Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Core Conditions > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Characteristics of vascular dementia ?

A

Represents cumulative effect of many small strokes:

  • sudden onset and stepwise deterioration
  • evidence of vascular pathology (hypertension, past stroke, focal CNS signs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Characteristic presentation of Lewy body dementia ?

A
  • fluctuating cognitive impairment
  • detailed visual hallucinations (e.g. Small animals or children)
  • Parkinsonism
  • histology= Lewy bodies in brainstem and neocortex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Characteristics of picks dementia ?

A
  • frontal and temporal atrophy without Alzheimer’s histology
  • linked to genes on chromosome 9
  • executive impairment
  • behaviour and personality change
  • early preservation of episodic memory and spatial orientation
  • disinhibition
  • hyper orality
  • emotional unconcern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the positive symptoms of dementia ?

A
  • wandering
  • aggression
  • flight of ideas
  • logorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathogenesis if Alzheimer’s disease

A

accumulation if beta amyloid peptide (degradation product of amyloid precursor protein) results in:

  • progressive neuronal damage
  • neurofibrillary tangles
  • increased no. Amyloid plaques
  • loss of acetylcholine
  • defective clearance of beta amyloid plaques by macrophages
  • selective neuronal loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which areas are vulnerable to neuronal loss in AD ?

A
  • hippocampus
  • amygdala
  • temporal neocortex and subcortical nuclei
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk factors for AD ?

A
  • first degree relative with AD
  • Down’s syndrome
  • vascular risk factors
  • depression and loneliness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Presentation of AD ?

A

Progressive and GLOBAL cognitive impairment (unlike any other dementia which affect certain domains)

  • visuospatial skills (gets lost)
  • memory
  • verbal ability
  • executive function
  • ansognosia (lack of awareness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacological treatment for cognitive decline in AD

A
  • donepezil (acetylcholinesterase inhibitor)
  • rivastigmine (parasympathomimetic) - also for Parkinson’s
  • galantamine (cholinesterase inhibitor) - vascular origin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Huntington’s disease ?

A

Incurable, progressive, Neurodegenerative disorder presenting. Middle age

  • often prodromal phase of mild symptoms (irritability, depression, incoordination)
  • progresses to chorea, dementia +/- fits
  • death ~15 years after diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathogenesis of huntingtons

A
  • Atrophy and neuronal loss of striatum and cortex
  • genetic basis: expansion of CAG repeat on chromosome 4
  • no treatment prevents progression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathogenesis of CJD

A
  • Prion protein (PrPSc), misfiled form of normal protein that can turn other proteins into prions
  • increased PrPSc -> spongiform changes (tiny cavities) in brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs of CJD

A
  • progressive dementia
  • focal CNS signs
  • myoclonus
  • depression
  • eye signs: diplopia, supranuclear palsy, Hallucinations etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 8 signs of delirium ?

A

DELIRIUM: globally impaired cognition, awareness/consciousness

D- disordered thinking
E- euphoric, fearful, depressed or angry: labile mood
L- language impaired: reduced, repetitive, disruptive
I- illusions, delusions, hallucinations (tactile or visual)
R- reversal of sleep-wake cycle
I- inattention: distractable
U- unaware/disorientated
M- memory deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of delirium

A
  • systemic infection (pneumonia, UTI, malaria, wounds
  • intracranial infection: encephalitis, meningitis
  • drugs: opiates, sedatives, anticonvulsants, levodopa
  • alcohol withdrawal
  • metabolic: uraemic, liver failure etc
  • hypoxia
  • head injury
  • epilsepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations in delirium

A
  • FBC, U&Es, LFT, blood glucose,
  • ABG
  • septic screen (urine dipstick, CXR, blood cultures)
  • ECG
  • malaria films
  • LP
  • CT/MRI
  • EEG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is somatisation

A

Multiple, recurrent and frequently changing physical symptoms usually present for several years with negative investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which conditions is somatisation associated with ?

A
  • IBS
  • chronic pain
  • post traumatic stress disorder
  • antisocial personality disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathogenesis of somatisation ?

A

The somatising patient seems to seek the sick role, which affords relief from stressful or impossible interpersonal expectations (‘Primary gain’)

  • in most societies this provides attention, caring and sometimes monetary reward (‘secondary gain’)
  • this is not malingering as patient is unaware of process through which symptoms arise, cannot will them away and genuinely suffers from the symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presenting features of somatisation

A
  • patients feelings and behaviours about symptoms are disproportionate or excessive
  • life long history of ‘sickliness’
  • combo if symptoms with and without organic causes
  • stress worsens symptoms
  • cardiac: palpitations, sob, chest pain
  • GI: abdo pain, bloating, diarrhoea, vomiting
  • MSK: back and joint pain
  • neuro: headaches, dizziness, vision changes, headaches
  • urogenital: low libido, dysmenorrhea, dysuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Typical features pointing to somatisation for diagnosis

A
  • multiple symptoms often in different organ systems
  • vague symptoms exceeding objective findings
  • chronic course
  • psychiatric disorder e.g. depression, anxiety
  • history of extensive diagnostic testing
  • rejection of previous physicians
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What emotional responses of practitioner to patient should point them. To considering somatisation

A
  • frustration and anger at number and complexity of symptoms snd the time required to evaluate them in an apparently well person
  • a sense of being overwhelmed by a patient who has had numerous evaluations by other physicians
23
Q

What questions should you ask someone you suspect has a somatoform disorder ?.

A

BATHE:

B- background - what is going on in their life
A- affect- how do you feel about that
T- trouble- what troubles you most about the situation
H- handle- what helps you handle that
E- empathy- understand it is a tough situation to be in, your reaction makes sense to me

24
Q

Management of somatisation

A
  • stress relief
  • coping methods
  • psychotherapy e.g. CBT
  • antidepressants if anxiety or depression present
25
Q

Investigations in dementia

A
  • FBC, ESR , U&Es, Ca, LFT, TSH, autoantibodies, B12/folate,
  • syphilis serology
  • CT/MRI For vascular damage , structural path etc
26
Q

Diagnostic criteria for major depression

A

At least one core symptom:
- persistent sad or low mood almost every day
- loss of interests or pleasure in most activities
Plus some of the followng:
- fatigue or loss of energy
- worthlessness, excessive or inappropriate guilt
- recurrent thoughts of death, suicidal thoughts, suicide attempts
- diminished ability to concentrate
- psychomotor agitation /retardation
- insomnia/hyper insomnia
- changes in appetite and/or weight loss

*5 required to make diagnosis, present for at least 2 weeks causing significant distress

27
Q

Risk factors for depression

A
  • female sex
  • past history of depression
  • chronic illness
  • other mental health problems e.g. Dementia
28
Q

What percentage of depressed patients present with somatisation ?

A

~2/3

29
Q

Which medications may cause depression ?

A
  • centrally acting antihypertensives e.g. Methyldopa
  • lipid soluble beta blocker (e.g. Propanolol)
  • benzodiazepines or other CNS depressants
  • progesterone contraceptives esp. Injection
30
Q

What conditions are associated with depression ?

A
  • eating disorders
  • substance misuse
  • other psych e.g. Anxiety, panic, OCD
  • Parkinson’s
  • chronic disease e.g. DM, Stroke, cancer, autoimmune
31
Q

First line antidepressant in children and young people ?

A

Fluoxetine (SSRI)

32
Q

First line antidepressant in adults ?

A

SSRI as same effectiveness as tricyclics but less side effects and less toxic in overdose
- citalopram, paroxetine, Sertraline

33
Q

Risk factors for generalised anxiety disorder

A
  • aged 35-54
  • being divorced or separated
  • living alone or a line parent
34
Q

Diagnostic criteria for generalised anxiety disorder ?

A

Excessive anxiety or worry occurring more days than not about wide range of events. Difficult to control worry. Associated with 3+ of:
- restlessness/on edge
- easily fatigued
- difficulty concentrating/mind blank
- irritability
- muscle tension
- sleep Disturbance
PLUS 4 of following, 1 from first group:
- autonomic arousal: palpitations, sweating, shaking
- chest & abdo: difficulty breathing, choking feeling, chest pain discomfort, abdominal distress
- mental state: dizzy, derealisation/depersonalisation, going crazy, fear of dying
- general: hot flushes, numbness, tingling, muscle tension aches and pains
- non-specific: being startled, persistent irritability, difficulty getting to sleep

35
Q

First line drug treatment for generalised anxiety disorder

A

Sertraline

36
Q

Define self harm

A

An act with nonfatal outcome in which an individual did 1+ of:

  • a behaviour intended to cause harm (e.g. Cutting)
  • ingesting a substance in excess e.g. Prescribed drug or illicit drug
  • ingesting a non-ingestible substance or liquid
37
Q

Which conditions are associated with self harm?

A
  • borderline personality disorder
  • depression
  • bipolar
  • schizophrenia
  • drug or alcohol abuse
38
Q

Risk factors for self harm

A
  • socioeconomic disadvantage
  • bullying, physcial/mental abuse
  • mental health conditions
  • eating disorders
  • South Asian women
39
Q

What symptoms of depression are most likely to present first ?

A
  • chronic fatigue

- headache

40
Q

What is dysthymia?

A

Chronic low grade unipolar depressive illness that lasts for 2 years or more and is characterised by tiredness and low mood

41
Q

What abnormal blood results may point to alcoholism ?

A
  • Abnormal LFTs
  • macrocytosis
  • raised MCV and deceased platelets
  • gamma-GT best indicator of excessive alcohol consumption
42
Q

What are the two main aspects of alcohol assessment ?

A
  • is their alcohol a problem

- do they have any illnesses relating to alcohol intake - physical, psychological and social

43
Q

What are the aspects of alcohol use needed to ask about in order to determine dependence ?

A
  • strong desire to drink
  • difficulty controlling alcohol
  • physiological withdrawal when intake reduced
  • tolerance e.g. Increasing amount to get same effect
  • harm from alcohol use e.g. Work, relationships
44
Q

What are the symptoms of alcohol withdrawal?

A
  • hyperactivity, anxiety and coarse peripheral tremor
  • mild Pyrexia, tachycardia, hypertension
  • sweating, nausea and retching
  • seizures
  • auditory and visual hallucinations
  • delirium tremens= severe form of above symptoms + circulatory collapse and ketoacidosis
45
Q

What signs of disease due to alcoholism should be looked for ?

A
  • malnourishment
  • signs of acute withdrawal e.g. Coarse tremor, tachycardia
  • liver disease: palmar erythema, gynaecomastia, spider naevi, jaundice
  • hepatomegaly ( in chronic alcoholic liver disease= shrunken)
  • Ascites
  • AF
  • Wernicke’s-korsakoff syndrome
46
Q

What is Wernicke’s-Kirsakoff syndrome ?

A

Encephalopathy resulting from thiamine deficiency, usually due to alcoholism

47
Q

Pathogenesis of Wernicke’s-Korsakoffs syndrome ?

A

Chronic alcohol consumption can result in thiamine deficiency by causing:
- inadequate nutritional thiamine intake
- decreased absorption of thiamine from GI tract
- impaired imagine utilisation in cells
Thiamine is required as cofactors in enzymatic processes and lack results in:
- neuronal loss
- interference with cellular function

48
Q

Symptoms of Wernicke’s-Korsakoffs?

A
  • vision changes: diplopia, eye palsy, ptosis
  • loss of muscle coordination
  • profound loss of memory
  • inability to form new memory’s
  • hallucinations
49
Q

Signs of Wernicke’s-Korsakoffs syndrome ?

A

Usually mentally alert with vocab, comprehension, motor skills, social habits and naming ability maintained:

  • polyneuropathy on nervous system exam
  • abnormal reflexes
  • gait and coordination abnormalities
  • nystagmus, bilat lat rectus palsy
  • low BP and body temp
  • high pulse
50
Q

Cognitive features of Wernicke’s-Korsakoffs

A
  • confabulation: falsification on memory in clear consciousness, can answer questions promptly with inaccurate and bizarre answers
  • memory loss: anterograde amnesia, disorientated in time and place
51
Q

When should patients in alcohol withdrawal be sent for inpatient detox ?

A
  • Disorientation, agitation or seizures occur
  • suicide risk
  • those without social support
  • history of severe withdrawal symptoms
52
Q

Drugs used to treat acute alcohol withdrawal

A
  • benzodiazepines: long term (e.g. Diazepam) to reduce tremor and agitation, short acting (e.g. Lorazepam)for seizures
  • vit B complex: IV pabrinex For few days then oral thiamine and multivitamins (pabrinex used to treat W-K)
  • beta blockers- reduce autonomic hyperactivity (not used often)
53
Q

Treatment for maintenance of abstinence from alcohol

A
  • Calcium acetyl-homotaurinate (acamprosate): blocks GABA and reduces NMDA receptor glutamate-related excitation, neuro protective, reduces cravings, doesn’t interact with alcohol
  • Naltrexone: reduces pleasure effects of alcohol by competitively binding to opioid receptor (preventing endogenous opioid from binding)

*all treatment in conjunction with psychosocial interventions

Core Conditions (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions