General Adult Flashcards

Question

DSM duration criteria for mania

Answer 1

Haloperidol Olanzapine Risperidone Quetiapine

Answer 2

Increase dose of mood stabiliser Check serum Li levels Consider adding antipsychotic to lithium or valproate - especially if incongruent psychotic sx ECT

Answer 3

Psychological intervention Moderate to severe: fluoxetine with olanzapine Quetiapine Lamotrigine (second line)

Answer 4

* after a manic episode involving significant risk and adverse consequences * bipolar I disorder with two or more acute episodes * Bipolar II disorder with significant functional impairment, or risk.

Answer 5

Suicide Mania Depression

Answer 6

``` Valproate Olanzapine Quetiapine Carbamazepine Lamotrigine ```

Answer 7

R/o hypothyroid and substance use and medication non-compliance Stop antidepressant Lithium, valproate or lamotrigine

Answer 8

2 years | 5 years if high risk factors for relapse

Answer 9

Psychoeducation Self monitoring Self regulation; action plans and modification Compliance

Answer 10

0.7-1.3 per 100,000

Answer 11

``` Psychoeducation CBT Family therapy if high EE Social skills training Vocational rehab ```

Answer 12

``` Late onset Obvious precipitating factors Acute onset Good premorbid adjustment Affective symptoms (esp. depression) Being married Family history of affective disorders Good social support Positive symptoms only Good initial response to treatment (best predictor) ```

Answer 13

``` Early onset* (not strong) No precipitating factors** Insidious onset** Poor premorbid adjustment Social withdrawal Single, divorced, or widowed Family history of schizophrenia* (weak, controversial) Poor social network, High EE families Negative symptoms Poor compliance Neurological signs and symptoms History of perinatal trauma No remissions in 3 years Many relapses History of violence ```

Answer 14

``` Anhedonia Avolition Apathy Amotivation Restricted affect. ```

Answer 15

4-6 weeks of PO atypical - amisulpride, aripiprazole, olanzapine, quetiapine, risperidone

Answer 16

4-5x chance

Answer 17

At least 5 years

Answer 18

Lack of satisfactory clinical response to sequential use of at least two antipsychotics for a period of 6 to 8 weeks: at least one of the agents must be from atypical (non-clozapine) group.

Answer 19

Rule out comorbidities and previous response to treatment Psychological therapy first line SSRIs Combination in complex disorders refractory to treatment

Answer 20

Earlier onset More severe Tics Poorer outcome

Answer 21

• Aggressive, sexual, and religious obsessions, and checking compulsions; • Symmetry and ordering obsessions and compulsions; (often chronic and treatment resistant) • Contamination obsessions and cleaning compulsions; • Hoarding obsessions and compulsions (may be neurobiologically distinct and often treatment resistant)

Answer 22

First line: self-help Second: CBT with ERP Third: SSRIs +/- CBT

Answer 23

SSRIs and CBT | If no response, switch to another SSRI or Clomipramine

Answer 24

3. 6% men | 9. 7% women

Answer 25

``` Younger Higher anxiety response to initial event External locus of control Previous mental illness Female Low socioeconomic and educational status Ethnic minority Cluster B PD Perceived threat to life Peritraumatic dissociation Severity of trauma Lack of social support Subsequent life stressors Physical illness - chronic pain ```

Answer 26

High IQ Higher social class Opportunity to grieve for loss

Answer 27

Watchful waiting if <4 weeks after trauma

Answer 28

Psychological treatment

Answer 29

Severe PTSD in first month after traumatic event | PTSD within first 3 months of trauma

Answer 30

Exposure therapy, cognitive therapy and stress management

Answer 31

Trauma-focused CBT or EMDR Up to 12 sessions

Answer 32

If limited improvement from psychological therapy

Answer 33

Paroxetine Mirtazapine Amitriptyline Phenelzine

Answer 34

Repeated confrontation of traumatic memories and repeated exposure to avoided situations with relaxation and anxiety reduction

Answer 35

Weekly for 8-12 sessions

Answer 36

Modification of misinterpretations that lead to overestimation of current threat and modification of other beliefs related to traumatic experiences and behaviour during trauma via cognitive restructuring

Answer 37

Allows processing of traumatic memories in the form of eye movements

Answer 38

While the patient focuses on specific images, negative sensations and associated cognitions, bilateral stimulation is applied to desensitize the individual to these memories and more positive sensations and cognitions are introduced.

Answer 39

``` Exposure to trauma Bullying Life events First degree relative of GAD Female ```

Answer 40

SNRI | Pregabalin

Answer 41

Education Relaxation training Exposure and cognitive restructuring

Answer 42

Escitalopram Paroxetine Sertraline

Answer 43

Imipramine Venlafaxine Duloxetine Buspirone

Answer 44

Paroxetine Escitalopram Venlafaxine Pregabalin

Answer 45

Olanzapine or Risperidone in low doses

Answer 46

42% patients recover in 12 months | Poorer outcome if another anxiety disorder

Answer 47

Generalised - fear occurs in most social situations | Situational - fear of public speaking or performance anxiety

Answer 48

SSRI first line | Venlafaxine

Answer 49

Fluoxetine Sertraline Escitalopram Fluvoxamine

Answer 50

6-12 months

Answer 51

Phenelzine

Answer 52

SSRI and clonazepam Gabapentin Pregabalin

Answer 53

CBT - 7-14 hours, weekly 1 hour sessions, complete within 4 months Self-help SSRIs

Answer 54

Imipramine | Clomipramine

Answer 55

Cognitive therapy with exposure | Continue meds for 6 months

Answer 56

CBT including group CBT | SSRIs

Answer 57

Low self-esteem Critical parents and significant others Early childhood trauma Unconscious displacement of emotional conflict

Answer 58

Depression 26% Social phobia 16% OCD 6%

Answer 59

High dose SSRIs for longer duration than as antidepressant - Fluoxetine CBT combination in treatment resistance case

Answer 60

Poor - waxing and waning course | Preserved psychosocial functioning

Answer 61

CBT | Antidepressant medications

Answer 62

Childhood psychological abuse - 57-90%

Answer 63

Integrate feelings, perceptions, thoughts and memories

Answer 64

Individual structured psychotherapy such as Acceptance and Commitment Therapy and DBT

Answer 65

0.5-1% in teenage girls

Answer 66

1-2% in 16-35 age group

Answer 67

65% have depression 34% have social phobia 26% have OCD

Answer 68

FHx of ED for anorexia FHx of substance misuse and obesity for bulimia Females, adolescence and early adulthood Adverse parenting - low contact and high expectations and parental discord Critical comments about eating, shape and weight from others Childhood sexual abuse Occupational and recreational pressure to be slim Low self-esteem and perfectionism History of obesity in bulimia

Answer 69

Recurrent episodes of binge eating without extreme weight-control behaviour

Answer 70

Self help - first line Behavioural weight loss programmes CBT and IP

Answer 71

CBT - 20 sessions over 5 months

Answer 72

33-50% make complete and lasting recovery | Antidepressants can decline frequency of binge eating and purging but effect not sustained

Answer 73

Illness present for <6 months No bingeing or vomiting Cooperative parents willing to participate in family therapy

Answer 74

CAT or CBT IPT Family interventions

Answer 75

SSRI - fluoxetine up to 60mg OD

Answer 76

63% male remand 49% sentenced 31% female prisoners

Answer 77

2% in general population

Answer 78

5x more common

Answer 79

``` Quasi-psychotic thoughts Self-harm Help-seeking suicide efforts Treatment regressions Countertransference problems ```

Answer 80

Depression, anger, loneliness and feelings of emptiness | General impulsivity

Answer 81

40% remit after 2 years | 88% no longer meet criteria in 10 years

Answer 82

* Obsessional thoughts-ideas, images or impulses, own thought, unpleasurable, repetitive, resistance & response * Compulsive acts/rituals-washing, cleaning, checking, counting, The anxiety symptoms associated with it. * Resistance and avoidance * Duration, effects and coping * Avoidance and anticipatory anxiety * Rule out co-morbidity-depression, anxiety

Answer 83

``` Own thought, Unpleasurable, Repetitive, Resistance Response ```

Answer 84

1. Details of the traumatic incident itself 2. Look for core features of post-traumatic stress disorder (PTSD) that includes hyperarousal, intrusions and avoidance 3. Assess the mode of onset, duration, progression of current symptoms and impairment in different areas of functioning (Social and occupational functioning) 4. Rule out co-morbidity.

Answer 85

1. Persistent anxiety and Irritability or outbursts of anger 2. Insomnia 3. Poor concentration and exaggerated startle response

Answer 86

1. Intensive intrusive imagery (flashbacks) 2. Vivid memories 3. Recurrent distressing dreams and nightmares

Answer 87

1. Actual or preferred avoidance of circumstances resembling or associated with the stressor 2. Emotional detachment and inability to feel emotions 3. Diminished interest in activities.

Answer 88

Explore the details of the accident, in particular the perceived severity and establish the level of distress and fear at the time of the event. • Could you describe the accident please? (Here approach the patient empathetically as it is difficult to talk about traumatic incidents, and acknowledge the patients distress.) • Find out about when it happened, how (terrifying) it was? • Ask about any injuries in particular head injury, loss of consciousness, whether any other person was injured etc. • Inquire about any blame, litigation, court cases and their outcome.

Answer 89

* How often do you think about the accident? * Do you sometimes feel as if the accident is happening again? * Do you get flashbacks? * Have you revisited the scene? * Do you get any distressing dreams/nightmares of the event? * What would happen if you hear about an accident? * Do you have any difficulties remembering parts of the accident?

Answer 90

* Have you had the feeling that you are always on the edge? * Do you tend to worry a lot about things going wrong? (Feeling anxious) * Do you startle easily? (Enhanced startle response) * Tell me about your sleep please. (Explore for sleep disturbance) * Are you sometimes afraid to go to sleep? * How has your concentration been recently? * How has your memory been lately? * Do you loose your temper more often that you used to? (Irritability)

Answer 91

• How hard is it for you to talk about the accident? • Do you deliberately try to avoid thinking about accidents? • Have you been to the place where the accident happened? • Do you make any effort to avoid the thoughts or conversations associated with the trauma? How would you do that? • Do you make any effort to avoid activities, places or people that arouse recollection of the trauma?

Answer 92

Obtain details of the traumatic accident- nature and extent of the problem, severity of symptoms and impairment on current functioning Hyper arousal Symptoms (Persistent Anxiety, irritability, Poor concentration, insomnia, enhanced startled response etc) Intrusions (flashbacks, nightmares, Recurrent distressing Day dreams) Avoidance of reminders of the events (Place, person and activities), emotional detachment, numbness Rule out co-morbidity, coping strategies (Depression, anxiety, substance misuse etc)

Answer 93

``` • Mode of onset, duration and progression of the symptoms • Ask in detail about cognitive, behavioural, psychological, physical and - biological symptoms • Risk assessment • Past medical history • Past psychiatric history • Relevant personal history • Relevant family history. ```

Answer 94

Short term vs long term memory Attention and concentration Temporal and spatial - time of day, wandering, losing way home Visuospatial/agnosia - recognising places and familiar faces Nominal dysphagia - names of people Language difficulties - way they speak, word-finding difficulties, understanding others ADLs Handling money Planning and making decisions, everyday problems

Answer 95

• Has there been any change in his behaviour like being more irritable than usual? • Have you noticed any change in personality that seems to have occurred recently? • Ask about becoming aggressive frequently, episodes of violent and anger outbursts • Also enquire about behaving inappropriately, socially withdrawn, wandering at nighttime, disinhibited behaviour, repetitive behaviours etc.

Answer 96

Presenting problems: Onset, duration, severity and progression Impact on normal functioning Memory & confusion- Short term and long term memory impairment with examples Orientation to time & place Attention & concentration, Visuospatial dysfunction Language/communication difficulties, Recognition, naming difficulties, Reading, writing etc Functional abilities- simple ADLs (Personal ADLs ) Complex ADLs- Domestic ADLs & Community ADLs Risk assessment- self-neglect, wandering, aggression, non compliance etc

Answer 97

``` Self-neglect Falls Wandering Self-harm Non-compliance Fires Financial abuse Aggression/others Driving Carer burnout ```

Answer 98

Identify specific behavioural problems- Nature, Mode of onset, duration and progression of symptoms, Identify triggers Explore Psychiatric symptoms that could be causing these problems – Depression/psychosis, dementia. Rule out Physical problems- constipation, UTI, pain, infection Assess environmental factors and Change in social environment 1. New resident disturbing the patient 2. Lack of stimulation and Regular visitors Other factors- Loss of mobility + loss of gardening activity, Lack of routines Structured activities at home to overcome boredom (Music, art, activity nurse, pet animals, bingo, games etc) Psychosocial interventions to improve quality of life (Reminiscence therapy/reality orientation)

Answer 99

``` Mode of onset, duration and progression of symptoms Further exploration of presenting symptoms (H/O Major strokes and TIAs) Cognitive symptoms (Short term; long term memory, Orientation, Intermittent confusion)- Seek examples Other areas of cognitive domains- Language difficulties, Visuospatial difficulties, recognition, reading, writing etc Assess Functional abilities- ADL skills Mood and Psychological Symptoms (Depression, anxiety, paranoia, delusions, hallucinations) Physical Symptoms- (Incontinence, gait disturbance, sensory & Motor deficits, aphasia, Parkinsonian movements) Medical History (Diabetes, Hypertension, Heart disease, high cholesterol etc) & Medications Personal and family history Risk assessment (Falls, aggression, wandering, Non-compliance, carer’ stress) ```

Answer 100

It refers to the capacity to make a valid will. The will may be legally valid if the testator is of “Sound disposing mind” at the time of making it. This depends on four legal criteria. ü Whether the testator understands what a will is and what the consequences are (Is ware of what a will constitutes) ü Basic understanding of the nature and extent of the property. (Knows the general extent of their assets) ü He/she must be aware of the people who might reasonably expect to benefit from the assets (should know the name of close relatives and can assess their claims to the property) ü He/She should be free from an abnormal state of mind and must be free of delusional beliefs that might affect the distribution of assets and must not be under the influence of any drugs that tend to distort the patient’s mental capacity as far as making a will is concerned.