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psychiatry > general > Flashcards

general Flashcards

1
Q

what things help to build a rapport when taking a psych history

A

eye contact
relaxed, non- threatening posture
appear unhurried

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2
Q

what is important about the safety of the interviewer in a psych history

A

easy exit - be near door

tell someone where you are

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3
Q

what are benefits of open questions

A

o Allows patients to start talking about themselves and puts them at ease as they have the floor
o Allows you time to think and plan areas of questioning as you assess their style and content of their response
o Allows a period of non-verbal response from interviewer; listening and facilitating.

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4
Q

what would you want to know about the circumstances of a psychiatry referral

A

who by
why
informal (voluntary) or not

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5
Q

what format should you record a persons presenting complaint

A

in their own words

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6
Q

what information do you want to obtain in the psychiatry history of presenting complaint

A

Onset, precipitants, course, severity
Associated symptoms, effects on daily living, effect on family/ relationships
Is it getting worse or better?
Has it responded to any treatment?

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7
Q

what questions may you ask about symptoms of depression

A 
Are you low/ depressed? 
Is life worth living? 
Can anything give you pleasure?
 Energy levels? 
Sleep /appetite? 
Can you concentrate? 
Are ypu feeling guilty? 
Is your confidence low? 
Have you lost your libido? 
Are you preoccupied with guilt, regret/ hopelessness? 
Suicidal thought?
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8
Q

what questions may you ask about symptoms of mania

A

Have you felt more energy than normal (despite not sleeping)?
Can you focus on things?
Are you having difficulty settling?
Are you spending more than usual?
Are you interested in sex with different/ inappropriate people?

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9
Q

what questions may you ask about symptoms of psychosis

A

Has anything odd or unusual been happening recently?
If they have odd ideas ask how did these occur?
What actions do you feel the need to take?
Might your thoughts be being interfered with?
Do you feel anyone is controlling you?
Is anyone putting thoughts in your head?
do other people access or hear your thoughts?
Is anyone harming you?
Any plots against you?
Do you hear voices when thers no one nearby?
What do they say?
Do you see things other can’t?

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10
Q

what questions may you ask about symptoms of dug and alcohol abuse

A 
What do you take? 
How much, how often and for how long? 
How much do you spend on all of this? 
Is it impacting you the next day? 
Has your use recently changed? 
Withdrawal signs?
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11
Q

what questions may you ask about symptoms of OCD

A

Any odd thoughts? Recurring, intrusive worries? Note any compulsive behavior

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12
Q

what questions may you ask about symptoms of anxiety

A 
Any worries? 
Are you always worried or does it happen in discrete episodes (attacks)? 
What causes this? 
What physical symptoms do you get? 
How do you manage your anxiety?
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13
Q

what questions may you ask about history of eating disorders

A

What are you currently eating? How do you feel about your weight? Are you dieting?

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14
Q

what questions may you ask about suicide risk

A

Have you ever felt so low that you have considered harming yourself?
Have you ever actually harmed yourself?
What stopped you harming yourself more than this?
Have you made any detailed suicide plans?
Are you wanting to harm anyone?
Have you stopped looking after yourself (dressing, washing, eating, drinking)?

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15
Q

what do you want to know about someone’s past psychiatric history

A

Past episodes/ diagnoses / contacts
Previous treatments (psychological, drug and physical)
Inter-episode functioning
Previous admissions to hospital
Attempted suicide/ repeated DSH
Previous detentions under Mental Health Legislation

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16
Q

what things may be relevant to psychiatry about someone s past medical history

A

Developmental problems
Head injuries
Endocrine abnormalities – thyroid can mimic psych
Liver damage, oesophageal varices, peptic ulcers – alcohol intake
Vascular risks factors – memory problems, amnesia

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17
Q

what would you ask in a persons drug history

A

about tablets, injections medication recently – if they are taking them or not
Any drugs discontinued (within past 6 months)
how long medication has been taken for and at what dose
Ask about adverse reactions and allergies

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18
Q

what social history is relevant in a psychiatric history

A 
Social circumstances including occupation
Current financial situation/stressors 
smoking/ alcohol/ illicit drug use 
Screening questionnaires eg CAGE
Current relationship/stressors
Children – contact, relationship
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19
Q

what things are asked in the personal psychiatric history

A

Developmental milestones - Schooling/Education
Occupational history
Significant relationships – sexual and marital history
Financial
Friendships, hobbies and interests
Pre-morbid Personality-

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20
Q

what should be included in the forensic history

A

“Have you ever been in contact with the police? Charged with any crime?”
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes

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21
Q

what is a good way to find someone’s pre-morbid personality

A

How would your best friend describe you as a person?

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22
Q

what things would you comment about appearance in the mental state examination

A

o Height/Build – literally what they look like, way to remember them
o Clothing - appropriate/inappropriate to occasion/ weather, bizarre
o Personal hygiene - clean/unshaven/malodorous
o Make up, jewellery, accessories

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23
Q

what things would you comment about behaviour in the mental state examination

A

o Greeting – shaking hand, hug etc. Idea of disinhibited/ wary
o Gesturing - normal, expansive, bizarre
o Eye contact
o Abnormal movements - tremor, choreioathetoid movements, posturing, akathisia
o Build a rapport / be Cooperative

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24
Q

what are some clinical signs of odd behaviour that may be picked up on MSE

A
  • Responding to unseen stimuli (what you can’t see but real to the person)
  • Evidence of side effects of medication – orofasial dyskinesia, rotunded
  • Evidence of intoxication – can present as unwell
  • Movement disorder etc catatonia, forced grasping, waxy flexibility, opposition
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25
Q

what is the difference between mood and affect

A

mood - patient’s subjective report on their current mood state
affect - objective manifestation of mood at interview (emotions conveyed)

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26
Q

what things would you comment on someones speech in the mental state examination

A

Content of speech (what the patient says) and form of speech (how they say it)
Spontaneity – offer information voluntarily
Volume - loud, quiet, poverty
Rate - pressured, slowed
Rhythm - rhyming and punning
Tone - monotonous, lilting
Dysarthria/ Dysphasia - expressive/receptive

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27
Q

if someone speaks about a mood disturbance, what should you probe them for

A

severity, duration, and ubiquity and any other associating features.

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28
Q

what 3 questions would you ask to check if someone has insight into their condition

A

Are symptoms due to illness?
Is this a mental illness?
Do they agree with treatment/ management plan?

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29
Q

what would you assess someones cognition in a mental state examination

A

Orientation - time, place, person
Attention/concentration - throughout interview,
standard test is reversed months DNOSAJJMAMFJ
Short term memory - 3 objects; name & address
Long term memory - personal history
If any concerns - perform objective tests eg MSQ, MMSE, MOCA, FAS, Clock drawing, executive function tests

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30
Q

what is the difference between pseudo and true hallucinations

A

pseudo - inside head

true - absence of stimuli

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31
Q

what is the difference between an illusion and a hallucination

A

illusions- misinterpret a stimulus

hallucination - true perception located in external space with no external stimulus

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32
Q

what different domains can a hallucination hold

A 
auditory
visual
somatic/tactile - touch
olfactory - smelll
 gustatory - taste
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33
Q

give some questions to ask about hallucinations

A

Have you seen or heard anything that other people have not been aware of?”
“Have you heard any people talking when there was nobody around?”
“What do they think is causing them?”
Does it seem possible?
“Has anything particular been playing on your mind?”
“Do you know why is this happening?”
“Have you noticed any change in your thoughts?”
“Has anyone interfered with your thoughts?”
“Does anyone else have access to your thoughts/ read your mind?”
“Is anyone deliberately trying to harm you, e.g. trying to poison you or kill you?”

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34
Q

how would you differentiate between a partial and full hallucination

A

Even when you seem to be most convinced, do you really feel in the back of your mind that it might not be true, it might be your imagination?

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35
Q

what 4 thins would you consider about someone’s thoughts

A

Speed and tempo of thoughts (slow)
Types of thoughts demonstrated (negative)
Linkage and thought form
Possession of thoughts (schizophrenia) – blocking/ insertion/ boradcasting

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36
Q

what is a formal thought disorder

A

A pattern of interruption or disorganisation of thought process
- broadcast, echo, insertion, thought block, withdrawal

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37
Q

what is a delusional belief

A

fixed, false belief out of normal cultural context, extraordinary conviction
“ a delusion is an unshakeable idea or belief which is out of keeping with the person’s social and normal cultural background; it is held with extraordinary conviction.”

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38
Q

what things should you think about someone having in their thoughts

A

Phobias/ Obsessions / Flight of ideas/ Preoccupations/ Over valued ideas

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39
Q

what is the prevalence of mental health disorders

A

15%

40
Q

what is the commonest cause of death in men under 35

A

suicide

41
Q

what is meant by formulation of the case

A

Organic, social and psychological factors are assessed as either predisposing, precipitating or perpetuating factors.

42
Q

what is phenomenology

A

refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patient’s experience feels like.

43
Q

what are delusions

A

beliefs held unshakably, irrespective of counter argument, that are unexpected and out of keeping with the patients cultural background.

44
Q

what is a nillhistic delusion

A

thinking you are rotting/ dying

45
Q

what is a grandiose delusion

A

thinking you are bigger and more important

46
Q

what kind of delusion are seen in schrizophrenia

A

Persecution delusion (theme of being followed, spied on, and conspired against with a belief that the persecutors intend to cause harms)

47
Q

what is othello syndrome

A

firm belief that a sexual partner is unfaithful made without proof
(jealous delusion)

48
Q

what are ideas of reference

A

Coincidental or innocuous events which are interpreted to have great personal significance. Associated with social phobia, psychosis and stress.

49
Q

how are ideas of reference different form overvalued ideas

A

over valued ideas are understandable and reasonable beliefs which dominate a patient’s life to detriment of functioning.

50
Q

what is the main characteristic of hallucinations

A

they are felt to occur in the external world along other objects, with the same quality as everything else, and can’t be consciously manipulated or stopped. They are real to the person experiencing them.

51
Q

what diseases are visual hallucinations more common in

A

eye pathology, delirium, epilepsy , alcohol withdrawal

52
Q

what are hypnagogic and hypnopompic hallucinations

A

Hypnagogic (going to sleep)

hypnopompic (waking up) auditory hallucinations are pseudohallucinations as the person knows it is in their mind.

53
Q

what is the management of Patients with medically unexplained physical symptoms

A

focus groups, physiotherapists, occupational therapists

54
Q

what % of hospital admission are directly related to ill effects of alcohol use

A

~ 20% of admissions

55
Q

what will All patients admitted with self-harm will routinely receive

A

a psycho-social (psychiatric) assessment – check suicidal ideation

56
Q

what is the biggest drug taken in overdose

A

paracetemol

57
Q

what diseases is depression more common in

A

chronic illness, e.g. chronic renal failure, diabetes, rheumatoid arthritis
certain neurological diseases, e.g. MS, Parkinson’s disease, stroke

58
Q

how may mental health disorders disguise themselves as physical disorders

A

pain, tiredness, lack of energy

reaction - anxious/ stress about physical condition

59
Q

what are Somatoform/ functional disorders

A

symptoms with no physical explanation

60
Q

why were mental health laws created

A

give the power to provide compulsory care and treatment for people with a mental disorder

61
Q

what are the principles of the Mental Health (care and treatment) (Scotland) Act 2003

A

Non-discrimination Participation
Equality Respect for carers
Respect for diversity Least restrictive alternatice
Reciprocity (do to other what you would want)
Benefit (maximum)
Informal care Child welfare

62
Q

what does the Mental Health (care and treatment) (Scotland) Act 2003 define a mental disorder as

A

any mental illness, personality disorder or learning disability
however caused or manifested.
(not alchohol/ drugs/ sexual )

63
Q

how long is detention authorised in the Emergency detention certificate EDC (Mental Health (care and treatment) (Scotland) Act 2003)

A

up to 72 hours

64
Q

how long is detention authorised in the Short-term detention certificate STDC (Mental Health (care and treatment) (Scotland) Act 2003)

A

up to 28 days

65
Q

how long is detention authorised in the Compulsory Treatment Order CTO (Mental Health (care and treatment) (Scotland) Act 2003)

A

up to six months

66
Q

how long is detention authorised by nurses power (Mental Health (care and treatment) (Scotland) Act 2003)

A

up to 3 hours for a medical assessment

67
Q

what are the 5 criteria for detention in the Mental Health (care and treatment) (Scotland) Act 2003

A
  • have a mental disorder
  • impairment of decision making
  • risk to health of them or another
  • treatment available
  • must be necessary
68
Q

what is the criteria to be a named person under the Mental Health (care and treatment) (Scotland) Act 2003

A

must be nominated by the patient and witnessed and the named person must have witnessed acceptance

69
Q

who can sign an Emergency detention certificate

A

registered medical practitioner

NOT FY1

70
Q

can the emergency detention certificate be appealed

A

no - not enough time for a solicitor

71
Q

who can sign a short term detention certificate

A

Approved Medical Practitioner – psychiatrist or working in psychology 4 years

72
Q

how is a compulsory treatment order section arranged

A

Application to Mental Health Tribunal made by Mental Health Officer for the granting of a CTO
Tribunal considers evidence and makes decision

73
Q

what does the Adults with Incapacity (Scotland) Act 2000

define an adult as

A

a person who has attained the age of 16 years

74
Q

what does the Adults with Incapacity (Scotland) Act 2000 define incapable as

A

a) Acting
b) Making decisions
c) communicating decisions
d) understanding decisions
e) retaining the memory of decisions

75
Q

what principles must be considered when applying the adults with incapacity act

A
  • must benefit the adult
  • least restrictive intervention possible
  • take into account past and present wishes of adult
  • take account of relative/ relevant other
76
Q

does every old person have capacity

A

until proven otherwise

77
Q

what is a guardianship order

A

Someone else is appointed to make decisions on behalf of the adult (financial or welfare or both)

78
Q

what do you do if you need to treat someone that doesn’t have capacity but there is no welfare attorney/ guardianship

A

section 47 certificate - adult with incapacity act 2000

79
Q

what is not allowed under the adults with incapacity act

A
  • use of force/ detention
  • action not consistent with competent court
  • hospitalise against will
80
Q

give 5 subsections of the Criminal justice and licensing (scotland) act 2010

A
  1. 51A - Criminal responsibility
  2. Unfitness for trial
  3. . 51B - Diminished responsibility
  4. restricted patients
  5. restricted pateitns
81
Q

what things must the court be satisfied before a person is restricted

A 
¥	Mental disorder
¥	Detention in hospital is necessary
¥	Civil risk criterion met
¥	Treatment
¥	Suitable bed available within 7 days
¥	Assessment could not be undertaken if not in hospital
82
Q

what illnesses are higher in prison than the community

A

Psychotic illness, major depression, alcohol misuse and drug misuses

83
Q

when is a patrons not criminally responsible for conducting an offence

A

if the person was at the time of the conduct unable by reason of mental disorder to appreciate the nature or wrongfulness of the conduct.

84
Q

when is a person un fit for a trial

A

if it is established on the balance of probabilities that the person is incapable, by reason of a mental or physical condition, of participating effectively in a trial.

85
Q

what should a person have the ability to do to have fitness for trial

A

(i) understand the nature of the charge,
(ii) understand the requirement to tender a plea to the charge and the effect of such a plea,
(iii) understand the purpose of, and follow the course of, the trial,
(iv) understand the evidence that may be given against the person,
(v) instruct and otherwise communicate with the person’s legal representative, and
(b) any other factor which the court considers relevant.

86
Q

when is diminished responsbility used for culpable homicide over murder

A

if the person’s ability to determine or control conduct for which the person would otherwise be convicted of murder was, at the time of the conduct, substantially impaired by reason of abnormality of mind

87
Q

what is needed for a restriction order (forensic) (1995 act)

A

ORAL evidence form at least 1 medical practitioner
- nature of charge
- antecedents of the person
- risk of offences he could commit
(no time limit - must be reviewed every 2 years)

88
Q

what must the court be staisfied with for a treatment order

A 
2 medical practitioners 
- mental disorders
- treatable 
- civil risk
no reasonable alternative
89
Q

what is stigma

A

is a social construction that devalues people due to a distinguishing characteristic or mark

90
Q

what is discrimination

A

is the actual behavior towards another group. It involves excluding or restricting members of one group from opportunities that are available to other groups

91
Q

what is the prejudice

A

is a prejudgment: i.e. an assumption made about someone or something before having adequate knowledge to be able to do so with guaranteed accuracy

92
Q

when is stigma developed

A

childhood

93
Q

why are people reluctant to risk talking about mental illness or seeking help for it

A

worried about consequences

94
Q

what are approaches to combat the stigma around mental illness

A

Good medication management
CBT approach to help overcome ‘felt’ stigma’ - lose ‘Us and Them’ attitude
Consider own attitudes and awareness eg disrespectful language/jokes
Influence of celebrities

95
Q

give some controversies in modern psychiatry

A
  • media stigma
  • social control by state
  • treatment without consent
  • rising antidepressant prescriptions
  • detention against will

psychiatry (5 decks)

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