Mental Health Flashcards

Question

Why was atypical antipsychotics developed?

Answer 1

Due to problematic extrapyramidal side-effects

Answer 2

- Parkinsonism - Acute dystonia (sustained muscle contraction) - akathisia (severe restlessness) - tardive dyskinesia

Answer 3

Routine referral to CMHT

Answer 4

Serotonin and noradrenaline reuptake inhibitor

Answer 5

- Subtype of delusion where they believe they or part of them is dead - Associated with depression

Answer 6

1) Auditory hallucinations 2) Thought disorder 3) Passivity phenomena 4) Delusional perceptions

Answer 7

Dialectical behaviour therapy

Answer 8

Targeted therapy that is based CBT, but has been adapted to help people who experience emotions very intensely.

Answer 9

Psychotic symptoms

Answer 10

DSM-5 5/9 symptoms required for diagnosis (everyday for at least 2 week): Core symptoms: 1. Low mood 2. Anhedonia Associated symptoms: 3. Disturbed sleep 4. Decreased or increased appetite 5. Fatigue /loss of energy 6. Agitation or slowing of movements 7. Poor concentration 8. Feelings of worthlessness 9. Suicidal thoughts

Answer 11

HAD scale | PHQ-9

Answer 12

- Bloods to eliminate other causes

Answer 13

- CBT - Group - based CBT Do not routinely offer antidepressants unless: - past hx of moderate or severe depression - persistent symptoms > 2 years - failed with other interventions

Answer 14

- Antidepressant (normally SSRI : citalopram, fluoxetine or sertraline) - Psychological intervention

Answer 15

Depression which occurs predominately around the winter months.

Answer 16

- Treated the same way as depression - Mild depression: psychological therapies Follow-up in 2 weeks to check no deterioration - SSRI - after therapy if needed - In SAD, you should not give the patient sleeping tablets as this can make the symptoms worse.

Answer 17

1. Chronic depressive state (2 years or more) 2. Persistent low mood not meeting depression diagnostic criteria 3. Not the consequence of a partly resolved major depression

Answer 18

1. Antidepressants (first line): --> Citalopram 2. Psychotherapy - -> Or group-based CBT

Answer 19

Chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression.

Answer 20

1. type I disorder: mania and depression (most common) 2. type II disorder: hypomania and depression

Answer 21

1. Hypomania: • Mild elevation of mood and increased energy / activity • 4 days of manic symptoms • Does NOT disrupt life ``` 2. Mania: • Mood change (7 days of persistently high, expansive, or irritable mood) AND 3 manic symptoms: --> Increased activity level --> Talkativeness --> Racing thoughts --> Distractibility --> Reduced need for sleep --> Inflated self esteem --> Faulty judgement ```

Answer 22

1. Admission for acutely manic patient 2. Pharmacotherapy - -> Mood stabilizers – 1st line: lithium, Valproate - -> Sedatives 3. Mania: - -> Antipsychotics- mainly atypicals (eg. risperidone), olanzapine, haloperidol 4. Depression - -> talking therapies - -> fluoxetine is the antidepressant of choice 5. ECT 6. Psychosocial

Answer 23

1. if symptoms suggest hypomania = routine referral to the community mental health team (CMHT) 2. if there are features of mania or severe depression then an urgent referral to the CMHT should be made

Answer 24

BMI 25-29.9 kg/m2

Answer 25

1. Assess underlying cause 2. Conservative: - Exercise - Diet 3. Drug treatment - orlistat (with hypocaloric diet) - only considered after diet + physical activity 4. Bariatric surgery

Answer 26

A. Restriction of energy intake relative to requirements, leading to a significantly low weight in the context of age, sex, developmental trajectory, and physical health B. Intense fear of gaining weight or persistent behaviour that interferes with weight gain C. Disturbance in body image.

Answer 27

- BMI <85% predicted (<17.5 adults). Often rapid loss - Amenorrhea 3/12 or longer - Delayed puberty - Fatigue, fainting, dizziness - Intolerance to cold - GI: constipation, abdo pain - Appearance: wearing baggy clothes

Answer 28

- fear/ dread gaining weight - Distorted body image - Social withdrawal - Denial of problem/ resistance to treatment

Answer 29

1. Weight restoration - -> Dietician – gradual increase of meal plan + multivitamin and mineral supplements - -> Monitor bloods – refeeding syndrome. - -> Pancytopenic – resolved gradually with weight restoration 2. Individual psychology 3. OT, psychology, medical groups 4. Medical: restarted olanzapine and fluoxetine. 5. Psychotherapeutic - -> CBT - ED 6. Manage physical risks – escalate early - -> Blood tests: FBC, U&E, bone profile, LFT, TFT, iron studies, folate, B12. consider ABG - -> Replace electrolytes as needed – risk of ↓K+ in particular - -> BM - ↓ glucose - -> IV fluids if dehydrated - -> ECG – long QT, bradycardia 7. Other medical treatment - Consider SSRI if low mood

Answer 30

1. chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) + inhibits NMDA-type glutamate receptors 2. alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

Answer 31

Symptoms start at 6-12 hours: - tremor - sweating - tachycardia - anxiety

Answer 32

1. peak incidence of seizures at 36 hours 2. peak incidence of delirium tremens is at 48-72 hours: - coarse tremor - confusion - delusions - auditory and visual hallucinations - fever - tachycardia

Answer 33

- Pt with complex withdrawals should be admitted until stabilised 1st line = long-acting benzodiazepines e.g. chlordiazepoxide or diazepam.

Answer 34

if all the medication is not taken within 1 hour

Answer 35

activated charcoal

Answer 36

Acetylcysteine if: - staggered overdose or doubt of ingestion time - the plasma conc is on or above single line of 100mg/l at 4 hours and 15 mg/L at 15 hours

Answer 37

IV over 1 hour

Answer 38

Aterial pH < 7.3 + 24 hours after ingestion or all of the following: 1. prothrombin time > 100 seconds 2. creatinine > 300 µmol/l 3. grade III or IV encephalopathy

Answer 39

- buprenorphine | - Methadone

Answer 40

- rhinorrhoea - needle track marks - pinpoint pupils - drowsiness - watering eyes - yawning

Answer 41

IV or IM naloxone: - has a rapid onset and relatively short duration of action Long-term for dependence: 1st line = buprenophine

Answer 42

- Type of eating disorder characterised by: 1. episodes of binge eating followed by 2. intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

Answer 43

A. Recurrent episodes of binge eating, character sited by BOTH: • Eating objectively large amount of food (larger than most would in a similar time period, and circumstances) in a discrete period of time (e.g. 2 hours) • Loss of control overeating during episode B. Recurrent inappropriate compensatory behavior in order to prevent weight gain – e.g. vomiting, using laxatives/ diuretics/enemas/ other meds C. Binge Eating and inappropriately compensatory behaviors both occur, on average at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight E. Disturbance does not occur exclusively during episodes of anorexia nervosa.

Answer 44

* Weight fluctuation * Low mood * Low self esteem * Body image concerns * Dental erosion * Parotid hypertrophy * Arrhythmias

Answer 45

``` - Referral to specialist for all cases • Psychotherapeutic: CBT-ED • Diet: meal planning • Medical: - manage physical risks - consider SSRI or SNRI - fluoxetine (not long-term, high-dose treatment) ```

Answer 46

- Acute stress reaction that occurs first 4 week after a person has exposed to a traumatic event

Answer 47

1. intrusive thoughts e.g. flashbacks, nightmares 2. dissociation e.g. 'being in a daze', time slowing 3. negative mood 4. avoidance 5. arousal e.g. hypervigilance, sleep disturbance

Answer 48

1. 1st line = trauma-focused CBT 2. benzodiazepine - -> used in acute symptoms 3. Beta-blockers - -> relieves physical symptoms caused by stress hormone

Answer 49

A period of mourning or loss

Answer 50

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Answer 51

1st line = counselling Medication: 1st line = SSRIs

Answer 52

1. Neglect 2. Sexual 3. Physical

Answer 53

1. story inconsistent with injuries 2. repeated attendances at A&E departments 3. late presentation 4. child with a frightened, withdrawn appearance - 'frozen watchfulness'

Answer 54

1. bruising 2. fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing 3. torn frenulum: e.g. from forcing a bottle into a child's mouth 4. burns or scalds 5. failure to thrive 6. sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

Answer 55

Social services | - referral for sexual assault referral centre

Answer 56

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse between people aged 16 years or over who are, or have been, intimate partners or are family members regardless of gender or sexuality

Answer 57

* Psychological * Physical * Sexual * Emotional * financial

Answer 58

1. inform senior | 2. referral to social services

Answer 59

1. Examine physical injuries 2. Asses protective factors (may reduce the person’s risk) 3. Refer to A & E 4. Follow-up – offer information for support 5. Refer to CAMHS 6. Manage other mental health problems

Answer 60

Attention Deficit Hyperactivity Disorder

Answer 61

DSM 5: Condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent.

Answer 62

For children up to the age of 16 years, 6 of these features have to be present; in those > 17 y/o the threshold is 5 features: Inattention: 1. Does not follow through on instructions 2. Reluctant to engage in mentally-intense tasks 3. Easily distracted 4. Finds it difficult to sustain tasks 5. Finds it difficult to organise tasks or activities 6. Often forgetful in daily activities 7. Often loses things necessary for tasks or activities 8. Often does not seem to listen when spoken to directly Hyperactivity/Impulsivity: 1. Unable to play quietly 2. Talks excessively 3. Does not wait their turn easily 4. Will spontaneously leave their seat when expected to sit 5. Is often 'on the go' 6. Often interruptive or intrusive to others 7. Will answer prematurely, before a question has been finished 8. Will run and climb in situations where it is not appropriate

Answer 63

Clinical diagnosis

Answer 64

1. 10-week watch and wait approach - -> If symptoms don’t resolve referral to secondary care. 2. Drug therapy should be last resort: - -> Only available for > 5 years - -> 1st line: methylphenidate (6-week trial basis) - --------> Potentially cardiotoxic – perform ECG for baseline

Answer 65

Fundamental and characteristic distortion of thinking and perception and affects that are blunted or inappropriate.

Answer 66

1. Auditory hallucinations 2. Thought disorder: - thought insertion - thought withdrawal - thought broadcasting 3. Passivity phenomena: - bodily sensations being controlled by external influence - actions/impulses/feelings - experiences which are imposed on the individual or influenced by others 4. Delusional perceptions - A two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. 'The traffic light is green therefore I am the King'.

Answer 67

Clinical diagnosis

Answer 68

1st line = Atypical antipsychotics e.g. Respirdone Acute setting = haliperidol (aggressive) CBT should be offered to all pts.

Answer 69

False beliefs which are sustained despite contrary evidence

Answer 70

- Grandiose - persecutory - mixed - erotomanic - jealousy - somatic - not classified

Answer 71

1. Jealousy/paranoia 2. Aggression 3. Abnormal behaviours 4. Feeling of persecution 5. Disordered thinking

Answer 72

1. Bloods o To rule out organic causes like anaemia, electrolyte abnormalities 2. X-ray Imaging o CT or MRI brain 3. Special Tests o Urine toxicology

Answer 73

1. Refer to a psychiatrist - -> Speed of referral depends on risk of harm to self or others 2. Psychotherapy

Answer 74

Symptoms of schizophrenia and a mood disorder (depressed or manic) are equally prominent

Answer 75

1. Admit to hospital if symptoms of acute psychosis 2. When stable, treatment options depend on prevailing symptoms - e.g antidepressants if depressive symptoms - or antipsychotics if schizophrenia

Answer 76

Trauma Screening Questionnaire

Answer 77

SNRI : Duloxetine

Answer 78

- Warn patients of the increased risk of suicidal thinking & self-harm

Answer 79

Weekly follow-up for the 1st month

Answer 80

DSM-5: core symptoms of excessive widespread worry for more days than not for at least 6 months

Answer 81

* Restlessness * Easily fatigued * Poor concentration * Irritably * Muscle tension * Sleep disturbance

Answer 82

- Agoraphobia - Social phobia - Simple phobia

Answer 83

1. Agoraphobia o Psychological therapy - Systematic desensitization o Medication can be useful – SSRI’s usually (sertraline or escitalopram) 2. Social phobia o CBT o Medication can be useful – SSRI’s usually 3. Simple phobia o Psychological therapy - Systematic desensitization

Answer 84

``` A panic attack is defined as a discrete episode of intense subjective fear, where at least four of the characteristic symptoms: • Palpitation • Sweating • Trembling or shaking • Dry mouth • SOB • Chest pain or discomfort • Dizziness ```

Answer 85

step 1: recognition and diagnosis step 2: treatment in primary care step 3: review and consideration of alternative treatments step 4: review and referral to specialist mental health services step 5: care in specialist mental health services

Answer 86

Either CBT or drug 1st line = SSRI --> if non-responsive for 12 weeks = imipramine or clomipramine

Answer 87

Series of maladaptive personality traits that interfere with normal function in life.

Answer 88

Cluster 1: Odd or eccentric - Paranoid - Schizoid - Schizotypal Cluster 2: Dramatic, emotional or erratic - Antisocial - Borderline (Emotionally Unstable) - Histrionic - Narcissistic Cluster 3: Anxious & Fearful - Obsessive-Compulsive - Avoidant - Dependent

Answer 89

1. Hypersensitivity and an unforgiving attitude when insulted 2. Unwarranted tendency to questions the loyalty of friends 3. Reluctance to confide in others 4. Preoccupation with conspirational beliefs and hidden meaning 5. Unwarranted tendency to perceive attacks on their character

Answer 90

1. Indifference to praise and criticism 2. Preference for solitary activities 3. Lack of interest in sexual interactions 4. Lack of desire for companionship 5. Emotional coldness 6. Few interests 7. Few friends or confidants other than family

Answer 91

1. Ideas of reference (differ from delusions in that some insight is retained) 2. Odd beliefs and magical thinking 3. Unusual perceptual disturbances 4. Paranoid ideation and suspiciousness 5. Odd, eccentric behaviour 6. Lack of close friends other than family members 7. Inappropriate affect 8. Odd speech without being incoherent

Answer 92

1. Deception 2. Impulsiveness 3. Irritability 4. Reckless 5. Consistent irresponsibly 6. Lack of remorse

Answer 93

1. Efforts to avoid real or imagined abandonment 2. Unstable interpersonal relationships 3. Unstable self image 4. Impulsivity in potentially self damaging area 5. Recurrent suicidal behaviour 6. Affective instability 7. Chronic feelings of emptiness 8. Difficulty controlling temper 9. Quasi psychotic thoughts

Answer 94

1. Inappropriate sexual seductiveness 2. Need to be the centre of attention 3. Rapidly shifting and shallow expression of emotions 4. Suggestibility 5. Physical appearance used for attention seeking purposes 6. Impressionistic speech lacking detail 7. Self dramatization 8. Relationships considered to be more intimate than they are

Answer 95

1. Grandiose sense of self importance 2. Preoccupation with fantasies of unlimited success, power, or beauty 3. Sense of entitlement 4. Taking advantage of others to achieve own needs 5. Lack of empathy 6. Excessive need for admiration 7. Chronic envy 8. Arrogant and haughty attitude

Answer 96

1. Is occupied with details 2. perfectionism 3. Is extremely dedicated to work 4. Is meticulous, scrupulous, and rigid about etiquettes 5. Is not capable of disposing worn out or insignificant things 6. Is unwilling to pass on tasks or work with others 7. Takes on a stingy spending style

Answer 97

1. Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection. 2. Unwillingness to be involved unless certain of being liked 3. Views self as inept and inferior to others 4. Social isolation accompanied by a craving for social contact

Answer 98

1. multiple physical SYMPTOMS present for at least 2 years | 2. patient refuses to accept reassurance or negative test results