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conditions Flashcards

1
Q

what are affective disorders

A

Disorders of mental status and function where altered mood is the core feature

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2
Q

what may be secondary causes of an affective mood disorder

A

cancer, dementia, drug misuse or medical treatment (steroids).

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3
Q

what 2 classification systems are used to diagnose affective disorders

A

ICD- 10 – International classification of disease 10th Edition – World Health Organisation
DSM-5 – Diagnostic and Statistical Manual of Mental Disorder 5th Edition – American Psychiatric Association

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4
Q

what is depression

A

An emotion/ state of feeling, or mood, that can range from normal experience to severe, life-threatening illness

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5
Q

what percentage of people with depression have recurrent episodes

A

80%

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6
Q

is depression more common in males or females

A

females

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7
Q

what age range is highest risk for depression

A

18-44

median 25, mean 27

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8
Q

does depression run in the family

A

increased risk in 1st degree relatives

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9
Q

what things is the onset of depression often associated with

A

excess of adverse life events such as separations, bereavements (exit events)

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10
Q

when does depression become abnormal

A
  1. Persistence of symptoms (length)
  2. Pervasiveness of symptoms (how they affect you)
  3. Degree of impairment to daily activities
  4. Presence of specific symptoms or signs
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11
Q

what is the diurnal variation of depression

A

worse in morning

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12
Q

what is anhedonia

A

loss of ability to derive pleasure from experience

can’t experience pleasure in the things you normally would

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13
Q

what are some physical changes in depression

A 
lack of energy 
can't sleep/ early wakening 
loss of appetite
loss of libido 
constipation 
pain
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14
Q

how can depression change psychomotor functioning

A

o Agitation – restless anxiety

o Retardation – abnormal slowness of thought and action

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15
Q

what are some signs of severe depression (SUICIDE)

A 
S – 	suicide plan/ ideas
U – 	unexplained guilt/ worthlessness
I – 	inability to function (pshycomotor retardation/ agitation)
C-	 concentration impairment
I –	 impaired appetite
D –	 decreased sleep/ early wakening
E- 	energy low/ unaccountable fatigue
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16
Q

what are some social changes that can occur in depression

A

Loss of interests
Irritability
Apathy
withdrawal, loss of confidence, indecisive
Loss of concentration, registration & memory

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17
Q

what is agitation

A

a state of restless overactivity, aimless or ineffective

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18
Q

what is apathy

A

loss of interest in own surroundings

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19
Q

what is stupor

A

a state of extreme psychomotor retardation in which consciousness is intact.
The patient stops moving, speaking, eating and drinking. On recovery can describe clearly events which occurred whilst stuporose. Very severe form of depression

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20
Q

how long do symptoms of depression last for diagnosis

A

2 weeks

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21
Q

what must you always ask about mood before you diagnose depression

A

ever had episodes of elevated mood - bipolar

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22
Q

what can depression as a diagnosis not be attributed to

A

psychoactive substance use,
organic mental disorder
recent bereavement

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23
Q

what is the required for a mild depression diagnose

A

At least 2 of the typical symptoms and 2 other core symptoms (4+ in total)

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24
Q

what is the required for a moderate depression diagnose

A

At least 2 of the typical symptoms and 4 other core symptoms (6+ in total)

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25
Q

what is the required for a severe depression diagnose

A

All 3 of the typical symptoms and additional 5 core symptoms (8+ in total)

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26
Q

what are the 3 ‘typical’ symptoms of depression used in ICD-10 classification

A

Depressed mood that is abnormal for most of the day almost every day for the past two weeks, largely uninfluenced by circumstances. May be slight diurnal variation (worse in morning)
Loss of interest or pleasure in daily life, especially things previously enjoyed. (anhedonia)
Decreased energy or increased fatigability that pervades life

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27
Q

what are additional core symptoms that add to the ICD-10 cdiagnosis of depression

A

¥ Change in appetite +/- weight loss without dieting.
¥ Disturbed sleep – initial insomnia or early wakening (3+ hours earlier than usual)
¥ Psychomotor retardation (limited spontaneous movement, sluggish thought process), or agitation (subjective feeling of restlessness)
¥ Decreased libido (sex drive)
¥ Reduced ability to concentration
¥ Unreasonable feelings of guilt or worthlessness or self-reproach. Loss of confidence or self esteem.
¥ Decreased concentration
¥ Recurrent thoughts of death by suicide or any suicidal behaviour

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28
Q

what time period is there increased risk of psychiatric admission after childbirth

A

30 days

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29
Q

what is baby blues

A

low mood within 2 weeks of burst - short lived, related to tiredness and hormonal changes

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30
Q

how many woman experience puerperal psychosis

A

1 in 500 deliveries with a risk of recurrence of 1-3 with subsequent deliveries

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31
Q

what is somatic syndrome

A

Mood disorder characterised by cluster of physical symptoms

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32
Q

give features of somatic syndrome

A

¥ Marked loss of interest or pleasure in activities that are normally pleasurable
¥ lack of emotional reactions to events or activities that normally produce an emotional response
¥ waking 2 hrs before the normal time
¥ Depression worse in the morning
¥ Objective evidence of psychomotor agitation or retardation
¥ Marked loss of appetite
¥ Weight loss (5%+ of body weight in a month)
¥ Marked loss of libido

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33
Q

what is the differential diagnosis of depression

A
  • Normal reaction to life event - SAD – seasonal effectiveness disorder
  • Dysthymia - Cyclothymia
  • Bipolar - Stroke, tumour, dementia
  • Hypothyroidism, Addison’s, Hyperparathyroidism
  • Drugs e.g. B-blockers
  • Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
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34
Q

give some measurement tools of depression

A

SCID (Structured Clinical Interview for DSM 5 disorders)
SCAN (Schedules for Clinical Assessment in Neuropsychiatry) – ICD10 classifications
HDRS (Hamilton Depression Rating Scale)
BDI-II (Beck Depression Inventory II)
HADS (Hospital Anxiety and Depression Scale)
PHQ-9 (Patient Health Questionnaire 9)

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35
Q

give classes of antidepressants

A

Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic antidepressants (TCAs)
Monamine Oxidase Inhibitors

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36
Q

what are psychological treatments of depression

A

CBT, IPT, Individual dynamic psychotherapy, family therapy

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37
Q

what are physical treatments of depression

A

ECT (strong evidence), Psychosurgery, Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS)

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38
Q

how long are anti-depressants continued for after recovery to prevent relapse

A

6 months

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39
Q

what regimen is used to switch antidepressant drugs

A

maudsley regimen

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40
Q

what is the 1st line treatment for depression

A

SSRI

fluoxetine, citalopram, sertraline

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41
Q

how long may SSRI’s take to work

A

6 weeks

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42
Q

what do you need to do if you prescribe someone citalopram

A

ECG - long QT intervals

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43
Q

why are SSRI’s first line treatment for depression

A

favourable benefit: risk ratio

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44
Q

what is 3rd line treatment for depression

A

Mirtazapine (noradrenergic and specific serotenergic antidepressant)
venlaflaxine (serotonin and noradrenaline reuptake inhibitor (SNRI))

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45
Q

what is 4th line treatment for depression

A

Lithium is effective as an adjunctive therapy but has significant toxicity problems.
Consider other antidepressants such as TCA (noritriptyline, clomipramine) or monoamine oxidase inhibitors (MAOIs) (moclobemide, phenezine).

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46
Q

what is the normal clinical course of depression

A 
typical episode lasts 4-6 months
54% recovered at 26 weeks
12% fail to recover
80+% have further episodes – 40% in mild
15% die by suicide
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47
Q

what is mania

A

A term to describe a state of elevated feeling/mood, that can range from near-normal experience to severe, life-threatening illness (can be a danger to yourself).
Rarely a symptom, often associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs

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48
Q

what kind of behaviours are seen in mania

A

rapid speech, hyperactivity, low sleep, hyper sexuality. extravagance

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49
Q

what is meant by hypo main

A

• Hypomania
o Lesser degree of mania, no psychosis, (hallucinations/ delusions)
o Mild elevation of mood for several days on end
o Increased energy and activity, marked feeling of wellbeing
o Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep
o May be irritable
o Concentration reduced, new interests, mild overspending
o Not to the extent of severe disruption of work or social rejection

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50
Q

what re the main differences between mania and hypomanis

A

hypomania has no psychosis and no disruption of work or social rejection

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51
Q

how long must the symptoms of mania last for diagnosis

A

1 week

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52
Q

what are symptoms of mania (without psychotic symptoms)

A

o Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
o Disinhibition
o Grandiosity – sense of self importance
o Alteration of senses
o Extravagant spending
o Can be irritable rather than elated.

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53
Q

what is the psychiatric differential diagnosis of mania

A 
Mixed Affective state	Schizoaffective disorder		Schizophrenia				Cyclothymia		
ADHD				
Alcohol
Antidepressants 		
cocaine/ amphetamine
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54
Q

what is the medical differential diagnosis of mania

A 
Stroke			
 MS				
Tumour
Epilepsy			
AIDS				Neurosyphilis
Endocrine – Cushing’s, hyperthyroidism
SLE
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55
Q

what methods can be used to measure symptoms of mania

A
  • SCID
  • SCAN
  • Young Mania Rating Scale (YMRS) – measure how symptoms change
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56
Q

what is the treatment of acute mania

A

Antipsychotics – Olanzapine, Risperidone, Quetiapine

Mood Stabilisers - Sodium Valproate, Lamotrigene, Carbamazepine

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57
Q

what can be used to treat severe mania

A

ECT

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58
Q

what is bipolar disorder

A

repeated (2+) episodes of depression and mania or hypomania.

If no mania or hypomania then diagnosis is recurrent depression.

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59
Q

what is the mean onset for bipolar disorder

A

21

>30 unusual

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60
Q

does bipolar disorder run in families

A

associated with 1st degree relatives

early onset 15-19

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61
Q

what is the treatment for bipolar disorder

A

successful treatment of depressive/ manic episodes

prophylaxis - lithium (mood stabiliser)

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62
Q

what mood stabiliser is used to treat bipolar disorder

A

lithium

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63
Q

what are signs of lithium toxicity

A

decreased vision, D&V, low potassium, ataxia, tremor, dysarthria, coma

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64
Q

what should you monitor when you prescribe lithium

A

Check Li levels weekly for 4 weeks, then monthly for 6 months, then 3 monthly if stable.

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65
Q

what is the typical clinical course of bipolar disorder

A 
typical manic episode lasts 1-3 months
60% recovered at 10 weeks
5% fail to recover
90% have further episodes
1/3 have poor outcome, 1/3-1/4 have good outcome
10% die by suicide
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66
Q

what is psychosis

A

Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
severe form of mental illness

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67
Q

what do people with psychosis lack

A

insight - into having illness, how it affects them, need for treatment/ hospitalization

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68
Q

what illnesses may have psychotic symptoms

A

Schizophrenia
organic mental disorder – delirium, brain tumour
If occur with Severe affective disorder - Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms

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69
Q

what are the main 2 features of psychosis

A

hallucinations - no external stimulus
delusional beliefs
disordered thinking

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70
Q

what is the most common cause of psychosis (not intoxication)

A

schizophrenia

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71
Q

what are the positive and negative symptoms of schizophrenia

A

positive - hallucinations, delusions, disordered thinking

negative - apathy, anhedonia, lack of emotion

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72
Q

how long must schizophrenic symptoms occur for to be diagnosed

A

over a month

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73
Q

what are single symptoms that diagnose schizophrenia

A

alienation of thought - thought broadcasting, insertion, withdrawal
delusions
auditory hallucinations
persisting delusions of other kinds that are impossible

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74
Q

give symptoms that if 2 are present then schizophrenia is diagnosed

A

persistent hallucinations that occur every day
breaks in train of thought - irrelevant speech
catatonic behaviour
negative symptoms - apathy, blunting, incongruity of emotional response

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75
Q

what is the most common form of schizophrenia

A

paranoid

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76
Q

what is meant by a predisposing, precipitating and perpetuating factor for a psychiatric illness

A

predisposing - at risk
precipitating - made it happen
perpetuating - keep it going

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77
Q

what are schneider’s first rank symptoms of schizophrenia

A

alienation of thought - thought broadcasting, insertion, withdrawal
delusions
auditory hallucinations
persisting delusions of other kinds that are impossible

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78
Q

give examples of catatonic behaviour

A

excitement, posturing or waxy flexibility (don’t correct odd position), negativism, mutism and stupor (unresponsive).

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79
Q

what neurochemistry is linked to schizophrenia

A

increased dopamine activity

Also Glutamate, GABA, Serotoninergic transmission linked to negative symptoms

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80
Q

what are some biological factors that may lead to schizophrenia

A 
genetics - neurkgulin, dysbindin 
neurochemistry - dopamine
Obstetric complications/ Maternal influenza 
Malnutrition and famine
Winter birth – more chance
Substance misuse
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81
Q

what population has a high excess of schizophrenic patients

A

migrants - change in time, moral and cultural symbols

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82
Q

what kind of psychotic symptoms are seen in a Depressive episode with psychotic symptoms

A

¥ Delusions of guilt, worthlessness and persecution (dead/ rotting)
¥ Derogatory auditory hallucinations – arguing etc.

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83
Q

what kind of psychotic symptoms are seen in a manic episode with psychotic symptoms

A

Delusions of grandeur; special powers or messianic roles

Gross overactivity, irritability and behavioral disturbance: Manic excitement

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84
Q

what class of drugs is used to treat schizophrenia

A

ant- psychotics

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85
Q

what side effects are seen with 1st generation anti-psychotics - chlorprozamine, haloperidol

A

extra-pyramidal - tremor, slurred speech akathisia (motor restlessness), dystonia (continuous spasms and muscle contractions

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86
Q

what side effects are seen with 2nd generation anti-psychotics

A

weight gain, hyperglycaemia, dyslipidamiea

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87
Q

what type of drug are 1st generation anti-psychotics

A

dopanima antagonists

e.g. chlorprozamine, haloperidol

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88
Q

what type of drug are 2nd generation anti-psychotics

A

serotonin and dopamine antagonists

e.g. amisulpride, olanzapine, quetiapine, risperidone, zotepine

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89
Q

what is the only licensed 3rd generation anti-psychotic

A

aripiprazole

dopamine partial agonist

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90
Q

what drug is used for treatment resistant schizophrenia

A

clozapine

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91
Q

what is a major Side effect of clozapine

A

blood dyscrasia - need weekly FBC for 18 weeks, then fortnight for 18 weeks then monthly

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92
Q

what is meant by early intervention in the treatment of schizophrenia

A

CBTp and increased family/social support

grade A evidence

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93
Q

what percentage of people recover after an episode of psychosis

A

80%

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94
Q

what are good prognostic factors for recovery of schrizophrenia

A

Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant ,
Acute onset
Mood disturbance
Prompt treatment, Maintenance of initiative, motivation

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95
Q

what are poor prognostic factors for recovery of schrizophrenia

A

slow, insidious onset
prominent negative symptoms
substance misuse
early age of onset

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96
Q

what is the DSM-5 definition of a personality disorder

A

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
(no history, no other diagnosis, no physiological change)

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97
Q

what are the prominent problems with cluster A personalities

A

perceived safety of interpersonal relationships

Thought as being a sequelae of severe problems in early relationships.

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98
Q

what are the prominent problems with cluster B personalities

A

keeping feelings tolerable without acting

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99
Q

what are the prominent problems with cluster C personalities

A

relate to anxiety and how it is managed (in relationships

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100
Q

what 3 personality disorders are seen in cluster A personalities

A

paranoid
schizoid
scizotypical

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101
Q

what is meant by a paranoid personality disorder

A

no one can be expected to have anything but malign intent and have a pervasive distrust and suspiciousness of others.
Patients with a Paranoid PD do not usually come for treatment

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102
Q

what is meant by a schizoid personality disorder

A

patients look as if they have no interest whatsoever in social relationships (restricted range of expressions and emotions) and may always choose soliatary experiences. Characteristically, they seem aloof and odd.

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103
Q

what is meant by a schizotypical personality disorder

A

very odd ways of thinking and relating that are not quite as engrained as in a psychotic disorder. Seen is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships and distortions of behaviour
not likely to be seen

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104
Q

what is meant by obsessive compulsive personality disorder

A

There is a preoccupation with obstinacy, perfectionism, and orderliness at the expense of efficiency and flexibility that probably protects the patient from anxiety

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105
Q

what 2 types of personality disorders are seen in cluster C personalities

A

obsessive compulsive personality disorder

avoidant/dependent personality disorder

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106
Q

what is meant by avoidant / dependent personality disorder

A

People often try to cope with anxiety about interpersonal situations either by avoiding them completely with hypersensitivity to negative evaluation or by getting other people to take over their lives with clinging behaviour and fears of separation. Seen in substance use disorders.

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107
Q

what 4 types of personality disorders are seen in cluster B personalities

A

antisocial personality disorder
borderline personality disorder
narcissistic personality disorder
histrionic personality disorder

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108
Q

what is meant by histrionic personality disorder

A

patients have had badly damaged development in their ability to relate to people. Have a pattern of excessive emotionality and attention seeking beginning in early adulthood. Instead of any straightforward relating, they tend to relate in a heavily sexualised way, inappropriate to the context and like to draw attention to themselves.

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109
Q

what is meant by narcissistic personality disorder

A

present with a grandiose sense of their own importance and a
sense of exceptional entitlement, but suspect instead that the patient is really quite damaged in their self-esteem, and relies on this rigid presentation of their importance in order to cover this
lack empathy

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110
Q

what is meant by antisocial personality disorder

A

=Characterised by a repeated tendency to
disregard and to violate the rights of others. Psychopathic people tend to engage in more extreme violence, with prominent callousness and lack of emotion, and with little remorse for their victims

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111
Q

where are there high rates of people with antisocial personality disorder

A

prison

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112
Q

what are the age restrictions for antisocial personality disorder

A

must be 18

evidence of conduct disorder <15

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113
Q

what is the ICD classification of antisocial personality disorder (read only)

A

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

  1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
  2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
  3. impulsivity or failure to plan ahead
  4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
  5. reckless disregard for safety of self or others
  6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
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114
Q

what is the most clinically relevant personality disorder

A

borderline

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115
Q

what is meant by borderline personality disorder

A

Emotionally Unstable Personality Disorder. Pervasive pattern of instability of interpersonal relationships and self-image.

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116
Q

what is the common history of people with borderline personality disorder

A

serious problems in their early attachments, or significant childhood trauma.
developed
an uncertain sense of the safety of relationships, and are prone to feeling like they are going to be abandoned

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117
Q

what is the ICD classification of borderline personality disorder (read only)

A

A pervasive pattern of instability of interpersonal relationships, self-image, andaffects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment. (Note:Do not includesuicidalor self-mutilating behavior covered in Criterion 5.)
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,Substance Abuse, reckless driving, binge eating).
Note:Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity ofmood(e.g., intense episodicdysphoria,irritability, oranxietyusually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-relatedparanoidideation or severedissociativesymptoms

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118
Q

what is the main management of personality disorders

A

psychotherapy - relationship therapy
best doen in a group
at least 18 months

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119
Q

what is meant by dialect behavioural therapy

A

derived from behavioural psychology and from mindfulness. In DBT, therapists help the patient to find ways to manage intense feelings, and to find behavioural strategies for how they relate to others that may prevent them from getting such strong feelings.

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120
Q

what is meant by mentalization based treatment

A

derived mainly from developmental psychology and from psychodynamic practice. Therapists help the patient to recognise times when they feel overwhelmed and cannot do anything but act. They work with them to think about what they are actually feeling, and to try to understand what the other party is feeling, and to use these alternative perspectives to make a more reality-oriented way of relating to others

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121
Q

when do most cases of anorexia nervosa start

A

before 22

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122
Q

what percentage of eating disorder cases are male

A

10%

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123
Q

what is diabulimia

A

omit insulin after meals

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124
Q

what personalities are attributed to eating disorders

A

intelligence
driven/ focused
perfectionist

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125
Q

what is a screening tool used for eating disorders

A

SCOFF

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126
Q

describe the SCOFF screening tool for eating disorders

A
  1. Do you make yourself Sick because you feel uncomfortably full?
  2. Do you worry you have lost Control over how much you eat?
  3. Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
  4. Do you believe yourself to be Fat when others say you are too thin?
  5. Would you say that Food dominates your life?
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127
Q

what is the main fear in anorexia

A

fatness

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128
Q

what is the diagnostic criteria for anorexia

A

reduced intake of calories to reduce weight
compensatory behaviours when food can’t be avoided
BMI <17.5 / 15% below ideal
fear of weight gain

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129
Q

what are some compensatory behaviours seen in eating disorders for eating food

A 
Self-induced vomiting
, laxative abuse, 
excessive exercise, 
abuse of appetite suppressants / diuretics to dehydrate
over activity 
cooling - inadequate dress
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130
Q

what is a sign of anorexia in postmenarchal woman

A

secondary amenorrhoea

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131
Q

what are signs of anorexia

A 
low tem, BP, pulse
constipation 
cold intolerance
dry skin 
languo hair 
fainting
scalp hair loss
fatigue
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132
Q

why does anorexia lead to bloating

A

gut muscle slows down leading to consitpation

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133
Q

what is bulimia nervosa

A

episodes of binge eating with a sense of loss of control followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets).

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134
Q

how many times must binging/ purging occur for a bulimia diagnosis

A

2x a week for 3 months

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135
Q

what is the BMI of people with bulimia

A

normal

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136
Q

why are people with eating disorders at risk of cardiac arrhythmia

A

electrolyte imbalance - low K

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137
Q

what is russels sign a sign of

A

callus on back of hand - during in bulimia

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138
Q

why may people with bulimia get more upper GI symptoms (mouth sores, heartburn, chest pain)

A

increased stomach acid

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139
Q

what commonly becomes swollen in pateitns with bulimia

A

parotid glands

140
Q

what drug can be used to help treat bulimia

A

fluoxetine

141
Q

what is the prognosis of bulimia

A

in 2-10 years, 50% improve, 20 % show no change

142
Q

what features are seen in binge eating disorder

A

unusually fast eating, usually alone.
unusually large amounts consumed.
uncomfortably full; often “buzzed” after eating.
embarrassment, shame, guilt, depression

143
Q

what are some common ways people avoid calories

A

going vege/ vegan
developing allergies
odd eating habits - slow, finish last
avoid parties/ social

144
Q

what are some behaviours seen in eating disorders

A

body checking - repeated weighing/ mirror

pro-ana websites

145
Q

what are psychological consequences of eating disorders

A

narrowed focus of interest
unable to interpret emotions
increased depression, anxiety and obsession with food

146
Q

what are social consequences of eating disorders

A

isolated form friendships

loss of interest in sexual reltionships

147
Q

what are some physical consequences of eating disorders

A 
reduced immunity 
fertility problems 
hear arrhythmias
dry skin, cold intolerance 
delayed puberty 
languo hair/ scalp hair loss 
short stature
148
Q

what are some predisposing factors to eating disorders

A

personality trait run in families - OCD, anxiety, perfectionism

149
Q

what are some precipitating factors to eating disorders

A

puberty/ hormonal changes
increased exercise
stressful life events - moving, bullying, break up, exams

150
Q

what are some perpetuating factors to eating disorders

A

delayed gastric emptying - feel bloated
obsession - phobia increases as avoidance increases
unsupportive families

151
Q

what psychiatric disorder has the highest mortality

A

anorexia

10x risk of premature death

152
Q

what is the average length of recovery for anorexia nervosa

153
Q

what is the first line treatment for severe anorexia

A

re-feeding

154
Q

how does re-feeding syndrome occur

A

rapid initiation of food after >10 days fasting, due to low phosphate

155
Q

do anti-depressants help anorexia

A

not on starved brain

high dose

156
Q

what anti-psychotic is occasionally used to treat anorexia

A

olanzapine

157
Q

what act give the right to treat people even in the absence of consent to save life or prevent serious deterioration

A

Scottish mental health act

158
Q

what is the biomechanical engineering model of stress

A

Stress and strain on a person can be tolerated until a breaking point then physiological and psychological stress occur ‘straw that broke the camels back’

159
Q

what is the medicophsyiological model of stress

A

general and non-specific event occurs and produces a fight or flight response. If stressor persists, person experiences an alarm reaction followed by a physiological adaptation that can be coped with until exhaustion is reached

160
Q

what is the psychological (transactional) model of stress

A

stress is a dynamic transaction between individual and environment. Assumes an environmental stressor doesn’t’t always cause an individual to cause stress and that response is personal . An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope

161
Q

what are the 2 different ways of coping

A

Problem focussed -Where efforts are directed toward modifying stressor.
Emotion focussed - Modify emotional reaction.

162
Q

what are the psychological symptoms of anxiety

A 
Fearful Anticipation – worrying before you know what’s going to happen
Irritability
Sensitivity to noise  
Poor concentration
Worrying Thoughts
163
Q

what are the autonomic symptoms of anxiety

A

GI – dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loose motion
Respiratory – tight chest, difficulty inhaling
Cardiovascular – palpitations, missed beats, chest pain
Genitourinary – frequency/ urgency of micturition
CNS – dizziness and sweating

164
Q

what is generalised anxiety disorder

A

Persistent (several months) symptoms not confined to a situation or object and can occur in any environment

165
Q

what are the classes of symptoms of anxiety

A 
Psychological arousal, 
Autonomic Arousal, 
Muscle Tension, - tremor , headache, muscle pain 
Hyperventilation
Sleep Disturbance
166
Q

what are the most common symptoms seen in generalised anxiety disorder

A

nervousness, sweating, trembling, light headed, palpitations, epigastric discomfort

167
Q

what disorder replaces anxiety with age

A

somatisation

168
Q

what is the non pharmacological treatment for GAD

A

counselling - education and explanation
advice re caffeine, alcohol, exercise
CBT

169
Q

what is the medical therapy of anxiety

A

SSRIs first line - TCA/ MOAI
preglabalin
B blockers can imporobce somatic symptoms

170
Q

what is proven to be the best method of treating anxiety and why

A

CBT - learn skills that can be applied

171
Q

what is the differential diagnosis of anxiety disorders

A

Psychiatric - Depression, Schizophrenia, Dementia , Substance, Misuse
Physical -Thyrotoxicosis, Phaeochromoctoma, Hypoglycaemia, Asthma or Arrhythmias

172
Q

what is different with GAD and phobic anxiety disorder

A

phobic only experience in specific circumstances that are not dangerous

173
Q

what is agoraphobia

A

fear of situations difficult to escape - tend to avoid

174
Q

what is social phobia

A

fear of scrutiny by other people

175
Q

what things does CBT challenge

A

¥ Negative views of self (question if reasonable)
¥ “Safety barriers” to avoid situations that make anxious
¥ Unrealistically high standards
¥ Excessive self monitoring
¥ Education and advice

176
Q

what is the treatment of social phobias

A

SSRI antidepressants effective - CBT remain remission

177
Q

what are the core features of OCD

A

experience of recurrent obsessional thoughts and compulsive acts.

178
Q

what are obsessional thoughts

A

stereotyped, purposeless words, ideas or phrases that come in to mind.
Occurring repeatedly not willed
Unpleasant and distressing (often the antithesis of personality type)

179
Q

what do people with OCD get when they try to resist their obsessive thoughts/ compulsive acts

A

key anxiety symptoms

180
Q

what are compulsive acts

A

Senseless, repeated rituals. (predictable)
Not enjoyable or helpful i.e. do not result in useful activity
Often viewed by sufferer as preventing some harm to self or others; “magical undoing” or preventing the distress of the obsession

181
Q

what is the management of OCD

A

educations/ explanation
CBT
fluoxetine (SSRI), clomipramine (TCA)

182
Q

what is post traumatic stress disorder

A

Delayed and or protracted reaction to a stressor of exceptional severity

183
Q

what things may precipitate PTSD

A 
Combat – military 		
Natural or human-caused disaster
Rape				
Assault/ sexual assault 
Torture 				
Witnessing any of these events
184
Q

why is PTSD twice as common in women than men

A

rape/ sexual assault

185
Q

what are risk factors for PTSD

A

nature of stressor
vulnerability - mood disorder, lack of social support
partly genetics
previous neurotic disease

186
Q

what are protective factors against PTSD

A

higher education and social group, good paternal relationship

187
Q

what are the 3 key element of reaction

A
  1. hyperarousal (autonomic)
  2. Re-experiencing phenomena
  3. avoidance of reminders
188
Q

when do the PTSD usually occur

A

3 moths after event

189
Q

what are the symptoms of PTSD caused by autonomic hyperarousal

A

persistent anxiety, irritability, insomnia, poor concentration, sweating

190
Q

what percentage of people recover form PTSD in 1 year

191
Q

what is given if people have severe PTSD

A

CBT - short term 16 sessions – includes relaxation, psychoeducation, cognitive coping strategies

192
Q

what special type of therapy is given to people with PTSD

A

Eye Movement Desensitisation and Reprocessing therapy – uses bilateral sensory stimulation to assist clients in processing traumatic experiences

193
Q

what are organic mental disorders

A

characterised by demonstrable organic brain damage or mental disorder arising in the context of demonstrable physical disease.

194
Q

what is different about the onset of organic mental disorders and learning disability

A

organic mental disorders are acquired whereas learning disabilities are present form birth/ childhood

195
Q

what are common features of cognitive impairment seen in organic mental disorders

A 
disorientation 
impaired concentration 
memory loss
language - expressive and receptive dysphagia 
insight 
poor judgement
196
Q

what is affected first in disorientation when someone has cognitive impairment due to an organic mental disorder

A

position in time and place

197
Q

what does the test of 7s assess

A

attention/ concentration

198
Q

what type of memory loss is usually seen in cognitive impairment due to an organic mental disorder

A

anterograde - difficulty to register information

199
Q

what behaviour abnormalities are seen in organic mental disorders

A

agitation, aggression – change in personality
Slowing, psychomotor retardation
Abnormal social conduct – disinhibited, hallucinations

200
Q

what mood changes are seen in organic mental disorders

A

low mood, anxiety, mania

201
Q

what psychotic features may be seen in organic mental disorders

A

Hallucinations (mostly visual), delusions (persecutory/ harm)

202
Q

what is the difference in hallucinations between schizophrenia and organic mental disorders

A

schizo - auditory

organic - visual

203
Q

what is difference about the onset of dementia and delirium

A

delirium - acute - mins/ hours/ days

dementia - insidious - weeks/ months/ years

204
Q

what is delirium

A

Transient organic mental syndrome of acute or subacute onset which is characterised by global cognitive impairment.

205
Q

give some presenting features of delirium

A

¥ Impaired attention/concentration
¥ Anterograde memory impairment
¥ Disorientation in time, place or person
¥ Fluctuating levels of arousal
¥ Disordered sleep/wake cycle
¥ Increased/decreased psychomotor activity
¥ Disorganised thinking as indicated by rambling, irrelevant or incoherent speech
¥ Perceptual distortions, leading to misidentification, illusions, and hallucinations
¥ Changes in mood such as anxiety, depression and lability

206
Q

when are symptoms of delirium often worse

207
Q

what is the difference between hypoactive delirium and hyperactive delirium

A

hypo- drowsy and withdrawn

hyper - agitated and upset

208
Q

give some causes of delirium

A 
drugs 
Infections - UTI
alcohol/ drug withdrawal 
metabolic 
endocrinopathies 
toxins 
dehydration/ constipation
209
Q

what is the management of delirium

A

find precipitating cause and treat

optimise support, get family in

210
Q

when are sedatives given in delirium

A

extreme agitation/ risk

investigations are needed

211
Q

what is dementia

A

A syndrome which characterised by global cognitive impairment which is chronic in nature

212
Q

give types of dementia

A

Alzheimer’s, vascular, lewy body, fronto-temporal

213
Q

what is meant by anterograde amnesia

A

lose orientation in place/ time, can’t hold new information, can’t learn new things

214
Q

what is meant by retrograde amnesia

A

have little memory from 2/3 years ago but full memory of past

215
Q

are global intellectual abilities spared in amnesic syndromes

A

yes , still present

216
Q

what things can cause damage to the hippocampus that may lead to amnesia

A 
Herpes simplex virus encephalitis			
Anoxia
Surgical removal of temporal lobes			
Head injury
Bilateral posterior cerebral artery occlusion		
Early Alzheimer’s
217
Q

what things can cause diencephalic damage that may lead to amnesia

A 
Korsakoff’s syndrome  – thiamine vit B1 
deficiency  
3rd ventricle tumours and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage – especially anterior communicating artery aneurysms
218
Q

What is developmental psychopathology

A

science underpinning psychiatry

219
Q

how is it proven that disorder such as ADHD and Autism are highly genetic.

A

twin studies - MZ vs DZ

220
Q

what studies are increasingly used to identify genetic risk factors for psychiatric disorder

A

Genome wide association studies (GWAS)

221
Q

what type of genetic factors are likely to be important in psychiatric disorders

A

Genetic factors serving modulation of gene expression - control influence of environmental factors on genetic expression

222
Q

if the pregnant mother smokes marijuana what is the child more susceptible to in childhood

A

depression

223
Q

what toxins affect formation of brain important for subsequent mental health (Intrauterine and perinatal factors )

A

lead, mercury and PCB’s

224
Q

why are twins more prone to mental health disorders

A

competing in intrauterine environment > reduced brain formation

225
Q

what conditions are higher in kids with foetal alcohol syndrome

A

ADHD, LD and DHD (developmental coordination disorder/ dyspraxia)

226
Q

why is white matter connectivity important in the brain

A

functions that require interplay between brain areas e.g. working memory between hippocampus and anterior cingulate

227
Q

what features are seen in conduct disorders

A

frequent loss of temper, arguing, becoming easily angered or annoyed, showing vindictive or other negativistic behaviours.

228
Q

what features are seen in ADD

A

distractibility, sustaining attention to tasks that don’t provide high level of stimulation or frequent rewards, distractibility and problems with organization

229
Q

what is impulsivity

A

tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences

230
Q

what are some environmental factors that can impact child mental health

A 
carer-child relationship 
parental mental disorders
family dysfunction 
abuse/ neglect 
bullying 
peer relationships
231
Q

how do early life stresses impact the brain

A

influences function of limbic circuit including amygdala. Mood and patterns of response to threat including withdrawal and/or aggressive response.

232
Q

what is the scientific basis of reward based learning

A

Dopamine neurons fire when you associate an action with a reward (Addiction)

233
Q

what is meant by the executive and cortical control behaviour pathway

A

Taking control over ‘automatic’ and learned behaviours through own development
Intentional decision-making and forward planning.
Requires self-awareness and capacity to self-monitor

234
Q

what behaviour pathway explains ADHD

A

delayed aversion/ gratification

inability to wait and maintain attention in the absence of immediate reward

235
Q

what is the theory of mind (absent in autism)

A

be able to understand a false belief and recognise a different mental state
compared to reality.

236
Q

what are some mental health problems associated with being out of school

A 
¥	Anxiety
¥	Conduct disorder – refusing / deciding not to do what is expected of them 
¥	Autism
¥	Depression
¥	Obsessional compulsive disorder
237
Q

what effects may mental health disorders have on school performance

A 
learning difficulties
poor attention 
difficulty controlling emotions 
anxiety/ depression/ lack of energy
difficulty joining in/ making friends
238
Q

what are the 3As of anxiety disorders

A

Anxious thoughts and feelings (e.g. impending doom)
Autonomic symptoms – tingling, churning, urination, blurred vision, heart palpating
Avoidant behaviour

239
Q

where in the brain is reduced connectivity seen in generalised anxiety disorders

A

Reduced connectivity between right ventrolateral cortex and amygdal

240
Q

what disorder is the child suffering from if they have problems at the doorstep or at the school gate

A

door - separation anxiety from paretns

social - fear of joining group

241
Q

is fluoxetine safe to use in children with anxiety

242
Q

how may anxiety be treated in kids

A

behavioural therapy

SSRIs

243
Q

describe a successful cognitive behaviour cycle

A

Challenge behaviour > succeed > improve self-confidence> increases resilience to take on more challenges

244
Q

describe an unsuccessful cognitive behaviour cycle

A

Challenge behaviour > avoidance gives sense of failure > lower self confidence > vulnerability and greater pattern of avoidance for new challenged

245
Q

why is cognitive behavioural therapy different in children

A

don’t have cognitive awareness

parents involved

246
Q

what are the goals of CBT in children

A

¥ Externalisation: take blame, guilt and anger away from disorder
¥ Psychoeducation: explaining the problem in terms that make sense to everyone
¥ Goal-setting: choosing reasonable objectives that can be achieved, agree on goals
¥ Motivatin.

247
Q

when is the onset of autism/ aspergers

248
Q

what brain neuropathology’s are assocoiated with autism

A

mainly glutaminergic synaptic function and GABA regulation

249
Q

what physical conditions are associated with autism

A

Rubella, Callosal agenesis, Down’s syndrome, Fragile X, Tuberous sclerosis.

250
Q

what ratio of males to females are affected by autism

251
Q

what are social features seen in autism

A

lack of reciprocal conversation, expressing emotional concern, abnormal response to being hurt

252
Q

how do autistic children have a lack of non verbal communication

A

no declarative pointing, modulated eye-contact, facial expression

253
Q

what repetitive behaviours are seen in autism

A

mannerisms, obsessions, bizarre preoccupations and interests

Rigid and inflexible patterns of behaviour – routines, rituals and repetitive play

254
Q

how can autism manifest as clinical problems

A 
learning disabilities
disturbed sleep/ eating
high naxiety/ depression 
OCD 
school avoidance
agression/ temper 
self injury/ harm
255
Q

what is the management of autism

A

¥ Recognition, description and acknowledgement of disability
¥ Decrease the demands -> reduce stress ->improve coping
¥ Parent training
¥ Psychopharmacology– risperidone (aggression), melatonin (sleep), SSRI (repetitive behaviour)

256
Q

what drug can be given to children to control aggression

A

risperidone

257
Q

what drug can be given to children to control repetitive behaviours

258
Q

what is the Most common neurobehavioral disorder of childhood

A

Attention deficit hyperactivity disorder (ADHD

259
Q

is ADHD genetic

260
Q

what are the core diagnostic criteria for ADHD

A

1 ) Inattention: unable to listen/ attend closely to detail, sustain attention in play activities, follow
instructions, finish homework, organise tasks needing sustained application, lose/ forget things
2) Hyperactivity: squirming/ fidgeting, always on the go, talks incessantly, climbs over everything, restless,
no quiet hobbies
3) mpulsivity: blurts out answers, interrupts others, can’t take turns, intrudes on others,

261
Q

how is ADHD diagnosed

A

clinically

history form parents/ school

262
Q

what is the rule of 1/3 for ADHD

A

At 18, 1/3 have no symptoms, 1/3 have symptoms that don’t need medications and 1/3 still need medication.

263
Q

what drugs can be used to manage ADHD

A

methylphenidate / atomoxetine (lasts 4 hours – purely symptomatic)
SE - appetite, weight, sleep

264
Q

what is the permanent management fo ADHD

A

parental training

265
Q

what are features seen on oppositional defiant disorder

A
  • Refusal to obey adult request - Often argues with adults
  • Often loses temper - Deliberately annoys people
  • Touchy or easily annoyed by others
  • Spiteful or vindictive
266
Q

what is ODD most likely to result form

A

impaired parenting

associated with adversity

267
Q

describe parent training programmes

A

¥ Structured training in groups, individuals or self-taught (e.g. DVD packages)
¥ 1-2hrs/wk for 8-12 weeks
¥ Informed by social-learning theory e.g modelling behaviour.
¥ Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships.

268
Q

what are lifetime outcomes of hard to manage children

A

antisocial behaviour, substance misuse, long-term mental health problems

269
Q

what is the best way to control hard to manage children

A

parent training programmes

270
Q

what do children use self injury as

A

is a coping mechanism

harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation

271
Q

what combination is particularly high risk for suicide

A

mood disorder, substance misuse and conduct disorder

272
Q

give factors that increase the risk of suicide

A
  • Persistent suicidal ideas
  • Previous suicidal behaviour
  • High lethality of method used
  • High suicidal intent and motivation
  • Ongoing precipitating stresses
  • Mental disorder
  • Poor physical health
  • Impulsivity, neuroticism, low self esteem, hopelessness
  • Parental psychopathology and suicidal behaviour
  • Physical and sexual abuse
  • Disconnection from support systems
273
Q

how is a suicide attempt i a young person handled

A

admit to age appropriate medical ward for treatments and psychosocial assessment

274
Q

what is the hospital prevalence of depression

275
Q

what is the hospital prevalence of dementia

276
Q

what is the hospital prevalence of delirium

277
Q

is dementia reversible

278
Q

when do dementia symptoms vary

A

day to day

279
Q

what is different about the attention span in dementia and delirium

A

normal in dementia

short in delirium

280
Q

what is different about consciousness span in dementia and delirium

A

dementia - clouded in late stage

delirium - fluctuating

281
Q

what is similar about depression and dementia

A

depressed mood coincides with memory loss

282
Q

what is the dementia syndrome of depression

A

depressive pseudo dementia

283
Q

what percentage of people with dementia will have co-existing symptoms of depression at some stage

284
Q

what is the ABCD of dementia

A

A for Activities of Daily Living (ADLs)
B for Behavioural and Psychiatric Symptoms of Dementia (BPSD)
C for Cognitive Impairment
D for Decline

285
Q

what are the cognitive features of dementia

A

¥ Memory loss (dysmnesia)
¥ Plus one or more of
o dysphasia (communication)- expressive, receptive
o dyspraxia (inability to carry out motor skills)
o dysgnosia (not recognising objects)
o dysexecutive functioning
Functional decline

286
Q

what are the 3 stages of AD progression

A

early
mild-moderate
severe

287
Q

describe the early stage of alzheimers disease

A

symptoms free

288
Q

describe the severe stage of alzheimers disease

A

functional ability is lost completely and institutionalization is inevitable.

289
Q

what are the 4A’s of alzheimers

A

amnesia
aphasia
agnosia
apraxia

290
Q

how is the diagnosis of alzheimers made

A 
clinical assessment 
clinical + collateral history 
mental state examination 
physical and bloods
cognitive assessment
291
Q

what deficits are seen in dementia with lewy body

A

Deficits of attention, frontal executive, visuospatial

292
Q

what are important features of lewy body dementia that may lead you to the diagnosis

A

Fluctuation - marked, important feature
Visual hallucinations
Parkinsonism

293
Q

whta scan may be abnormal in LEWY body dementia

A

DAT scan sensitivity and specificity around 85%

full stop sign

294
Q

what is different about the DAT scan in a patient with dementia with Lewy bodies and AD

A

AD patient will show normal re-uptake of the dopamine transporter in the head of the caudate nucleus and putamen in the shape of a ‘comma’
DLB, re-uptake in the putamen is reduced, leading to the ‘full-stop’ sign

295
Q

what sign is seen on a DAT scan of a patient with dementia with lewy bodies

296
Q

what are key features of frontotemporal dementia

A

behaviour/ personality change
early onset
speech disorder

297
Q

what speech disorders may be seen in FTD

A

altered output, stereotypy, echolalia, perseveration, mutism

298
Q

what is seen on neuroimaging of FTD

A

abnormalities in frontotemporal lobes

299
Q

what things are not severely impaired in neuropsychology

A

Memory, praxis and visuospatial function not severely impaired

300
Q

what is the usual clinical presentation of vascular dementia

A

gradual deterioration in executive function, as well as mood changes such as apathy or irritability

301
Q

who should you notify when you make a diagnosis of dementia

302
Q

why is memory relatively spared in vascular dementia

A

preservation of cortical grey matter

303
Q

what are the 2 most common tests done to assess cognition

A

mini- mental state examination

MOCA

304
Q

is capacity task specific

305
Q

what 5 things must be present for a person to have capacity

A

Act, communicate, understand, make decisions, retain memory

306
Q

what are the 2 types of guardianship

A

finance

wellfare

307
Q

what drugs are used to treat mild to moderate dementia

A

Acetylcholinesterase Inhibitors (AChI) - donepezil, rivastigmine, galantamine

308
Q

what drug is licensed for severe dementia

309
Q

what other classes of drugs may be used to treat dementia

A

¥ Antipsychotics - risperidone, quetiapine, amisulpride)
¥ Antidepressants - mirtazapine, sertraline)
¥ Anxiolytics - lorazepam
¥ Hypnotics - zolpidem, zopiclone, clonazepam
¥ Anticonvulsants - valproate, carbamazepine

310
Q

how do Acetylcholinesterase Inhibitors treat dementia

A

Improve cognitive function

Slow decline but do not stop disease progression

311
Q

what are side effects of Acetylcholinesterase Inhibitors

A

Nausea, vomiting, diarrhoea, fatigue, insomnia, muscle cramps, headaches, dizziness, syncope, breathing problems

312
Q

what fraction of care home residents have dementia

A

three quarters

313
Q

what is the prevalence of depression in the elderly community

314
Q

what is different about the way depression presents in the elderly

A

Less – depressed mood, expressed suicidal wishes

More – insomnia, hypochondriasis, suicide, agitation

315
Q

what are normal reactions to grief

A 
Ð	Alarm
Ð	Numbness
Ð	Pining – illusions or hallucinations may occur
Ð	Depression
Ð	Recovery and reorganisation
316
Q

when does fried become abnormal

A

over 2 months

317
Q

what are abnormal features of grief

A 
Ð	Persisted beyond 2 months
Ð	Guilt
Ð	Thoughts of death
Ð	Worthlessness
Ð	Psychomotor retardation
Ð	Prolonged and marked functional impairment
Psychosis
318
Q

what are triggers for suicide in the elderly

A

loneliness, widowed, ill health, chronic pain, recent life events

319
Q

what is the management of late onset schizophrenia

A

Often needs compulsory admission
Neuroleptics
Increase in social contact

320
Q

what imaging would you do to confirm the diagnosis of alzheimers

A

T1 weighted MRI

321
Q

what is a learning disability

A

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’

322
Q

what are the 3 diagnostic criteria for learning disability

A
  1. Intellectual impairment (IQ < 70)
  2. Social or adaptive dysfunction
  3. Onset in the developmental period (
323
Q

what are classed as social/ adaptive dysfunctions in learning disabilities

A

communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure & work

324
Q

what scale is used to assess social or adaptive dysfunction in learning disabilities

A

vineland scale

325
Q

what percentage of learning difficulties are mild

326
Q

what is the IQ of mild, moderate, severe and profound learning disability

A

mild - 50-69
moderate - 35-49
severe- 20-34
profound - <20

327
Q

what level are people with a mild learning disability

A

High school level, can read/ write, support

independently but still need help with money, work and safety

328
Q

what level are people with a moderate learning disability

A

Primary school level, problems with executive function

e.g. planning say and getting to activities so need support at home

329
Q

what level are people with a severe learning disability

A

Pre-school – need help with most things, limited verbal

speech, can’t concentrate or manage on their own

330
Q

what level are people with a profound learning disability

A

often no verbal communication, need 24/7 support,often

co-exists with other co-morbidities

331
Q

what should health professionals think about when dealing with severe learning deficiencies

A

alternative communication strategies
observable signs are relied on more in making the diagnosis e.g. weight loss, withdrawal, agitation, tearfulness in depression and behavioural disturbance in psychotic disorder

332
Q

what is diagnostic overshadowing (learning disability)

A

putting presenting symptoms down to learning disability rather than another potentially treatable cause.

333
Q

why is the prevalence of IQ <70 2.5% but he prevalence of LD is 1-2%

A
  • higher mortality in LD

- if can function <70 not a LD

334
Q

what single gene mutations are associated with LDs

A

Fragile X, PKU, Retts Syndrome

335
Q

what micro deletion/ duplication mutations are associated with LDs

A

DiGeorge Syndrome, Prader-Willi, Angelman syndrome

336
Q

what chromosomal abnormalities are associated with LDs

A

Down Syndrome chr21

Turners

337
Q

what ante natal and post natal infections may cause LD

A

ante-natal e.g. rubella (less common due to MMR), zika globally
post-natal e.g. meningitis, encephalitis

338
Q

what toxin may cause LD in the womb

A

alchohol - foetal alcohol syndrome

339
Q

what % of people with epilepsy have a LD

340
Q

name some Physical conditions associated with learning disabilities:

A 
epilepsy 
sensory impairments - haring 40%, vision 20%
obesity 
constipation 
cerebral palsy
341
Q

what infection is very common in learning difficulties

A

Helicobacter pylorii

342
Q

what is different about auditory hallucinations in scrizophrenia and in LD

A

schrizo - angry and distressing

LD - make them fell better

343
Q

why are mood disorder sin people with LD more likely to be picked up by carers

A

Less likely to complain of mood changes

biological symptoms such as lack of appetite, loss of interest in sex

344
Q

why are OCD and LD closely linked

A

Ritualistic behaviour and obsessional themes

345
Q

what fraction of people with autism have a LD

346
Q

what is similar about ADHD and LD

A

in severe LD children are overactive, distractible and impulsive but NOT to extent that would indicate diagnosis of ADHD

347
Q

why don’t people with less than moderate IQ go to prison

A

cant have trial as won’t understand trial or crime

psychiatry (5 decks)

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