Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1 - Psychiatry AE > Lectures > Flashcards

Lectures Flashcards

1
Q

How old are the children in CAMHS?

A

4-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is CAMHS mainly based?

A

In the community

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are there inpatient beds in CAMHS?

A

There are in-patient beds but they are very limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between CAMHS and adult psych?

A

[1] less pharmacological treatment; [2] wider range of therapies available (especially creative therapies); [3] more emphasis on involving family, school, college and any system around the child.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which patients might get special transition from CAMHS to adult psychiatry?

A

ADHD; psychoses; anorexia; high risk patients (early intervention teams can take these patients early if needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is attachment theory?

A

An infant needs to develop a relationship with at least one primary caregiver for the child’s successful social and emotional development, and in particular for learning how to effectively regulate their feelings.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the recovery model in psychosocial treatment?

A

People can change their attributes , skills and goals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is involved in psychosocial treatment?

A

Help with independent living, money, housing, education, employment, meaningful activities (days structured, back to work, volunteering)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of formulation?

A

Going beyond the diagnosis. Constructing a formulation all focus on the process rather than the finished product.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the four different things you ask about in the biopsychosocial formulation?

A

Predisposing factors (vulnerability); precipitating factors (triggers); prolonging factors (maintaining); protective factors?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What sort of predisposing factors would you ask about?

A

Genetics, developmental disabilities; sensory impairments; temperament; early trauma; core beliefs; formative relationships; school life; security (housing/finance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What sort of precipitating factors would you ask about?

A

Hormones; drug use; physical illness; head injuries; transitions and life stages; life events; bullying; work; relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What prolonging factors would you ask about?

A

Alcohol and drug misuse; non-adherence; unhelpful coping styles; lack of insight; destructive patterns of behaviour; relationships - anger/dependency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What protective factors would you ask about?

A

Intact cognitive function; physical health and mobility; adherence; insight; motivation for change; goals; supportive relationships; engagement with services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is IAPT?

A

Improving access to psychological therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where is IAPT bases?

A

In the community and GP practices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What conditions does IAPT deal with?

A

Mainly depression and anxiety but it’s remit is widening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some models of psychotherapy

A

Psychodynamic; CBT; counselling; cognitive analytical therapy; interpersonal therapy; dialectic behavioural therapy; family therapy; marriage therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Freud’s original model based on?

A

Focussed on therapy as a process of uncovering past trauma to resolve present day symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long would you have psychodynamic psychotherapy for?

A

Once a week for about a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the waves of CBT?

A

1st wave: behavioural therapy
2nd wave: cognitive behavioural therapy
3rd wave: combines mindfulness and acceptance with the above therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How many CBT sessions would you normally have?

A

They are generally structured and fairly brief (6-20 sessions) but may be longer in some cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does CBT focus on?

A

Mainly focuses on the here and now, and on problems in day to day life rather than on the therapeutic relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the aims of counselling?

A

It is fairly short and aims to help patient be clearer about their problems and find answers on their own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When is counselling used?

A

Often used to help someone cope with recent events that are difficult. It does not aim to change you as a person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the aims of cognitive analytical therapy?

A

Integrates cognitive and psychotherapy. Patient describes how problems have developed from events in their life and their personal experiences. Focuses on their way of coping and how to improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How often would you have cognitive analytical therapy?

A

You would have 16-24 sessions over 4-6 months. Each one is about 50 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does interpersonal therapy work?

A

Aims to help the patient understand how problems may be connected to the way their relationships work. Helps identify how to improve relationships and find better ways of coping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What disorders is dialectic behavioural therapy focus on?

A

Helps with problems associated with borderline personality disorder (repeat self harming)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does dialectic behavioural therapy aim to do?

A

Goal is to help patients learn to manage difficult emotions by letting them experience, recognise and accept them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the three different concepts in phenomenology?

A

Concrete concept (real objects or situations); defined concept (classes of concepts); concepts systems (sets of related concepts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is an illusion?

A

Illusionsare misperceptions of real external stimuli e.g.if you think a coat rack is a person, the coat rack is real but the interpretation is wrong.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a hallucination?

A

Hallucinationsare perceptions occurring in the absence of an external physical stimulus. Modalities include Auditory, visual, olfactory, gustatory, tactile, somatic. E.g. if you see someone who is not there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a hypnopompic hallucination?

A

A hallucination that happens when you’re waking up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a hypnogogic hallucination?

A

A hallucination that happens when you’re falling asleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is a reflex hallucination?

A

Experience stimulus in one modality and feel it in another modality. Modality = sense “When you write, I can hear your pen pressing on my heart”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is an extracampine hallucination?

A

Hallucination that cannot possibly be experienced. ” I can hear people talking to me from Australia.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the types of auditory hallucinations?

A

1st person, 2nd person, 3rd person (running commentary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is an over-valued idea?

A

A false or exaggerated belief sustained beyond logic or reason but with less rigidity than a delusion, also often being less patently unbelievable. (eg. I’m the best employee ever, lecture week would fail without me!) not as fixed as a delusion, can be changed with evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a delusion?

A

Delusion is a false, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background. It is held with extraordinary conviction and subjective certainty. It is a phenomenon that is outside normal experience. They are held without insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the types of delusions?

A

Persecutory – outside agency to cause harm
Grandiose – inflated importance / self-esteem
Self-referential – television, tie, etc
Nihilisitic – bowels rotted, already dead etc
Religious – more refers to the content of a delusion, all can contain religious reference
Hypochondriacal – illness, somatisation
Guilt – responsibility for harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the Capgras delusion?

A

The Capgras delusion is the belief that (usually) a close relative or spouse has been replaced by an identical-looking impostor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the Fregoli delusion?

A

The Fregoli delusion is the belief that various people the believer meets are actually the same person in disguise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is intermetamorphosis?

A

Intermetamorphosis is the belief that people in the environment swap identities with each other whilst maintaining the same appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a delusional perception?

A

Delusional perception describes a delusional belief resulting from a perception. For example, a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as the defining moment when they realised they were being monitored by the government

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the different thought symptoms?

A

Thought insertion; thought withdrawal; thought broadcast; thought echo; thought block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is concrete thinking?

A

Lack of abstract thinking, normal in childhood, and occurring in adults with organic brain disease and schizophrenia . Very literal (would not understand a metaphor e.g. don’t throw stones in a glass house)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is loosening of association?

A

there is a lack of logical association between succeeding thoughts. It gives rise to incoherent speech (in the absence of brain pathology). It is impossible to follow the patients train of thought (knight’s move thinking/derailment). Not related thoughts at all.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is circumstantiality?

A

Irrelevant wandering in conversation. Talking at great length around the point. Lots of little stories , like when dad spoke about oskar and started talking about Norway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is perseveration?

A

Repetition of a word, theme or action beyond that point at which it was relevant and appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is confabulation?

A

Giving a false account to fill a gap in memory. Severe end of schizophrenia and in alcohol misuse disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is somatic passivity?

A

Delusional belief that one is a passive recipient of bodily sensations from an external agency. Something is brushing on my arm, it’s the devil passing over my arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is made act/feel/drive?

A

Made bit – the object in question is experience or carried out by the person, but is considered as alien or imposed. Act – action, feeling – feeling, drive – impulse. “The devil is making me sidestep across the room”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is stupor?

A

More or less complete loss of activity with no response to stimuli; may mark a progression of motor retardation; found in a wide range of neurological and psychiatric conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is psychomotor retardation?

A

Slowing of thoughts and movements, to a variable degree. Occurs in depressionbut other causes include psychotropics, Parkinson’s disease etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is flight of ideas?

A

Rapid skipping from one thought to distantly related ideas, the relation often being so tentative as for instance the sound (rhyming) of different utterances. Volume of speech is increased (not loudness but amount of it).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is pressure of speech?

A

Manifest in a very rapid rate of delivery, a wealth of associations which may be quite unusual, (e.g. rhymes and puns) and often wanders off the point of the original conversation. This is highly suggestive ofmania. (doesn’t have to be connected)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is anhedonia?

A

The inability to experience pleasure from activities usually found enjoyable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is apathy?

A

Loss of interest in things, loss of energy and motivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is incongruity of affect?

A

Emotional responses which seem grossly out of tune with the situation or subject being discussed. They might be genuinely upset and just not presenting it. Wrong expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is blunting of affect?

A

An objective absence of normal emotional responses, without evidence of depression or psychomotor retardation. No expression at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is belle indifference?

A

Lack of concern and/or feeling of indifference about a disability or symptom. Links to conversion. Patient suffering from domestic abuse, presents with arm that can’t move, arm is physically fine but the patient believes they can’t move their arm, but are indifferent about the fact that they can’t move it.

63
Q

What is depersonalisation?

A

A feeling of some change in the self, associated with a sense of detachment from one’s own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities. Loses the experience of themselves, could be a response to trauma.

64
Q

What is derealisation?

A

A sense of one’s surroundings lacking reality, often appearing dull, grey and lifeless. They believe they are real but the world is not. “the world is made out of paper”.

65
Q

What is dissociation?

A

An experience where a person may feel disconnected from himself and/or his surroundings. It’s like being locked in a wardrobe in my mind. They know what’s going on but feel they cannot control it

66
Q

What is conversion?

A

Unconscious mechanism of symptom formation, which operates in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature

67
Q

What is a mannerism?

A

A sometimes bizarre elaboration of normal activities on response to stimulation. (twirling hair when speaking in public) Alone, not an example of mental health problem

68
Q

What is stereotyped behaviour?

A

Uniform, repetitive non goal-directed actions not related to stimulation (may take a variety of forms from simple movement to an utterance)

69
Q

What is an obsession?

A

A recurrent persistent thought, image, or impulse that enters consciousness unbidden, is recognised as being ones own and often remains despite efforts to resist

70
Q

What is a compulsion?

A

Repetitive, apparently purposeful behaviour performed in a stereotyped way accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and often resistance by the patient. Recognised as morbid by the affected individual

71
Q

What is Akathisia?

A

A condition marked by motor restlessness, ranging from anxiety to inability to lie or sit quietly or to sleep,. Common side effect of treatment.

72
Q

What the affective (mood) disorders?

A

Depression; bipolar; cyclothymia

73
Q

What are the core symptoms of depression?

A

Low mood; loss of energy (anergia); loss of pleasure (anhedonia)

74
Q

What are the non-core symptoms of depression?

A

Change in sleep; change in appetite; change in libido; diurnal mood variation; agitation; loss of confidence; loss of concentration; guilt; hopelessness; suicidal idealation

75
Q

What is mild depression?

A

Core symptoms and 2-3 others

76
Q

What is moderate depression?

A

Core symptoms and 4 others and functioning affected

77
Q

What is severe non-psychotic depression?

A

Several symptoms, suicidal, marked loss of functioning

78
Q

What is severe psychotic depression?

A

Typically mood congruent (nihilistic and guilty delusions, derogatory voices)

79
Q

What are the two types of bipolar?

A

Bipolar 1 - both mania and depression
Bipolar 2 - more episodes of depression, very few episodes of mania, only mind hypomania
Rapid cycling - episodes only last a few hours

80
Q

What is cyclothymia?

A

A milder form of bipolar

81
Q

What are the symptoms of mania?

A

Extreme elation (uncontrollable); overactivity; pressure of speech; impaired judgement; extreme risk tasking behaviour; social disinhibition; inflated self-esteem; psychotic symptoms; mood congruent

82
Q

What are the conditions that can cause psychosis?

A

Schizophrenia; delusional disorder; schizotypal disorder; depressive psychosis; manic psychosis; organic psychosis

83
Q

What age is schizophrenia common?

A

Onset typically in 2nd-3rd decade but 2nd (smaller) peak incidence in late middle age

84
Q

How does schizophrenia differ between women and men?

A

Men tend to get it earlier than women

85
Q

What is schizophrenia?

A

Splitting of thoughts or loss of contact with reality
Affects - thoughts, perceptions(sight, smell, taste, touch, sounds), mood, personality, speech, volition, sense of self……

86
Q

What are the first rank symptoms of schizophrenia?

A

Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception

87
Q

What are the secondary symptoms of schizophrenia?

A 
Delusions
2nd person auditory hallucinations
Hallucinations in any other modality
Thought disorder
Catatonic behaviour
Negative symptoms
88
Q

What are the positive symptoms of schizophrenia?

A 
Hallucinations
Delusions
Passivity phenomena
Thought alienation
Lack of insight
Disturbance in mood
89
Q

What are the negative symptoms of schizophrenia?

A 
Blunting of affect (not very expressive)
Amotivation
poverty of speech 
Poverty of thought
Poor non-verbal communication
Clear deterioration in functioning
self neglect
Lack of insight
90
Q

What are the symptoms of generalised anxiety?

A

Excessive anxiety across different situations
>6 months
Tiredness
Poor concentration
Irritability
Muscle tension
Disturbed sleep (usually initial insomnia rather than EMW)

91
Q

What are the physical symptoms of panic disorder?

A 
Palpitations
chest pain
choking
Tachypnoea
Dry mouth
Urgency of micturition
Dizziness
Blurred visions
Parasthesiae
92
Q

What are the psychological symptoms of panic disorder?

A 
Feeling of impending doom
Fear of dying
Fear of losing control
Depersonalisation
Derealisation
93
Q

What are the characteristics of the obsessions in OCD?

A 
Often unpleasant – death/ sexual/ blasphemous
Repetitive
Intrusive
Irrational
Recognised as patient’s own thoughts
94
Q

What are some examples of compulsions in OCD?

A

Checking, washing, counting, symmetry, repeating certain words or phrases

95
Q

What are the subtypes of dementia?

A 
Alzheimer's
Fronto temporal (Pick’s Disease)
Vascular 
Lewy Body
Parkinson’s
Normal pressure Hydrocephalus
96
Q

What are the clinical features of Alzheimer’s disease?

A

Insidious changes – missing appointments, lack of self-care, wandering
Cognitive Fx - 4As
Amnesia – recent memory, disorientation for time>place
Apraxia – clothes, using appropriate cutlery
Agnosia – recognise parts of the body
Aphasia – late, mixture of receptive & expressive speech

97
Q

What are the neuroradiological signs of Alzheimers ?

A

Cerebral and hippocampus atrophy, enlarged ventricles

98
Q

What are the clinical features of vascular dementia?

A 
Onset and progression
Acute
Stepwise decline
Focal neurology
CVA
Expressive dysphasia
99
Q

What are the neuroradiological signs of vascular dementia?

A

Cortical and subcortical lesions, seen as white dots of MRI

100
Q

What are the clinical features of fronto-temporal lobe dementia?

A

Onset 50-60 years (a lot younger than Alzheimers)
Personality change
Apathy, disinhibition, emotional blunting (no reactivity to things that are happening around them), coarsening of sociability (undress inappropriately in public)
Language Changes (not being able to name things as well)
Intellectual functioning (can’t manage the bills)
Progressive
Memory imp may occur later (quite good preserved memory)

101
Q

What are the clinical features of Lewy body dementia?

A

Onset and progression
Fluctuating onset and progression with a more rapid decline (quicker decline than Alzheimers)
Visual Hallucinations
Small children, animals, complex scenes
Parkinsonian signs
REM sleep behaviour disorders
Frequent falls (postural hypertension from the dementia)

102
Q

What should you look at in the mental state examination?

A 
Appearance
Behaviour
Mood
Speech
Thoughts 
Perception
Insight
103
Q

What does the Addenbrookes Cognitive Examination look at?

A 
Attention/Orientation 18/18
Memory 26/26
Language 26/26
Visuospatial 16/16
Fluency 14/14
104
Q

How would you treat Alzheimers?

A

NMDA antagonist - Memantine

Acetyl-cholinisterase inhibitors - Rivastigmine

105
Q

How would you treat vascular dementia?

A 
Statin
Antihypertensive medication
Aspirin
Treat diabetes
No benefits of acetylcholinesterase inhibitors, but still get all the side effects
106
Q

What is BPSD?

A 
Behavioural and psychological symptoms of dementia: Anxiety
Depression (more in early dementia)
Agitation
Psychosis
Disinhibition
107
Q

What causes BPSD?

A

Pain (they can’t tell you they’re in pain, so if they’re aggressive they may be showing distress)
Infection
Nutrition
Constipation
Hydration
Medication (may be having side effects such as hallucinations, look to see if any new drugs)
Environment

108
Q

What are the non-pharmacological treatments of dementia?

A 
INFORMATION
Carer Support
Life story
Psychological
Target symptoms Mood etc
Occupational therapy
Physiotherapy
Social Inclusion
Social activity
109
Q

What psychotic disorders occur in the elderly?

A 
Late onset Schizophrenia
Persistent Delusional disorder
Psychotic depression
Dementia
 - Delusions
 - Hallucinations eg Lewy Body Dementia
110
Q

What is late onset schizophrenia?

A

Onset after 45 years old

111
Q

How does late onset schizophrenia differ from schizophrenia?

A

Patients have less emotional blunting and personality decline compared to younger onset

112
Q

Why is late onset schizophrenia often misdiagnosed?

A

Late-onset schizophrenia often goes undiagnosed because older patients with the disorder tend to be socially isolated

113
Q

What are the clinical features of late onset schizophrenia?

A

delusions and hallucinations prominent
primarily paranoid
many symptoms similar to younger onset
Hallucinations in very late-onset schizophrenia are often prominent and can occur in multiple modalities, including auditory, visual, and olfactory partition” delusion, which leads the patient to believe that people or objects can transgress impermeable barriers
Less negative symptoms (less emotional blunting) and formal thought disorder compared to early onset schizophrenia

114
Q

What are the risk factors for late onset schizophrenia?

A

Social Isolation
Sensory deficits
Reclusive and suspicious premorbid personality (always been very difficult)
More common in women than men
Relatives of very-late-onset patients have a lower risk for schizophrenia than the relatives of early-onset schizophrenia patients

115
Q

What is the prognosis of late onset schizophrenia?

A

Chronic with partial remissions and exacerbations
Better outcomes than that in early-onset
Responsive to low dose antipsychotics?
Factors associated with positive outcome include early identification and treatment and good social support

116
Q

When and who does delusional disorder F22 occur?

A

Population prevalence – 0.03%
Middle to late adulthood
Higher among women
Age of onset is earlier for men

117
Q

What are the clinical features of delusional disorder F22?

A 
Long standing Delusions main feature
Over 3/12 Hx
 - single or related
 - culturally appropriate
 - No persistent Hallucination
     - Can be transitory
     - NOT 3rd Person
 - No passivity or blunting of affect
 - No Organic cause
118
Q

What are the common delusions in elderly F22 diagnosis?

A

skin infestation
Illness or cancer (believe they had it or the doctors failed to diagnose it)
being spied on
Followed
Poisoned
Infidelity (quite high risk as people can act on this delusion)

119
Q

What are the clinical features of psychotic depression?

A

Mood congruent delusions (depressed, low mood delusions)
Nihilistic Delusions
Cotard’s Syndrome (sensation that all your organs have gone rotten and smell)
Owing money (think they owe money to people)
Burden to others (very high risk of suicide)
Somatic Delusions
- unable to swallow (think they can’t do it, difficult to treat as they don’t take their medication, always check that it is a delusion and they don’t have an actual GI issue)
pain
Olfactory Hallucinations
2nd person derogatory Auditory hallucinations

120
Q

What is Charles-Bonnet Syndrome?

A

Experience of complex visual hallucinations in a person with partial or severe blindness
Patients understand that the hallucinations are not real and often have insight compared to other disorders

121
Q

What are the underlying principles behind the mental health act?

A

respect for patients’ past and present wishes and feelings
respect for diversity generally
minimising restrictions on liberty,
involvement of patients in planning, developing and delivering care and treatment appropriate to them,
avoidance of unlawful discrimination,
effectiveness of treatment,
views of carers and other interested parties,
patient wellbeing and safety, and
public safety.

122
Q

What is section 2 of the mental health act?

A

Duration – 28 days (cannot be renewed)
Purposes – assessment (although treatment can be given without patients’ consent)
Professionals involved - 2 doctors (one S12 approved), AMHP

123
Q

What is section 3 of the mental health act?

A

Duration – 6 months (and can be renewed for another 6 months, and then yearly)
Purposes – treatment (can treat without consent for first three months, after that consent is needed)
Professionals involved – 2 doctors, 1 AMHP

124
Q

What evidence is needed for section 2 of the mental health act?

A

Evidence required:

a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others

125
Q

What evidence is required for section 3 of the mental health act?

A

Evidence required:

(a) The patient is suffering from mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital; and
b) The treatment is in the interests of his or her health and safety and the protection of others; and
c) Appropriate treatment must be available for the patient

126
Q

What is section 4 of the mental health act?

A

Duration – 72 hrs
Purposes – only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay. no power to treat
Professionals required – 1 doctor and 1 AMHP

127
Q

What evidence is needed for section 4 of the mental health act?

A

Evidence required –

a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others
c) There is not enough time for 2nd doctor to attend (risk)

128
Q

What is section 5(4) of the mental health act?

A

For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave
Nurses’ holding power until doctor can attend
6 hours
Cannot be treated coercively whilst under section

129
Q

What is section 5(2) of the mental health act?

A

For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave
Doctors’ holding power – 72 hours
Allows time for Section 2 or Section 3 assessment
Cannot be coercively treated

130
Q

Can police section people on the mental health act?

A

Yes.
S136 – person suspected of having mental disorder in a public place, compulsory detention from public place (not home) to a place of safety. Upto 24 hours – MHA assessment
S135 – needs court order to access patient’s home and remove them to

131
Q

What is a community treatment order?

A

Extension of section 3 into community.
Conditions – take meds, attend appointments
Break conditions – 72 hours to return to hospital
Review 6 monthly

132
Q

What is section 117 of the mental health act?

A

Duty to provide after care for people wo have been subject to certain sections of the act (3)
Support their mental health as long as required
Don’t have to pay for services
Must be discharged by local authority

133
Q

What are the 4 key neurotransmitter systems?

A

Dopamine; serotonin; acetylcholine, glutamate

134
Q

What pathways does dopamine effect and what conditions are the linked to?

A

Mesocortical - negative symptoms of psychosis
Mesolimbic - positive symptoms of psychosis
Nigrostriatal - Parkinson’s disease

135
Q

What is the dopamine hypothesis behind schizophrenia?

A

Overactivity of dopamine receptors (D2)
- Mesolimbic = hallucinations
Underactivity of dopamine receptors (D1)
- Mesocortical = blunted and apathetic

136
Q

What is the main mechanism of anti-psychotic treatment?

A

Block D2 receptors

137
Q

What are the side effects of D2 antagonists?

A

Extrapyramidal side effects: acute dystonic reaction [eyes roll back in head, neck spasm] (hours); Parkinsonism [days]; akasthesia (inner restlessness, pacing and agitated)[days to weeks]; tardive dyskinesia (grimacing, lip smacking, tongue protrusion [months to years]

138
Q

What are some examples of some anti-psychotics?

A

Haloperidol; chlorpromazine; pipothiazine; olanzapine; clozapine is used in treatment resistant schizophrenia

139
Q

What neurotransmitter is in the pathophysiology of depression?

A

Serotonin and noradrenaline

140
Q

What are some types of antidepressants?

A

SSRIs (selective serotonin reuptake inhibitors); SNRIs (serotonin and noradrenaline reuptake inhibitors)

141
Q

How do SSRIs work?

A

Reuptake pumps and transporters recycle any serotonin within the synapse
Inhibiting the reuptake pumps increases free serotonin

142
Q

How do SNRIs work?

A

Inhibits the reuptake pumps

Inhbits the noradrenaline transporter

143
Q

Give some examples of SSRIs

A

Sertraline; Citalopram; Fluoxetine

144
Q

Give some examples of SNRIs

A

Venlafaxine; Duloxetine

145
Q

What are some side effects of SSRIs?

A

Sexual
Weight gain
Increased bowel motility
Agitation

146
Q

How do tricyclics work?

A

Blocks both seratonin and noradrenaline pumps
BUT also blocks muscarinic and cholinergic receptors = “anticholinergic” side effects
Dry mouth
Blurred vision
Urinary retention

147
Q

How would you treat bipolar?

A 
Lithium
Sodium Valproate
Carbamazepine
Lamotrigene
antipsychotics
148
Q

What is lithium used to treat?

A

Acute treatment of mania

Relapse prevention

149
Q

How does lithium work?

A

Inhibits cAMP production

150
Q

What are the side effects of lithium?

A

Level (of lithium)- 0.6 to 1.0 mmol/L, Leukocytosis
Insipidius - Nephrogenic Diabetes (Increase in ADH)
Tremors = mild, Tremors = coarse ?Toxicity
Hydration - Dry mouth, diarrhoea, thirsty - must drink
Increased - GI, Skin, memory problems
Under active thyroid (decreased TSH)
Metallic taste, Mums beware = Ebsteins Phenomena

151
Q

What levels would give you lithium toxicity?

A

Usually levels greater than 1.0mmol/L

152
Q

What are the clinical features of lithium toxicity?

A 
Onset usually sudden
Sudden dehyration - on holiday
Overdose 
Other medications
Systemic illness
Coarse tremor, hyperreflexia,seizures, Heart block
153
Q

How do you treat lithium toxicity?

A

STOP lithium, rehydrate, haemodialysis

1 - Psychiatry AE (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions