Mental Health Flashcards

Question

Atypical Antipsychotics: Mechanism of Action

Answer 1

D2-dopamine & serotonin receptor antagonists

Answer 2

- Hyperprolactinemia (>2000ml) - significant weight gain - metabolic syndrome

Answer 3

Aripiprazole and Lurasidone

Answer 4

- Used for Tourettes, ADHD, mania/hypomania, postpartum psychosis,schizophrenia - Main cause for drug-induced cause hyperprolactinemia (Switch to aripiprazole).

Answer 5

- Causes weight gain & HbA1c >7.5% (Change to Aripiprazole) - Cause Hypertriglyceridemia (but not cholesterol) METABOLIC SYNDROME

Answer 6

- Agranulocytosis: Stop when WBC goes < 3000. - Myocarditis: Measure troponin - Tachycardia - Hypersalivation

Answer 7

- Causes sleeping: Drug of choice for psychosis with insomnia - Doesn't cause hyperprolactinemia

Answer 8

- GI distress: Most common and temporary. Nausea, Vomiting, Diarrhoea (sertraline) - Sexual side effects: Erectile dysfunction, anorgasmia, delayed ejaculation and decreased libido - Nervous System: Agitation, insomnia, tremor - SSRRs: GI bleeding in combination with AAS or NSAIDs. The best option is TCA's - Serotonin Syndrome

Answer 9

Some adverse effects are likely, but most will go away after 1–2 weeks [incomplete flash card]

Answer 10

Identical symptoms: - rigidity - bradykinesia - postural instability Differentiating symptoms: - Tardive: involuntary movements of face and tongue - Parkinsonism: Stiffness

Answer 11

- Common in the elderly due to diminished brain dopamine stores - Caused by neuroleptic drugs - Tardive dyskinesia is the primary symptom - Treatment is to cease offending neuroleptic

Answer 12

Avoid in pregnancy: -causes pulmonary HT in the fetus.

Answer 13

- Indicated: smoking cessation - Contraindicated: Seizures and eating disorders - Decrease seizure threshold - Minimal Sexual Side Effects

Answer 14

- Causes weight gain and sedation - Indicated for patients with history ofother drug overdose MOA: NA and serotoninergic antidepressant.

Answer 15

- Contraindicated in HTA because it causes diastolic HTN

Answer 16

- Long half-life: most likely to cause serotonin symptoms, sleep, and paralysis. - Useful for post-stroke depression - Indicated in pregnancy and adolescents

Answer 17

- Altered mental status - Hyperthermia > 40C - Hypersalivation - Autonomic Dysregulation: Tachycardia, hypertension, muscle spasms, diaphoresis, erythema

Answer 18

- **Onset: < 24 h** - **Dose dependant. Increasing doses** - Severe muscle WEAKNESS, CLONUS, and HYPERreflexia - Nausea, vomiting - Increased bowel sounds - **Dilated pupils** (Mydriasis)

Answer 19

1. SSRIs 2. MAOIs 3. TCAs 4. Opioids: Tramadol, Morphine, Meperidine 5. Illicit drugs 6. St John’s wort

Answer 20

1. DRABCDE 2. Stop medications 3. Cyproheptadine + BZD 4. Chlorpromazine

Answer 21

- **Onset: Days / Weeks** - **Not dose dependant. ** Occurs any time - Severe **muscle RIGIDITY with HYPOreflexia** - No nausea or vomiting - Reduced bowel sounds - **Normal pupils**

Answer 22

Dopamine Antagonist (Antipsychotics/Neuroleptics) such as haloperidol

Answer 23

1. DRABCDE 2. Stop medications 3. Benzodiazepines + Bromocriptine

Answer 24

1. Serotonin syndrome (SS) 2. Neuroleptic malignant syndrome (NMS)

Answer 25

3C's + Anticholinergic symptoms TCAs DON'T cause impotence!

Answer 26

Alpha-adrenergic inhibition

Answer 27

1. Cardiac arrhythmias (prolong QT, MCC of death) 2. Convulsions (drowsiness) 3. Coma (Respiratory depression, hypoxia)

Answer 28

- Hyperreflexia - Urinary retention - Dilated pupils (mydriasis)

Answer 29

- Cardiac Arrhythmias - Aspiration pneumonia **Tricyclic antidepressants (TCAs)** are a type of medication that can be dangerous in large amounts (overdose). Here’s why an overdose can lead to **cardiac arrhythmias** and **aspiration pneumonia** in simple terms: ### 1. **Cardiac Arrhythmias**: - **What Happens**: TCAs affect the electrical signals in the heart that control the heartbeat. - **Why It’s a Problem**: In an overdose, TCAs can interfere with these signals, leading to **irregular heartbeats** (arrhythmias). This means the heart might beat too fast, too slow, or in an uncoordinated way. - **Why It’s Dangerous**: Irregular heartbeats can reduce the heart’s ability to pump blood effectively, which can be life-threatening. ### 2. **Aspiration Pneumonia**: - **What Happens**: TCAs can make a person very drowsy or even unconscious. - **Why It’s a Problem**: When someone is unconscious or has a reduced level of consciousness, they may vomit and accidentally inhale (aspirate) some of the vomit into their lungs instead of clearing it out of their airway. - **Why It’s Dangerous**: The stomach contents that enter the lungs can cause a serious lung infection known as **aspiration pneumonia**. This happens because the lungs are not meant to handle anything other than air, so inhaled vomit can cause inflammation and infection. ### Summary: - **Cardiac Arrhythmias** in TCA overdose occur because the drug disrupts the heart's electrical signals, leading to potentially dangerous irregular heartbeats. - **Aspiration Pneumonia** can happen if the person vomits while unconscious from the overdose and inhales vomit into their lungs, causing a serious lung infection. Both of these complications are serious and require immediate medical attention.

Answer 30

1. ECG 2. Paracetamol levels (30-40 min after arrival)

Answer 31

- < 1hr: Gastric lavage and ECG for 48hrs - > 1hr: Alkalinisation w/ IV sodium bicarbonate (antidote) - if severe Hypotension: IV NS + IV glucagon + Mg sulphate (stabilizes the cardiac membrane) - if seizures: IV Diazepam

Answer 32

2 core symptoms + 5 other symptoms > 2 weeks MSIGECAPS

Answer 33

- Low mood - Anhedonia - Lethargy

Answer 34

- Change in appetite and weight - Poor concentration - Early morning awakening - Suicidal ideations - Tiredness - Guilt

Answer 35

Mood (low) Sleep Interest (low) Guilt Energy (low) Concentration Appetite (low) Psychomotor Retardation Suicidal ideation

Answer 36

Counseling (CBT) + medication - Monotherapy preferred - 1st episode: Treatment for 6-12m - > 1 episode: Treatment for 3-5y 1. SSRI (Sertraline) 2. Change to another SSRI 3. Augmentation therapy by adding Lithium (1st) and atypical antipsychotics (2nd). 4. Change to an SNRI 5. ECT (Very severe)

Answer 37

ECT (0.8) > CBT (0.5) > Anti-depressants (0.4)

Answer 38

Criteria: > 2w with 2 core symptom + ≤ 3 other symptoms

Answer 39

1. CBT 2. SSRI

Answer 40

1 core symptom + ≤ 3 other symptoms > 2w

Answer 41

1. Weight gain 2. Hypersomnia 3. Rejection sensitivity 4. Reverse diurnal variation

Answer 42

Depression before puberty (usually) + less severe and persisting symptoms > 2y

Answer 43

1. CBT 2. SSRI

Answer 44

1. Weight gain 2. Fine tremors 3. Stomach pain 4. Hypothyroidism 5. Hyperparathyroidism 6. Diabetes insipidus 7. Hair loss

Answer 45

- Chronic renal failure - Hypothyroidism

Answer 46

Seizures Tremors Fever Hyperreflexia

Answer 47

In cases of severe bipolar disorder, the benefits outweigh the risks - 1st-trimester low risk of Epstein's anomaly (0.05%) & midfacial and other defects. - displacement of the tricuspid valve - US & ECHO at 16-20w (2nd trimestrer) to exclude foetal anomalies, especially cardiac anomalies

Answer 48

approximately 1 in 1000 to 2000 compared with 1 in 20000 in the general population.

Answer 49

The tricuspid valve is incorrectly formed and located lower than usual in the heart.

Answer 50

1 - 12 weeks Keep the same dose as before pregnancy

Answer 51

13 - 26 weeks Continue the same lithium dosage. But heavily monitor the fetus by US at 16-20 weeks.

Answer 52

Since 27 weeks Decrease lithium dosage by 25% to avoid floppy baby syndrome due to neonatal toxicity.

Answer 53

After delivery **immediately** increase lithium dosage due to increased risk of relapse in the postpartum period. NO BREASTFEEDING!!!!

Answer 54

- Dehydration (vomiting, gastro) - Diuretics (Thiazides) - NSAIDs - Exercise - Renal failure Here’s how and why each of these factors can cause lithium toxicity: - **Dehydration (vomiting, gastro)**: When you're dehydrated, your body retains more lithium because there's less fluid to dilute it, leading to higher concentrations in the blood. - **Diuretics (Thiazides)**: These medications increase urine production, causing the kidneys to retain more lithium to compensate for the loss of other electrolytes, raising lithium levels. - **NSAIDs**: Nonsteroidal anti-inflammatory drugs reduce kidney function, which can decrease the elimination of lithium from the body, causing it to accumulate. - **Exercise**: Intense exercise can lead to dehydration and electrolyte imbalances, both of which can reduce lithium excretion and increase its levels in the blood. - **Renal failure**: If the kidneys aren't working properly, they can't filter out lithium efficiently, causing it to build up in the body.

Answer 55

- Polyuria - Polydipsia - Coarse tremors - Hypertonia - Seizures - Arrhythmias Lithium toxicity occurs when there is too much lithium in the body, often due to an overdose or poor kidney function. Here's why and how it causes the symptoms listed: - **Polyuria (frequent urination)** and **polydipsia (excessive thirst)**: Lithium affects the kidneys' ability to concentrate urine, leading to increased urine production and, consequently, increased thirst. - **Coarse tremors**: High levels of lithium interfere with the normal function of nerves and muscles, causing noticeable shaking. - **Hypertonia (increased muscle tone)**: Lithium can disrupt the balance of electrolytes and nerve signals, causing muscles to become unusually stiff or tight. - **Seizures**: Excessive lithium can overstimulate the brain's electrical activity, leading to seizures. - **Arrhythmias (irregular heartbeats)**: Lithium affects the electrical conduction system of the heart, potentially causing abnormal heart rhythms.

Answer 56

- < 1 hour: Gastric lavage - > 1hr: Check lithium levels: Normal: 0.6-0.8 > 2 Hospitalisation > 4 haemodialysis until zero. **Monitor for the next 7d because lithium can rebound**

Answer 57

1st trimester: decrease dose to prevent neural tube defects + High dose folic acid (5mg) 2nd semester: continue decreased dosage through to 3rd semester 3rd trimester: increase the dosage to prevent seizures

Answer 58

- Adding an antidepressant to the prophylactic mood stabilizer: the choices of the drug would be the same as for major depression. SSRls first line. - Increasing the dose of prophylactic mood stabilizer: ONLY if the patient's psychosis is indicated in coming back, otherwise continue the same dose

Answer 59

Symptoms ≥7 days + Functional impairment + Delusions

Answer 60

- Grandiosity - Decreased sleep - Talkative, flight of ideas, - Distractibility - Psychomotor agitation - Excessive involvement in pleasurable activities

Answer 61

1. Antipsychotics + Mood Stabilisers. Antipsychotics: Olanzapine first, Risperidone if olanzapine not given Mood stabilizers: Lithium, Sodium Valproate, Carbamazepine 2. Combine 2-3 of these drugs 3. ECT NOTE: Psychosis requires hospitalization

Answer 62

1. Verbal de-escalation and psychological intervention 2. Agitation: - If agitation is caused by drug intoxication, then benzodiazepine (Midazolam) - If agitation is caused by psychosis atypical antipsychotic is preferred. - Zuclopenthixol (according to eTG) or - Haloperidol (less preferred I think)

Answer 63

1st trimester: Lithium, quetiapine, olanzapine, risperidone 2nd trimester: Carbamazepine

Answer 64

- Symptoms ≥4 days + NO Functional impairment + NO Delusions and hallucinations - NO Hospitalization

Answer 65

Olanzapine or Risperidone

Answer 66

Bipolar I: 1 manic episode + depression Bipolar II (True bipolar) 1 hypomania + 1 Depression episode

Answer 67

1 parent: 15-30% 2 parents: 50-70%. Fraternal twins: 15-25%

Answer 68

1. First-line drugs: - lamotrigine - lithium - lurasidone - olanzapine - quetiapine 2. If no response: add SSRI (any) For PROPHYLAXIS: Use lithium

Answer 69

1. Lamotrigine, quetiapine, olanzapine 2. Lithium Lurasidone: May cause extrapyramidal or withdrawal symptoms in neonates when exposed in the third trimester.

Answer 70

BPD: - impulsivity in at least two areas that are potentially self-damaging - **unstable and intense interpersonal relationships** - alternating between extremes of idealization and devaluation Cyclothymic: - many periods of depressed mood - many episodes of hypomanic mood for at least **2 years** - 1 year in children and adolescents - During the above 2-year period the hypomanic and depressive periods are present for at least half the time and - the individual has not been without the symptoms for more than 2 months at a time

Answer 71

Alternating episodes of hypomania and moderate depression for >2y Karla: is the managmeent of this disorder the same as BPD?

Answer 72

< 2 weeks of delivery. -80% of the postpartum women

Answer 73

- neglects baby BUT **no thoughts of hurting it** - low mood - sadness - mild depression

Answer 74

Family support, usually resolves in 1m

Answer 75

Appears within 2-w post delivery.

Answer 76

- **thoughts of hurting the baby** - Hallucinations - Delusions

Answer 77

1. If hurting baby: CPS and organize psych review 2. If the prior history of previous postpartum psychosis: start antipsychotics after delivery 3. Antipsychotics: Olanzapine, risperidone NO CLOZAPINE 4. ECT: Initial treatment-resistant

Answer 78

Breastfeeding: YES: Sodium Valproate NO: Lithium

Answer 79

- Bromocriptine: Can lead to post partum psychosis!!! - Cabergoline Bromocriptine can cause postpartum psychosis because it messes with the hormones that change after childbirth. This hormonal disruption can trigger severe mental health problems in some women, leading to symptoms like delusions and mood swings.

Answer 80

Appears 1-3m postdelivery.

Answer 81

- Thoughts about hurting baby - Features of depression. - Risk in future pregnancies: 20-40%.

Answer 82

1. Antidepressants: Sertraline or Paroxetine Avoid Fluoxetine (Karla: why?) 2. ECT NOTE: If mum took SSRI or SNRI during pregnancy, observe the baby for 3 days (observing for what?) in the hospital, then discharge

Answer 83

- Appears 1-3m postdelivery. - Obsession of hurting the baby

Answer 84

1–3 sessions per week for 8–12 sessions total Prior procedure: - 8 h Fasting - 2 h refrain from smoking - Dentures and jewelry removed - Ensure hair is clean During the procedure: EEG monitoring

Answer 85

Unilateral therapy

Answer 86

Transcranial direct current electromagnetic stimulation - No anesthetic is required, and less invasive

Answer 87

1. Psychotic depression (e.g. delusions, hallucinations) 2. Melancholic depression unresponsive to antidepressants 3. Severe postnatal depression and psychosis 4. Substantial suicide risk 5. Ineffective antidepressant treatment and/or previous response to ECT 6. Severe psychomotor depression (catatonia): refusal to eat or drink, depressive stupor, severe personal neglect

Answer 88

Raised intracranial pressure

Answer 89

- Hypertension - Myocardial Infarction <3 m - Bradyarrhythmia - Cardiac Pacemakers - Intracranial Pathology - Aneurysms - Epilepsy - Osteoporosis - Skull Defect - Retinal Detachment - Benzodiazepines (lower seizure threshold) - Water (amitriptyline)

Answer 90

headache, myalgia, nausea, and drowsiness. - 10 to 30 mins after: Acute confusion - Resolves at 2w: Anterograde amnesia - Appears in weeks to months: Retrograde amnesia

Answer 91

1. Acute post-ECT delirium: - Mild: Impaired comprehension and disorientation. Mx: Supervision - Severe: Psychomotor restlessness. Mx: IV Psychotropics 2. Confusion can be Ongoing ictal activity (non-convulsive status epilepticus) Ix: EEG monitoring Mx: Midazolam.

Answer 92

- Cause seizures. Taper them, washout, and then ECT - TCA's + cardiac disease = life-threatening

Answer 93

- Advisable to withdraw completely - Alternative: Use short-term sedative antipsychotics in low-dose (treat both, night sedation and agitation)

Answer 94

Carbamazepine and sodium valproate: increase seizure threshold. Reducing or ceasing (EXCEPT epilepsy)

Answer 95

Can cause post-ECT delirium. Could be suspended during ECT unless there is a strong reason for its continuation

Answer 96

ECT Malignant catatonia is a severe form of catatonia, a condition where a person has difficulty moving normally and may become almost completely immobile. In malignant catatonia, the symptoms are extreme and can include severe muscle stiffness, fever, confusion, and autonomic instability (like blood pressure and heart rate changes). It can be life-threatening and requires urgent medical treatment.

Answer 97

Involuntary hospitalization of a patient who is at risk of harming himself or others. Ideally, the mental health team treats and reviews the patient.

Answer 98

Inability to switch ideas along with the social context Schizophrenia negative symptom Perseveration in schizophrenia is when a person repeats the same words, phrases, or actions over and over, even when it no longer makes sense to do so. This can happen because their thoughts get "stuck" on certain ideas or actions, making it hard for them to move on to something else.

Answer 99

Inability to answer a question without unnecessary and excessive detail Schizophrenia negative symptom Circumstantiality in schizophrenia is when a person talks in a roundabout way, giving many unnecessary details before finally getting to the main point. Their thoughts and speech might wander, but they eventually circle back to the original topic.

Answer 100

Fixed false belief

Answer 101

Same as delusion but holds stronger, and occupies a person's mind

Answer 102

Misperception of a real external stimulus

Answer 103

Misperception without a real stimulus

Answer 104

Misperception of a real external stimulus and association with meaning known to the observer. Eg. Moon rabbit Pareidolia is when you see patterns or familiar images in random objects. For example, seeing a face in the moon or in the clouds is a common experience of pareidolia.

Answer 105

Happen as you're falling asleep NOTE: It's normal Hypnagogic hallucinations are vivid, often strange sensory experiences that happen just as you're falling asleep. They can include seeing, hearing, or feeling things that aren't really there.

Answer 106

Happen as you're waking up NOTE: It's normal Hypnopompic hallucinations are vivid, often unusual sensory experiences that occur just as you're waking up. For example, you might see a figure standing by your bed or hear someone calling your name as you're transitioning from sleep to being fully awake.

Answer 107

Responsive appropriate to the environment gives the situation **OCPD** Egosyntonic means that a person’s thoughts, behaviors, or feelings are in harmony with their self-image and values, so they don’t see them as a problem. For example, someone with anorexia might see their extreme dieting as a positive, healthy choice rather than recognizing it as harmful.

Answer 108

Responses and behaviors that are against a person’s beliefs and will **OCD** Egodystonic means that a person’s thoughts, behaviors, or feelings are in conflict with their self-image and values, so they find them distressing or upsetting. For example, someone with obsessive-compulsive disorder (OCD) might be troubled by their intrusive thoughts and rituals because they know these behaviors are irrational and unwanted.

Answer 109

Inability to think of abstract terms Schizophrenia symptom Concrete thinking refers to a literal, straightforward way of understanding things, without abstract or symbolic interpretation. It's focused on facts, actual objects, and immediate experiences rather than deeper meanings or concepts. For example, someone with concrete thinking might struggle to understand metaphors or sarcasm because they interpret language very literally.

Answer 110

Disorder in which a person believes that a relative or friend has been replaced by an identical impostor.

Answer 111

1. Narcissistic 2. Immature 3. Anxiety/Neurotic 4. Mature

Answer 112

1. Projection (mirror) 2. Denial (don't accept) 3. Splitting (Black or White)

Answer 113

1. Blocking (temporary inability to remember) 2. Regression 3. Somatization 4. Introjection (idea or object) 5. Identification (people)

Answer 114

1. Displacement (emotion shifted to another person) 2. Repression (Bad feelings or ideas removed from the consciousness) 3. Isolation of affect (Reality accepted without emotions) 4. Intellectualization (Use the intellectual process to avoid the emotions) 5. Acting out (tantrums) 6. Rationalization (EXCUSES. Rational explanations to justify behaviors) 7. Reaction Formation (Unacceptable impulse transformed in its opposite) "Pyromaniac to a firefighter" 8. Undoing (Acting out an unacceptable behavior) "Pyromaniac burning down" 9. Passive-Aggressive (Unconscious passive hostility) 10. Dissociation (Separates the experience to the body)

Answer 115

1. Humor #foreveralone 2. Sublimation (Unacceptable impulse into an acceptable channel) "Pyromaniac working in a special effect company" 3. Suppression (Conscious forgetting)

Answer 116

Cluster A: Odd, eccentric behavior or withdrawn personality. Cluster B: Dramatic, emotional and erratic personality Cluster C: Anxious and fearful personality Other

Answer 117

Withdrawn Cluster 1. Paranoid: Suspicious but not delusional, accept explanations for their wrong ideas. DDx: In paranoid delusion, they are suspicious about one thing only, and functioning is normal. 2. Schizoid: Happy loner. Emotionally cold 3. Schizotypal: Bizarre, magical thinking. Doesn't fulfill the criteria for schizophrenia “ISOLATED HIPPIE”

Answer 118

Antisocial cluster 1. Antisocial: Breaking the law with no remorse. a) Deliberate psychopaths (villains) b) Impulsive psychopaths (dumbs) - cruel to animals - vandalism •Treatment: extremely difficult to treat • • The aim of treatment si usualy ot prevent existing symptoms from progressing. Older individuals with antisocial personality disorder are typically incarcerated. 2. Histrionic: Usses seduction to attract attention but sexually frigid. Suggestible. Very dramatic. 3. Narcissistic: I'm the best. Can't take criticism. Lack of empathy. 4. Borderline: Mood instability + impulsive. Self-harm can lead to suicide or parasuicide Mx: Dialectal behavioural therapy

Answer 119

Dependent cluster 1. Avoidant: Fears rejection, "Unhappy loner" 2. Dependent: Avoids responsibility. Seek protection. Difficulty making everyday decisions. 3. Obsessional **OCPD**: No insight. Egosyntonic.

Answer 120

Personality Change: - Labile type - Masochistic - Disinhibited type - Aggressive type - Passive Aggressive type - Apathetic type - Combined type - Unspecified type

Answer 121

1. Generalized Anxiety Disorder 2. Panic Disorder (≠ Panic Attack) 3. Acute stress disorder 4. Social Anxiety Disorder (Social Phobia) 4. Agoraphobia (afraid to leave environments considered to as safer) 5. Separation Anxiety Disorder 6. Specific Phobia 7. Substance/Medication-Induced Anxiety Disorder 8. Anxiety Disorder Due to Another Medical Condition

Answer 122

- Genetic. - Psychological. - Environmental.

Answer 123

- Females. - Social history - Family history. - Past mental illness.

Answer 124

1. Obsessive-Compulsive Disorder 2. Body Dysmorphic Disorder 3. Hoarding Disorder 4. Trichotillomania (Hair-Pulling Disorder) 5. Excoriation Disorder (Skin-Picking)

Answer 125

1. PTSD 2. Acute Stress Disorder

Answer 126

Excessive anxiety for at least 6 months. ***Most common anxiety in general practice*** The most common psychiatric disorder is depression, however.

Answer 127

1. CBT - SPS (structured problem-solving) 2. Severe or CBT ineffective after 3M: - SSRI: Suspend after symptom-free for 6M

Answer 128

- SNRI - Benzodiazepine: Short term (2W and tapered over next 2W) - Buspirone (Anxiolytic) - Beta-blockers: palpitation / tremors.

Answer 129

1. Intense symptoms: palpitations, tachycardia, sweating, shaking, SOB, choking, fear of dying, paraesthesia. 2. develop abruptly and reaches a peak in 10m. Total 30 min duration 3. Trigger identified

Answer 130

- Hyperthyroidism. - Hypoglycaemia. - Pheochromocytoma.

Answer 131

1. Perform physical examination and/or initial investigations to exclude medical conditions. 2. Distraction methods (breathing in and out in a paper bag) 3. BDZ: Diazepam / Lorazepam 3. To prevent future attacks: CBT (flooding), stress management, exposure and desensitization, SSRI (Paroxetine)

Answer 132

1. Recurrent panic attacks. 2. triggers identified. 3. At least 1 panic attack within 1 m

Answer 133

1. CBT 2. Behavioural therapy (Graded exposure) 3. SSRI for 6-12m (Fluoxetine) NOTE: if there is no trigger, exposure therapy is not indicated

Answer 134

- Persistent fear of social performance - linked to panic attacks - avoidance of social events. - Kids: symptoms > 6 m for making a diagnosis

Answer 135

1. CBT 2. BT (exposure-based) 3. Training for social skills 4. B-Blockers (situational) 4. SSRI/SNRI/MAOI

Answer 136

1. Anxiety about being in open places where escape might be difficult (theatre, queue, public transport) 2. Avoidance of situations

Answer 137

Depressed mood and feeling of guilt

Answer 138

1. CBT 2. SSRI

Answer 139

Most common anxiety disorder in children. 1. Psychotherapy- CBT. 2. Family therapy. 3. Medications if severe.

Answer 140

Excessive fear of stimulus which interferes with lifestyle

Answer 141

1. CBT 2. Behaviour Therapy: Exposure and desensitization therapy - Teach relaxation techniques and breathing exercises. - Hierarchy of unpleasant stimulus

Answer 142

- Obsessive (not inserted thought) and compulsive (do it with rituals, they know it's unreasonable and excessive) intentional rituals. - Have insight - Egodystonic - Functioning impaired.

Answer 143

- Cleanliness - order. - Counting - Hoarding - Safety checking. - Sexual issues. - Religious / moral issues. Combinations can happen too.

Answer 144

CBT + SSRI **together** 1. CBT: Psycodyniamic Psicotherapy 2. BT: Exposure and response prevention 3. SSRI: Fluoxetine, sertraline, paroxetine

Answer 145

Egodystonic

Answer 146

- Anorexia Nervosa - Bulimia Nervosa

Answer 147

- Belief that some part of the body is abnormal or defective (face or secondary sexual character) - Significant functional impairment

Answer 148

- CBT - BT counseling. - Might require SSRI if depression is associated.

Answer 149

– Female Adolescent – Low self-esteem – Personal or family history of depression – Family history of obesity – High personal expectations – Family history of eating disorders – Disturbed family interactions - Social factors - Childhood sexual abuse - Perfectionism and obsessionist

Answer 150

- < 17.5 BMI - Significant electrolyte disturbance (K < 3.0 or Na < 130) – Amenorrhoea – Constipation. – Lanugo. – Cold intolerance. – Cachexia. – Hypothermia. – Bradycardia. (< 40bpm) – Hypotension (< 90mmHg) - Raised liver enzymes and Albumin < 35g/L

Answer 151

- Secondary amenorrhoea due to low levels of LH and FSH - Low TSH levels (Hypothermia) - Depression - Obsessive-compulsive disorder - Increased risk of fractures in later life due to osteoporosis

Answer 152

3 symptoms for >1m after a serious stressor (threatened death or serious injury): - Response with intense fear, horror, and helplessness. - Flashbacks - Difficulty falling asleep - Irritability

Answer 153

- Acute <3m - Chronic >3m - Delayed onset: >6m after traumatic event

Answer 154

1. CBT 2. Behavioural therapy (Graded exposure/eye movement desensitization and reprocessing) 3. SSRI for 6-12m

Answer 155

occurring within 4 weeks of trauma and resolving within 4 weeks

Answer 156

1. Debriefing and counselling 2. Stress based psychotherapy

Answer 157

1. Within 3 months of the new stressor (new job, migration, divorce) 2. Resolves within 6 months ***associated with a very increased risk of suicide ***

Answer 158

1. Listen and empathy (counselling) 2. CBT 3. Intermittent BZD x 2w (Diazepam 20 mg max. per day) 4. SSRI

Answer 159

4 symptoms lasting at least 12 months - preoccupation on gambling - increasing stakes on gambling - unsuccessful attempts to stop - gamble to escape reality - lie to cover up the problem - rely financially on others - get into criminal activities - loss of job - irritable anxious

Answer 160

1. Intermittent Explosive disorder (anger therapy) 2. Kleptomania 3. Pyromania

Answer 161

CBT – BT

Answer 162

1. Somatic Symptom Disorder: With predominant pain (4) / sexual sympoms (1) / neurological (1) / GI (2) 2. Conversion Disorder (Functional Neurological Symptom Disorder) "la belle indifférence" 3. Factitious Disorder: purposely getting sick or by self-injury

Answer 163

1. Dissociative Identity Disorder 2. Dissociative Amnesia: With dissociative fugue 3. Depersonalization/Derealization Disorder

Answer 164

Amnesia to escape from distress but they don’t travel away Dissociative amnesia is a condition where a person experiences memory loss that can't be explained by ordinary forgetfulness. It often occurs after a stressful or traumatic event and involves forgetting important personal information, such as their identity or significant life events. This memory loss is typically temporary and can vary in severity.

Answer 165

Different personalities at different times

Answer 166

Amnesia to get away from intolerable situations, sudden travel away from home. They don’t remember the previous episode

Answer 167

Out-of-body experience. Changes in body shape or size, cannot be recognized in the mirror, feel like watching characters in a boring movie. Associated with: Schizophrenia, borderline, temporal lobe epilepsy, and PTSD

Answer 168

The external world seems unreal. The feeling of being transported to place you don’t know and don’t understand

Answer 169

Recurrent depressive symptoms over the course of 3-5 years "Prodrome symptoms" in schizophrenia or psychosis refer to early warning signs or changes that happen before a full-blown psychotic episode. These signs might include things like social withdrawal, trouble sleeping, difficulty concentrating, or unusual thoughts or beliefs. Essentially, it's like a warning signal that something might be going wrong with a person's mental health, and it could be an opportunity to intervene early and prevent a more severe episode from happening.

Answer 170

- Paranoid ideation - Odd beliefs

Answer 171

Loss of motivation and social disability developing within 12 to 18 months of first recurrent depressive symptoms

Answer 172

BMI<17.5 Amenorrhoea Loss of body fat Increased lanugo Bradycardia (MC finding) Feelings of inferiority

Answer 173

BP: Postural drop >10mmHg Bradichardia <45 Albumin <20 BMI<15 Arrhythmias Haemonamicly unstable Severe dehydration

Answer 174

CBT + SSRI's ???

Answer 175

Refeeding Syndrome: high mortality rate Clinical Features: - Hypophosphatemia (hallmark) Leads to acute respiratory failure - Hypokalemia. Leads to metabolic alkalosis - Hypomagnesemia (+ Hypokalemia = torsades de pointes) - Thiamine deficit. Leads to Wernicke's and Korsakoff's encephalopathy.

Answer 176

BMI>18 Dry skin Parotid gland swelling Erosion of dental enamel Hair loss Calluses on dorm of hands (Russell's sing) Amenorrhoea Hypokalemia

Answer 177

- Delusional Disorder: 1 month - Schizophreniform disorder: > 1 month and < 6 months - Schizophrenia: > 6 months. - Schizoaffective/psychogenic disorder: Schizophrenia + major affective disorder. - Folie a Deux

Answer 178

- 1 month of JUST delusions with no other psychotic symptoms. - The delusions are not bizarre and can occur in real life (being followed, having an infection, etc)

Answer 179

1. Antipsychotics 2. Psychotherapy

Answer 180

Commonest type. Believes they are being persecuted or harmed.

Answer 181

Delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance.

Answer 182

The patient feels something is going on around them but cannot describe what. It usually becomes clearer and more specific when a delusional idea or perception occurs.

Answer 183

The patient thinks that another is in love with them, even if they have never met them before. Usually of higher status, the version involves a celebrity or famous person (Cleraumbault's Sx). It's a secondary delusion

Answer 184

Occurs when the delusion forms in response to an ordinary object. For example, the traffic light turns green, and Bert therefore knows he is the King of England.

Answer 185

Arise out of nowhere are termed autochthonous delusions. Can rarely occur in people without mental illness.

Answer 186

Believes that has inflated worth or power.

Answer 187

**Somatic delusions** are false beliefs related to the body or physical health. Here’s a simple way to understand them: - **Body Not Functioning**: The person might believe that a part of their body isn’t working properly, even though there's no medical evidence of a problem. For example, they might think their organs are failing or that their stomach doesn’t digest food. - **Infested with Insects**: The person might believe that they are infested with bugs or parasites, even though there's no physical sign of this happening. They might feel like insects are crawling under their skin. - **Emitting a Foul Odor**: The person might believe that their body is giving off a terrible smell, even though no one else can smell it and there's no reason for them to have this odor. ### Summary: Somatic delusions involve strong, false beliefs about the body—thinking it’s not working right, believing they’re infested with insects, or fearing they smell bad when there’s no actual problem. Delusions around the body function like parts not functioning, infested with insects, emitting a foul odor.

Answer 188

- Symptoms between 1d and 1m - 1st Depression, then psychosis (Brief) with a stressor present

Answer 189

- Only antipsychotic for 1 month. - Don’t treat the depressive part.

Answer 190

Symptoms like schizophrenia lasting at least 1 month but less than 6 months duration

Answer 191

 Treated as first psychotic episode.  Then like schizophrenia.  ECT for drug-resistant cases.

Answer 192

Affects about 1 in 100 people Men and women equally affected Usually diagnosed between the ages of 15 and 35. Age of onset tends to be slightly earlier in men (18-25) and later in women (25-35). Higher incidence in urban areas and among migrants, and lower socioeconomic classes

Answer 193

Criteria: - Symptoms >6m. - 1 of Positive Symptoms (DHD): - 2 of Negative Symptoms: ***usually have poor insight*** - MCC of death: CV disease.

Answer 194

- delusions - hallucinations - thought disorder - disorganized speech and behaviour

Answer 195

- flat affect - poverty of thought - lack of motivation - social withdrawal - reduced speech output

Answer 196

0 parents: 1% risk 1 parent: 13% risk 2 parents: 45% risk

Answer 197

1. Treatment of agitation: - Admission and control agitation with verbal de-escalation. - If pt tolerates oral/Cooperative: Diazepam or Lorazepam. - If doesn’t: Haloperidol or midazolam IM 2. Antipsychotics: All except olanzapine because of metabolic side effects. - Symptoms last <6m, keep for 1y - Symptoms last >6m, keep for 2y

Answer 198

1. Antipsychotics - Typical: Positive symptoms (DHD) - Atypical: Negative symptoms. *If using typical and not responding, change to atypical. *Increase dose if there is no response in 3-4w *Change to another antipsychotic if no response in 4-6w doing crossover period *If 2 different antipsychotics were tried, and there was no change after 6-12w: ECT 2. Psychotherapy, family counseling

Answer 199

Schizophrenia + major affective disorder If psychotic symptoms are present despite full treatment of depression (bipolar or unipolar) is schizoaffective 1st Psychosis, then depression. The best way to make the DD is that this px will need a combination of drugs ALWAYS, not only during an episode Schizoaffective disorder is a mental health condition that includes symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder. This means a person might experience delusions or hallucinations (like in schizophrenia) along with mood swings, depression, or mania. Treatment usually involves a combination of medication and therapy to manage both the psychotic and mood symptoms.

Answer 200

Criteria: Delusion in a person in a close relationship with another who already has established delusion.

Answer 201

1. Separate the people 2. Antipsychotics

Answer 202

Pinpoint pupils Resp depression Euphoria Constipation CNS depression

Answer 203

Naloxone and naltrexone

Answer 204

Flu-like reaction with rhinorrhoea Dilated pupils Piloerection Cramps Diarrhea Yawning NO FEVER according to Bluebook When someone stops using opioids, their body reacts to the sudden lack of the drug, leading to withdrawal symptoms. Here's what happens: 1. **Restlessness and Anxiety**: The brain's reward system is disrupted, causing feelings of unease and anxiety. 2. **Muscle Aches**: Without the opioid's pain-relieving effects, people may feel widespread muscle pain. 3. **Sweating and Chills**: The body's temperature regulation is thrown off, causing sweating and chills. 4. **Runny Nose and Yawning**: The nervous system becomes overactive, leading to these symptoms. 5. **Nausea, Vomiting, and Diarrhea**: The digestive system is affected, resulting in stomach cramps, nausea, and other gastrointestinal issues. 6. **Dilated Pupils**: The withdrawal removes the drug's constriction effect on pupils, causing them to dilate. 7. **Insomnia**: Disruption in brain chemicals makes it hard to sleep. These symptoms occur because opioids mimic natural pain-relieving chemicals in the brain, and when the drug is stopped, the body has to readjust to functioning without it.

Answer 205

Buprenorphine or methadone

Answer 206

Agitation Tachycardia Fever Diaphoresis Arrhythmias Seizures Midriasis HTN ALSO COCAINE: - ECG alterations - Fever When someone is intoxicated with amphetamines or cocaine, their body goes into overdrive because these drugs stimulate the central nervous system. Here's what happens: 1. **Increased Heart Rate and Blood Pressure**: These drugs make the heart pump faster and harder, which raises blood pressure. 2. **Dilated Pupils**: The drugs cause the pupils to widen. 3. **Increased Energy and Alertness**: Users feel very awake, energetic, and may talk a lot or move around more. 4. **Euphoria**: There's a strong feeling of happiness or pleasure because the drugs increase levels of dopamine, a "feel-good" neurotransmitter, in the brain. 5. **Reduced Appetite**: These drugs decrease feelings of hunger. 6. **Restlessness and Agitation**: Users can feel jittery, anxious, or overly excited. 7. **Hyperthermia**: Body temperature can rise because the body's metabolism is ramped up. These effects happen because amphetamines and cocaine increase the levels of certain neurotransmitters (dopamine, norepinephrine) in the brain, which stimulate the nervous system.

Answer 207

Haloperidol

Answer 208

Crash with: Anxiety Lethargy Headache Cramps Fatigue Nightmares

Answer 209

Wait it out? Activated charcoal of option is given history of patient ingesting within 2 hours

Answer 210

No proper medication to treat withdrawal. but to treat symptoms that arise such as mood disorders in which case : TCA

Answer 211

- Stroke - seizures - hyperthermia

Answer 212

**Agitation**: benzodiazepines (lorazepam IV if not cooperative, diazepam oral if patient cooperative) **Hypertension**: nitrates (nitroprusside), beta blockers (metoprolol 2-5mg IV) **Hyperthermia**: evaporative cooling, icepacks and maintenance of intravascular volume and urine flow with IV normal saline solution. **Seizures**: Phenothiazines as last resort

Answer 213

Antidepressants When someone stops using cocaine or amphetamines, they might experience withdrawal symptoms like depression, fatigue, and irritability. These drugs cause a spike in feel-good chemicals (like dopamine) in the brain, so when the drugs are stopped, levels of these chemicals drop suddenly, leading to withdrawal symptoms. To help manage these symptoms, doctors sometimes prescribe antidepressants. Antidepressants can help by: 1. **Increasing Neurotransmitters**: They boost levels of certain neurotransmitters (like serotonin and norepinephrine) in the brain, which can improve mood and energy levels. 2. **Stabilizing Mood**: They help stabilize the brain's chemistry, reducing feelings of depression and anxiety that come with withdrawal. 3. **Improving Sleep and Appetite**: They can also help regulate sleep and appetite, which are often disrupted during withdrawal. By addressing these symptoms, antidepressants can make the withdrawal process more manageable and support recovery.

Answer 214

They are synergistic (increase concentration of serotonin in the body) --> Serotonin Syndrome

Answer 215

Severe violence Psychomotor agitation HTN Nystagmus

Answer 216

Benzos or haloperidol ### Management of Phencyclidine (PCP) or Angel Dust Intoxication According to RACGP Guidelines **Phencyclidine (PCP) intoxication** can present with a range of symptoms, from mild agitation to severe psychosis, seizures, and life-threatening complications. Management focuses on symptomatic treatment and supportive care. #### 1. **Initial Assessment and Stabilization** - **Safety First**: Ensure the safety of healthcare providers and the patient, as individuals intoxicated with PCP may exhibit unpredictable and violent behavior. - **Airway, Breathing, Circulation (ABCs)**: Prioritize stabilization of vital signs. - **Monitoring**: Continuous monitoring of vital signs, cardiac rhythm, and oxygen saturation. #### 2. **Symptomatic Treatment** - **Agitation and Psychosis**: - **Benzodiazepines** (e.g., lorazepam, diazepam): First-line treatment for agitation, anxiety, muscle spasms, and seizures. - **Antipsychotics** (e.g., haloperidol): May be used for severe agitation or psychosis, though benzodiazepines are generally preferred due to fewer side effects and lower risk of exacerbating PCP-related symptoms. - **Severe Hypertension**: - **Benzodiazepines**: First-line to reduce anxiety and hypertension. - **Antihypertensives**: If hypertension persists, consider agents like nitroprusside or labetalol, carefully titrated to avoid rapid blood pressure changes. #### 3. **Supportive Care** - **Hydration**: Intravenous fluids to maintain hydration and support renal function. - **Cooling**: If hyperthermia is present, initiate cooling measures such as external cooling with ice packs or cooling blankets. - **Electrolyte Monitoring**: Regular monitoring and correction of electrolyte imbalances. #### 4. **Complications** - **Seizures**: Treat with benzodiazepines, and consider additional anticonvulsants if seizures persist. - **Rhabdomyolysis**: Suspected if there is muscle rigidity, elevated creatine kinase levels, or myoglobinuria. Manage with aggressive hydration and monitoring of renal function. - **Cardiac Arrhythmias**: Continuous cardiac monitoring and management according to ACLS protocols if arrhythmias occur. #### 5. **Psychiatric Evaluation** - **Mental Health Assessment**: Once stabilized, patients should receive a psychiatric evaluation to address any underlying mental health issues or substance use disorders. - **Referral**: Consider referral to addiction specialists for ongoing treatment and support. ### Summary 1. **Safety and Initial Stabilization**: Ensure a safe environment and stabilize vital signs (ABCs). 2. **Symptomatic Treatment**: - **Benzodiazepines**: For agitation, seizures, and muscle spasms. - **Antipsychotics**: For severe psychosis. - **Antihypertensives**: For persistent severe hypertension. 3. **Supportive Care**: Hydration, cooling, electrolyte monitoring. 4. **Complications Management**: Seizures, rhabdomyolysis, cardiac arrhythmias. 5. **Psychiatric Evaluation and Referral**: Address underlying mental health and substance use disorders. This approach provides a clear framework for managing PCP intoxication, focusing on safety, symptom control, and addressing potential complications.

Answer 217

Euphoria Social withdrawal Can't drive Conjunctival injection Hallucinations

Answer 218

Insomnia Night sweats Nausea Depression Irritability Anger

Answer 219

Hypotension Bradycardia Resp failure (mixed with alcohol)

Answer 220

1. Monitor with IV fluids 2. Flumazenil

Answer 221

Rebound anxiety Depression Seizure Insomnia HTN Tachycardia Noise sensitivity

Answer 222

- In anxiety: Difficulty in initiation sleep - In depression: Early morning awakening

Answer 223

1. Tx comorbidities causing insomnia 2. Implementing good sleep hygiene 3. Sleep restriction and stimuli control programs 4. Cognitive therapy (Best for chronic >4w) 5. Drugs: Best for acute: Short-acting Benzos -- Temazepam, zolpidem, zopiclone, eszopiclone (do not give with alcohol->resp depression). Chronic >55w (>1 year): Melatonin

Answer 224

1. A self-reported complaint of poor sleep quality 2. Sleep difficulties occur despite adequate sleep opportunity. Impaired sleep produces deficits in daytime function. 4. Sleep difficulty occurs **three nights per week** and is present **for three months**

Answer 225

1. Treat the comorbidities causing insomnia 2. Implementing good sleep hygiene 3. Sleep restriction and stimulus control programs 4. Cognitive therapy (Best for chronic >4w) 5. Drugs: *Acute: Short-acting Benzos (Temazepam, zolpidem, zopiclone, eszopiclone. DO NOT give with alcohol ----> Resp depression) Chronic insomnia for >55 weeks (1y): Melatonin

Answer 226

1 Denial 2 Grief and despair (until 6m) 3 Acceptance (6m-1y). *If it continues then treatment NOTE: It's normal to have a relapse of symptoms during the anniversary

Answer 227

Normal grief 1. Short-acting benzos Abnormal grief: Stage 2 sx for >6m 1. Psychotherapy 2. SSRI-Antipsychotics 3. CBT 4. ECT

Answer 228

- More common season: Spring - More common season in schizophrenics: Winter - Highest risk: 1. After discharge from hospital. 2. After improvement of tx

Answer 229

1. Do you feel hopeless? 2. Have you felt that you've lost interest in your usual activities?

Answer 230

S: Male SEX 1 A: AGE < 20 and > 45 1 D: DEPRESSION/depressed mood 2 P: PREVIOUS attempts 1 E: EXCESSIVE alcohol/substances 1 R: RATIONAL thinking Loss 2 S: SEPARATE (no spouse) 1 O: ORGANIZED plan 2 N: NO Support 1 S: Sickness (chronic or fatal) 1

Answer 231

0–4: Low Fleeting thoughts of self-harm or suicide but no current plan or means 5–6: Medium Suicidal thoughts and intent but no current plan or immediate means 7–10: High Continual/specific suicidal thoughts, intent, plan and means

Answer 232

1. Discuss the availability of support and treatment options. 2. Arrange a follow-up consultation. 3. Identify relevant community resources and provide contact details.

Answer 233

1. Discuss the availability of support and treatment options. 2. Organize reassessment within 1 week. 3. Have a contingency plan in place for rapid reassessment if distress or symptoms escalate. 4. Develop a safety plan (a prioritized written list of coping strategies and sources of support to use when experiencing suicidal thinking).

Answer 234

1. Ensure that the person is in an appropriately safe and secure environment. 2. Reassessment within 24 hours and monitoring for this period. Follow-up outcome of assessment: *If there is concern about suicide risk and treatment is supervised outside the hospital, prescribe drugs that are less toxic in overdosage (e.g. mianserin or fluoxetine).

Answer 235

1. Substance abuse 2. Chronic health issues, pain, or physical disability 3. Feelings of isolation or helplessness 4. Negative life events: Abuse history, significant loss, financial crisis (Adjustment Disorder) 5. Previous suicide attempts or exposure to suicide behavior in others (family, friends) 6. Young men in rural areas 7. Borderline personality disorder

Answer 236

Criteria: Sexual fantasies for >6m with clinical impairment. Management: 1. Insight-oriented psychotherapy

Answer 237

The most common sexual disorder in Australians Management: - Short term: *Lignocaine before sex - Long term: *SSRI/TCA

Answer 238

MCC: Vascular problem Investigation: Detailed Hx including information about libido and morning erections

Answer 239

1. Optimise RFs and comorbidities 2. Phosph 5 inhibitors: Sildenafil 3. PgE1 for Erection

Answer 240

1. Daytime: Amphetamines/Modafinil 2. Nightime: Sodium oxybate

Answer 241

Seen in stress, heavy alcohol drinkers. Management: Place a hot towel against the side of face, counseling, yoga, relaxation exercises, meditation

Answer 242

Impaired judgment and coordination Gait instability Slurred speech Mood and behavior changes Nausea and vomiting Hypothermia Dysarthria Amnesia Diplopia and nystagmus

Answer 243

6 and 24 hours after the last drink

Answer 244

Onset within 12-24 hours of abstinence with normal consciousness

Answer 245

Onset after 2-3 days of abstinence Visual hallucinations Confusion Tachycardia Hypertension Hyperthermia Agitation Diaphoresis Seizures

Answer 246

History of Delirium Tremens Concurrent illness Advanced age Hypokalemia Prior withdrawal symptoms or detoxification

Answer 247

Most reliable investigation to diagnose alcoholism: Carbohydrate deficient transferrin --------------------------------------------------- NO RELIABLE INFO: 1. ECG: cardiac arrhythmias 2. ABG: Lactic acidosis 2. Electrolytes: hypoglycemia, hypomagnesemia, hyponatremia, and hypophosphatemia 3. Liver function test; prothrombin time 4. Brain CT scan to rule out intracranial pathology

Answer 248

Acute: 1. Diazepam or Midazolam IV 2. Tiamine IV 3. Glucose IV 4. Metoclopramide IV Prophylaxis: - Disulfiram, Naltrexone, Baclofen, or Acamprosate NOTE: *Unresponsive to benzodiazepine: Add phenobarbital or propofol + Mechanical Ventilation *Rapid correction of HypoNatremia can cause central pontine myelinolysis *ACUTE NOT USE: Neuroleptic drugs (Antipsychotics)

Answer 249

C- Have you ever felt you should Cut down on your drinking? A- Have people Annoyed you by criticizing your drinking? G- Have you ever felt bad or Guilty about your drinking? E- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? (Eye-opener)

Answer 250

Benzodiazepine (Diazepam)

Answer 251

-1 or more somatic symptoms that are distressing or result in significant disruption of daily life - Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. 4. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

Answer 252

hypochondriasis: already have a diagnosis **failure to respond to reassurance** is an explicit criterion illness anxiety disorder: has as its primary focus preoccupation with having or acquiring a serious (and undiagnosed) medical illness (think **general overall health**)

Answer 253

Serotonin syndrome

Answer 254

- SJW reduces the effectiveness of COCs and increases the risk of unintended pregnancy -Induce the cytochrome P450 enzymes CYP1A2, CYP2C9, and CYP3A4. Therefore metabolizing COCPs at a faster rate, decreasing its effectiveness.

Answer 255

- SJW reduces the effectiveness of warfarin and increases the risk of stroke, ischemia, arterial blockage etc. - SJW's extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9, and CYP3A4. Therefore metabolizing COCPs at a faster rate, decreasing its effectiveness.

Answer 256

Appearance Attitude Behavior Mood Affect Speech Thought process Thought content Perception Cognition Insight Judgment

Answer 257

Normal: 25 - 30 Mild Dementia: 20 - 25 Moderate Dementia: 10 - 25 Severe Dementia: < 10 Pseudo-dementia/ Depression > 24

Answer 258

Correct sight impairment and redo test, or perform other cognitive tests that do not require sight (Six-item Cognitive Impairment Test)

Answer 259

CT scan (to see if there's any degeneration of brain tissue, such as atrophy)

Answer 260

MMSE >24 Depression with cognitive impairment. The symptoms are worse in the morning The patient has insight Common in elderly "Give up patient"

Answer 261

1. Alzheimer's disease 2. Frontal Lobe Dementia (FLD) 3. Vascular Dementia (VD) 3. Lewy body dementia (LBD) 4. Parkinson's dementia 5. Alcohol-related dementia: - Korsakoff’s syndrome - Wernicke’s encephalopathy

Answer 262

It is the most common form of dementia. Short-term memory loss. Repeatedly saying the same thing Disability to plan, problem solve, organize, and think logically Language and comprehension difficulties, such as problems finding the right word Disorientation in time, place, and person Changes in behavior, personality, and mood.

Answer 263

Acetylcholinesterase inhibitors: donepezil, galantamine or rivastigmine Moderate to severe: Add Memantine Severe agitation: - Citalopram - Avoid antipsychotics. If it's indispensable, review every 4–12 w

Answer 264

Overstimulation of the parasympathetic nervous system, such as increased hypermotility, hypersecretion, bradycardia, miosis, diarrhea, and hypotension, may be present. Cholinergic crisis, also known as SLUDGE syndrome: S: Salivation L: Lacrimation U: Urination D: Diaphoresis G: Gastrointestinal upset E: Emesis Same in toxicity by organophosphates

Answer 265

Atropine + Pralidoxime (2-PAM) --> Synergistic effect Seizures = Diazepam Atropine is given to manage acetylcholinesterase inhibitor toxicity because it blocks the effects of excess acetylcholine, a chemical that can build up to dangerous levels due to the toxicity. By blocking acetylcholine, atropine helps reduce symptoms like muscle twitching, difficulty breathing, and excessive saliva production.

Answer 266

Gastric ulcer (increased risk of gastrointestinal bleeding) Urinary retention Bradycardia or cardiac conduction diseases (sick sinus syndrome). Antihypertensive medications --> Reduce the dose of antihypertensive, risk of severe hypotension. NOTE: The two previous conditions can be evidenced by syncopal episodes.

Answer 267

-Symptoms are more subtle and are subject to change: *Hyperactivity may be replaced with restlessness *Impulsivity may be replaced with the inability to control emotions or social inappropriateness. - 60% of the children will continue to exhibit symptoms into adulthood

Answer 268

Inhibition of dopamine and norepinephrine reuptake

Answer 269

- Squalor and decline in personal hygiene - Sometimes hoarding useless items - Significant frontal lobe impairment

Answer 270

- Formed visual hallucinations in blind or partially sighted elderly who are not delirious. - Always ocular or occipital disease not psychiatric. - The patient has good insight - Hallucinations characteristics: *Last for seconds or hours at a time *Vivid, colorful, and well-organized. *Not distressing but may be quite engaging

Answer 271

Two forms: 1. '**restless legs' syndrome** 2. Delusional infestation with parasites or worms in schizophrenic patients Treatment: treat the underlying iron deficiency anaemia, and levodopa

Answer 272

The patient believes they have lost important body parts, blood, internal organs, or even their soul Prevalent in schizophrenia, bipolar disorder, non-dominant temporoparietal lesions, and migraine.

Answer 273

Antipsychotics Carbamazepine SSRIs SNRIs

Answer 274

**More common in the elderly** - Confusion - Lethargy - Worsening of psychosis or dementia

Answer 275

SADPHAM Schizophrenia: ↑ dopamine Alzheimer's: ↓ acetylcholine Depression: ↓ serotonin/norepinephrine Parkinson's: ↓ dopamine Huntington's: ↓ acetylcholine Anxiety: ↓ GABA Mania: ↑ serotonin/norepinephrine Neurotransmitter abnormalities occur when the chemicals in the brain that send messages between nerve cells (neurotransmitters) are out of balance. This can affect mood, behavior, and bodily functions. For example, low levels of serotonin are linked to depression, while high levels of dopamine can be associated with schizophrenia.

Mental Health Flashcards

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