Block 33 Week 6 Flashcards
1
Q
how does E coli lead to watery diarrhoea?
A
Escherichia coli(heat-labile enterotoxin) - activates adenylate cyclase (via Gs) leading to increases in cAMP levels -> watery diarrhoea
2
Q
Vitamin B6 deficiency?
A
Vitamin B6 deficiency can result in seizures due to reduced production of GABA - the major inhibitory neurotransmitter in the CNS
3
Q
Vitamine B1 deficient?
A
(thiamine)muscle weakness and anergia
4
Q
Vitamin C deficiency?
A
bleeding gums and prolonged wound healing
5
Q
vitamin B7 deficiency
A
(biotin)alopecia and dermatitis
6
Q
vitamin B3 deficieny?
A
niacin)pellagra, diarrhoea and dermatitis
7
Q
vitamin B6 deficiency
A
- (pyridoxine) seizures (pyridoxine is an important cofactor required for the synthesis of GABA),
- peripheral neuropathy,
- sideroblastic anaemia
8
Q
attributable risk =
A
the rate in the exposed group minus the rate in the unexposed group
9
Q
most common causative agents of cellulitis?
A
- Staphylococcus aureusandStreptococcus pyogenes
- staph pyoegenes causes 2/3rd of cases
10
Q
vasodilation is caused by?
A
PGI2
11
Q
ciclosporin and tacrolimus mechanism?
A
inhibit calcineurin thus decreasing IL-2
12
Q
Where is ACh synthesised?
A
ACh is synthesised in the basal nucleus of Meynert in the central nervous system.
13
Q
hyperacute organ rejection =
A
hours after transplantation - mediated by B cells
14
Q
acute organ rejection/ chronic?
A
develops months to years later, cytotoxic T cells
15
Q
neural tube ->
A
CNS neurons, astrocytes and oligodendrocytes, POST PITUITARY
16
Q
surface ectoderm ->
A
anterior pituitary, epidermis and lens of the eye.
17
Q
neural crest ->
A
- autonomic nerves, cranial nerves and the facial and skull bones, Schwann cells
- melanocytes
18
Q
down and out lesion?
A
- down and out appearance of eyes
- CNIII lesion
- caused by the unopposed function of the lateral rectus muscle (supplied by cranial nerve VI) and the superior oblique muscle (supplied by cranial nerve IV).
19
Q
action of LR?
A
abduct the eye
20
Q
Superior oblique muscle?
A
abduct, depress and intort the eye.
21
Q
which ab inhibit peptidoglycan cross linking?
A
penicillins,cephalosporins,carbopenems
22
Q
peptidoglycan synthesis inhibitors?
A
glycopeptides(e.g. vancomycin)
23
Q
50S subunit inhibitiors?
A
macrolides,chloramphenicol,clindamycin,
24
Q
30s subunit inhibitors?
A
aminoglycosides,tetracyclines
25
inhibits DNA synthesis?
* quinolones (e.g. ciprofloxacin)
26
which ab damaged DNA?
* metronidazole
27
Which ab inhibits folic acid formation?
* sulphonamides
* trimethoprim
28
29
which ab inhibits RNA synthesis?
* rifampicin
30
VW classification mneumonic?
Some - sodium blockers
Block - beta blockers
Potassium - potassium blockers
Channels - calcium blockers
31
which ab found in breast milk?
IgA
32
Alpha 1 receptors?
* vasoconstriction
* relaxation of GI smooth muscle
* salivary secretion
* hepatic glycogenolysis
33
Alpha 2 receptors?
* mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
* inhibits insulin
* platelet aggregation
34
Beta 1 receptors?
* mainly located in the heart
* increase heart rate + force
35
beta 2 receptors?
* vasodilation
* bronchodilation
* relaxation of GI smooth muscle
36
beta 3 receptors?
* lipolysis
37
why should GTN be taken sublingually?
if GTN is taken orally (swallowed) it undergoes FPM so it should be taken sublingually
38
aspirin overdose?
Aspirin overdose causes a decrease in ATP production by inhibiting the electron transport chain in mitochondria
39
IE inc risk of?
stroke
40
methotrexate can cause?
methotrexate -> pulm fibrosis -> decreased lung compliance
41
which nerve can be damaged during chest drain insertion?
Long thoracic nerve is susceptible to damage during chest drain insertion -> winging of the scapula
42
what do PAs do in the presence of hypoxia?
vasoconstruct
43
raised serum ACE levels ->
think sarcoidosis
44
raised transfer factor?
asthma, haemorrhage, left-to-right shunts, polycythaemia
45
low transfer factor?
everything else - fibrosis, pneumonia, pulm emboli, pulm oedema, emphysema, anaemia, low cardiac output
46
Ramsay Hunt syndrome?
Bell's palsy facial paralysis, in addition to the herpetic rash, deafness, tinnitus, and vertigo.
47
low CO2 causes?
- shifts the oxygen dissociation curve to the left, increasing the oxygen affinity of haemoglobin, thus limiting the oxygen available to tissues.
- Hypercarbia, in contrast, shifts the curve in the opposite direction.
48
main features of cholestaetoma?
* foul-smelling, non-resolving discharge
* hearing loss
49
other features of cholestaetoma determined by local invasion?
* vertigo
* facial nerve palsy
* cerebellopontine angle syndrome
50
cholestaetoma on otoscopy?
attic crust
51
central chemo receptors?
- Respond to increased H+ in BRAIN INTERSTITIAL FLUID to increase ventilation.
- C for CO2
52
high FEV1/ FVC ratio ->
restrictive pattern -> e.g. neuromuscular disorders
53
acidosis and pH curve?
- In acidosis, the number of [H+] ions increases, which reflects a greater amount of metabolic activity.
- This causes the curve to shift to the right and, therefore, a decreased affinity of haemoglobin for oxygen. A helpful way to remember this is low [H+] levels causes a shift to the left.
54
shifts to the left?
for given oxygen tension there is increased saturation of Hb with oxygen i.e. decreased oxygen delivery to tissues
55
shifts to the right?
for given oxygen tension there is reduced saturation of Hb with oxygen i.e. enhanced oxygen delivery to tissues
56
shifts summary table?
57
ROME mneumonic
58
PP is located at?
10th rib in the mid-axillary line
59
internal laryngeal nerve?
mediates the cough reflex
60
mysasthenia gravis?
Myasthenia gravis can cause a restrictive pattern of lung disease
61
neonatal feature of CF?
Meconium ileus is a common neonatal feature of cystic fibrosis
62
CF is associated w?
absent vas deferens in men, leading to infertility
63
legionella pneumonoa?
should be suspected where multiple people contract pneumonia in an air conditioned space - strep most common cause overall
64
dull percussion note + absent breath sounds + trachea moving to the affected side ->
lung collapse
65
pneumothorax?
Pneumothorax is indicated by the diminished breath sounds and hyper-resonant chest, ipsilateral to the pain - CF is a key RF
66
gene in CF?
most common gene causing cystic fibrosis is Phe508del (DeltaF508)
67
T in grading?
* T1 is less than 3 cm
* T2 is between 3 cm and 7 cm
* T3 is more than 7 cm and/or involves invasion of the chest wall, parietal pleura, diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium
* T4 can be any size but involves invasion of other structures
68
N1/ N2?
- N1: ipsilateral hilar or peribronchial lymph nodes
- N2: ipsilateral mediastinal and/or subcarinal lymph nodes.
69
Phrenic nerve?
innervates the pericardium, and since the nerve travels from the neck down through the thoracic cavity, it causes referred pain to the shoulder in pericarditis.
70
ciprofloxacin?
inhibits hepatic metabolism of theophylline - increased risk of theophylline toxicity
71
life threatning feature of asthma?
silent chest
72
most common cause of bac otitis media?
haemophilus influenzae
73
statutory resp =
* agencies that have a legal right to intervene in child abuse is suspected are: social services, police, National Society for the Prevention of Cruelty to Children (NSPCC)
74
roles of social workers?
* The job of the social worker is to safeguard and promote the welfare of children.
* They work with families/carers and with other professionals to keep children safe and healthy.
75
when may social workers become involved w a family?
* They may become involved with families/carers due to poverty, child abuse, mental health problems, disabilities or conditions such as ADHD
76
police?
* identifying if there is a history of unlawful Tx and drugs or alcohol
* history of violence including domestic abuse, sexual offences and any other matter relevant to the welfare of the child
77
NSPCC?
* This is a voluntary organisation with a statutory right to apply for a court order to safeguard children. It has a team of social workers who work together with local social workers.
* Its goal is to prevent abuse and it works with those children who are most vulnerable
78
statutory duties?
* all organisations that work with children share a commitment to safeguard and promote welfare - statutory duties
79
contributions to personality development?
* genetic influence - twin studies
* some evidence for inheritance - cluster B, familial relationship between schizotypical and schizophrenia, bipolar, affective disorders
* adverse intrauterine and perinatal and postnatal experience - affects neurodevelopment
80
life events associated w a PD?
* childhood trauma, attachment disorder, and early life adversity associated w developing ways of coping that are later associated w risk of personality disorder
81
What is associated w personality disorders?
* low serotonin levels associated w personality disorders
* decreased activity in amygdala in psychopathy
82
amygdaala role?
* threat detection, fear conditioning, harm avoidance
* very responsive to facial expressions
83
Personality is disordered when:
* Persistent, Pervasive and Pathological personality
* Deviation in; affect, impulse control, arousal,perception, relation with others
* Enduring
* affects Broad range of personal/social situations
* Personal distress
* Occupational and social problems
84
PD - personality issues arise during?
* Appear during childhood/adolescence and continue into adulthood
85
Arguments against PDs?
* personality is who we are - does that make it an illness
* personality develops as out brain's way of surviving as a result of our life experiences - does the way out brains adapt to hostile environments justify being considered a personality disorder
86
what are the most common PDs?
* Most prevalent are emotionally unstable borderline personality, antisocial and schizotypal
87
EUPD, antisocial and schizotypal are more prev in?
males >females
88
borderline, histrionic and dependent PD more common in?
female> male
89
epidemiology of PDs?
* 50% of the prison population
* 5-10% of the general population
90
diagnostic guidelines of PDs?
G1 markedly disharmonious attitudes and behaviour, involving usuallyseveral areas of functioning, manifesting in more than one of the following areas:
a) Cognition
b) Affectivity
c) Control over impulse and gratification needs
d) Manner of relating to others and of handling interpersonal situations
G2 The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive or otherwise dysfunctional across a broadrange of personal and social situations
G3 There is personal distress, or adverse impact on thes ocial environment, or both, clearly attributable to the behaviour referred to in criterion G2.
G4 There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
G5 The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from coexist.
G6 Organic brain disease, injury or dysfunctional must beexcluded as the possible cause of the deviation.
91
EUPD?
* marked tendency to act impulsively w/o consideration of the consequences togetehr w affective instability
* minimal ability to plan ahead and outbursts of intense anger may oftenlead to violence or "behavioural explosions"; these are easily precipitated when impulsive acts are criticized or thwarted by others.
92
2 subtypes of EUPD?
impulsive and borderline
93
impulsive type of PD?
A: The general criteria for personality disorder (F60) must be met.
B: At least three of the following must be present, one of which must be (2):
1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious mood
94
borderline type of unstable PD?
A: The general criteria for personality disorder (F60) must be met.
B: At least three of the symptoms mentioned in criterion B for impulsive type must be present, with at least two of the following in addition:
1.disturbances in and uncertainty about self-image, aims and internal preferences (including sexual);
2.liability to become involved in intense and unstable relationships, often leading to emotional abandonment;
3.excessive efforts to avoid abandonment;
4.recurrent threats or acts of self-harm;
5.chronic feelings of emptiness.
95
criteria for dissosical/ antisocial PD: at least 4 of the following need to be met?
1. callous unconcern for the feelings of others;
2. gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
3. incapacity to maintain enduring relationships, though having no difficulty in establishing them;
4. very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. incapacity to experience guilt or to profit from experience, particularly punishment;
6. marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.
96
features of dissocial/ antisocial PD?
* Cannot conform to law
* Obligations ignored
* Reckless disregard for safety
* Remorseless
* Underhanded (deceitful)
* Planning insufficient (impulsive)
* Temper (irritable and aggressive)
97
Dissocial PD vs conduct?
- dissocial for those 18+
- conduct disorder is diagnosed in childhood/ adolescence
98
Dissocial PD - FIGHTS mneumonic?
*Forms relationships easily but can’t maintain them
*Irresponsible (behaves riskily/dangerously/illegally)
*Guiltless
*Heartless
*Temper easily lost
*Someone else’s fault
99
paranoid PD - SUSPICIOUS mneumonic?
*Suspicious
*Unforgiving
*Sensitive about setbacks
*Possessive
*Excessive self importance
*Conspiracy theories
*Tenacious sense of rights
100
schizotypal PD - features?
*Magical thinking
*Experiences unusual perceptions
*Paranoid ideation
*Eccentric behaviour or appearance
*Constricted or inappropriate affect
*Unusual thinking or speech
*Lacks close friends
*Ideas of reference
*Anxiety in social situations
*Rule out psychotic/developmental dx
101
avoidant PD?
*Criticism/rejection preoccupies thoughts socially
*Restraint in relationships due to fear of shame
*Inhibited in new relationships
*Needs to be sure of being liked before engaging
*Gets around occupational activities with little need for interpersonal contact
*Embarrassment prevents new activity/taking risks
*Self viewed as unappealing or inferior
102
Avoidant PD mneumonic - AFRAID?
*Avoids social contact
*Fear of rejection
*Restricted lifestyle
*Apprehensive
*Inferiority
*Doesn’t get involved unless sure of acceptance
103
Social anxiety disorder vs APD?
Social Anxiety Disorder; this is characterised by fear whereas APD is characterised by avoidance of social situations due to feelings of ineptitude/inferiority
104
Dependent personality disorder involves an?
over-reliance on others to meet needs
105
features of dependent PD?
*Reassurance required
*Expressing disagreement difficult
*Life responsibilities assumed by others
*Initiating projects difficult
*Alone (feels helpless anduncomfortable when alone)
*Nurturance (goes to excessive lengths to obtain)
*Companionship sought urgently when relationship ends
*Exaggerated fears of being left to care for self
106
Narsisitic PD?
* Grandiose
* Requires attention
* Arrogant
* Need to be special
* Dreams of success and power
* Interpersonally exploitative
* Others (unable to recognize feelings/needs of)
* Sense of entitlement
* Envious, lacks empathy
107
histrionic PD?
*Appearance focused
*Center of attention
*Theatrical
*Relationships (believed > intimacy)
*Easily influenced
*Seductive behavior
*Shallow emotions
*Speech (impressionistic & vague)
108
Histrionic PD - PRAISE mneumonic?
*Provocative/seductive behaviour
*Racked with concern over appearance
*Attention/Approval seeking
*Impressionable/easily influenced
*Shallow + labile affect
*Exaggerated expressions of emotions
109
assessment of PD?
* Co-mordid psychiatric disorders
* substance misuse
- Questionnaires
- psycopathy checklist
- borderline PD scale
110
questionnaires for PD?
Eysenck Personality Questionnaire, MMPI (Minnesota Multiphasic Personality Inventory), Self report questionnaire
111
Mood disorders?
*discreet episodes
*not always a clear trigger,
- ”normal” self in between
*1st episode later, not pervasive since adolescence
112
Tx for PDs?
- CMHT primary focus for treatment
- Long term and Crisis plans
* Psychological therapies: DBT, CBT, CAT
113
DBT?
* Based off CBT, but been adapted to help ppl who exp emotions very intensely
* It’s mainly used to treat problems associated with borderline personality disorder (BPD)
* DBT therapists usually teach skills in a group setting.
* There are usually two therapists in a group and the sessions typically occur every week.
114
what are the 4 skill modules in DBT?
- mindfulness
- distress tolerance
- interpersonal effectiveness
- emotional regulation
MIDE
115
DBT - mindfulness?
a set of skills that help focus the patients attention to living life in the present, rather than being distracted by worries
116
DBT - distress tolerance?
teaching to deal with crises in a more effective way, without having to resort to harmful behaviours such as self-harm.
117
DBT - interpersonal effectiveness?
teaching how to ask for things and say no to other people, while maintaining self-respect and important relationships.
118
DBT - emotional reg?
a set of skills used to understand, be more aware and have more control over emotions.
119
cognitive analytic therapy?
* collaborative programme
* looks at the way a person thinks, feels and acts
* the events and relationsships that underlie these experiences (often from childhood or earlier in life)
* incorporates cognitive and psychodynamic insights
120
ideas of the psychodynamic theory ?
* based on psychoanalytic ways of understanding personal and emotional development.
* The way we see and relate to the world develops through relationships made in infancy, childhood, and later life.
121
psychodynamic theory - disurbances in these relationships can?
produce continuing vulnerabilities, and symptoms and relationship problems in later life.
122
APD Mx?
* Prevention in childhood (conduct disorder – 30% develop antisocial personality disorder)
* Motivation to engage in psychological therapy predicts success
* Group-based cognitive and behavioural therapy interventions focused on reducing offending behaviour can be effective
123
% of schizotypal PD that evolves into schiz?
50
124
suicide risk in BPD?
3-10%
125
childhood experiences and personality development?
* childhood adversity is linked to personality dysfunctions and disorders bc of the negative influence on socio-cognitive and emotional functions
* negative familial experiences, such as parental absence or parent-offspring conflict, affect behavioral, and neuroendocrine responses to stress
* early exposure to an unstable or unpredictable emotional environment has been found to change the reactions to negative experiences
126
emotionan instability vs mood disorders?
* Mood swings tend to be more rapid and frequent in BPD than bipolar disorder
* Someone with BPD may cycle between high and low moods on the same day.
* In bipolar disorder, manic and depressive episodes last for days or longer.
127
RF for PD?
* traumatic events in early life e.g. childhood abuse, early parental loss or separation
* Maladaptive patterns of thinking, feeling, behaving, and interacting with others are thought to develop in response to dysfunctional early environments that prevent normal development.
* childhood temprament and psychological traits
* FH of MH disorders
128
Conduct disorder?
* usually begins in childhood or adolescence
* characterised by aggressive, rule-breaking behaviours that lead to conflict with adults and peers.
129
up to 50% w conduct disorder go on to develop
APD in adulthood
130
conduct disorder prev?
* prevalence inc throughout childhood, is more common in boys than girls
131
CFs of conduct disorder?
* principle feature - persistent abn conduct the condition is usually first manifested as abnormal conduct in the home, for example stealing, lying, verbal and physical violence.
* Later the condition is manifest in behaviour outside the home, for example truancy, delinquency, reckless behaviour, alcohol and drug abuse.
132
beta 2 adrenoreceptors cause?
vasodilation, bronchodilation, and relaxation of GI smooth muscle
133
HPV 16/18 inc risk of?
- orophranyngeal cancer
- Cervical cancer
- anal cancer
134
tarcolimus can cause?
hyperglycaemia
135
what is the pathogen in most cases of bronchiolitis?
RSV
136
Illness behaviour =
* the ways in which given symptoms may be differentially perceived, evaluated, and acted (or not acted) upon by different kinds of persons.“
137
what is disease?
disorder due to organic pathology.
138
what is illness?
the state experienced by a person who perceives him or herself as suffering from ill-health.
139
the sick role?
* role in society occupied by a person who has declared himself as ill, and whose illness has been legitimised by a doctor, or by family or friends
140
obligations of the sick role?
* The person must want to get well as soon as possible.
* They should seek professional medical advice and cooperate with the doctor.
141
priv of the sick role?
- The person is allowed (and perhaps expected) to shed some normal responsibilities and activities.
* They are regarded as being in need of care and unable to get better by his/her own will.
142
abn illness behaviours?
* inappropriately perceiving, evaluating and acting in relation to their health
143
illness denial?
* Behaviours to avoid the ‘stigma’
* Inability to accept the physical/mental disease
144
illness affirmation?
* behaviours which inappropriately affirm illness behaviours
* Invalidism
* Disproportionate disability compared to symptoms/signs
145
types of abn illness behaviour>
- illness affirmation
- illness denial
146
living w chronic conditions?
* Managing a long-term condition can be stressful
* Illness denial can be a major concern especially if there are consequences to poor management
* Patients can feel isolated and stigmatised
147
MUS =
* physical symptoms not explained by organic disease, symptoms strongly linked to psychological factors
* most are transient
* Where multiple MUS occur, more likely to be associated with psychiatric disorder
148
Cost of MUS
* 20% of GP new episodes
* £1.2bn
149
Types of MUS?
* Psychologically-based physical symptoms (unconscious)
* Malingering (conscious)
* Factitious / feigned symptoms (conscious)
150
psychosomatic =
A disorder having physical symptoms but originating from mental or emotional causes. Often used in mainstream media to describe MUS
151
Somatoform =
* Somatoform = repeated presentation of physical symptoms, with persistent requests or medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis
152
dissociative/ conversion disorders?
* Dissociative/conversion disorders = simulated conditions related to acute trauma.
* Present acutely, often dramatically, with the patient’s idea of a devastating condition e.g. leg weakness with normal reflexes
153
somatisation =
Somatisation = a process where patients present with physical symptoms as a manifestation of psychological distress.
154
functional =
Functional = Characterised by patterns of persistent bodily complaints for which adequate examination does not reveal sufficiently explanatory structural or other specified pathology
155
e.g.s of fungctional syndromes?
* IBS
* chronic pelvic pain
* chronic fatigue
* hyperventilation syndrome
* fibromyalgia
* tension headache
156
what is somatisation?
* expression of personal and social distress in an idiom of bodily complaints and medical help seeking
* process, can be acute or chronic
* not a concious process
157
recognising somatisation?
* Many unexplained symptoms (often pain)
* Frequent consultations in primary and secondary care
* Multiple investigations
* Excessively disabled
* Polypharmacy
* Odd beliefs
* Unrealistic expectations of cure
* Denial or minimisation of life problems
158
aetiology of somatisation?
* predisposing
* precipitating
* perpetuating
159
predisposing factors in somatisation ?
* History of early (chronic) physical illness:family or patient
* Somatic vocabulary
* alexithymia / LD / difficulties establishing mental representations of emotion
* Childhood neglect / abuse
* Early regime: attention for physical illness but not for emotional distress
* central pain mechanisms
* emotional avoidance culture
* absent, insufficient or dismissive communication with significant adults…
* difficulty communicating about problems, concerns and emotions re: stress
160
MUS - precipitating factors?
* stressful events can often trigger it
* life events - losses, threats, traumatas
* acute disease e.g. viral illness
161
perpetuating factors in MUS?
* Dilemma / conflict resolution
* Role changes / reduced social responsibility and expectation
* Changing dynamics of relationships
* Physical consequences of illness behaviour
* Iatrogenic harm
* public recognition of suffering
162
Somatisation disorder?
* AKA briquet's syndrome
* Multiple medically unexplained physical symptoms, beginning before the age of 30 and persisting for many years.
* 13 physical symptoms from a list of 35, with no pathophysiological mechanism to account for any of those being considered to support the diagnosis
* Also unconscious
163
MUS is correlated w ?
* depression, anxiety, panic disorder, OCD, PTSD, PND
164
dissociation vs conversion?
- Dissociation is an unconscious separation from a difficult, usually traumatic stimulus
- Conversion is an unconscious ‘converting’ of a psychological stressor into a physical illness
165
dissociation and conversion are?
* distinct from somatisation - which is an unconscious expression of psychological difficulties through physical symptoms
* These are simulated conditions- a deflection or distancing from the psychological stressor through the presentation of an abnormal state.
| ****Somatic = symptoms
Conversion = conduction (i.e. nerve problems)****
166
dissociation can present as?
* dissociation can present through a highly abn mental state e.g. amnesia fugue (where the person flees the stressor but without any memory of doing so)
167
what is the gain from dissociation and conversion?
* The primary gain is relief of primary stressor
* Mechanism for coping with an intolerable situation
168
what is a conversion disorder?
* A deflection or distancing from the psychological stressor through the presentation of physical illness.
* The basis for this is nearly always trauma
* Acute, dramatic onset of a serious physical condition e.g. blindness, paralysis
169
function in conversion disorder?
* Often simulates patient’s ideas about neurological disease e.g. paraesthesia that does not follow dermatomes
* Majority are acute (can become chronic)
* Function is intact eg leg ‘paralysis’, but normal tone and reflexes.
170
conciously mediated symptoms?
- maligneting and factitious disorder
171
malingering?
* Malingering = presenting with made-up symptoms of an illness for secondary material gain e.g. money, housing, benefits, drugs
172
FD?
* Factitious disorder more complicated = conscious production of symptoms but the main gain is attention and intervention from healthcare professional
* enduring pattern of fabrication or a life punctuated by episodes of this behaviour
173
Prev of FD?
* prevalence - 1% of all OP in general hospitals, high proportion are HCPs
174
Features of FD?
* Inconsistent history, course of illness atypical
* patient disruptive on unit or non compliant with diagnostic tests
* lab evidence disputes patient information
* multiple requests for medication
* Seeking treatment at different hospitals or clinics, patient may be ‘caught in the act’
175
Approach to FD?
* collect evidence (from multiple sources),
* supportive confrontation with a colleague and offer of psychological support
* discuss w their registration body
176
fabricated illness imposed on others?
* Used to be called Munchausen syndrome by proxy
* Where a caregiver feigns symptoms in a dependent (most often parent and child)
* many also have a personality disorder
* this is child abuse - needs to be reported to safe guarding
177
identifying MUS?
* The symptom doesn’t fit with known disease models
* The patient is unable to give a clear and precise description of the symptoms
* Symptom/disability seem excessive in comparison to pathology
* Temporal relationship to stressful life events
* Patient attends frequently (with different symptoms)
* The patient is overly anxious about the meaning of the symptoms and has strongly held beliefs about a disease process causing the symptoms
* Patient complains of pain in various sites
178
assessment of MUS?
* current stressors/ problems
* how are they managing symptoms - alcohol/ drugs?
* identify co-existing mental illness
179
Tx of MUS?
* review of symptoms every 6-8 weeks
* Symptom management – analgesics, laxatives, antispasmodics, exercise/weight loss, acupuncture
* pain referral services
* promote self efficacy - websites/ self help literature
180
MUS - When to refer to MH services?
* Frequent attendances in primary/secondary care
* Diagnostic dilemmas
* Very distressed or very disabled
* Longer history >12 months
* Conversion Disorders the exception- should be referred sooner rather than later if problems haven’t resolved within a few weeks
181
MUS - management by psychological medicine team?
* Increase function – physio/OT
* Develop skills/social networks – moving away from the sick role
* Treat depression/anxiety
* Clear shared management with GP
* Psychotherapeutic options- problem solving, behavioural, cognitive, psychodynamic therapies
* Long term strategy required for chronic MUS in primary and secondary care – containment, preventing iatrogenic damage
182
possible causes of MUS?
- Stress
* Depression
* Anxiety
*Irritable bowel syndrome
* Chronic fatigue syndrome
*Somatisation disorder
* Fibromyalgia
*Psychosis
183
Red flags in MUS?
* Systemic features (e.g. weight loss, loss of appetite, malaise, fever, sweats)
* Persistent and worsening symptoms
* Abnormal physical examination
* Abnormal blood tests
184
psych response to illness - leventhal's self-regulatory model of illness behaviour
185
Leventhal suggested that patients?
- organise their understanding of their illness around five areas, called illness representations
- identity
- cause
- consequences
- timeline
- control/cure
186
Leventhal - identity?
- Symptoms, concrete signs, labels, diagnosis, what they think it is
187
Leventhal - cause?
- Perceived causes; includes internal and external attributions
188
Leventhal - consq?
- Perceived physical, social, economic, emotional consequences
189
leventhal - timelines?
- Perceived timescale for development and duration of illness
190
leventhal - cure/ control?
- By individual or external means
191
the illness perception questionnaire (IPQ)?
* Derived from Leventhal's self regulatory model
* quantitative measure
* provides clinician w qualitative framework for useful discussion w the patient
192
emotional response to health threat?
* depression and anxiety are twice as common in patients with medical problems than in the general population
* associated w significant morbidity and mortality
* hospital anxiety and depression scale
193
problem focused coping strategies?
* learning new sklls
* seeking support and information
* developing new interests if previous ones are compromised by illness
* actively participating in Tx
194
emotion focused coping strategies?
* shared feelings and concerns abt illness
* acknowleding loss
* emotional support through religion
* giving up unrealistic hopes of reovery
* distancing - temporarily closing off emotional worries in order to cope
195
coping strategies that aren't helpfiul
* denial - if it prevents the patient from seeing appropriate tx
* Obsessively focusing on minute details of the medical problem
* Preoccupation with medical/health, fringe/alternative websites, leading to over interpretation or misinterpretation of symptoms
* Seeking to blame someone else
196
Relationship between physical and psychiatric illness - psychiatric problems as a result of physical illness?
direct effects of physical illness and its Tx
*Organic depression
*Acute organic brain reactions (delirium)
*Chronic organic brain syndromes
*Psychoses
197
psych illness reactive to the presence and/or treatment of physical illnes?
*Adjustment disorders
*Depressive disorders
*Anxiety disorder (including agoraphobia)
- PTSD
198
Physical illness as a presentation of psychiatric disorder - MUS
- somatization
- dissociation
- factitious disorder
- malignering
199
somatization?
(process in which psychological distress is manifested as physical symptoms, e.g. pain, fatigue, etc. Mechanism unknown)
200
dissociation/ conversion?
(states in which psychological distress is manifested as physical/mental signs, e.g. paralysis, blindness, amnesia, etc.
201
factitious disorder?
(physical symptoms/signs fabricated by patient but underlying reasons often unconscious e.g. in response to deep feelings of insecurity physical illness might keep relevant people attached to patient)
202
malingering?
physical symptoms/signs fabricated by patient for a clear conscious purpose e.g. monetary gain, avoidance of jail/punishment, etc.
203
Depressed mood, apathy, fatigue can be due to?
hypothyroidism, Cushing’s syndrome
204
Anxiety, panic attacks can be due to?
thyrotoxicosis
205
Mood disorder, emotional lability, personality changes, cognitive impairment can be due to?/
space-occupying lesions (SOLs) – symptoms will vary according to site and rate of growth of SOL
206
mood/ behaviour disturbances can be due to?
brain metastases or non-metastatic presentations (hormones/peptides secreted by some tumours)
207
anxiety, stress etc can precipitate:
pain, seizures, relapses in MS, complications of diabetes
208
psych effects of physical illness?
* depression
* anxiety
* social withdrawal, embarassment
* behavioural maladaptations
* PTSD
209
unhealthy adjustment responses?
* feeling sad and hopeless
* crying
* worrying, feeling anxious
* feeling irritable
* suicide/ self harm
* withdrawal
* difficulty wirh daily activities
210
relationship between psychiatric illness and neurological disorders?
* 50% prevalence rates of depression and anxiety among neurology patients
* neurological patients with psychiatric morbidity tend to develop more intense illness behaviour than their counterparts without psychiatric morbidity
211
MH experienced by ppts w parkinsons?
anx, depression, hallucinations, memory problems, dementia
212
strategies for MUS?
* Clinically indicated diagnostic tests to rule out physical causes
* psychological evaluation
* patients w common psychiatric conditions may present to PC with non specific somatic symptoms - including fatigue, aches, pains, palpitations, dizziness, and nausea
* CBT
* challenging the patient's beliefs and maladaptive behaviours
* intensive short term psychotherapy
213
Key principles of the reattribution model?
* To make the patient feel understood.
* Then to broaden the agenda.
* Finally, to negotiate a new understanding of the symptoms, including psychosocial factors.
214
identifying stress in children?
* watch for negatuive changes in behaviour - irritable, withdrawal from social activities, crying, sleeping/ eating too much/ little
* physical symptoms - stomach aches and headaches
* unusual interactions w others
215
managing stress in children>?
* address it
* active listening - let the child explore concerns and feelings
216
symptoms of factitious disorder
* Factitious disorder symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others
* extensive knowledge of medical terms and diseases
* Vague or inconsistent symptoms
* Conditions that get worse for no apparent reason
* Conditions that don't respond as expected to standard therapies
* Seeking treatment from many different doctors or hospitals, which may include using a fake name
* Reluctance to allow doctors to talk to family or friends or to other health care professionals
* Frequent stays in the hospital
* Eagerness to have frequent testing or risky operations
* Many surgical scars or evidence of numerous procedures
* Having few visitors when hospitalized
* Arguing with doctors and staff
217
RF for FD
* Childhood trauma, such as emotional, physical or sexual abuse
* A serious illness during childhood
* Loss of a loved one through death, illness or abandonment
* Past experiences during a time of sickness and the attention it brought
* A poor sense of identity or self-esteem
* Personality disorders
* Depression
* Desire to be associated with doctors or medical centers
* Work in the health care field
218
Mechanisms of FD
* affection derived from the sick role, especially in those who sensed a lack of affection during childhood
* seeking and maintaining relationships
* enjoying being cared for by others
* Coping with stressful life events or a lack of identity.
* A sense of accomplishment in duping physicians
219
what is FD associated w?
BPD
220
Tx of FD?
* non judgemental approach
* talking therapy or family therapy
* Other mental health disorders, such as depression, also may be addressed.
* stay in a psychiatric hospital may be necessary for safety and treatment
221
Primary prevention for MH?
* targets those individuals vulnerable to developing mental disorders and their consequences because of their bio-psycho-social attributes
* MH awareness programs in schools, and suicide risk prevention programs in the community
222
Secondary rpevention for mH
* LGBTQIA+ support programs, grief and loss groups, single parent support groups, and trauma recovery support
223
Tertiary prevention for MH?
* helps those who are alr struggling w a mental disorder
* Any mental health treatment is an example of tertiary prevention, but some specific examples are relapse prevention programs, community mental healthcare clinics, school counseling programs, and peer-led support groups.
224
Examples of primary prevention strategies
* physical healthcare
* aquate sleep and exercise
* help meeting basic needs
* psychoeducational programs
* learning how to effectively deal with stress, mindfulness.
225
examples of secondary prev
* trauma interventions for the elderly and disabled
* support for victims of crime
* improved treatment access for public service professionals (military, police, first-responders, victims of bullying groups
* domestic violence and rape response teams
* rehabilitation services
226
examples of tertiary prevention
* proper diagnosis and treatment planning
* availabilty of treatment
* access to medication
* peer-led groups like Alcoholics Anonymous
* school counselling programs
227
paranoid PD?
- Hypersensitivity and unforgiving attitude when insulted
- question loyalty of friends
- unwarranted tendency to percieve attacks on their characters
228
schizoid PD?
- Movie psychopath
- indifference to praise and critisim
- prefer to be alone and have a lack of intrest in sex or companionship
- few interests and few friends
- emotional coldness
229
Schizotypal PD?
- ideas of reference
- negative symptoms of schiz
- magical thinking
- odd eccentric behav
230
what are the cluster A PDs?
- odd or eccentric
- paranoid, schizoid and schizotypal
231
cluster B PDs?
- dramatic, emotional or erratic
- antisocial
- boderdline (EUPD)
- Histrionic
- narissistic
232
Antisocial PD is more common in ?
men
233
AS PD?
- Failure to conform to social norms and laws
- deception
- impulsive
- irritable and aggressive
- disregard for others
- consistent irresponsibility
- lack of remorse
234
Borderline PD?
- Effots to avoid abandoment
- unstable self image
- impulsive
- recurrent suidical behav
- temper
235
Borderline - relationships tend to be?
Unstable interpersonal relationships which alternate between idealization and devaluation
236
Histrionic PDs?
- inappropriate sexual seductiveness
- need to be center of attention
- rapidly shifting and shallow exp of emotions
- suggestbility
237
Histrionic PD tend to use their...
physical appearance for attention seeking
238
Narcissitic PD?
- Grandiose sense of self importance
- sense of entitlement
- need for admiration
- chronic envy
- arrogance
239
Cluster C PD?
- Anx and fearfuk
- OC
- avoidant
0 dependent
240
Obssessive compulsive PD?
- occupation with details
- perfectionism
- meticulous
- Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
- Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
241
Avoidant PD?
- Pre-occupation with ideas that they are being critised/ rejected in social situations
- feels inferior
- Social isolation accompanied by a craving for social contact
- avoidace of occupational activity due to fear of critisism
242
dependent PD?
- requires reassurance
- needs others to take resp
- diffoculty in disagreeing
- urgently search for a new relationship when a close relationship ends
243
