Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 psychiatry > Conditions > Flashcards

Conditions Flashcards

1
Q

Psychosis

A

an individual is experiencing a reality different to everyone else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Schizophrenia

A

Schizophrenia - disorder characterised by psychotic episodes and negative symptoms

  • paranoid (most common) - dominated by positive symptoms (hallucinations & delusions)
  • hebephrenic - thought disorganisation predominates
  • catatonic - rare form characterised by one or more catatonic symptoms
  • simple - rare form where negative symptoms develop without psychotic symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hallucinations

A

1) hallucinations

  • perception of an object in the absence of an external stimulus
  • 5 modalities - visual, auditory, gustatory, olfactory & tactile
    • auditory is the most common in psychosis (2nd and 3rd: 3rd most likely for schizophrenia)
    • check for organic pathology, eg. olfactory - frontal lobe pathology, visual - delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Delusions

A

2) delusions

  • fixed, firmly held belief that is (usually) false, that cannot be reasoned away, that is held despite evidence to the contrary and is out of keeping with a person’s sociocultural norms
  • different content - persecutory, grandiose, reference, erotomanic, hypochondriacal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Formal thought disorder

A

3) formal thought disorder

  • a problem of speech which means that each sentence does not follow on from the next
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fragmentation of boundaries of the self

A

4) fragmentation of the boundaries of the self

  • individual can no longer distinguish himself and the world
    • thought broadcast - feelings are thoughts are heard out loud by others
    • passivity phenomena - actions, feelings or emotions being controlled by an external force
    • thought insertion - feelings that thoughts are being inserted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Negative symptoms

A
  • avolition (decreased motivation) - reduced ability (or inability) to initiate and persist in goal-directed behaviour
  • asocial behaviour - loss of drive for any social engagements
  • anhedonia - lack of pleasure in activities that were previously enjoyable to the patient
  • alogia (poverty of speech) - a quantitative and qualitative decrease in speech
  • affected blunted - diminished/absent capacity to express feelings
  • attention (cognitive deficits) - may experience problems with attention, language, memory and executive function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Schizophrenia investigations

A

Blood tests - FBC, TFTs, glucose/HbA1c, serum calcium, U&Es, LFTs, cholesterol, vitamin B12 & folate

Urine drug test

ECG

CT scan - rule out space-occupying lesions

EEG - rule out temporal lobe epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ICD-10 criteria for schizophrenia

A

ICD-10 criteria for schizophrenia:

  • group A
    • thought echo/insertion/withdrawal/broadcast
    • delusions of control, influence or passivity phenomenon
    • running commentary auditory hallucinations
    • bizzare persistent delusions
  • group B
    • hallucinations in other modalities that are persistent
    • thought disorganisation
    • catatonic symptoms
    • negative symptoms
  • One clear symptoms from group A or two or more from group B for at least 1 month or more (DON’T DIAGNOSE in presence of organic brain disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Psychosis general management

A

First presentation of psychosis - early intervention in psychosis team: provide interventions targeted at reducing the duration of untreated psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Psychosis biological management

A
  • antipsychotics: typical and atypical
    • atypical are first line
    • depot formulations should be considered if patient prefers/problem with non-compliance
    • clozapine is used for treatment-resistant schizophrenia (failure to respond to two other antipsychotics)
  • adjuvants
    • benzodiazepines can provide short-term relief of behavioural disturbance
    • antidepressants and lithium can be used to augment antipsychotics
  • ECT
    • pts who are resistant to pharmacological agents
    • effective for catatonic schizophrenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Psychosis psychological treatment

A
  • CBT - strongly recommended & reduces residual symptoms
  • family intervention
  • art therapy - alleviation of negative symptoms
  • social skills training - behavioural approach to help patients improve interpersonal, self-care and coping skills needed in everyday life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Psychosis social management

A
  • support groups
  • peer groups - delivered by a peer support worker who has recovered from psychosis/schizophrenia & remains stable
  • supported employment programmes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Depression

A

An affective mood disorder characterised by a persistent low mood, loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Depression core symptoms

A
  • anhedonia - lack of interest in things
  • low mood - present for at least 2 weeks
  • anergia - lack of energy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Depression cognitive symptoms

A
  • lack of concentration
  • negative thoughts
  • excessive guilt
  • suicidal ideation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Depression biological symptoms

A
  • diurnal variation in mood
  • early morning wakening
  • loss of libido
  • psychomotor retardation - slow speech & slow movement
  • weight loss & loss of appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Depression psychotic symptoms

A
  • hallucinations - 2nd person auditory hallucinations
  • delusions - hypochondriacal, guilt, nihilistic or persecutory in nature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Depression ix

A
  • diagnostic questionnaires
  • blood tests - FBC, TFTs, U&Es, LFTs, calcium levels, glucose
  • imaging - MRI/CT scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Depression staging

A
  • mild depression = 2 core symptoms + 2 other symptoms
  • moderate depression = 2 core symptoms + 3-4 other symptoms
  • severe depression = 3 core symptoms + >3 other symptoms
  • severe depression with psychosis = 3 core symptoms + >3 other symptoms + psychosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Depression biological management

A

Antidepressants (not recommended as first-line for mild depression)
Adjuvants
ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Depression psychological management

A

Psychotherapies - CBT, IPT, behavioural activation, counselling, psychodynamic therapy
Self-help programmes - works through a self-help manual
Physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Depression social management

A

Social support groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bipolar

A

Chronic episodic mood disorder, characterised by at least one episode of mania and a further episode of mania or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Bipolar aetiology

A
  • genetics - strong FHx
  • neurochemical - increased dopamine, increased serotonin
  • endocrine - increased cortisol, increased aldosterone, increased thyroid
  • adverse life events
  • post-partum period
  • loss of a loved one
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Bipolar symptoms

A
  • symptoms of mania or depression
  • mania symptoms
    • irritability
    • disinhibited
    • impaired insight
    • grandiose delusions
    • flight of ideas
    • sleep decreased
    • pressured speech
    • elevated mood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bipolar ix

A
  • blood tests - FBC, TFTs, U&Es, LFTs, glucose, calcium
  • urine drug test - illicit drugs
  • CT head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bipolar diagnosis

A
  • requires at least two episodes in which a person’s mood and activity levels are significantly disturbed
    • one of which must be mania/hypomania
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bipolar mx

A

Biological - mood stabilisers, benzodiazepines, antipsychotics, ECT (severe uncontrolled mania)

Psychological - psychoeducation, CBT

Social - social support groups, self-help groups, encourage calming activities

Patients who present with an acute episode should be followed-up once a week initially & then 2-4 weekly for the first few months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

GAD

A

A syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognises as excessive and inappropriate

  • must be present on most days for 6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

GAD aetiology

A
  • biological
    • genetics - concordance rate greater for monozygotic twins than dizygotic twins, 5-fold in GAD in first degree relative of patients of GAD
    • neurophysiology - dysfunction of ANS, exaggerated responses in the amygdala and hippocampus
  • environmental
    • stressful life events, history of child abuse, problems with relationships, personal illness, employment/finances
    • substance dependence/exposure to organic solvents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

GAD risk factors

A
  • predisposing
    • genetics
    • childhood upbringing
    • personality type & demands for high achievement
    • being divorced
    • living alone/as a single parents
  • precipitating
    • stressful life events
      • domestic violence
      • unemployment
      • relationship problems
      • personal illness eg. chronic medical issues
  • maintaining
    • continuing stressful events
    • marital status
    • living alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

GAD symptoms

A
  • worry
  • autonomic hyperactivity
  • tension in muscles/tremor
  • concentration difficulty/chronic aches
  • headache/hyperventilation
  • energy loss
  • restlessness
  • startled easily/sleep disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

GAD diagnosis

A
  • period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems
  • at least four of the anxiety symptoms with at least one symptoms of autonomic arousal
    • palpitations
    • sweating
    • shaking/tremor
    • dry mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

GAD mx

A
  • biological
    • first-line drug treatment of choice is an SSRI which has anxiolytic
      • sertraline
    • if this does not help, SNRI can be given
    • if both of those cannot help → pregabalin
    • medication should be continued for at least a year
    • benzodiazepines should not be offered except as short-term measures
  • psychological
    • psychoeducation groups
    • CBT
    • applied relaxation
  • social
    • self-help methods
    • support groups
    • exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Panic disorder

A

Characterised by recurrent, episodic, severe panic attacks which are unpredictable & not restricted to any particular situation or circumstance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Panic disorder aetiology

A
  • biological
    • one of the most heritable anxiety disorders
    • post synaptic hypersensitivity to serotonin and adrenaline
    • fear or worry stimulates the SNS → increased cardiac output which can lead to further anxiety
  • cognitive
    • misinterpretation of somatic symptoms
  • environmental
    • life stressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Panic disorder risk factors

A
  • family history
  • major life events
  • age (20-30)
  • recent trauma
  • females
  • other mental disorders
  • white ethnicity
  • asthma
  • cigarette smoking
  • medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Panic disorder symptoms

A
  • palpitations
  • abdominal distress
  • numbness
  • nausea
  • intense fear of death
  • choking feeling
  • sweating
  • shortness of breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Panic disorder diagnosis

A
  • recurrent panic attacks that are not consistently associated with a specific situation or object & often occur spontaneously → not associated with marked exertion/with exposure to dangerous or life-threatening situations
  • all of the following:
    • discrete episode of intense fear or discomfort
    • starts abruptly
    • reaches a crescendo within a few minutes and lasts at least some minutes
    • at least one symptom of autonomic arousal
    • other symptoms of anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Panic disorder mx

A
  • SSRIs are first line, TCA can be given if not suitable
  • CBT
  • Self-help methods: support groups and encouraging exercise
  • Stepped care approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Phobias

A
  • phobia: an intense, irrational fear of an object, situation, place or person that is recognised as excessive or unreasonable
  • agoraphobia: fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack
  • social phobia: fear of social situations which may lead to humiliation, criticism or embarrassment
  • specific phobia: a fear restricted to a specific object/situation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Phobias aetiology

A
  • agoraphobia: maintained by avoidance which prevents deconditioning and sets up a vicious cycle of anxiety
  • social phobia: uncertain aetiology
  • specific phobia: conditioning event in early life, possibly a role for learned behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Phobias risk factors

A
  • aversive experiences
  • stress and negative life events
  • other anxiety disorders
  • mood disorders
  • substance misuse disorders
  • family history
45
Q

Phobias symptoms

A
  • biological - tachycardia is the usual autonomic response, syncope from a vasovagal response
  • psychological - unpleasant anticipatory anxiety, inability to relax, urge to avoid the feared situation & fear of dying
46
Q

Agoraphobia

A

Marked & consistently manifest fear in, or avoidance of, at least two of the following:
1) crowds
2) public spaces
3) travelling alone
4) travelling away from home
Symptoms of anxiety in the feared situation with at least two symptoms present together (& at least one symptoms of autonomic arousal)
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation

47
Q

Social phobia

A

Marked fear of being the focus of attention, or fear of acting in a way that will be embarrassing or humiliating
At least two symptoms of anxiety in the feared situation & one of the following:
1) blushing
2) fear of vomiting
3) urgency/fear of micturition/defecation
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation

48
Q

Specific phobia

A

Marked fear of a specific object or situation that is not agoraphobia or social phobia
Symptoms of anxiety in the feared situation
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation

49
Q

Agoraphobia mx

A

CBT - behavioural component includes graduated exposure and desensitisation
Graduated exposure - walking increased distances from home day by day can be used
SSRIs

50
Q

Social phobia mx

A

CBT - specifically designed for social phobia
Graduated exposure to feared situations is included both within treatment sessions and as homework
SSRIs, SNRIs
If no response, a MAOI can be used
Psychodynamic psychotherapy for those who decline CBT or medication

51
Q

Specific phobia mx

A

Exposure either using self-help methods or more formally through CBT
Benzodiazepines may be used as anxiolytics for short term eg. patients needs an urgent CT scan & they are claustrophobic

52
Q

OCD

A
  • obsessive-compulsive disorder: characterised by recurrent obsessional thoughts/compulsive acts
  • obsessions: unwanted intrusive thoughts, images or urges that repeatedly enter the individual’s mind
    • distressing for the individual who attempts to resist
  • compulsions: repetitive, stereotyped behaviours/mental acts that a person feels driven into performing
53
Q

OCD aetiology

A
  • biological
    • decreased serotonin and abnormalities of the frontal cortex and basal ganglia
    • genetic contribution
    • childhood group A beta-haemolytic streptococcal infection (PANDAS)
  • psychoanalysis
    • filling the mind with obsessional thoughts → prevent undesirable ideas from entering consciousness
  • behavioural
    • compulsive behaviour is learned and maintained by operant conditioning
54
Q

OCD risk factors

A
  • early adulthood
  • relatives with OCD
  • developmental factors - neglect, abuse, bullying and social isolation may have a role
55
Q

OCD symptoms

A
  • failure to resist obsession/compulsion
  • originate from patient’s mind
  • repetitive and distressing
  • carrying out the obsessive thought is not in itself pleasurable
56
Q

OCD diagnosis

A
  • obsessions or compulsion present on most days for a period of at least 2 weeks
  • obsessions or compulsions share a number of features of which all must be present
    • failure to resist
    • originate from own mind
    • repetitive and distressing
    • carrying out the obsessive thought is not in itself pleasurable
  • obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time
57
Q

OCD mx

A
  • CBT
    • ERP (exposure and response prevention) - patients are repeatedly exposed to the situation which causes them anxiety → after initial anxiety on exposure, the levels of anxiety gradually decrease
  • pharmacological therapy
    • SSRIs - fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram
    • clomipramine is an alternative drug therapy
  • general
    • psychoeducation techniques
    • distracting techniques
    • self-help books
    • risk should be identified and managed
58
Q

PTSD

A
  • Post-traumatic stress disorder - an intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event
  • Abnormal bereavement - delayed onset, is more intense and prolonged (> 6 months)
  • Acute stress reaction - abnormal reaction to sudden stressful events
  • Adjustment disorder - significant distress (greater than expected), accompanied by an impairment in social functioning
59
Q

PTSD aetiology

A
  • Exceptionally stressful event in which the individual was involved directly or as a witness
  • Pre-existing vulnerability
  • Cognitive theories → failure to process emotionally charged events causes memories to persist in an unprocessed form which can intrude into conscious awareness
60
Q

PTSD risk factors

A
  • exposure to a major traumatic event
    • professions at risk - armed forces, police, fire services, journalists, doctors
    • groups at risk - refugees, asylum seekers
  • pre-trauma
    • previous trauma
    • history of mental illness
    • females
    • low socio-economic background
    • childhood abuse
  • peri-trauma
    • severity of trauma
    • perceived threat to life
    • adverse emotional reaction during/immediately after event
  • post-trauma
    • concurrent life stressors
    • absence of social support
61
Q

PTSD symptoms

A
  • reliving the situation - flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances as the stressor
  • avoidance - avoiding reminders of the trauma
  • hyperarousal - irritability or outbursts, difficulty with concentration, difficulty with sleep
  • emotional numbing - negative thoughts about oneself, difficulty experiencing emotions
62
Q

PTSD diagnosis

A
  • exposure to stressful event or situation of extremely threatening or catastrophic nature
  • persistent remembering of the stressful situation
  • actual or preferred avoidance of similar situations resembling or associated with the stressor
  • either:
    • inability to recall some important aspects of the period of exposure to the stressor
    • persistent symptoms of increased psychological sensitivity and arousal
  • above should all occur within 6 months of the stressful event/end of stressful period
63
Q

PTSD where sx < 3 months mx

A

Watchful waiting may be used for mild symptoms < 4 weeks
Trauma-focused CBT should be given at least once a week for 8-12 sessions
Short-term drug treatment may be considered in the acute phase for management of sleep disturbance
Risk assessment to assess risk of neglect/suicide

64
Q

PTSD sx > 3 months mx

A

CBT & eye movement desensitisation and reprocessing (EMDR)
EMDR - reduce distress in the shortest period of time
Drug treatment (little benefit from therapy, patient preference, co-morbid depression/severe hyperarousal)
Paroxetine, mirtazapine, amitriptyline & phenelzine

65
Q

PD

A
  • deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture, is pervasive and inflexible
  • has an onset in adolescence/early adulthood, is stable over time & leads to distress/impairment
66
Q

PD aetiology

A
  • genetic
  • adverse social circumstances
  • difficult childhood experiences
67
Q

PD risk factors

A
  • society: both low socioeconomic status & social reinforcement of abnormal behaviour
  • genetics: positive family of PD
  • dysfunctional family
  • abuse during childhood
68
Q

PD types

A
  • cluster A (odd)
    • paranoid
    • schizoid
  • cluster B (dramatic/emotional)
    • emotionally unstable
    • dissocial
    • histrionic
  • cluster C
    • dependent
    • avoidant
    • anankastic (obsessional)
69
Q

Cluster A PD symptoms

A

Paranoid - suspicious of others, unforgiving, perceives attack, envious, self-reference, trust in others reduced
Schizoid - detached affect, indifferent to praise/criticism, sexual drive reduced, absence of close friends, no emotion

70
Q

Cluster B PD symptoms

A

EUPD - abandonment feared, mood instability, suicidal behaviour, intense relationships, impulsivity, emptiness (chronic)
Dissocial - callous, others blamed, remorseless, underhanded, temper, tendency to violence
Histrionic - provocative behaviour, real concern for physical attractiveness, attention seeking, egocentric

71
Q

Cluster C PD symptoms

A

Dependent - reassurance required, expressing disagreement is difficult, abandonment feared, exaggerated fears
Anxious - inadequacy felt, certainty of being liked needed before becoming involved with people, embarrassment potential prevents involvement in new activities, social inhibition
Anankastic - loses point of activity, ability to complete tasks compromised, workaholic, fussy, rigidity, stubborn, inflexible

72
Q

PD mx

A
  • treatment of co-morbid conditions
  • risk assessment is crucial, especially in EUPD
  • psychosocial interventions
  • pharmacological management may be used to control symptoms
  • written crisis plan
73
Q

Substance misuse disorder types

A

Acute intoxication - acute, usually transient, effect of the substance

Harmful use - recurrent misuse associated with physical, psychological and social consequences, but without dependence

Dependence syndrome - prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal syndromes

Withdrawal state - physical and/or psychological effects from complete cessation of a substance after prolonged, repeated or high level of use

Psychotic disorder - onset of psychotic symptoms within 2 weeks of substance use; must be more than 48 hours

Amnesic syndrome - memory impairment in recent memory & ability to recall past experiences, also defect in recall, clouding of consciousness and global intellectual decline

Residual disorder - specific features (flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse

74
Q

Complications of substance misuse

A

Physical - death, infection, endocarditis, superficial thrombosis, DVT, PE

Psychological - craving, anxiety, cognitive disturbance, drug-induced psychosis

Social - crime, imprisonment, homelessness, prostitution, relationship problems

75
Q

Substance misuse ix

A

Bloods - HIV screen, hep B, hep C & TB, U&Es, LFTs and clotting & drug levels

Urinalysis - drug metabolites can be detected in urine

ECG for arrhythmias

ECHO if suspected endocarditis

76
Q

Substance misuse mx

A

Keyworker with a therapeutic alliance

Hep B immunisation for those at risk

Motivational interviewing to help with controlling substance misuse & CBT may be offered

Contingency management - changing specific behaviours by offering incentives for positive behaviours eg. abstinence

Supportive help - housing, finance, employment; co-existing alcohol misuse & smoking cessation

Self-help groups

77
Q

Opioid dependence mx

A

Methadone or buprenorphine for detox & maintenance

Naltrexone - formerly opioid dependent but have now stopped & motivated to continue abstinence

IV naloxone - antidote to opioid overdose

78
Q

Oppositional disorder sx

A

Uncooperative, unwilling to comply with requests, frequent temper tantrums

Wilful, defiant, may also be aggressive aggression

Unless managed, tends to escalate

79
Q

Conduct disorder types

A

Socialised and unsocialised types

  • socialised - usually viewed as less serious and tends to be phasic in nature; able to still have good peer relationships
  • unsocialised - more serious, and potentially leads to criminality and a later diagnosis of antisocial personality disorder
  • lying, stealing, truanting, violence to people & animals
80
Q

Conduct disorder RFs

A

Lack of clear boundaries, inconsistent parenting

Rejection

Family conflict, especially witnessing violence and aggression

Child abuse

Child temperament

Comorbid learning or development difficulties

81
Q

Conduct disorder mx

A

Consistent care and parenting

Behavioural therapy

School-based interventions

Community interventions

82
Q

Anorexia nervosa

A

Anorexia nervosa is an eating disorder characterised by deliberate weight loss, an intense fear of fatness, distorted body image and endocrine disturbance

83
Q

Anorexia nervosa aetiology (biological)

A

Genetics, family history, female, early menarche
Adolescence and puberty
Starvation leads to neuroendocrine changes that perpetuate anorexia

84
Q

Anorexia nervosa aetiology (psychological)

A

Sexual abuse, preoccupation with slimness, dieting behaviours in adolescence, low self-esteem, premorbid anxiety/depressive disorder, perfectionism, obsessional/anankastic personality
Criticism regarding eating, body shape or weight
Perfectionism, obsessional/anankastic personality

85
Q

Anorexia nervosa aetiology (social)

A

Pressure to diet in a society that emphasises that being thin is beauty, bullying around weight, stressful life events
Occupational or recreational pressure to be slim
Occupation, western society

86
Q

Anorexia sx

A
  • fear of weight gain
  • emaciated
  • deliberate weight loss
  • distorted body image
  • physical - fatigue, hypothermia, bradycardia, arrhythmias, peripheral oedema, headaches, lanugo hair
87
Q

Anorexia ix

A
  • FBC, U&Es, TFTs, LFTs, lipids, cortisol, sex hormones, glucose, amylase
  • VBG
  • DEXA scan
  • ECG
  • questionnaires
88
Q

Anorexia diagnosis

A
  • adults: BMI < 18.5 OR rapid weight loss (more than 20% total body weight within 6 months)
  • persistent pattern of restrictive eating/other behaviours aimed at establishing or maintaining abnormally low body weight
    • fasting
    • choosing low calorie food
    • excessively slow eating of small amounts of food
    • hiding food
    • chewing and spitting
  • excessive preoccupation with body, weight and shape
89
Q

Anorexia mx

A
  • treatment of medical complications
  • SSRIs for co-morbid depression/OCD
  • psycho-education about nutrition
  • CBT, MANTRA, SSCM, family therapy
  • self-help groups
90
Q

Anorexia complications

A
  • metabolic - hypokalaemia, hypercholesterolaemia, hypoglycaemia, impaired glucose tolerance, deranged LFTs
  • endocrine - increased cortisol, increased GH, decreased LH, FSH, oestrogens & progestogens
  • gastrointestinal - enlarged salivary glands, pancreatitis, constipation, peptic ulcers
  • cardiovascular - cardiac failure, ECG abnormalities, arrhythmias
  • renal - renal failure, renal stones
  • neurological - seizures, peripheral neuropathy
  • haematological - iron deficiency anaemia, thrombocytopenia, leucopenia
  • msk - proximal myopathy, osteoporosis
91
Q

ASD

A

Pervasive developmental disorder characterised by a triad of impairment in social interaction, impairment in communication and restricted, stereotyped interests and behaviours

92
Q

ASD aetiology

A
  • prenatal
    • genetics - chromosome 7, fragile X syndrome, tuberous sclerosis
    • parental age - a study found that women who are 40 years old have a 50% greater chance of having a child with autism as compared with women aged 20-29 years
    • drugs - exposed to certain medications in the womb have a greater risk of developing autism (include sodium valproate in particular)
    • infection - viral infections increase the risk of autism
  • antenatal
    • hypoxia during childbirth
    • decreased gestational age at birth
    • very low birthweight
  • postnatal
    • toxins - lead and mercury may increase the risk of autism
    • pesticide exposure may affect those genetically predisposed to autism
93
Q

ASD risk factors

A
  • males are 4x more likely
  • genetics
  • family history
  • advancing parental age
  • parental psychiatric disorders
  • prematurity
  • maternal medication use
94
Q

ASD sx

A
  • asocial
    • few social gestures
    • lack of eye contact, social smile, response to name, interest in others, emotional expression, sustained relationships
  • behaviour restricted
    • restricted, repetitive and stereotyped behaviour
    • upset at any change in daily routine
    • obsessively pursued interests
  • communication impaired
    • distorted and delayed speech
    • echolalia (repetition of words)
95
Q

ASD diagnosis

A
  • presence of abnormal or impaired development before the age of three
  • qualitative abnormalities in social interaction
  • qualitative abnormalities in communication
  • restrictive, repetitive and stereotyped patterns of behaviour, interests and activities
  • the clinical picture is not attributable to other varieties of pervasive developmental disorder
96
Q

ASD mx

A
  • general points
    • local autism teams
    • CBT
    • ensure all physical health, mental health and behavioural issues
    • families and carers should also be offered personal, social and emotional support
  • interventions
    • social-communication intervention
    • treat co-existing physical disorders, mental health and behavioural problems
    • modification of environmental factors which initiate or maintain challenging behaviour
    • antipsychotics
97
Q

ADHD

A

Characterised by an early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development

  • present in more than one situation
98
Q

ADHD aetiology

A
  • genetic predisposition - DRD4 and DRD5 thought to be implicated
  • neurochemical - abnormality in dopaminergic pathways
  • neurodevelopmental - abnormality of pre-frontal cortex
  • social - social deprivation, family conflict, parental cannabis & alcohol exposure
99
Q

ADHD RFs

A
  • males
  • family history
  • social deprivation
  • family conflict
  • parental cannabis
  • alcohol exposure
100
Q

ADHD symptoms

A
  • inattention
  • hyperactivity
  • impulsivity
101
Q

ADHD diagnosis

A

Demonstrate abnormality of attention, activity and impulsivity at home for the age & developmental level of the child

Onset < 7 years

Duration > 6 months

IQ > 50

102
Q

ADHD treatment

A

Support groups

Parent training & education programmes

Psychoeducation & CBT

Severe → offer methylphenidate (CNS stimulant)

  • atomoxetine is alternative
  • SE: headache, insomnia, loss of appetite and weight loss
103
Q

Bulimia

A

Characterised by recurrent binge-eating episodes with a loss of control, followed by inappropriate compensatory behaviours to prevent gain

Compensatory behaviours - self-induced vomiting, laxative or diuretic misuse, fasting or excessive exercise

Behaviours/episodes occur once a week/more for one month

104
Q

Bulimia symptoms

A

Psychological symptoms

  • binge eating: loss of control, consuming large amounts of high-caloric food urgently
  • purging: induced vomiting, laxative or diuretic misuse & excessive exercise
  • body image distortion: distorted perception despite maintaining normal/slightly above average weight

Physical symptoms

  • dental erosion
  • parotid gland swelling
  • Russell’s sign
  • amenorrhea
  • excessive vomiting complications - Boerhaave syndrome or Mallory-Weiss tear
105
Q

Bulimia mx

A

Bulimia nervosa focused guided self-help/focused family therapy for children

Specialist referral - essential for ongoing management

High-dose fluoxetine considered in some cases

106
Q

Binge-eating disorder

A

Recurrent episodes of binge eating in the absence of compensatory behaviours

Episodes are marked by feelings of lack of control

107
Q

Binge eating disorder symptoms

A

Recurrent episodes of binge eating (once per week for 3 months) in the absence of compensatory behaviours

Body weight may be maintained at normal, overweight or obese

108
Q

Binge eating mx

A

Psychological interventions

  • group/individual CBT-ED
  • evidence-based self-help programmes with brief supportive sessions

Y4 psychiatry (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions