General Psychiatry Flashcards
What are the features of schizophrenia?
- Hallucinations
- Delusions
- Disorganised Thinking / Speech
- Catatonia
- Negative Symptoms
What are the clusters of personality disorders?
Cluster A (mad): schizotypal, schizoid, paranoid Cluster B (bad): antisocial, histrionic, narcissistic, borderline Cluster C (sad): OCPD, anxious-avoidant, reliant
What are the 5 axes of DSM V?
Axis I: principle disorder (e.g. depression, schizophrenia)
Axis II: personality and developmental disorders
Axis III: medical problems
Axis IV: psychosocial stressors
Axis V: global assessment of functioning
What are the features of depression?
D - depressed mood I - loss of interest G - feelings of guilt S - sleep disturbance P - psychomotor agitation or retardation A - appetite change C - poor concentration E - lack of energy S - suicidal ideation
What are the features of borderline personality disorder?
Mood swings, transient paranoia or dissociation, impulsive behaviour, self-harm, suicidal ideation, unstable relationships, fear of abandonment
What is the presentation of serotonin syndrome and how is it treated?
Mental State: agitation, hypomania, confusion, hallucinations, coma
Autonomic: hyperthermia, tachycardia, nausea, diarrhoea
Neuromuscular: myoclonus, tremor, hyperreflexia, ataxia
Treatment: cessation of medication, supportive care, cyproheptadine
What are the features of Wernicke’s encephalopathy?
Ataxia
Opthalmoplegia
Confusion
What are the features of Korsakoff Syndrome?
- Anterograde amnesia
- Retrograde amnesia
- Confabulation
- Miminal content of conversation
- Lack of insight
- Apathy
What are Bowlby’s four attachment styles?
Type B: balanced & secure (most common)
Type A: anxious avoidant (second most common)
Type C: anxious ambivalent / preoccupied
Type D: disorganised
What are the domains of dysfunction in Autism Spectrum Disorder?
Deficit in social communication + interaction
Restricted, repetitive behaviour
What are the two components of ADHD?
- Inattention
2. Hyperactivity + Impulsivity
What are the commonly used bedside screening tests for cognitive function and when is each used?
MMSE: moderate cognitive deficit (no executive testing)
FAB: frontal lobe / executive dysfunction only
MoCA: mild cognitive impairment + executive dysfunction
ASAS-Cog: impairment in AD
What is the difference between a guardianship and an administration order?
Guardianship: lifestyle + medical decisions
Administration: financial + asset decisions
How is delirium managed?
- Treat underlying cause
- Reorioentation, behavioural intervention
- Sedation (haloperidol, quetiapine, olanzapine, lorazepam)
How can you distinguish delirium from dementia?
In delirium, patients tend to be more distractible and unable to focus or pay attention
What are the subtypes of Anorexia Nervosa?
Restricting type: dieting, fasting, excessive exercise
Binge-purge type: vomiting, laxatives, enemas
What is the difference between the binging-purging type of Anorexia Nervosa and Bullimia Nervosa?
Anorexia = BMI <17 Bullimia = BMI normal or overweight
What is conversion disorder?
1+ symptoms of altered motor/sensory function (e.g. mimic stroke) with no medical explanation
How is conversion disorder managed?
- Psychoeduation
- CBT + physical therapy
- Antidepressants, hypnosis
What are the risk factors for suicide?
S - Male Sex A - Age (biggest cause of death 15-24, highest rates >65) D - Depression or other psychiatric disorder P - Previous attempt E - Excess alcohol or substance abuse R - Rational thinking loss S - Social supports lacking O - Organised plan N - No spouse S - Sickness
What are the components of the mental state examination?
A - Appearance B - Behaviour C - Conversation A - Affect P - Perception C - Cognition I - Insight J - Judgement R - RapportW
What are the four symptom domains of mood disorders?
- Mood
- Psychomotor activity
- Cognition
- Vegetative
What is the difference between Bipolar I and Bipolar II?
I: at least one manic episode
II: at least one hypomanic episode and one major depressive episode, without a manic episode
What is the difference between mania and hypomania?
Mania: 1 week, impairs functioning
Hypomania: 4 days, no marked impairment, no psychosis, no hospitalisation
What is a mixed episode?
Concurrent presence of depressive symptoms with manic symptoms (DSM-V = with mixed features)
What is the timeframe for adjustment disorder?
Onset within 3 months of stressor and don’t persist >6 months after removal of stressor
What are the key features of Borderline Personality Disorder?
I - Instability of affect (mood swings)
I - Interpersonal relationship issues (abandonment)
I - Impulsivity (suicidal + self-harm behaviours)
I - Identity disturbance (dissociation, paranoia)
What are the indications for CBT?
Mild-moderate depression, anxiety disorders, OCD, eating disorders, drug/alcohol dependence
Which patients are likely to respond well to CBT?
Willing and motivated to engage Internal locus of control Good insight Average intelligence Not psychotic or manic
What are the negative symptoms of schizophrenia?
Avolition (motivation) Anhedonia (pleasure) Apathy (interest) Affective blunting Alogia (speech) Asociality
What are the features of psychosis?
Hallucinations Delusions Formal thought disorder Catatonia (negative symptoms are in schizophrenia)
What is Freud’s topographic theory of the mind?
Unconscious mind: not directly accessible
Preconscious mind: ordinary memory
Conscious mind: current awareness (10%, like iceberg)
What is Freud’s structural theory of the mind?
Id: basic instinctual drives
Superego: culture, ideals, spirituality, conscience
Ego: conscious awareness, reconciles Id and Superego
List some immature ego defence mechanisms.
Acting out
Wishful thinking
Passive aggression
List some mature ego defence mechanisms.
Mindfulness Thought suppression Emotional self-regulation Distress tolerance Emotional self-sufficiency
List some pathological ego defence mechanisms.
Denial
Distortion
Inferiority / superiority complex
List some neurotic ego defence mechanisms.
Rationalisation Intellectualisation Regression Repression Upward / downward social comparisons
What are the features of substance dependence?
S - Social impairment
H - High-risk use
I - Impaired control
P - Pharmacological tolerance and withdrawal
What are the features of alcohol withdrawal?
Autonomic hyperactivity: nausea, agitation, tremor, tachycardia, hypertension, palpitations, anxiety, insomnia
Hallucinations
Tonic-clonic seizures
What are the features of delirium tremens?
Change in consciousness + cognition (delirium)
Fever
What are the different specifies of depression?
with Melancholic Features with Atypical Features with Catatonia with Psychotic Features (mood congruent or incongruent) with Postpartum Onset with Anxious Distress with Mixed Features with Seasonal Pattern
What are the features of a schizotypal personality disorder?
Eccentric behaviour, beliefs, dress and language
Lack close friends
Often identify as ‘psychic’ or as having a ‘sixth sense’
May have anxiety and ideas of reference
What is Couvade syndrome?
A condition of male partners of pregnant women who experience indigestion, weight/appetite change, bloating constipation, abdominal pain, etc.
