MENTAL HEALTH Flashcards
The proportion of the population that have general anxiety and panic disorder is the same. This is
a) 4%
b) 20%
c) 40%
d) 80%
a) 4%
what percentage of the population suffer from phobias?
a) 1%
b) 8%
c) 20%
d) 40%
b) 80%
anxiety disorders are generally more common in what gender?
female
sympathetic nervous system over activation in anxiety disorders lead to what 2 things?
hyperventilation
increased muscle tension
give 2 risk factors for anxiety
first degree relative
bullying
what are the 2 classifications for anxiety?
persistant (generalised) or episodic
give 2 endocrine differential diagnoses for anxiety
hyperthyroidism
hypoglycaemia
phaeochromocytoma
what is the most common form of anxiety?
anxiety and depression
what are the type of attacks common on panic disorder?
a) repetitive, long attacks
b) repetitive sudden attacks
c) one-off long attack
d) one off sudden attack
b) repetitive sudden attacks
panic disorder is often associated with severe ____ symptoms
physical
stimuli in panic disorders is often followed by
avoidance
give 2 triggers for acute stress disorders
trauma
bereavement
acute stress reaction is ___-lived, with numbness followed by ____ or _____
short
withdrawal
anxiety
adjustment disorder follows which other anxiety disorder?
acute stress
adjustment disorder is a reaction to a life event how long after it occurs? What are the symptoms?
6 months–> anxiety and low mood
what are the 5 stages of normal grief post bereavement?
shock disbelief emotional stage acceptance resolution
flashbacks, insomnia, emotional blunting, avoidance, detachment and hyper vigilance are all features of what condition?
post-traumatic stress disorder
cognitive analytical therapy is a combination of what two therapies?
CBT (behaviour therapy) psychodynamic therapy ( symptomatic relief and personality change)
give 2 examples of anxiogenic substances
caffeine
alcohol
where in the CNS do benzodiazepines work?
GABA receptors
what effect do BZDP’s have?
sedative and have withdrawal symptoms
give 2 examples of anti-psychotics
aripiprazole
olanzapine
when are anti-psychotics given in anxiety?
severe, refractive cases
what are beta blockers given for in anxiety?
peripheral symptoms only e.g. tremor, palpitation
__% of men and __% of women report withdrawal symptoms following drinking alcohol
a) 4, 2
b) 2, 4
c) 10, 15
d) 15, 10
a) 4, 2
1 in __ male admissions to AMU are alcohol related?
5
what kind of drinker is described by this?:
causes or experiences physical, psychological and social harm when drinking
problem
what kind of drinker is described by this?:
drinks excessive quantity or frequent drinker to an unsafe level. excessive short bouts followed by long periods of abstinence
binge drinker
what type of drinker is described by this?:
physical addiction with repeated self administration, characterised by tolerate, withdrawal and compulsive taking
dependant
alcoholism is defined as drinking over how many units a day for men and women respectively?
a) 3, 2
b) 5, 4
c) 7, 6
d) 9, 8
a) 3, 2
why is naltrexone prescribed for alcohol dependance?
opiod antagonists prevents endogenous opoid release to act on receptor
Reduces relapse risk and pleasurably effect
what would you give a patient with wernicke korsakoff syndrome?
thiamine
patients with alcohol dependance are __ times more likely to die
a) 0
b) 2-3
c) 7-8
d) 10
b) 2-3
what type of seizure can occur upon withdrawal from alcohol?
grand mal convulsions
what 3 factors make up delirium tremens in an alcoholic?
Rapid onset of confusion from alcohol withdrawel
dehydration
liver disease
Wernicke-Korsakoff syndrome
how many alcoholics go on to have chronic dependancy?
a) 10%
b) 25%
c) 50%
d) 75%
b) 25%
__% of general hospital patients and __% of intensive care patients have delirium
a) 10, 50
b) 20, 80
b) 40, 40
c) 5, 15
b) 20, 80
give a systemic cause of delirium
systemic infection and fever
give 2 metabolic causes of delirium
liver failure
kidney failure
hypoxia
Dehydration
what two conditions that are caused by thiamine deficiency which can lead to delirium?
Wernicke-Korsakoff
beriberi
what can cause nicotinic acid deficiency that can lead to delirium?
pellagra
what other vitamin deficiency can cause delirium?
vitamin B12
give 2 endocrine causes of delirium
hypothyroidism
cushing’s
give 3 intracranial causes of delirium
tumour trauma abscess haemorrhage epilepsy
give 3 examples of drugs that can cause delirium
hypnotics TCAs digoxin drugs/alcohol withdrawal antimuscarinics
give 3 environmental factors that can cause delirium
change of environment extremes of sensory stimuli sleep deprivation immobilisation visual/auditory impairment
at what time of the day is confusion most common in delirium?
night
‘toxic confusional state’ and ‘acute organic psychosis’ are used to describe which mental health condition?
delirium
what alcohol related condition is a differential diagnosis for delirium?
delirium tremens
fill in the blanks:
delirium is described as a sudden ___ in cognition, that develops over a ___ period of time and ____ over the course of the day
change
short
fluctuates
give an example of a drug which may be given to calm a patient with delirium
haloperidol
olanzapine
what is the most common form of dementia?
alzheimer’s
what is the pathophysiology of Alzheimer’s?
beta amyloid deposition in plaques in cerebral cortex
damages synapses
give 6 examples of degenerative dementias
alzheimer's lewy body frontotemporal huntington's parkinson's CJD (prion)
give an example of vascular dementia
vascular dementia
give 2 examples of metabolic causes of dementias
uraemia
liver failure
give 2 examples of toxic causes of dementia
alcohol
solvent abuse
heavy metals
give 2 examples of vitamin deficiency causes of dementia
B12
thiamine
give 2 examples of intracranial causes of dementia
tumour
subdural haematoma
hydrocephalus
give 3 examples of infective causes of dementia
HIV
syphillis
TB
Whipple’s
give 2 examples of endocrine causes of dementia
hypothyroid
hyperparathyroid
what is the distinguishing feature between dementia and delirium?
clear consciousness
which mental health condition is defined as “acquired loss of higher mental function in at least 2 cognitive domains”?
dementia
what is the addenbroke’s cognitive examination used to test for?
dementia
clock drawing test for dementia test which lobe?
parietal
naming/reading tasks for dementia test which function?
language
verbal fluency and stop-go tasks for dementia test which lobe?
frontal
give 3 examples of types of dementia for which cholinesterase’s may be useful
alzheimer’s
dementia with lewy bodies
parkinson’s
what is the prevalence of generalised depression in the UK?
a) 1%
b) 5%
c) 15%
d) 20%
b) 5%
mutations in serotonin transporter genes could indicate a ____ cause of depression
genetic
which part of the brain is smaller in patients with recurrent depression?
hippocampus
anhedonia is what?
suicidal thoughts
how long must symptoms last to be classed as depression?
at least 2 weeks
Significant loss of capacity to do activity of daily living
describe the duration of dysthymia and the symptoms?
Intermittent for 2 or more years
Lack of pleasure, low mood, low self-esteem, discouragement and tiredness
what depressive disorder follows a patterns of relapse and remittance?
dysthymia
what is SAD characterised by and what are the symptoms?
Recurrent depression in winter months
Causing increase appetite, weight gain, fatigue and hypersomnia
give 2 treatments for SAD
bright light therapy
SSRIs
what is the most common type of puerperal affective disorder?
maternity blues= Tearful, emotional and irritable
When does maternal blues occur and how is it resolved?
50% of women 2-3 days postpartum and resolves spontaneously
what puerperal affective disorder occurs in 1 in 500-1000 births?
post partum psychosis
what percentage of mothers experience non-psychotic postnatal depression during the first year?
a) 1%
b) 10%
c) 40%
d) 60%
b) 10%
what scale is used to diagnose post natal depression?
Edinburgh postnatal depression scale
which mental disorder increases the risk of suicide when coupled with depression?
bipolar
what percentage of primary care depression patients commit suicide?
a) 1%
b) 5%
c) 15%
d) 20%
b) 5%
what percentage of hospitalised depression patients commit suicide?
a) 1%
b) 5%
c) 15%
d) 20%
c) 15%
what gender is more likely to commit self harm and at what age?
male and peaks at 60/70 yrs old
90% of self harm cases are what
poisoning with 1/3rd being paracetamol overdose
what is self-harm defined as?
un-successful suicide attempt
what is the main cause of somatisation?
chronic fatigue
fibromyalgia
IBS
give 2 infectious conditions that can trigger somatisation
infectious mononucleosis
viral hepatitis
what are the three types of factors which can cause somatisation?
predisposing
precipitating
perpetuating
what is the estimated pathophysiology to somatisation?
inappropriate sensory response to stimuli
name a chronic somatisation disorder and its symptoms?
hypochondriasis= believe you are suffering from a serious illness and need constant medical treatment for proof/reassurance
what is a characteristic of chronic somatisation disorders
multiple, recurrent, unexplained symptoms
Starts early in adult life
what is the recommended treatment for chronic fatigue?
programme of increased activity
what is the recommended treatment for fibromyalgia?
analgesia
TCA
anti-convulsants (pregabalin, gabapentin)
what percentage of somatisation patients recover with CBT and rehab therapy
a) 10%
b) 20%
c) 40%
d) 60%
d) 60%
What are psychatric DD of anxiety?
OCD, Depression, substance misuse and withdrawel, presensile dementia
Is general anxiety acute or chronic?
Chronic
What causes phobic disorder and what are the actions of the patient?
Caused by a stimuli and often avoidance of the stimuli
What is the treatment for abnormal grief? (excessive, prolonged and denail)
Guided mourning
What is ODC and what is it linked to?
Pattern obsession, with belief of disaster if failed
Linked to depression and torture
How quick do SSRi’s act?
Delayed response take weeks, acts on the CNS
Give example of SSRi’s that can be used in
Citulopram, Escitalopram, setraline, flouxetine and paroxetine
What is a complication of anxiety?
Hyperventilation panic disorders
What are the signs and symptoms of panic disorders?
Dysponea Palpitations Chest pain Chest pain Sweating Dizziness Increase breathing, decrease Co2 which cause increase in PH and hypocalcaemia
How do you manage panic disorder?
Breath into paper bag and breathing techniques
What are the physical signs and symptoms of anxiety?
Palpitations Chest pain Sweats Dry mouth Difficulty swallowing Diarrhoea hyperventilation Sleep distrubance Tremor Restlessness fatigue Lack of libido
What are the physiological signs and symptoms of anxiety?
irritability Lack of concentration Depersonalization Apprehension fear
What the social symptoms of alcohol dependence
Crime Domestic violence Child abuse Difficulty with job Financial problems
What are the drinking problems with drinking dependancy
Increase tolerance Drinking in morning Trembling without a drink Memory loss Missing meals
What are the psychological symptoms of drinking?
Depression Anxiety Memory problems Delirium Suicide attempts Pathological jealousy
What are the risk factors for alcohol dependency?
Coming from a non alcoholic family 1 in 10 From alcoholic family 1 in 4 Genetic Social surroundings Psychiatric illness Alcohol dehydrogenase abnormalities
What is the physiological intervention for alcohol dependent drinkers?How succesful
early intervention and CBT
30-50% small drinkers/absent 2 years afterwards
What drug reduces the craving effects of alcohol by blocking GABA and NMDA receptors?
Acamprsotae
How does alcoholism cause thiamine (B1) deficiency?
Malnourishment causing inadequate thiamine intake
Reduce absorption of thiamine from the GI tract
Poor utilisation of thiamine by cells
What is the triad of symptoms caused by Wernicke–Korsakoff Syndrome?
Ataxia, nystagmus and confusion
How does Wernicke–Korsakoff Syndrome develop? Thiamine deficiency
First have Wernicke encephalopathy which is bleeding and damage to the hypothalamus and thalamus
If left untreated then get
Korsakoff psychosis causes permanent damage to part of brain controlling memory
What drug is given for acute alcohol withdrawal?
Benzodiazepine
What type of seizure can occur as a complication of alcohol withdrawal ?
Grand mal convulsion–> general tonic clonic seizures
Common complications of alcohol withdrawal?
Tachycardia Palpitations Sweating Headaches Hallucinations Nausea 2-3* more likely to die from the seizures
What 3 vitamin deficiencies cause delirium?
Vitamin B1 and 12
Nicotinic acid
What drug intoxication cause delirium?
Anticonvulsants Antimuwcarinics Hypnotics TCA's Digoxin Drug/alcohol withdrawel Dopamine antagonist
What is the PINCH ME stand for in terms of causes of delirium?
Pain Infection--> v common Nutrition Constipation --> common Hydration --> common Medication Electrolysis and environment
What are the 4 key aspects of diagnosing delirium?
Acute onsent Change in consciousness levels Altered attention Fluctuates over 24 hours Not eating or drinking properly
What are the DD for delirium?
lewy body dementia, delirium tremens
Does having dementia increase chance of delirium?
yes
What are the 3D’s for confusion in elderly?
Depression
Dementia
Delirium
Is delirium reversible?
Yes
What two drugs do you give in delirium?
Olanzapine and haloperidol
Name the cognitive domains that can be affected in dementia? At least 2 must be affected
Episodic memory Visuospatial function Language function Frontal executive function Apraxia, agnosia
What is the pathology of alzheimer’s?
The deposition of B amyloid in amyloid plaque in the cortex and the formation of tau
Damaging the synapse and causing neuronal death
If a first degree relative has dementia, how much does your chance of developing the disease increase by?
Doubles
How do you differentiate between dementia and delirium?
In dementia you have clear consciousness and its chronic disease
MMSE is used for diagnosing dementia what is the limitations of this test?
Not sensitive to Mild cognitive impairment or frontal lobe dysfunction
What are the purposes of doing a blood test and brain imaging in a patient with potential dementia?
Blood test –> to exclude treatable causes
Brain imaging–> to identify the location of the dementia and any signs of cerebral lesions
What are two physical causes of depression?
Reduced sleep and childhood trauma
Chronic depletion in what compound can cause depression?
Monoamines
What are common signs and symptoms of a depressive patient?
World looks grey Irritable Weight loss Self harm Insomnia Fatigue Headache Misserable Quiet Libido loss and erectile dsyfunction
What is pseudodementia and what group of patients commonly have it?
It’s usually the elderly
Patient has dementia and cognitive impairment similar to dementia
What are common risk factors for depression?
Unemployment Divorce/ separation Bereavement Lack of social support Excessive and chronic use of alcohol and drug
What are psychiatric DD of depression?
Dementia Delirium Grief Alcohol and amphetamine misuse Personality disorder Schizophenia
What are organic DD of depression?
Cushings, hyperparathyroidism, hypothyroidism, long term corticosterioid use and tumour
What are the symptoms of post partum psychosis
80% depression
Think child is deformed/devil
Might try to commit suicide or kill child
What are the risk factors of non physchosis postnatal depression and what is the potential outcome?
RF are 1st pregnancy, poor relationship with father and ambivalence about pregnancy
Outcome is lack of bonding with baby
What are common drug and non drug treatment for depression?
Drug: SSRI’s and TCA’s
Non drug: CBT, counselling, regular excercise and stop depressive drugs
Which gender is self harm more common in under 35’s?
Females
What is included in the assessment of a patient who self harmed?
Cause? Impulsive or planned? Intent to repeat? Psychiatric problems Left a note? Secretive
What are the signs and symptoms of chronic fatigue?
Muscle pain
Altered sleep
Impaired memory
Poor concentration
What are the signs and symptoms of fibromyalgia?
Fatigue
Sleep disturbance
Muscle and joint pain
Abnormal sensory processing
What are the predisposing factors to somatisation?
Fhx
Perfectionist
Introverted
Childhood trauma
What are the precipitating factors for somatisation?
Trauma
Physical problem
Infection
Blaming other people for incidents
What factors act as perpetuating somatisation?
Avoidance behaviour Excessive restrictive diet Stimulant drugs Sleep disturbance Mood disorder Unresolved acceptance Inactivity
What gender is somatisation commonly seen in?
Females
What is the general pathophysioligy of somatisation?
No obvious patholigcal/anatomical changes
Inappropriate sensory response to stimuli.
Over time the brain adapts to the inappropriate response and central changes occur
What genetic condition is linked to alzheimers?
Down syndrome
Link between trisomy 21 and increase production of amyloid precursor protein
What causes thiamine deficiency:?
Excessive alcoholic drinking
Crohn disease
Anorexia,
