Intro to Psych Flashcards
2 manuals used to diagnose and classify in psych
ICD10 and DSM V
Which manual is used in Europe
ICD10
Differences between DSM V and ICD 10
ICD10 focuses more on clinical use and is more descriptive not operational
DSM V has profusion on diagnoses and has operational criteria
Define mental disorder
Clinically recognisable set of symptoms or behaviours associated with distress and with interference with personal functions
What are the five axis in multiaxial diagnosis
1 = clinical disorder
2 = personality disorder or mental retardation
3 = medical or physical conditions
4 = contributing environmental or psychosocial factors
5 = global assessment of functioning
Is the multiaxial diagnosis still in use
No, DSM V removed it but it’s still useful (was in DSM IV)
List features of the biopsychosocial models
Biological, psychological, social
Predisposing, precipitating and perpetuating features
Describe the psych patient journey
Mild mental illness would go to GP - managed by GP/counselling
Moderate to severe illness who can engage and are a manageable risk would go to hospital/picked up by police - managed by GP/community mental health services/secondary care
Severe illness with significant risk would be picked up by social services - managed in ‘ward in the community’ or at home treatment / psychiatric ward (voluntary or sectioned)
List the 2 types of affective disorders
Bipolar and depression
List OCD related disorders
OCD
body dysmorphia
Hoarding
Hyperchondriasis
Define anxiety
Constellation of psychological and physiological response to potential or uncertain threat
What is the purpose of anxiety
Exists to automatically motivate us to avoid harm
What is state anxiety
The state of feeling anxious, which can be helpful in daily life
What is trait anxiety
The propensity of an individual to experience state anxiety in response to any event
Benefits of higher trait anxiety
Slightly higher life expectancy - lower chance of dying under 25
Causes of higher trait anxiety
Environmental - constant threat, insecurity
Genetic - polymorphisms of serotonergic / noradrenergic function
How does avoidance affect state anxiety
Perpetuates the conditioned fear
Symptoms of depression
Low energy
Low mood
Anhedonia
What is anhedonia
Incapacity to experience positive emotions in things that usually make you happy
How do depressogenic stressors cause symptoms of depression
Prolonged stress causes recuperative response which overwhelms homeostasis
Also decrease self worth
What is cognitive bias
Finding evidence that supports your view only
What features are needed to perpetuate addiction
State of distress
Distress reducing behaviour eg substances / self harm / disordered eating
Temporary relief from the stress due to the behaviour
Negative reinforcement causes an urge
What is positive reinforcement
When you feel okay and then something makes you feel better
What is negative reinforcement
When you’re in a state of distress, then something makes you feel temporarily better
What does repeated negative reinforcement cause
Repetition —> habit formation —> compulsion
Why can’t someone choose to stop the behaviour in addiction
Habit formation erodes control to stop the behaviour
Causes of psychosis
Schizophrenia
Schizoaffective disorder
Depression
Other psychotic disorders
Two main symptoms of psychosis
Hallucinations (usually auditory) and delusions
Define psychosis
Group of pathologies that disrupt the process of perceiving and interpreting reality
How is psychosis different from delirium
Psychosis can make sense of what you’re saying and aren’t drowsy / less responsive. They just have a shifted sense of what is real
Genetic predisposition of psychosis
80% heritability
High risk if you have a first degree relative with psychosis
Genes must confer significant advantage
Prevalence of psychosis
1/100
What is depression
Persistent low mood or loss of interest
Symptom of depression
Irritability, sadness, tearfulness, anhedonia
What are the 5 biological symptoms
Sleep, appetite, energy, concentration and libido
Other features of depression
Negative thoughts, suicidal intent
What is mania
Persistent elevation in mood, can be a mix of elation and irritability
Symptoms of mania
Increased self confidence and sense of well-being
Increased appetite, libido, energy, concentration
Over familiar and inappropriate behaviour
Psychosis
Reduced need for sleep, quickened speech and thoughts
Symptoms of anxiety
Restlessness, tremor, dry mouth, butterflies, nausea, shortness of breath, palpitations
Excessive worries
4 anxiety disorders
Generalised anxiety
Phobias
Social phobia
Panic disorders
What is OCD
Obsessional thoughts are unpleasant, unwanted, intrusive thoughts entering the mind despite attempts to resist them - images, impulses or doubts
They are the patients own thoughts
Themes of OCD
Contamination, sexual themes, religious, not closing windows/doors, impulse to do something dangerous
In OCD, is the patient aware that their thoughts are their own and that they are irrational?
Yes and yes
What are compulsions
Repetitive, stereotypical rituals
Can be physical or mental eg counting
May have to be done a certain number of times
What is overvalued ideas
A reasonable belief that is pursued excessively, dominates the persons life and causes distress to self / others
Give an example of overvalued ideas
Anorexia nervosa
What is psychosis
Experience of losing touch with reality through delusions, hallucinations and or formal thought disorder
Give an example of psychosis
Schizophrenia
Subtypes of schizophrenia
Paranoid, catatonic, Simple’s, hebephrenic and residual
Other types of psychosis
Acute / transient psychosis
Schizoaffective disorder
Delusional disorder
What are delusions
Fixed, false beliefs, held despite rational argument or evidence to the contrary. Out of keeping with the persons cultural / social background
What are the types of delusions
Primary = occur out the blue
Secondary = develop after another symptoms eg hearing a voice, smelling gas
Persecutory, grandiose, nihilistic, hypochondriacal, guilt, reference, erotomania, interference
What is a perception
Awareness of stimulus through your senses
What is an illusion
Misperception of stimulus
What is a hallucination
Perception in the absence of stimulus
Types of hallucinations
Auditory, visual, gustatory, tactile, olfactory
What are schneiders first rank symptoms of schizophrenia
Delusional perception
Thought interference - thought insertion, thought withdrawal, thought broadcasting
Auditory hallucinations
Passivity phenomena
What is delusional perception
See something ordinary and it triggers delusional belief
What is Thought interference
Delusional belief that someone is interfering with your thoughts
What is thought insertion
An alien thought is put in your mind that is not your own
What’s thought withdrawal
Thoughts are being removed from your mind, suddenly gone
What is thought broadcasting
The public can hear or know your thoughts or they’re put on billboards / notices etc
Type of auditory hallucinations typical of psychosis
Third person voices talking about the patient
Other types of auditory hallucinations
Third person running commentary
Thought echo
Third person voices talking about the patient
What is passivity phenomena
Someone is controlling your movements emotions or impulses
Sections of psychiatric Hx
PC, HPC
Past psychiatric history and medical history
Drug and family history
Personal history
Substance misuse
Forensic history
Social history
Premorbid personality
When you present the patient, what do you start with
Patient - age, sex, single/married, occupation
Setting - how did they come in, who came with them, police involved
On the ward - check if they’re voluntary or sectioned
What is constituted in PC
Depends on setting
Outpatient - patients issues
Ward - reason for admittance
A&E - why they have come, corroborated by whoever bought them
Always take patients view in their own words, then add anything else other people have said
HPC Qs
How long has it been going on for
The build up to an event
Explore different symptoms
Run through MSE
What is in the past psychiatric history
Any previous diagnoses
Previous Tx in primary or secondary care
Admissions, whether sectioned or not
Any psychiatric medications and doses etc
Medical conditions with psychiatric symptoms
Thyroid disease, MS, post MI, diabetes
Secondary to drugs eg steroids, beta blockers
Chronic pain
What medical conditions can be impacted by psychiatric drugs
DM - antipsychotics can cause raised glucose
What important Q must you ask with medication
Compliance - are they actually taking what they were prescribed
FHx questions
Name, age, occupation of parents, siblings
Relationship with family members
Any medical / psychiatric conditions in the family
What Qs are involved in a personal history
Ask the patient to take you through their life story
Pregnancy / birth
Developmental milestones
Home life during childhood - trauma
Academic ability / friends / bullying / behaviour problems
Jobs - types, reasons for leaving, relationships with colleagues
Relationships, children - details about any children
Substance misuse Qs
Smoking, alcoholic, recreational drugs
Don’t make assumptions
Age of starting, pattern of use, harmful use ie problems caused
Look for dependence / medical complications
Qs in forensic history
Any trouble with police
Arrested / convicted / charged
History of crime without getting into trouble
Think about any temporal links to mental illness
What is meant by premorbid personality
What were you like before you become Ill
How would your friends and family describe you
Where can you get collateral information from
Ambulance, police, friends, family
Do you need consent to talk to their relative
Yes to share information about them with other people
But not to just listen to a family members concerns
What is involved in the mental state examination
Appearance and behaviour
Speech and thought form
Mood
Thought content
Perception
Cognition
Insight
What do you assess in appearance and behaviour
Age, gender, build
Level of self care, clothing
Scars, piercings, tattoos
Facial expression, posture
Eye contact
Engagement
Level of activity
Odd movements
How would you describe an emotion not suitable for the situation
Incongruent
What do you comment on with speech
Rate
Volume
Tone - calm, hostile, sarcastic
Flow - spontaneous, hesitant, uninterruptible
What is formal though disorder
Where speech is disturbed as a reflection of disordered thought
Thoughts can become muddled, vague, disorganised, disjointed
Poverty of thought or racing thoughts
Sudden break in speech
Too much information but still makes sense
Can have derailment and word salad - random words
What is flight of ideas
Too many thoughts which are linked
Can involve using the same word in multiple contexts, or rhyming
What does formal thought disorder suggest?
Schizophrenia
What is commented on in mood
Depressed with negative cognitions and biological sx of depression
Elated mood with increased sense of well-being and biological sx of mania
If they’ve not come with depression specifically, then look for it
List depression questions
How have you been feeling
Are you enjoying things are normal
Has your sleep been okay
How is your appetite
How are your energy levels
Can you concentrate as normal
How do you feel about yourself
What are your plans for your future
Questions on suicide attempt / self harm
Get as much detail as possible
What happened during event - details!
What did the patient think would happen
How do they feel now
What is nihilistic delusion?
Belief that things are dead that aren’t
What 2 things do you need to comment on in mood?
Subjective and objective mood and whether it’s congruent
(Their perception and your impression)
What types of thought content do you comment on
Depressive, anxious, obsessional, overvalued ideas, delusions
What constitutes full insight
They are aware something is wrong
They know the problem is mental health
They know they require treatment
Do patients often have full insight?
No, usually partial insight, eg knowing something is wrong but they think it’s their neighbours fault or that they think theres nothing wrong but will take medication anyway
What is the difference between psychology and psychiatry?
Psychologist do not have a general medical background, they are purely specialised in psychology
Psychiatrists prescribe, psychologists do not
Psychologists are based around talking therapy
Under what section of MHA can someone be detained?
2 or 3
What is an informal admission?
Voluntary admission to psych ward as the person has capacity and is willing to go
Can someone on informal admission leave the pscyh ward at will?
YES (in theory) - they have capacity to consent to admission so can leave. But sometimes in ward they have deprivation of liberty so can’t
Who has the final say on whether someone is detained?
AMPH - approved mental health professional
Who is involved in the MHA assessment?
AMPH
2 doctors - one of which knows the patients, write recommendations
The nearest relative
Difference between S2 and S3 of MHA
- S2 = assessment +/- Tx - 28days
- S3 = Tx - 6 months
Criteria for detention under MHA
- suffering from mental disorder (not substance use)
- of a nature / degree to warrant admission to hospital
- admission is needed to protect health / safety of patient and others
- S2 = assessment +/- Tx - 28days
- S3 = Tx - 6 months
- Must have considered alternatives
What is section 5(2)?
Doctor’s holding power
- used to temporarily detain patient who is trying to leave
- can only be used on inpatients NOT A&E
how long does section 5(2) last?
72 hours
Purpose of section 5(2)?
Trigger for MHA assessment (MHAA) - allowing time for this
What 3 criteria must be met to legally use section 5(2)?
- Approved clinician (consultant) or their deputy (99% of the time, its their deputy)
- Must have a full licence (ie not F1, only F2 or above)
- Has to be the team looking after the patient, not the psych team
What is not included in 5(2)?
Authorisation for treatment
Process of using 5(2)
Personally examined the patient
State why informal admission is no longer appropriate, what you think is causing Sx and the acute risks
Sign & date it
Given to nurse in charge / hospital managers
Triggers a MHAA
Length of section 2
up to 28 days
purpose of section 2
assessment through MHAA
length of section 3
up to 6 months
purpose of section 3
treatment through MHA
length of section 5(4)
up to 6 hours
purpose of section 5(4)
urgent detention on a non ward
who does a section 5(4)
NURSE ONLY - no need for Dr
length of section 5(2)
up to 72 hours
purpose of section 5(2)
urgent detention on a ward
who does a section 5(2)
1 doctor in charge
what is section 136 & who does it
emergency power that POLICE have to remove suspected mentally ill person from a public place to a place of safety for further assessment
How long does section 136 last
24 hours
when can section 136 not be used
if the person is NOT in a public place
what is section 135
similar to section 136 but involves private property not public places
what is a community treatment order (CTO)
an order for supervised treatment in the community, and rapid recall if conditions not met
