Mental Health 1 Flashcards
1
Q
What constitutes the MSE?
A
Appearance and Behaviour incl rapport
Speech (production and things like neologisms, echolalia)
Mood (ask - objective and subjective) and affect
Thoughts (form, content, possession phenomena)
Perceptions (hallucinations, pseudo)
Cognition
Insight
2
Q
What specifically is assessed in the thought section of the MSE?
A
Form
Content
Possession etc.
3
Q
What specifically is assessed in the insight section of the MSE?
A
Know you’re unwell?
Know what the problem is?
Treatment and willingness to accept
4
Q
What are the 6Ps of formulation?
A
Problem Predisposing factors Precipitating factors Perpetuating factors Protective factors Plan
5
Q
Diagnostic sieve for psychiatry?
A
Medical or drugs and alcohol e.g. Thyroid, epilepsy Organic e.g. Dementia Psychotic Affective Anxiety Personality disorder
6
Q
What should be screened for in HPC in psych Hx?
A
Mood - depression and mania (ask about sleep, energy, activity)
Anxiety - worries or fears
Psychotic - delusions and FTDs, hallucinations
7
Q
What biological changes indicate Alzheimer’s dementia?
A
Cortical atrophy and reduced Ach
B amyloid plaque formation
Neurofibrillary tangles
8
Q
Describe the presentation of Alzheimer’s dementia?
A
Insidious, often over a decade or so
9
Q
Early Sx of Alzheimer’s dementia?
A
Memory lapses - dates, names of people, missing appointments etc.
Difficulty finding words
Short term memory loss
10
Q
Progressing Sx of Alzheimer’s dementia?
A
Early frontal dysfunction - language difficulties, apraxia, planning and decision making, confusion
11
Q
Late symptoms of Alzheimer’s dementia?
A
Personality change Apathy Wandering, disorientation Incontinence Change in eating habits
12
Q
5 screening tests potentially suitable for testing memory?
A
MMSE Addenbrookes/ACE AMTS MOCA 6-CIT
13
Q
What imaging is used in assessing Alzheimer’s dementia?
A
MRI and spect scans
14
Q
Early management of Alzheimer’s dementia?
A
Achesterase inhibitors (donepezil, Rivastigmine, galantamine) Memantine (NMDA antagonist)
15
Q
Describe progression of vascular dementia?
A
Stepwise progression, may be semi-sudden onset
16
Q
3 types of changes resulting in vascular dementia?
A
Stroke
Multi-infarct
Chronic small vessel change (subcortical dementia)
17
Q
Inherited type of vascular dementia?
A
CADASIL
18
Q
Presentations of dementia associated with vascular cause?
A
Focal neurological deficits
Depression/anxiety and associated signs
Early gait disturbance and incontinence
19
Q
Presence of which 2 features occurring much earlier than normal are suggestive of vascular dementia?
A
Gait disturbance
Incontinence
20
Q
What features characterise Lewy body dementia?
A
Fluctuating memory, awareness and attention
Spatial awareness problems
Mild Parkinsonism
Recurrent well-formed visual hallucinations
21
Q
Which type of dementia is associated with major REM sleep disturbance?
A
LBD
22
Q
Which type of dementia is significantly more common in under 65s?
A
Frontotemporal
23
Q
3 clinical syndromes of FTD?
A
Behavioural variant
Progressive non-fluent aphasia (Brocas)
Semantic dementia
24
Q
What is the most common type of FTD?
A
Behaviour variant
25
Early signs of Huntington's disease?
Personality changes
Apathy, self neglect (?schizophrenia prodrome)
Clumsiness, fidgeting, facial grimaces
Mild psychosis/behavioural Sx
26
What is the progression of the movement disorder in Huntington's chorea?
Chorea (involuntary movements) -> rigidity and dystonia -> Parkinsonism and dementia
27
What is delirium?
An acute confusional state
28
3 major causes of delirium in elderly?
Infection - UTI, pneumonia
Constipation
Medications
29
3 types of delirium?
Hyperactive - easily visible, restless, sleep disturbed etc.
Hypoactive - reduced oral intake, looks bit like depression
Mixed - most common (fluctuant - more hyperactive at night)
30
What type of dementia may appear similar to delirium?
LBD
31
3 features of anxiety that can start to make it pathological?
Intensity
Frequency and Persistency
Impact on daily living
32
General psychological Sx of anxiety disorders?
Internal tension
Fear of losing control, dying
Agitation
33
Under what circumstances can anxiety cause chest pain?
Hyperventilation can recruit accessory muscle use and wearing out
34
4 types of phobic anxiety disorder?
Agoraphobia
Panic disorder
Social phobia
Specific phobia
35
What 2 phobic anxiety disorders often go hand in hand?
Agoraphobia and panic disorder
36
What triggers panic disorder attacks?
Nothing - paroxysmal feeling of losing control, psych + physical Sx
37
What characterises social phobia?
Incapacitating anxiety in situations of judgement or evaluation -> Sx -> subsequent escape and avoidance
38
Best method of managing specific phobias?
Systematic desensitisation
39
3 types of stress reaction anxiety disorders?
Acute stress reaction
Post traumatic stress disorder
Adjustment disorder
40
What characterises an acute stress reaction?
Symptoms over minutes or hours which typically settle within hours-days following major crisis
Symptoms include low mood, irritability, poor sleep, emotional fluctuation
41
What largely determines whether the diagnosis is PTSD or adjustment disorder?
The nature of the event - was it life threatening (PTSD) or not (AD)
42
Following a 'normal life event', over how long must symptoms have developed for adjustment disorder?
Within 1 month
43
Symptoms of adjustment disorder?
Often mixed anxiety and depression
44
Describe the symptoms of PTSD and their duration?
> 1m of recurring thoughts/flashbacks/dreams etc. of major traumatic event, subsequent distress and avoidance of potential triggers
Emotional blunting or detachment, depression symptoms
Hypervigilance
45
What typifies GAD?
Anxiety Sx present for most days for long period of time, triggered by anything and sometimes nothing
46
When does OCD typically present?
In teens or 20s
47
Major comorbidities associated with OCD?
Major depressive disorder
Tics, phobias, eating disorders, alcohol
Schizoid PD
48
What are the 2 component features of OCD?
Obsessive thoughts - intense, self-thought impulses which provoke anxiety (repetitive, unwanted, resisted) with retained insight
Compulsive thoughts - anxiety relieving, internalised consequences of the obsession
49
5 types of somatoform disorders?
```
Somatisation disorder
Hyperchondriasis
Conversion disorder
Body dysmorphic disorder
Pain disorder
```
50
What characterises somatisation disorder?
Repeated Sx affecting multiple different organ systems for which investigations are no help
51
What is hyperchondriasis?
Fear that minor (but real) Sx are due to serious underlying cause (e.g. Headache caused by brain tumour)
52
What is conversion disorder?
Acute presentation with serious neurological disorder e.g. Blindness, paralysis often following a stressful event
53
In whom are somatoform disorders most common?
Young women
54
What are the common types of dissociation disorder?
Depersonalisation and derealisation, possibly together
55
What type of disorder are depersonalisation and derealisation?
Anxiety (dissociative)
56
What is a dissociative fugue?
Travel to new location during temp loss of identity, severe dissociative amnesia and subsequent new role/identity - eventually recall
57
What is multiple personality disorder now called?
Dissociative identity disorder
58
What is neurasthenia?
Marked physical fatigue after minimal mental or physical effort
59
Conservative management of anxiety disorders?
Understanding and advice
Psychotherapy, counselling
Anxiety management courses
CBT
60
Medications that may be used for medical management of anxiety disorders?
Benzodiazepines - acute or severe spells
Antidepressants (SSRIs)
Buspirone for GAD
Symptomatic control with B blockers
61
Genetic background of personality disorders?
Multi focal - quantitative trait loci (QTLs)
62
Does Every Passage from childhood to adulthood cause problems for self and others?
Disharmonious - internal conflict between attitudes and behaviours in multiple areas of functioning
Enduring
Pervasive and maladaptive to broad range of situations
Appears in childhood and persists into adulthood
Causes significant personal distress
Causes occupational, social problems
63
How many of the 6 icd 10 criteria for personality disorder need to be fulfilled for a diagnosis?
3 or more
64
What must be included in a psychiatric Hx that is not present in a normal Hx?
```
PPH incl admissions, sections etc. Suicide attempts
Risk assessment
Personal and childhood Hx
Social and employment Hx
Drugs and alcohol Hx
Forensic Hx
```
65
3 clusters of personality disorder?
Cluster A - eccentric type
Cluster B - flamboyant type
Cluster C - anxiety type
66
Cluster A (eccentric) personality disorders?
Paranoid PD - suspicious, paranoid, may look like schizophrenia
Schizoid PD - solitary, introspective and emotionally cold, indifference to praise or criticism
Schizotypal PD - can look like extreme discomfort in emotional situations and lead to delusions or perceptual disorders
67
Cluster B (flamboyant) personality disorders?
Dissocial (antisocial) PD - victim of society, no guilt or regrets of actions, tendency to blame, inability to sustain relationships. Failure to learn from actions and often impulsive
EUPD (borderline) - may be borderline or impulsive type
Histrionic/narcissistic PD
68
Cluster C (anxiety type) personality disorders?
Anxious avoidant PD - limited by fear of rejection or negative evaluation
Dependant PD - automatic subordination and need to be cared for
Obsessional/compulsive PD (anankastic) - the compulsive part of OCD (perfectionist, inflexible and preoccupied with detail)
69
What characterises dissocial/antisocial personality disorder?
Impulsive actions and failure to learn from mistakes
Inability to maintain relationships due to lack of empathy and guilt/remorse, tendency to blame others
The murderers/psychopaths
70
Characteristic features of EUPD (borderline or impulsive type)?
```
Tendency towards impulsive actions
Variable, unpredictable mood
Intolerance of being left alone
Chronic boredom
Self injury/damaging behaviour
```
71
Difference between histrionic and narcissistic PD?
```
HPD = need to be centre of attention for approval, low self esteem
NPD = thinks superior to everyone else
```
72
Which type of personality disorder is typified by inappropriate seductiveness and over-exaggerating/manipulative behaviour but sexual frigidity?
Histrionic personality disorder
73
Personality disorder defined by constant need for approval via the centre of attention, seductiveness and manipulation and low self esteem?
Histrionic personality disorder
74
Personality disorder characterised by inflated feelings of self worth and importance?
Narcissistic personality disorder
75
Personality disorder characterised by impulsive actions, lack of empathy/guilt and remorse and inability to learn from these, often manifesting as trouble maintaining relationships and trouble with the law?
Dissocial personality disorder
76
Personality disorder characterised by chronic boredom, impulsive behaviour, intolerance of being alone and labile unpredictable mood often accompanied by self-harm?
EUPD
77
What typifies paranoid personality disorder?
Looks like paranoid schizophrenia
| May lead to agoraphobia, anxiety, depression, substance abuse
78
Personality disorder that can look like paranoid schizophrenia?
Paranoid PD
79
What characterises schizoid personality disorder?
Prefers solitude, cold, emotionally withdrawn
| Indifferent to praise or criticism
80
Personality disorder typified by cold, emotional withdrawal and indifference to praise or criticism?
Schizoid PD
81
What characterises Schizotypal PD?
Extreme discomfort in social situations, can precede delusional or hallucinatory behaviour
82
Personality disorder characterised by extreme discomfort in social situations, possibly with delusions or hallucinations?
Schizotypal PD
83
What typifies anxious-avoidant personality disorder?
Constant fear of rejection or negative evaluation, feeling of ineptitude and apprehension
84
Personality disorder characterised by feelings of ineptitude and fear of negative evaluation or fear of rejection?
Anxious-avoidant PD
85
What characterises dependent PD?
Pervasive need to be bossed around, cared for by others so chronic subordination
86
Personality disorder characterised by constant subordination in order to feel cared for?
Dependent PD
87
What is the difference between obsessional/compulsive (anankastic) personality disorder and OCD?
OCD can be obsessions or obsessions and compulsions
| O/CPD is just compulsions, no obsessional pervasive intrusive thoughts behind it
88
What personality disorder may present as a perfectionist, pre-occupied with detail who has had an MI?
Obsessional/compulsive PD
89
CHASM of Hx taking premorbid personality?
```
Character
Hobbies
Attitude
Sociability
Mood
```
90
Eponymous syndrome whereby sufferers believe they are dead/walking corpses?
Cotard delusion
91
Eponymous syndrome whereby sufferer believes a celebrity is in love with them?
De Clerambault syndrome/delusion or erotomania
92
When do baby blues occur?
Start 3-5 days PP, subside by 10 days
93
Within what time frame does PND occur after birth?
3 months, subsides within 6 months
94
What is Couvade syndrome?
Blokes having pregnancy like Sx near time of wife giving birth to child
95
How long must Sx of GAD be present to diagnose?
Over 6m
96
5 potential SEs of atypical antipsychotics?
```
Weight gain
EPSEs
Agranulocytosis
Postural hypotension
Hepatitis
```
97
5 areas of first rank Sx of schizophrenia?
```
3rd person auditory hallucinations
Thought alienation (insertion/withdrawal/broadcast)
Made feelings/actions/impulses (control)
Somatic passivity
Delusional perception
```
98
What needs to be present to identify the somatic syndrome?
At least 4/8 biological Sx of depression
99
What self report questionnaire is used for identifying PND?
Edinburgh
100
What is Retts syndrome?
A neurodevelopmental disorder not unlike autism, starting around 1-2 years of age in someone following otherwise normal development
101
What is Fregoli's syndrome?
Delusions that a persecutor is able to impersonate others e.g. Friends and family
102
What do the Sx of serotonin syndrome mimic?
Like mega hyperthyroidism
103
What is a section 135?
Right for police to take someone from private property (community) to safe place e.g. Hospital, police station
104
What is a section 136?
Right for police to take someone from a public place to a safe place
105
What is a section 5 (4)?
Nurses holding power - keep patient in for 6 hours
106
What is a section 5 (2)?
Doctors holding power - keep a patient in for 72 hours (long enough for a section 2)
107
What is a section 4?
Emergency admission to hospital for assessment for 72 hours
| Requires only 1 doctor and can have input from another to launch into a section 2
108
What is a section 4 used for?
Emergency assessment when only one doctor is available
109
What is a section 2?
Detainment for assessment for up to 28 days
| Requires 2 doctors, at least one of whom is section 12 approved
110
What is a section 3?
Detainment for treatment for up to 6m - can be renewed for another 6m and then further years at a time
111
What is a section 117?
Aftercare post-section 3
112
What section of MHA is used to detain a patient for assessment for 28 days?
Section2
113
What section of MHA is used to detain patient for treatment for up to 6m?
Section 3
114
What section of MHA details aftercare post-section 3?
Section 117
115
What section of MHA is used to detain for emergency assessment for 72 hours?
Section 4
116
What section is doctors holding power? How long does it last?
Section 5(2) for 72 hours
117
What section of MHA is nurses holding power? How long does it last?
Section 5(4) - lasts for 6 hours
118
What section of MHA is used to bring someone from private community setting (via break in) to a safe place by police?
Section 135
119
What section of MHA is used by police to bring someone from a public place to a safe place?
Section 136
120
Section of MHA used to allow supervised leave from inpatient facility?
Section 17
