation (insertion, withdrawal + broadcasting)
- Passivity phenomenon, incl. somatic
- ≥1 for at least 1m is strongly suggestive Dx
5
Q
GAD
What are 3 cardinal features of GAD?
A
- Symptoms of muscle + psychic tension
- Causes significant distress + functional impairment
- No particular stimulus
6
Q
GAD
What model can be used to explain the causes of GAD?
A
Triple vulnerability –
- Generalised biological
- Generalised psychological (diminished sense of control)
- Specific psychological (stressful events)
7
Q
GAD
What is the ICD criteria of GAD?
What are the groups of symptoms present in GAD?
A
- Difficulty controlling worry, present for more days than not for ≥6m
- ≥4 symptoms with ≥1 from autonomic arousal section
- Autonomic arousal, physical, mental, general, tension, other
8
Q
GAD
What are the investigations for GAD?
A
- History, MSE + risk assessment
- GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire
- Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)
9
Q
PANIC DISORDER
What is panic disorder associated with?
What are some risk factors?
A
- Meds like SSRIs, BDZs, zopiclone withdrawal
- Widowed, divorced or separated, living in city, limited education, physical or sexual abuse, FHx
10
Q
PTSD
What are the 4 core symptoms of PTSD?
How long do they need to be present for to diagnose?
A
HEAR (≥1m) –
- Hyperarousal
- Emotional numbing
- Avoidance + rumination
- Re-experiencing (involuntary)
11
Q
ANOREXIA NERVOSA
How may endocrine disturbance present?
A
- Amenorrhoea
- Reduced libido/fertility
- Abnormal insulin secretion
- Delayed/arrested puberty if onset pre-pubertal
12
Q
ANOREXIA NERVOSA
What are some complications of anorexia?
A
- Osteoporosis, thyroid issues, cardiac atrophy
- Electrolyte disturbances (hypokalaemia > arrhythmias)
- Decrease in WBC > increased infections
- Death due to health complications or suicide
13
Q
ANOREXIA NERVOSA
What screening tool can be used in anorexia?
A
SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you’ve lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you’re FAT when others say you’re thin?
- Does FOOD dominate your life?
14
Q
ANOREXIA NERVOSA
In anorexia, most things are low apart from what?
A
Gs + Cs –
- GH, Glucose, salivary Glands
- Cortisol, Cholesterol, Carotinaemia
15
Q
ANOREXIA NERVOSA
What are the biological treatments for anorexia nervosa?
A
- Fluoxetine, chlorpromazine + TCAs may be used for weight gain
16
Q
ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?
A
- Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
- Electrolyte stores depleted as needed to convert glucose>energy
- Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
17
Q
ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?
A
- Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
- Abdo pain, vomiting, constipation, infections
18
Q
ANOREXIA NERVOSA
What are the biochemical features of refeeding syndrome?
A
- Hypophosphataemia main disturbance due to role of converting glucose>energy
- Hypokalaemia, hypomagnesaemia + thiamine deficiency too
- Abnormal fluid balance
19
Q
ANOREXIA NERVOSA
What should be monitored before + during refeeding?
A
- U+Es (Na+, K+), phosphate, magnesium, glucose, ECG, fluid balance
20
Q
BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?
A
BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week
21
Q
BULIMIA NERVOSA
What are some investigations for bulimia?
A
- SCOFF
- BP (low), temp, SUSS test
- ECG (arrhythmias from hypokalaemia)
- FBC (anaemia), LFTs, urinalysis, serum proteins
- Monitor U+Es, calcium, magnesium, phosphate in vomiting, laxative abuse, diuretics or waterloading (for deceitful weighing)
22
Q
BULIMIA NERVOSA
What metabolic abnormalities may be present?
A
- Hypochloraemic hypokalaemic metabolic alkalosis due to vomiting
- Hypokalaemia > muscle weakness + arrhythmias
23
Q
PERSONALITY DISORDERS
What are some differentials of schizotypal personality disorder?
A
- Autism
- Asperger’s
- Schizophrenia (50% may develop it)
24
Q
PERSONALITY DISORDERS
What are some investigations for personality disorders?
A
- Assessed (Hx + MSE) more than once
- Minnesota Multiphasic Personality Inventory (MMPI)
- Eysenck Personality Inventory + Personality Diagnostic Questionnaire
25
PERSONALITY DISORDERS
What are the psychological therapies for personality disorders?
- Dialectical behavioural therapy for EUPD
- CBT (change unhelpful ways of thinking)
- Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours)
- Psychodynamic therapy (looks at how past experiences affect present behaviour)
26
WERNICKE'S
How does Wernicke's present?
Triad –
- Ataxia
- Confusion
- Ophthalmoplegia + nystagmus
27
KORSAKOFF'S
What are some causes of Korsakoff's?
- Heavy alcohol drinkers
- Head injury, post-anaesthesia
- Basal or temporal lobe encephalitis
- CO poisoning
- Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)
28
LITHIUM TOXICITY
What is lithium toxicity?
What can precipitate it?
- Serum lithium >1.5mmol/L
- >2mmol/L = life-threatening
- Dehydration, renal failure, diuretics, anti-HTNs + NSAIDs
29
LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?
- Ataxia, dysarthria, confusion (drunk)
- COARSE tremor, blurred vision, hyperreflexia
- N+V, diarrhoea
- Myoclonus, seizures + coma if severe
30
LITHIUM TOXICITY
What are some complications of lithium toxicity?
- Arrhythmias (VT)
- Acute renal failure
- Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination
31
LITHIUM TOXICITY
What is the management of lithium toxicity?
- ABCDE approach as emergency
- Stop + check lithium levels, serum creatinine, U+Es
- IV fluids (bolus + 1.5–2x maintenance
- ?Whole bowel irrigation with polyethene glycol for severe, acute ingestion
- Haemodialysis
32
ACUTE DYSTONIA
What is the management of acute dystonia?
- ABCDE approach as emergency
- Anticholinergic – IM procyclidine
- Stop antipsychotic (switch to atypical as less EPSEs)
33
NMS
What is the pathophysiology of neuroleptic malignant syndrome (NMS)?
- Dopamine antagonism often due to typical antipsychotic OD or acute withdrawal of Parkinson's meds
34
NMS
What is the clinical presentation?
Bodybuilder–
- Pyrexia >38 + diaphoresis
- Muscle rigidity (diffuse "lead-pipe" rigidity)
- Confusion, agitation, altered consciousness
- Tachycardia, high/low BP
- Hyporeflexia
35
SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?
Sx onset + recovery fast –
- Neuro = confusion, agitation
- Neuromuscular = myoclonus, tremors (incl. shivering), hyperreflexia, ataxia
- Autonomic = hyperthermia, diarrhoea, tachycardia, mydriasis
36
SEROTONIN SYNDROME
What are some investigations for serotonin syndrome?
- FBC, U+Es, biochemistry (Ca2+, Mg2+, phosphate), CK, drug toxicology scren
- ECG monitoring for prolonged QRS or QTc interval
37
SEROTONIN SYNDROME
What is the management of serotonin syndrome?
- ABCDE
- Stop offending agent
- IV access to correct volume + reduce risk of rhabdomyolysis as in NMS
- BDZs like slow IV lorazepam for agitation, seizures + myoclonus
- Serotonin receptor antagonists like PO cyproheptadine or chlorpromazine if severe
38
SEROTONIN SYNDROME
What is the management of serotonergic drug OD?
- ?Gastric lavage ± activated charcoal
39
LEARNING DISABILITIES
What is a learning disability?
- Condition of arrested or incomplete development of mind, characterised by impairment of skills that contribute to overall intelligence (language, cognition, social) which has manifested during developmental period
40
LEARNING DISABILITIES
How is a learning disability different to learning difficulties?
- Learning difficulties (dyslexia) are difficulties in acquiring knowledge + skills to the normal level expected of those of the same age, especially due to a mental disability or cognitive disorder
41
LEARNING DISABILITIES
What is the triad in learning disabilities?
- Low intellectual performance (IQ < 70)
- Onset during birth or early childhood
- Wide range of functional impairment
42
LEARNING DISABILITIES
What physical disorders may be present in those with learning disabilities?
- Motor disabilities (ataxia, spasticity)
- Epilepsy
- Impaired hearing/vision
- Incontinence
43
LEARNING DISABILITIES
How is mild learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 50–69
ii) 9–12
iii) Mobile
iv) Mostly adequate
v) Difficulties reading + writing
vi) Most independent
44
LEARNING DISABILITIES
How is moderate learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 35–49
ii) 6–9
iii) Mobile
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support
45
LEARNING DISABILITIES
How is severe learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 20–34
ii) 3–6
iii) Marked impairment
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support
46
LEARNING DISABILITIES
How is profound learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) <20
ii) <3
iii) Severe impairment
iv) Basic non-verbal comms, understands basic commands
v) None
vi) Complete dependency
47
ADHD
What are some risk factors for ADHD?
- Epilepsy, low socioeconomic status, learning difficulties
- Premature or LBW
- Brain damage (in vitro or after severe head injury later)
48
ADHD
What is the triad of symptoms in ADHD?
- Inattention
- Impulsivity
- Hyperactivity
49
GENDER DYSPHORIA
What are some risks of the hormone therapy?
- Oestrogen = clots, gallstones, high triglycerides
- Testosterone = polycythaemia, acne, dyslipidaemia
- Both = elevated LFTs, infertility, weight gain
50
SELF-HARM
What are some risk factors for self-harm?
Female
Social deprivation,
Single or divorced,
LGBTQ+,
mental illness
51
TIC DISORDERS
What might cause them?
- Stress, gestational + perinatal insults, PANDAS
52
ANOREXIA NERVOSA
What are the consequences of refeeding syndrome?
Can lead to cardiac arrhythmias, convulsions, cardiac failure, coma + death
53
OCD
What is a potential cause of OCD?
Neurochemical dysregulation of 5-HT system
54
NMS
what is the management of neuroleptic malignant syndrome?
- stop antipsychotic
- IV fluids to prevent renal failure
- dantrolene
- bromocriptine
