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Revision Qs > Mental Health 2 > Flashcards

Mental Health 2 Flashcards

1
Q

What are first rank symptoms of schizophrenia and what are their drawbacks?

A

Symptoms that, if present, are strongly suggestive of schizophrenia
However are also present in other disorders e.g. Dissociative identity disorder

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2
Q

4 areas of positive symptoms of schizophrenia?

A

Delusions
Hallucinations
Formal thought disorders
Thought passivity phenomena - withdrawal, echo, insertion, broadcasting

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3
Q

What is a delusion?

A

A fixed belief (conviction) held on inadequate grounds and not susceptible to rational argument or conflicting evidence to the contrary, not culturally emissable

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4
Q

5As of negative symptoms of schizophrenia?

A 
Alogia
Anhedonia
Avolition
Affective blunting
Amotivation
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5
Q

What group of schizophrenic patients are highest risk of suicide?

A

Young males who have insight

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6
Q

If someone has delusions but no other disturbances, do they have schizophrenia?

A

No, they have a delusional disorder

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7
Q

What if psychotic symptoms last for less than a month?

A

Acute and transient psychotic disorder

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8
Q

What if someone develops psychotic and affective symptoms at the same time?

A

Probably schizoaffective disorder

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9
Q

PAD THCNeg of schizophrenia criteria?

A

Passivity phenomena
Auditory hallucinations (running commentary, 3rd person)
Delusions - bizarre, control or perception

Thought disorder
Hallucinations of any modality
Catatonia
Negative symptoms

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10
Q

What is delusional perception?

A

Normal stimulus -> irrational conclusion

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11
Q

How many of PAD must be present and for how long to make a diagnosis of schizophrenia?

A

At least 1 for at least a month

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12
Q

How many of THCNeg must be present and for how long to make schizophrenia diagnosis?

A

At least 2 for at least a month

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13
Q

What is a typical schizophrenia prodrome?

A

Withdrawal, lack of interest in personal appearance and hygiene, anxiety, depression, pre-occupation

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14
Q

What characterises paranoid schizophrenia?

A

Prominent positive symptoms often with paranoid background e.g. Persecutory delusions, running commentary, thought withdrawal/echo/insertion/control

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15
Q

Apart from the prominence of positive symptoms, what else differentiates paranoid schizophrenia from other types?

A

Often no affective blunting or formal thought disorder

Negative symptoms uncommon

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16
Q

What characterises hebephrenic/disorganised schizophrenia?

A

Earlier onset (~age 20), rapid progression of negative symptoms
Affective blunting and avolition with marked formal thought disorder
Inappropriate emotional responses and behaviour

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17
Q

What does someone with a shy and solitary premorbid personality who develops negative symptoms and a major FTD around age of 20 suggest?

A

Hebephrenic schizophrenia

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18
Q

What characterises catatonic schizophrenia?

A

Marked psychomotor disturbance with at least one dominant feature over the other positive and negative symptoms of schizophrenia

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19
Q

What are some examples of catatonic behaviour?

A 
Stupor and mutism
Violent excitement
Bizarre posturing
Waxy flexibility
Negativism 
Perseveration, echolalia
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20
Q

What is residual schizophrenia?

A

Have initial positive symptoms which subside and then at least a year later prominent negative symptoms present

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21
Q

What is simple schizophrenia?

A

Slowly progressive negative symptoms in absence of major psychotic symptoms, with massive behaviour change and vagrancy

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22
Q

What is expressed emotion EE and is it a good or bad thing?

A

Level of emotional expression and family and social support not helping in schizophrenia
Bad thing

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23
Q

What are the 3 components of thought form?

A

Associations
Determinate tendency
Goal

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24
Q

Disorders of thought form - association? What are these typical of?

A

Loosening of associations, which include concepts such as knights move thinking
More suggestive of schizophrenia

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25
Q

What are some disorders of determinate tendency and goal in thought form? What are they suggestive of?

A

Tangentiality or circumferential thinking
Flight of ideas
Word salad
Concrete thinking
More suggestive of mania, however word salad is often schizophrenic

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26
Q

What are common causes of secondary delusions?

A

Severe depression and mania

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27
Q

What are primary delusions?

A

No underlying cause of delusion - strongly suggestive of schizophrenia

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28
Q

What is Capgras delusion?

A

That close friends and loved ones have been replaced with identical clones

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29
Q

What is Othello’s syndrome?

A

Delusional jealousy

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30
Q

Other disorders of thought content besides delusions?

A

Preoccupations
Overvalued ideas and obsessions
Confabulation

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31
Q

What is an illusion?

A

False processing of a normal stimulus that is not delusional (not believed to be true)

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32
Q

What is perception?

A

The ability to integrate and process external stimuli

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33
Q

What are hallucinations?

A

Integration and processing in the absence of external stimuli

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34
Q

What does a visual hallucination suggest?

A

Organic disease e.g. Substance use, LBD

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35
Q

What are pseudohallucinations?

A

A sensory experience that is as vivid as a true hallucination but recognised as not being real (a hallucination recognised as a hallucination)

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36
Q

What are pseudohallucinations commonly associated with?

A

Anxiety disorders - conversion disorder, somatisation disorder, dissociative disorders

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37
Q

What are common causes of olfactory hallucinations?

A

Organic cause - MTL epilepsy, tumours

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38
Q

What is the most common type of tactile hallucination? What are they typically associated with?

A

Formication (insects under skin)

Associated with cocaine, alcohol withdrawal (DT)

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39
Q

Infectious disease that can cause formication?

A

Lyme disease

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40
Q

Examples of general somatic hallucinations?

A

Bowels twisting

Flesh decomposing

41
Q

What is Charles Bonnet syndrome?

A

Visual hallucinations in patients who can’t see (secondary to eye disease)

42
Q

Signs of alcohol dependence?

A 
Withdrawal symptoms if don't drink
Compulsion to drink
Mental or physical health problems resulting from drinking
CAGE
Amount of money being spent
Impacting negatively on daily life
43
Q

Timeline of alcohol withdrawal symptoms?

A

Usually peak around day 2 after significant fall in blood alcohol levels, easing by day 5
Early minor symptoms -> alcoholic hallucinosis -> withdrawal seizures -> DT

44
Q

Early symptoms of alcohol withdrawal?

A 
Nausea and vomiting, headache
Craving for alcohol
Insomnia and fatigue
Anxiety, restlessness, agitation 
Sweating and palpitations, anaemia
Mood lability
45
Q

Common hallucination modalities in alcoholic hallucinosis?

A

Visual, auditory, tactile

46
Q

Medication of choice for acute alcohol withdrawal?

A

Chlordiazepoxide

47
Q

3 reasons why alcohol use may lead to thiamine deficiency?

A

It is a coenzyme in alcohol metabolism
Malabsorption
Gastritis

48
Q

When does DT normally present in relation to stopping alcohol?

A

1-3 days after significant drop in blood alcohol

49
Q

Sx of DT?

A 
Hallucinations
Delusions
Confusion
Agitation
Seizures
50
Q

What type of state is DT and what signs does it therefore produce?

A

Hyperadrenergic -> mydriasis, tachycardia, sweating, hypertension, hyperthermia and sweating, tremor, ataxia

51
Q

What is an important metabolic abnormality that can occur as a result of alcohol withdrawal acutely?

A

Hypoglycaemia

52
Q

What is Wernicke-Korsakoff disease?

A

Spectrum of pathology due to thiamine (B1) deficiency

53
Q

Triad of Wernickes syndrome?

A

Ataxia (cerebellar signs)
Mental confusion - anterograde amnesia, hallucinations
Ophthalmoplegia - double vision, movement abnormalities, droopy lids

54
Q

3 thought/memory problems characteristic of Wernickes syndrome?

A

Anterograde amnesia
Confabulation
Telescoping of ideas

55
Q

What is Korsakoff’s syndrome?

A

Sort of chronic thiamine deficiency, causing neuronal loss and mammillary body haemorrhage

56
Q

6 key symptoms of Korsakoff’s syndrome?

A 
Anterograde amnesia
Retrograde amnesia (long term and contextual)
Confabulation
Minimal conversational content
Lack of insight
Apathy
57
Q

What are the ABCDS of Schneiderian first rank symptoms of schizophrenia?

A

Auditory hallucinations (third person running commentary)
Broadcasting of thought
Controlled thought (insertion, withdrawal, echo)
Delusional perception (normal stimulus -> bizarre conclusion)
Somatic hallucinations

58
Q

3 endocrine causes of depression?

A

Addison’s disease
Cushing’s
Hypothyroidism

59
Q

5 medications that can cause depression?

A 
L dopa
B blockers
Steroids
Digoxin
OCP
60
Q

What is Becks cognitive triad?

A

Negative views about self, world and future

61
Q

3 core Sx of depression?

A

Low mood
Anhedonia
Low energy/tiredness

62
Q

4 factors of low mood that makes it more likely depression than ‘normal low mood’?

A

Duration (>2 weeks)
Intensity
Additional Sx
Diurnal variation

63
Q

GAPES of additional depression Sx?

A 
Guilt
Attention/concentration and Appetite
Pessimism and psychomotor
Esteem
Sleep and Suicidal ideas
64
Q

Besides sleep and appetite, examples of somatisation of depression?

A

Diurnal variation of mood
Loss of libido
Psychomotor retardation
Amenorrhea, constipation

65
Q

4 examples of psychotic depression?

A

Stupor
Loss of insight
Hallucinations - auditory
Delusions - mood congruent

66
Q

When classifying >1 episode of depression, what must be included?

A

Recurrent depressive disorder or BAD depending on presence of mania
Classification of current episode

67
Q

What is dysthymia?

A

Low mood, not meeting criteria for depression

68
Q

What is euthymia?

A

Normal mood

69
Q

What is cyclothymia?

A

Persistently fluctuant mood never meeting criteria for depressive or manic/hypomanic episodes

70
Q

Conservative management of mild-moderate depression?

A

Watchful waiting, review within 2 weeks

Low intensity CBT, psychodynamic psychotherapy

71
Q

Indications for antidepressant use in mild-moderate depressive episode?

A

Previous severe illness
Refractory to other interventions
Interfering with physical health

72
Q

Management of moderate-severe depression?

A

SSRI + CBT/interpersonal therapy

Risk assessment and consider MHA referral

73
Q

3 things to advise patients starting an antidepressant?

A

Monitor for akithesia
Might get better before get worse - monitor for suicidal ideas
Monitor for agitation/anxiety

74
Q

Second line treatment options after one SSRI for depression?

A

Another SSRI
Mertazapine (NaSSA)
Moclobemide (MAOI)
SNRI

75
Q

Why are venlafaxine and TCAs best avoided if possible?

A

High risk in overdose

76
Q

3 indications for ECT?

A

Severe depression with psychosis
Treatment resistant mania
Puerperal psychosis

77
Q

How long does the average depressive episode last?

A

6-8m

78
Q

2 major endocrine causes of mania?

A

Hyperthyroidism

Acute phase steroids

79
Q

Which mood disorder does FH play a bigger role in?

A

Mania/BAD

80
Q

Describe the mood and insight associated with hypomania?

A

Mildly elated mood but full insight retained - euphoric sociability

81
Q

SADFIR of mania symptoms?

A 
Speech (pressure), self esteem, sex
Activity
Disinhibition, distractibility
Flight of ideas
Insomnia
Reckless behaviour
82
Q

How long for and how many Sx must be present for mania diagnosis?

A

At least 3 symptoms for at least 7 days

83
Q

For how long must mood disturbance last to diagnose depression?

A

2 weeks

84
Q

For how long and how many symptoms of hypomania must be present to make diagnosis?

A

At least 3 Sx for at least 4 days

85
Q

Mood and insight in mania?

A

May be elevated but may also be irritable

Insight may be present but often isn’t

86
Q

Psychotic Sx associated with mania?

A 
Delusions, often persecutory or grandiose
Hallucinations (auditory)
No sleep and neglecting of self care
Incoherent speech
Suspicion and violence
Complete loss of insight
87
Q

Psychomotor change in mania?

A

Psychomotor agitation

88
Q

What 2 medications should be given in an acute manic episode?

A

Mood stabiliser +/- antipsychotic

89
Q

4 examples of mood stabilisers?

A

Lithium
Valproate
Lamotrigine
Carbamazepine

90
Q

Commonly used antipsychotics for mania?

A

Haloperidol
Resperidone
Olanzapine
Quetiapine

91
Q

What is type I bipolar?

A

‘Classical’ type - recurrent manic episodes +/- depressive episodes

92
Q

What is bipolar type II?

A

Hypomanic (less disabling) episodes and depressive episodes

93
Q

Difference between bipolar II and cyclothymia?

A

Cyclothymia is BAD II but with less bad depressive episodes

94
Q

How long do manic episodes typically last?

A

2 weeks - 4/5 months

95
Q

What is rapid cycling BAD?

A

> 4 cycles of depression and mania in a year with no intervening asymptomatic episodes

96
Q

6 features of alcohol dependence syndrome?

A

Tolerance
Withdrawal of stopped
Strong desire/compulsion
Difficulty stopping or avoiding
Lack of other activities or loss of interest
Continuation despite harmful consequences

97
Q

Features of an alcohol Hx?

A

CAGE to screen
Explore - how much, when, where, who, what, why?
Any social complications incl jobs, law trouble
Physical health complications - liver + GI, anaemia, Neuro, CV
Previous attempts to stop and outcomes (incl withdrawal)
Motivation to change

98
Q

MANIC of mania symptoms?

A 
Mood elated
Activity levels increased
Naughty behaviour - sex, spending sprees, drugs/alc
Insomnia
Confidence and chatty
99
Q

What are Schneiders first rank Sx of schizophrenia?

A

Thought interference
Auditory hallucinations
Delusional perception
Delusions of control

Revision Qs (28 decks)

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