Exam 3 Flashcards
Criteria for drug/alcohol dependence (6)
-Compulsion to take the substance
-Physiological withdrawal state
-Persistence despite harm
-Neglect of alternative pleasures
-Tolerance
-Difficulty in controlling use
(need three or more)
CAGE questionnaire includes what questions?
- Do you ever think you should CUT-DOWN?
- Do you get ANNOYED when someone asks you about..?
- Do you ever feel GUILTY?
- EYE-OPENER?
Area of the brain which mediates impulse control. Which group of people is this undeveloped in?
The prefrontal cortex- underdeveloped in adolescents
Role of the orbito-frontal cortex
Motivation in response to environmental cues. E.g. drug cues increase activation in this area and motivation to perform drug seeking behaviour
How should patients whose drinking is harmful/mildly dependent be managed?
Brief intervention followed by motivational enhancement therapy
What should be discussed in a brief intervention? (4)
Advice on dangers of drinking + leaflets
Info about support groups
Trying to find out what factors influence the patient to drink
Agreeing objectives and strategies to achieve these e.g. drinking weaker drinks , spacing
What drug is used for medically-assisted withdrawal?
Chlordiazepoxide (benzo)
Co-morbidities caused by B1 (thiamine) deficiency (4)
Wernickes
Korsakoffs
Peripheral/cerebellar neuropathy
Treatment for Wernicke/Korsakoff
Pabrinex (thiamine + riboflavin)
Triad of Wernickes and other features (2)
Nystagmus
Optalmoplegia
Ataxia
+ sensory peripheral neuropathy, confusion
Drugs for alcohol relapse prevention (3)
Naltrexone (opioid blocker)
Acamprosate
Dilsufiram (induces an immediate “hangover” effect)
Features of Korsakoff syndrome (3)
Anterograde and retrograde amnesia
Confabulation
Lack of insight
Classifications of learning disability:
a) borderline
b) mild
c) moderate
d) severe
e) profound
a) around 70
b) 50-69
c) 35-49
d) 20-34
e) less than 20
Chromosomal causes of learning disability (5)
Downs syndrome Patau syndrome Edward syndrome Cri du chat syndrome Angelman/Prader-Willi
Drugs used in ADHD treatment and how they work?
Stimulants e.g. methylphenidate, dexamfetamine- improve dopaminergic transmission in exective function networks, particularly the pre-frontal cortex
Autistic triad of impairments
Impaired social interaction
Impaired speech and language
Inflexible thought and behaviour
Diagnostic features of delirium (5)
Impairment of consciousness Disturbance of cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
What does “sundowning” in the context of delirium mean?
Symptoms get worse at night
What features of cognition may be impaired?
Disorientated in time and space
Impaired memory and attention
Disturbed perceptions
What are the components of the confusion assessment method?
Need both ACUTE ONSET AND FLUCTUATING COURSE, and INATTENTION
and either DISORGANISED THINKING
or
ALTERED CONSCIOUS LEVEL
Standard first-line treatment for agitation in delirium
Haloperidol (once non-pharmacological measures have been tried)
What drug should be given for patients with Lewy body dementia or Parkinsons disease?
Lorazepam (antipsychotics worsen the extrapyramidal side effects)
Defining clinical features of anorexia nervosa (3)
BMI less than 17.5
Having a dread of gaining weight
Over-evaluation of size
Other key features of anorexia nervosa (4)
Amenorrheoa
Fatigue, fainting, dizziness (hypotension)
Lanugo
Enhanced weight loss by over-exercise, direutrics, laxatives
Management of anorexia nervosa
Self-help, family interventions (best evidence). Hospitalisation (either voluntary or under MHA) if BMI less than 15
How may fatal arrythmias arise in anorexia?
Hypokalaemia
Distinguishing features of bulimia (3)
Binge-eating,with attempts to counter the effects of binge eating
Morbid dread of fatness
Preoccupation with eating
Signs of bulimia (2)
Knuckle calluses
Parotid hypertrophy
An alcohol history should take place in the context of what?
a psychiatric history
Units present in
a) pint of lager
b) 70cl vodka/other spirits
c) bottle of wine
a) 3 units
b) 30 units
c) 9-10 units
What are the four As of insight in the mental status exam?
Awareness of symptoms
Attribution of symptoms to a mental illness
Appraisal of the consequences of symptoms
Acceptance of treatment
Important aspects of an attempted suicide history
Before (events leading up to, planning, precautions)
During (method, when and where, discovery, drugs/alcohol involved?)
After (feelings now, future intent)
Rest of psych history
Aspects of the mental status exam
Appearance Behaviour Speech Mood and affect (including suicidality) Thoughts (form and content) Perception (hallucinations/illusions) Insight (awareness, attribution, appraisal, acceptance)
Important aspects of a psych history (4)
Risk assessment particularly in depression
Previous psychiatric history
Detailed alcohol and illicit drugs history
Forensic history
