Diseases Flashcards
What is involved in the appearance and behaviour part of the MSE?
- Age, gender and race
- Grooming
- Clothing
- Posture
- Gait and odd movements
- Evidence of injuries and illness
- Smell
- Eye contact
What is involved in the speech part of the MSE?
- Rate
- Amount
- Tone variation
- Volume
What is involved in the mood and affect part of the MSE?
- how the patient is feeling today is mood
- Affect is the doctor’s assessment including how it varies and if this is appropriate
- Affect can be blunted and level or unreactive and low
What is involved in the cognitive function part of the MSE?
- Orientation to time, place and person
- Concentration
- Memory
- Attention
What is involved in the insight part of the MSE?
- Recognition of being unwell
- Need for treatment
- Cause of being unwell
What is involved in the perception part of the MSE?
- Hallucinations: auditory, visual, taste, touch etc
- Second person and third person
- Mood congruent or mood incongruent
- Voices in heads or through their ears
- Illusions
What is an illusion?
your brain thinks something is something else for a short time
What is involved in the thoughts part of the MSE?
- Control
- Content
- Flow: circumstantial, tangential or complete thought block
- Form
- Delusion
- Obsession
- Speed or lack/excess of thought
What is the MSE?
technical description on the behaviour at the time of consultation not a history
What are the parts of the MSE?
- Appearance and behaviour
- Speech
- Mood and affect
- Cognitive function
- Insight
- Perception
- Thoughts
What are some extra important aspects of the social history in psychiatry?
- childhood, upbringing, school, abuse in the house, mother pregnancy and substance misuse
- bullying, interaction with friends, social development
- ACEs
- sexual and friend relationships
- marital history, family relationships
- substance misuse, history with police, prison stays, types of crime, history of violence and possession of weapons
- occupation
- self-harm
- general social behaviours
- religion and beliefs
- sleep, mood and appetite
What is psychosis?
mental disorder in which thoughts and ability to recognise reality is impaired and there is an inability to cope with reality or function
What is schizoaffective disorder?
overlap between bipolar disorder and schizophrenia
What are some psychotic symptoms?
- hallucination
- ideas of reference
- delusions
- formal thought disorder
- thought interference
- passivity phenomena
- loss of insight
What are ideas of reference?
innocuous and coincidental events that are ascribed significant meaning by a person
What is paranoia?
- ideas about the person themselves that can be positive or negative
- can be persecutory
What are primary vs secondary delusions?
- Primary= arrive fully formed in the brain without need for explanation
- Secondary= attempts to explain other psychotic experiences eg hallucinations or thought insertions
What are the pathological thought issues?
though insertion, withdrawal, broadcasting or blockage
What is the passivity phenomena?
- passivity of volition = made actions
- passivity of affect = made feelings
- passivity of impulse = made urges
What is Type 1 trauma?
single incident trauma which is sudden and unexpected
What is Type 2 trauma?
ongoing repetitive trauma such as abuse which is more likely to cause PTSD
Where do the fight or flight reactions come from in the body?
PAG and ventral tegmental area
What is the difference in bodily reactions for when a threat is inescapable compared to if it is distant?
- inescapable=tonic immobility
- distant=freezing can be voluntary
What happens to the activity in the brain when the body is under threat?
shifts from the cortex to the brain stem
What happens in the brain when a person accesses traumatic memories?
deactivation of Broca’s area so it is hard to put things into words
What is a normal acute reaction to trauma?
- fear
- numbness
- anger
- guilt
- impaired sleep
- avoidance
- intrusive experiences
- hypervigilance
What are some psychological reactions after trauma?
- acute stress disorder
- PTSD
- depression
- panic attacks
What is the measurement for 1 unit of alcohol?
10ml of pure alcohol
What is hazardous drinking?
drinking over 14 units per week and is enough to increase someone’s risk of harm
What is harmful drinking?
causes mental/ physical damage (>35u for w, >50u for m)
What are the criteria for alcohol dependence?
3 of 6:
- Strong desire to take substance
- Difficult controlling onset, termination and level of use
- Physiological withdrawal
- Tolerance
- Neglect of other pleasures or interest because of substance
- Persistence despite evidence of harm
What is the COWS scale?
opiate withdrawal scale which involves a lot of physical symptoms
What is substitute prescribing in opiate misuse?
deliberate prescribing of drugs in a controlled manner to introduce some order and control into their lifestyle
What is the process of controlled reduction in substance?
- induction: starting treatment
- optimization: find right dose to eliminate illicit use on top of prescription
- maintenance: keep dose steady
- reduction
What is the action of methadone?
Mu receptor agonist with a long half life that is metabolised in the liver
What is Buprenorphine?
Mu receptor partial agonist which comes as sublingual tablets
What are the negative effects of Methadone?
- long QT so isn’t given if patient has heart issues
- sedation
- can’t be combined with certain other drugs as it is metabolised in the liver
- drugs diversion risk so dispensing is supervised
What is associative learning?
making connections between a certain object or stumuls and the reward of the substance
What is positive reinforcement?
positive feeling so this increases frequency of behaviour
What is negative reinforcement?
substance takes away a negative feeling so increases frequency of behaviour
What are the roles of attention and memory bias in opiate use?
- paying more attention to things associated to their substance
- remembering only the good parts
What is episodic memory?
remembering things that have happened to you
What is semantic memory?
remembering facts
What is procedural memory?
implicit memory that is used unconsciously
What are the most common physical diseases to have associated depression?
post-stroke depression and post-MI depression
Want are the types of long-term memory?
- explicit which is conscious (including declarative which can be episodic or semantic)
- implicit which is unconscious (including procedural which is skills and tasks)
What is anterograde amnesia?
difficulty acquiring new material and remembering events since onset of illness or injury
What is retrograde amnesia?
difficulty in remembering information prior to the onset of the illness or injury
What are the yearly peaks and troughs of suicide?
spring peak
autumn trough
What is the biological difference in the brains of those who die by suicide?
- abnormalities in serotonin functioning
- severity of changes are proportional to the violence of the method of suicide
What can childhood sexual abuse cause in the brain?
change the HPA axis which increases risk of self-harm
What increases and decreases suicide risk?
- lithium decreases
- smoking increases
What is the difference in males vs females in terms of suicide and self-harm?
- males die by suicide more
- females self-harm more
What is passive death wish?
patient wouldn’t mind dying but wouldn’t initiate anything
What are the reversible causes of cognitive impairment?
- medication eg tramadol/steroids/amitriptyline
- delirium
- thyroid/other endocrine disorders
- depression
- brain lesions
- neuroinfections/inflammation
What is mild cognitive impairment?
decline due to age but is not affecting them enough to be a dementia
What is subjective cognitive impairment?
- people believing they are impaired but cognitive testing and daily function are normal which can be associated with anxiety, depression or stress
- usually have close relation with dementia
- vicious cycle of anxiety about memory loss
When is CT used for memory issues?
for most unless patient has Alzheimer’s presentation and is over 80
When is MRI used for memory issues?
young, fast progression or other atypical things
When is SPECT used for memory issues?
frontotemporal dementia or clarifying Alzheimers
When is DAT used for memory issues?
DLB/DPD when there isn’t enough clinically to make a diagnosis
