Extra Flashcards
What is an acute stress reaction?
Acute Stress Reaction (ASR) is a transient psychological response to a traumatic event, occurring immediately or within minutes/hours, and typically resolving within days.
What are common triggers of acute stress reactions?
Serious accidents, physical assault, sexual violence, natural disasters, witnessing death/injury, or other life-threatening events.
What is the physiological basis of an acute stress reaction?
It involves activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, releasing cortisol and catecholamines in response to perceived threat.
Elevated __________ levels during ASR help the body respond to immediate danger.
cortisol
What are the core features of acute stress reaction?
Disorientation or daze
Anxiety, panic, or agitation
Hyperarousal (↑ HR, ↑ BP)
Detachment or emotional numbing
Sleep disturbances
Flashbacks or intrusive thoughts
Symptoms of ASR typically begin within __________ of the stressor and resolve within a few days.
minutes to hours
How is ASR distinguished from PTSD or adjustment disorder?
ASR: Immediate and short-lived (within 3 days).
PTSD: Symptoms persist >1 month.
Adjustment disorder: Emotional or behavioural symptoms in response to a stressor, starting within 3 months but not immediate.
What investigations are required for ASR?
Usually none; diagnosis is clinical. Rule out organic causes (e.g., hypoglycaemia, head injury, drug use) if atypical features are present.
A key part of ASR assessment is ruling out __________ causes of altered mental state.
organic
What is the first-line management of acute stress reaction?
Psychological first aid (reassurance, safety, emotional support)
Watchful waiting
Encourage social support and rest
Are medications recommended for ASR?
No. Medication is generally not recommended unless symptoms are severe or disabling (e.g., short-term anxiolytics for overwhelming anxiety).
When should referral to mental health services be considered?
If symptoms persist beyond a few days, worsen, or develop into PTSD or another mental health condition.
What are potential complications of an untreated acute stress reaction?
Progression to PTSD
Depression
Substance misuse
Impaired social and occupational functioning
Acute stress reaction can be a precursor to __________ if symptoms persist.
PTSD
What is Chronic Fatigue Syndrome?
Diagnosed after at least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms
Epidemiology of Chronic Fatigue Syndrome
more common in females
past psychiatric history has not been shown to be a risk factor
Presentation of Chronic Fatigue Syndrome
Fatigue is the central feature, other recognised features include
sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
muscle and/or joint pains
headaches
painful lymph nodes without enlargement
sore throat
cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
physical or mental exertion makes symptoms worse
general malaise or ‘flu-like’ symptoms
dizziness
nausea
palpitations
Ix for Chronic Fatigue Syndrome
NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis
Dx for Chronic Fatigue Syndrome
NICE publish diagnostic criteria
a diagnosis is typically made if the symptoms persist for 3 months
Management of Chronic Fatigue Syndrome
refer to a specialist CFS service if the diagnostic criteria are met and symptoms have persisted for 3 months
energy management
a self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional
physical activity and exercise
do not advise people with ME/CFS to undertake exercise that is not part of a programme overseen by an ME/CFS specialist team
should only be recommended if patients ‘feel ready to progress their physical activity beyond their current activities of daily living’
graded exercise therapy used to be recommended but is now specifically not recommended by NICE
cognitive behavioural therapy
NICE stress this is ‘supportive’ rather than curative for CFS
CFS has a better prognosis in children.
What is a vulgarism in clinical or psychiatric terms?
Vulgarisms are socially inappropriate or offensive words or phrases, often involving profanity, racial slurs, or sexually explicit language, which may be uttered intentionally or involuntarily.
In which clinical condition are involuntary vulgarisms most classically observed?
Tourette’s syndrome (specifically in coprolalia)
What neuropsychiatric conditions may involve the use of vulgar language?
Tourette’s syndrome (coprolalia)
Frontal lobe damage
Temporal lobe epilepsy (in rare ictal events)
Certain dementias (e.g. frontotemporal dementia)
Mania
Substance misuse or intoxication
What brain regions are implicated in pathological use of vulgarisms in disorders like Tourette’s or FTD?
Dysfunction in the basal ganglia, frontal lobe, and limbic system are often involved.
How do vulgarisms typically present in patients with Tourette’s syndrome?
As sudden, involuntary utterances of socially inappropriate words or phrases, occurring as part of vocal tics.
Coprolalia affects only a __________ of people with Tourette’s syndrome.
minority (approx. 10%)
What might the use of frequent vulgar language in an adult suggest if new in onset?
Possible neurological or psychiatric illness, including frontotemporal dementia, brain injury, or mania.
How are pathological vulgarisms managed in Tourette’s syndrome?
Behavioural therapy (e.g. Comprehensive Behavioral Intervention for Tics - CBIT)
Medications (e.g. antipsychotics like risperidone)
Supportive psychotherapy and education for family/school
The behavioural therapy most effective in managing tics is __________.
CBIT (Comprehensive Behavioral Intervention for Tics)
In neurodegenerative causes (e.g., FTD), how is disinhibition involving vulgarisms managed?
Supportive care
Environmental modification
Medications like SSRIs or antipsychotics in select cases
What are some psychosocial consequences of involuntary use of vulgar language?
Social stigma
School or workplace exclusion
Emotional distress
Impaired interpersonal relationships
What is an important ethical consideration when managing patients who use vulgarisms involuntarily?
Educating others to reduce stigma and promote understanding that the behaviour is unintentional and part of a medical condition.
What is disease prevention in general practice?
Disease prevention in GP involves measures taken to prevent the onset, progression, or complications of disease through interventions such as lifestyle advice, immunisation, and screening.
What is the goal of primary prevention?
To prevent disease before it occurs (e.g., immunisations, smoking cessation).
What is secondary prevention?
Detecting disease in its early stages to prevent progression (e.g., screening programmes).
What is tertiary prevention?
Reducing the impact of established disease by preventing complications and improving function.
Name one key framework used to assess whether a screening programme is appropriate.
The Wilson and Jungner criteria
A good screening test should be __________, __________, and acceptable to the population.
sensitive, specific
What are the 3 main questions to consider when assessing a screening programme?
Is the condition important?
Is there a suitable test?
Is there effective treatment available?
At what ages is NHS cervical screening offered in the UK?
Ages 25 to 64
Cervical screening is offered every __________ years from age 25 to 49 and every __________ years from age 50 to 64.
3; 5
What is the age range for breast cancer screening in the UK?
Women aged 50 to 71 every 3 years
What modality is used for breast cancer screening?
Mammography
What is the main screening test for bowel cancer in England?
Faecal immunochemical test (FIT)
Bowel screening is offered from age __________ to __________ every 2 years.
60; 74 (being expanded to start at age 50)
Who is offered AAA screening in the UK?
Men aged 65 (one-off ultrasound scan)
Name three primary prevention strategies routinely used in general practice.
Smoking cessation advice
Immunisations (e.g. flu, HPV, shingles)
Alcohol and obesity screening with lifestyle advice
Patients aged 40–74 are eligible for an NHS Health Check every __________ years.
5
What is the purpose of the NHS Health Check?
To assess the risk of heart disease, stroke, diabetes, and kidney disease and offer preventive advice.
Which vaccine is offered to all 65+ year olds annually in the UK?
The seasonal influenza vaccine
The shingles vaccine is offered to adults aged __________ to __________.
70 to 79 (check local updates for specifics)
What vaccine is offered to boys and girls in Year 8 (age 12–13)?
HPV vaccine
What are common ethical concerns in screening programmes?
False positives or negatives
Overdiagnosis
Patient anxiety
Consent and autonomy
The risk of overdiagnosis is a known downside of __________ screening.
cancer
