Mental Health Flashcards

Question

Ideas of reference

Answer 1

Normal events are of special importance to the patient (eg. News reporter)

Answer 2

They believe they are dead, decomposed, no organs, not human etc.

Answer 3

Exaggerated distrust of others and suspicious of motives

Answer 4

Other individuals are in love with them

Answer 5

Patient insists they are being cheated on, contoured against, or harassed

Answer 6

Experience bodily functions or sensations when none are present

Answer 7

Incoherent thinking, expressed as illogical, sudden, frequent changes of topic NB- Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

Answer 8

Incoherent thinking expressed as a sequence of words without a logical connection

Answer 9

Nonlinear thought expressed as a gradual deviation from a focused idea or question

Answer 10

Creation of new words

Answer 11

Repetition of others words or sentences

Answer 12

Quick succession of thoughts usually demonstrated in a continuous flow of rapid speech and abrupt changes in topic (although discernible links between ideas)

Answer 13

Using rhyming words rather than words of meaning

Answer 14

Non linear thought expressed as a long winded manner of explanation, with many deviations from central topic, before finally expressing the central idea

Answer 15

Objective observation of an abrupt ending in a thought process, expressed as sudden interruption in speech

Answer 16

Accelerated thoughts expressed as rapid, loud, voluminous speech (often in absence of social stimulation)

Answer 17

A severe psychiatric disorder characterised by chronic or recurrent psychosis

Answer 18

Distorted perception of reality characterised by delusions, hallucinations, and or disorganised thoughts

Answer 19

Schizophrenia Mania Depression Medication induced Substance induced Poisoning eg. Heavy metals/ insecticides etc.

Answer 20

Opiates Levodopa Antiepileptics Corticosteroids

Answer 21

Alcohol Cannabis Cocaine LSD Glue Amphetamines

Answer 22

Bedside- ECG, urine drug screen, urine pregnancy test Bloods- FBC UE LFT TFT CRP B12 Folate lipids blood glucose (HIV syphilis serology potentially) Imaging- MRI head (exclude dementia/ brain injury or disease) NB- if person is a known schizophrenia/ bipolar, may want to do plasma drug level monitoring (are they compliant with medication eg. lithium levels in a BP patient)

Answer 23

Urgent input from CRT Section under MHA Admit to acute psychiatry ward Oral typical antipsychotic (not clozapine or olanzapine- big SE profile so reserved for more resistant disease) eg. Quetiapine, aripriprazole or risperidone If necessary IM, or may need IM benzo

Answer 24

CMHT, EIT, CRT (crisis) give them access to these services when they need it (tell to make family and friends aware), organise care co-ordinator Family therapy Treat co-morbid conditions Regular health check up's (lipids, BP, prolactin, etc.) Advice on lifestyle factors (help with above risk factors) NB- address co-morbidities (AP therapy is high risk of CV disease)

Answer 25

Mood congruent ie. they fit with the mood Depression- nihilistic, guilty of a major crime etc. Bipolar (manic episode)- they have special powers

Answer 26

affective disorder (manic and depressive episodes), with psychosis

Answer 27

increased risk of VTE and stroke

Answer 28

Antipsychotics Sudden stopping of PD drugs (either due to lack of absorption (illness/ vomiting/ obstruction (constipation)) or not giving them at the correct time

Answer 29

Anyone in community with mania- urgent referral to CMHT and CRT Psychosocial intervention (family therapy) Medications- lithium is mood stabiliser of choice (also anticonvulsants like valproate or AP like quetiapine). Stop antidepressant during acute mania Give AP if presenting with acute mania/hypomania Can also give an antidepressant once mood stabiliser commenced (SSRI eg. citalopram) NB- address co-morbidities (AP therapy is high risk of CV disease)

Answer 30

Antidepressants should not be used before initiating therapy with mood stabilizers because antidepressants can precipitate a manic episode eg. Stop someone’s mirtazapine/citalopram first NB- antidepressants can cause a manic shift in undiagnosed BAD patients (follow up in depression is essential- make sure they don’t develop mania)

Answer 31

Distractibility Irresponsibility (sex, money) Grandiosity (psychotic symptoms) Flight of ideas Activity increase Sleep deficit Talkativeness NB- lasts for at least a 7 days

Answer 32

Patients psychotic due to schizophrenia may not be as restless and hyper agitated as manic patients Illness course is different- patient will be less sick less often in mania (BAD) and will have depressive episodes. Schizophrenic/psychotic patients are constantly I’ll until treated In mania there is no thought interference, 3rd person auditory hallucinations, running commentary etc.)

Answer 33

ECG, physical exam, observations Bloods- FBC UE LFT bone profile TFT magnesium Imaging- if phaechromocytoma suspected (CT abdomen)

Answer 34

Lifestyle management- sleep hygiene, substance misuse education, diet, exercise Psychological support- low intensity CBT (high intensity if moderate to severe) Medical- if moderate to severe, try SSRI (sertraline), then SNRI, then pregabalin

Answer 35

Recurrent spontaneous and unexpected panic attacks that often occur without a known trigger NB- GAD= constant, doesn’t dissipate

Answer 36

Pronounced anxiety lasting longer than 6 months of social situations that might involve scrutiny by others Anticipatory anxiety and drinking Avoiding social situations

Answer 37

Intrusive thoughts (ego dystonic) Compulsions and rituals that cause relief Time consuming and distressing

Answer 38

ECG, ACE-III, BM, top to toe physical exam, urinalysis (no infection) Bloods- FBC, UE, LFT, TFT, CRP, ESR, B12, folate, bone profile Imaging- MRI brain

Answer 39

Impaired consciousness Fluctuating symptoms (worse at night/periods of normality) Abnormal perceptions (hallucinations) Agitation, fear Delusions

Answer 40

Short history, rapid onset Biological symptoms eg. Weight loss, sleep disturbance Patient worried about their memory Reluctant to take tests, disappointed with results Global memory loss (dementia- characteristically recent memory loss)

Answer 41

Neuroleptics eg. Antipsychotics Can cause akinetic crises/NMS (also caused by withdrawal of levodopa meds). Don’t always have to treat the psychosis and if we do, quetiapine is best tolerated

Answer 42

AD and LBD NB- there is no direct treatment for vascular dementia

Answer 43

Be careful in DLB as this can exacerbate neuropsychiatric and cognitive symptoms

Answer 44

CBT Benzo’s (short term)

Answer 45

Treat co morbidities/nutritional supplementation Eating disorder focused CBT

Answer 46

CBT SSRI (if not working, then imipramine)

Answer 47

Persistent complex hallucinations occurring in clear consciousness (no neuropsychiatric disturbance). May have visual impairment

Answer 48

Patient believes that they (or a part of their body) is dead. May not eat or drink for this reason

Answer 49

AKA erotomania (a form of delusional disorder) Delusional belief that a person is in love with the patient NB- delusional disorder can be a disorder on its own

Answer 50

Delusional belief that they are filled with worms/bugs/fungus etc.

Answer 51

Severe depression refractory to medication (Catatonia) or with severe psychotic symptoms NB- Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment

Answer 52

Headache Nausea Cardiac arrhythmia Short term memory loss (some people report these memory problems long term but they are usually transient)

Answer 53

Pathological jealousy that a partner is cheating on someone without proof

Answer 54

Treat normal as you would with depression No sleeping tablets Light therapy not routinely recommended

Answer 55

Used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as medication compliance

Answer 56

Family have been replaced by an identical imposter

Answer 57

Parasthesia- feels like insects are crawling on the skin

Answer 58

Urgent referral to CMHT Routine referral- hypomania or non severe depression The CMHT can then decide if they need to section them NB- this is for BAD, wouldn’t refer everyone with severe depression to CMHT

Answer 59

Failure to conform to social norms with respect to lawful behaviour More common in men Deception and lying Impulsiveness Aggressiveness (fights) Disregard for safety Irresponsibility Lack of remorse

Answer 60

Avoidance of activities which involve interpersonal contact Preoccupied with ideas that they are being criticised or rejected in social scenarios Restraint in intimate relationships Reluctance to take risks due to fear of embarrassment Inferior view of self Self isolation but craving for social contact

Answer 61

Efforts to avoid abandonment Unstable interpersonal relationships which alternate between idealisation and devaluation Unstable self image Impulsivity in damaging areas eg. Sex and substances Recurrent suicidal behaviour Affective instability Difficulty controlling temper Chronic feelings of emptiness

Answer 62

Difficulty making everyday decisions without help from others Need others to assume responsibility for major areas of their life Difficulty in expression disagreement for fear of losing support Lack of initiative Unrealistic care of being left to care for themselves Urgent search for relationships Extensive efforts to obtain support from others

Answer 63

Inappropriate sexual seductiveness Centre of attention Rapidly shifting and shallow expression of emotions Suggestibility Physical appearance used to seek attention Self dramatisation Relationships considered more intimate than they are

Answer 64

Grandiose sense of self importance Preoccupation with fantasies of unlimited success, power, or beauty Sense of entitlement Taking advantage of others Lack of empathy Excessive need for admiration Chronic envy Arrogant and haughty attitude

Answer 65

Occupied with details, rules, lists, order, organisation Perfectionism that hampers tasks Dedicated to work and efficiency to the elimination of spare time activities Rigid about etiquette of morals, ethics, etc. Can’t throw away insignificant things Inability to delegate work Stingy spending habits

Answer 66

Hypersensitivity Unforgiving attitude when insulted Questions loyalty of friends Reluctance to confide in others Preoccupation with conspiracy beliefs and hidden meaning Perceives attacks on character

Answer 67

Indifference to praise or criticism Preference for solitary activities Lack of interest in sexual relationships Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family NB- negative symptoms of schizophrenia

Answer 68

Ideas of reference (but some insight retained) eg. TV talks to them Odd beliefs and magical thinking Unusual perceptive disturbances Paranoid ideation and suspiciousness Odd eccentric behaviour Lack of close friends other than family In appropriate affect Odd speech without being coherent NB- positive symptoms of schizophrenia

Answer 69

Dialectical behavioural therapy NB- can’t diagnose until out of teens

Answer 70

Another psychiatric disorder presenting as dementia eg. Depression, anxiety

Answer 71

Can be normal, or may show cortical atrophy NB- early changes in Alzheimer's: temporal lobe deficits

Answer 72

Parkinsonism Acute dystonia (sustained muscle contraction eg. Torticollis (twisted neck), oculogyric crisis (eye deviation)- procyclidine Akathisia/(severe restlessness) Tardive dyskinesia (abnormal involuntary movements eg. Chewing, jaw pouting) NB- torticollis is also known as cervical dystonia

Answer 73

NSAID (give PPI if together) Warfarin and heparin (give mirtazapine instead) Triptans MAO-I

Answer 74

2 weeks Under 25 or high risk, 1 week

Answer 75

6 months after symptoms abate

Answer 76

Over a 4 week period (not fluoextine)

Answer 77

Mood changes eg. anxiety Restlessness Difficulty sleeping Unsteadiness and dizziness Sweating GI symptoms Parasthesia eg. electric shock sensations NB- treatment= give old dose of SSRI

Answer 78

Anti cholinergic eg. Drowsiness Dry mouth Blurred vision Constipation Urinary retention QTc lengthening

Answer 79

N v diarrhoea Fine tremor Polyuria, nephrogenic DI Hypothyroidism Weight gain T wave flattening, inversion Intracranial hypertension Leukocytosis Hyperparathyroidism and hypercalcaemia NB- benign leukocytosis

Answer 80

Good if 2 SSRI’s can’t be taken (warfarin),p or not tolerated SE- weight gain and sedation Class- Noradrenergic and specific serotonergic antidepressants

Answer 81

Antidepressants are not addictive but when stopped suddenly they can cause discontinuation syndrome

Answer 82

Typical- zuclopenthixol, haloperidol Atypical- amisulpride, risperidone

Answer 83

-pine Olanzapine Clozapine Quetiapine NB- aripiprazole has one of the better side effect profiles

Answer 84

Not typically done, but may see venlafaxine + mirtazapine (increased risk of serotonin syndrome and antidepressant SE’s)

Answer 85

TIA/stroke Can almost pinpoint when things started to change (rather than AD- insidious onset) Emotional lability

Answer 86

Occupational therapists- safe around the home/blister packs Carers- personal care Physiotherapists- stairs Fire brigade- gas (stove) Social services- LPA

Answer 87

Carbamazepine AD AP Severe cases- benzodiazepines

Answer 88

They are part of the normal grieving process

Answer 89

Symptoms associated with the extrapyramidal system of the cerebral cortex (involuntary movement). They include; Dystonia (continuous and sustained contraction eg. oculogyric crisis, torcillosis) Akathisia (inner restlessness and inability to sit still) Parkinsonism Tardive dyskinesia- irregular jerky movements, typically of face and neck (lip smacking)

Answer 90

Buprenorphine is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet

Answer 91

Smoking cessation can cause a significant rise in clozapine levels, and so it should be discussed with a psychiatrist before stopping smoking. Starting smoking, or smoking more, can reduce clozapine levels. Stopping drinking can also reduce levels, as alcohol binges can increase the level. Omitting doses will cause a reduction in clozapine levels, and stress and weight gain won't have significant effects on the level.

Answer 92

Dermatitis, diarrhoea, dementia/delusions, leading to death (vitamin B3 deficiency)

Answer 93

Typically involves loss of motor or sensory function. May be caused by stress

Answer 94

Symptoms often present later after the event, and have to be present for a month re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images avoidance: avoiding people, situations or circumstances resembling or associated with the event hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating emotional numbing - lack of ability to experience feelings, feeling detached from other people depression drug or alcohol misuse anger unexplained physical symptoms

Answer 95

Conservative- watchful waiting may be used for mild symptoms lasting less than 4 weeks, or trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases/after 4 weeks Medical- if CBT hasn't worked- venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Answer 96

Exposure to trauma or combat, refugee/asylum seeker status, first responder occupation, combat specific (duration of exposure, low morale, poor social support, lower rank, unmarried, low educational attainment, childhood adversity), previous psychiatric disorders.

Answer 97

If they say they would do it again -admit to a psychiatric hospital for assessment (section 5(2) as a junior doctor- hold for 72 hours, if they are unwilling) If not- refer to CMHT, take a bio/psycho/social approach eg. talking therapy, address any social concerns, may require medication eg. for concomitant depression

Answer 98

First line- acetylcholinesterase inhibitor (donepezil, galantamine, rivastigmine) Second line- memantine (NMDA receptor antagonist) NB- don't use donepezil if bradycardia, and it can cause insomnia

Answer 99

3rd person/ running commentary/ heading thoughts out loud auditory hallucinations Thought with drawl/insertion Thought broadcasting Somatic hallucinations Delusional perceptions

Answer 100

monoamine oxidase inhibitors SSRIs- St John's Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome ecstasy amphetamines tramadol

Answer 101

neuromuscular excitation -hyperreflexia -myoclonus -rigidity autonomic nervous system excitation -hyperthermia -sweating altered mental state -confusion

Answer 102

supportive including IV fluids benzodiazepines more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Answer 103

pyrexia muscle rigidity autonomic lability: typical features include hypertension, tachycardia and tachypnoea agitated delirium with confusion raised creatine kinase Acute kidney injury (secondary to rhabdomyolysis) leukocytosis

Answer 104

stop antipsychotic patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units IV fluids to prevent renal failure dantrolene may be useful in selected cases bromocriptine, dopamine agonist, may also be used

Answer 105

SS- faster onset, hyperreflexia, myoclonus (muscle jerks, rather than rigidity), dilated pupils NMS- slower onset, hyporeflexia, lead pipe rigidity, normal pupils

Answer 106

-gastrointestinal symptoms are the most common side-effect -reduced libido and sexual performance -there is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID hyponatraemia (duodenal ulcers) -patients should be counselled to be vigilant for increased anxiety and agitation after starting a SSRI -fluoxetine and paroxetine have a higher propensity for drug interactions NB- may initially worsen symptoms (why people are reviewed soon after)

Answer 107

Use during the first trimester gives a small increased risk of congenital heart defects Use during the third trimester can result in persistent pulmonary hypertension of the newborn

Answer 108

Mild- cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) Severe- admit to a secondary service and treat whilst waiting referral, SSRI and CBT (including ERP)

Answer 109

multiple physical SYMPTOMS (S for S) present for at least 2 years patient refuses to accept reassurance or negative test results

Answer 110

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer (C in cancer and hypochondriasis) patient again refuses to accept reassurance or negative test results

Answer 111

typically involves loss of motor or sensory function the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering) patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Answer 112

typically involves loss of motor or sensory function the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering) patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Answer 113

dissociation is a process of 'separating off' certain memories from normal consciousness in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Answer 114

also known as Munchausen's syndrome the intentional production of physical or psychological symptoms

Answer 115

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain (ie. they want something out of it)

Answer 116

This describes an episode of psychosis lasting less than a month with a subsequent return to baseline functioning.