MENTAL HEALTH Flashcards
1
Q
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
a) 4%
2
Q
what percentage of the population suffer from phobias?
a) 1%
b) 8%
c) 20%
d) 40%
A
b) 80%
3
Q
anxiety disorders are generally more common in what gender?
A
female
4
Q
sympathetic nervous system over activation in anxiety disorders lead to what 2 things?
A
hyperventilation
increased muscle tension
5
Q
give 2 risk factors for anxiety
A
first degree relative
bullying
6
Q
what are the 2 classifications for anxiety?
A
persistant (generalised) or episodic
7
Q
give 2 endocrine differential diagnoses for anxiety
A
hyperthyroidism
hypoglycaemia
phaeochromocytoma
8
Q
what is the most common form of anxiety?
A
anxiety and depression
9
Q
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
A
b) repetitive sudden attacks
10
Q
panic disorder is often associated with severe ____ symptoms
A
physical
11
Q
stimuli in panic disorders is often followed by
A
avoidance
12
Q
give 2 triggers for acute stress disorders
A
trauma
bereavement
13
Q
acute stress reaction is ___-lived, with numbness followed by ____ or _____
A
short
withdrawal
anxiety
14
Q
adjustment disorder follows which other anxiety disorder?
A
acute stress
15
Q
adjustment disorder is a reaction to a life event how long after it occurs? What are the symptoms?
A
6 months–> anxiety and low mood
16
Q
what are the 5 stages of normal grief post bereavement?
A
shock disbelief emotional stage acceptance resolution
17
Q
flashbacks, insomnia, emotional blunting, avoidance, detachment and hyper vigilance are all features of what condition?
A
post-traumatic stress disorder
18
Q
cognitive analytical therapy is a combination of what two therapies?
A
CBT (behaviour therapy) psychodynamic therapy ( symptomatic relief and personality change)
19
Q
give 2 examples of anxiogenic substances
A
caffeine
alcohol
20
Q
where in the CNS do benzodiazepines work?
A
GABA receptors
21
Q
what effect do BZDP’s have?
A
sedative and have withdrawal symptoms
22
Q
give 2 examples of anti-psychotics
A
aripiprazole
olanzapine
23
Q
when are anti-psychotics given in anxiety?
A
severe, refractive cases
24
Q
what are beta blockers given for in anxiety?
A
peripheral symptoms only e.g. tremor, palpitation
25
__% 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
26
1 in __ male admissions to AMU are alcohol related?
5
27
what kind of drinker is described by this?:
| causes or experiences physical, psychological and social harm when drinking
problem
28
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
29
what type of drinker is described by this?:
| physical addiction with repeated self administration, characterised by tolerate, withdrawal and compulsive taking
dependant
30
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
31
why is naltrexone prescribed for alcohol dependance?
opiod antagonists prevents endogenous opoid release to act on receptor
Reduces relapse risk and pleasurably effect
32
what would you give a patient with wernicke korsakoff syndrome?
thiamine
33
patients with alcohol dependance are __ times more likely to die
a) 0
b) 2-3
c) 7-8
d) 10
b) 2-3
34
what type of seizure can occur upon withdrawal from alcohol?
grand mal convulsions
35
what 3 factors make up delirium tremens in an alcoholic?
| Rapid onset of confusion from alcohol withdrawel
dehydration
liver disease
Wernicke-Korsakoff syndrome
36
how many alcoholics go on to have chronic dependancy?
a) 10%
b) 25%
c) 50%
d) 75%
b) 25%
37
__% 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
38
give a systemic cause of delirium
systemic infection and fever
39
give 2 metabolic causes of delirium
liver failure
kidney failure
hypoxia
Dehydration
40
what two conditions that are caused by thiamine deficiency which can lead to delirium?
Wernicke-Korsakoff
| beriberi
41
what can cause nicotinic acid deficiency that can lead to delirium?
pellagra
42
what other vitamin deficiency can cause delirium?
vitamin B12
43
give 2 endocrine causes of delirium
hypothyroidism
| cushing's
44
give 3 intracranial causes of delirium
```
tumour
trauma
abscess
haemorrhage
epilepsy
```
45
give 3 examples of drugs that can cause delirium
```
hypnotics
TCAs
digoxin
drugs/alcohol withdrawal
antimuscarinics
```
46
give 3 environmental factors that can cause delirium
```
change of environment
extremes of sensory stimuli
sleep deprivation
immobilisation
visual/auditory impairment
```
47
at what time of the day is confusion most common in delirium?
night
48
'toxic confusional state' and 'acute organic psychosis' are used to describe which mental health condition?
delirium
49
what alcohol related condition is a differential diagnosis for delirium?
delirium tremens
50
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
51
give an example of a drug which may be given to calm a patient with delirium
haloperidol
| olanzapine
52
what is the most common form of dementia?
alzheimer's
53
what is the pathophysiology of Alzheimer's?
beta amyloid deposition in plaques in cerebral cortex
| damages synapses
54
give 6 examples of degenerative dementias
```
alzheimer's
lewy body
frontotemporal
huntington's
parkinson's
CJD (prion)
```
55
give an example of vascular dementia
vascular dementia
56
give 2 examples of metabolic causes of dementias
uraemia
| liver failure
57
give 2 examples of toxic causes of dementia
alcohol
solvent abuse
heavy metals
58
give 2 examples of vitamin deficiency causes of dementia
B12
| thiamine
59
give 2 examples of intracranial causes of dementia
tumour
subdural haematoma
hydrocephalus
60
give 3 examples of infective causes of dementia
HIV
syphillis
TB
Whipple's
61
give 2 examples of endocrine causes of dementia
hypothyroid
| hyperparathyroid
62
what is the distinguishing feature between dementia and delirium?
clear consciousness
63
which mental health condition is defined as "acquired loss of higher mental function in at least 2 cognitive domains"?
dementia
64
what is the addenbroke's cognitive examination used to test for?
dementia
65
clock drawing test for dementia test which lobe?
parietal
66
naming/reading tasks for dementia test which function?
language
67
verbal fluency and stop-go tasks for dementia test which lobe?
frontal
68
give 3 examples of types of dementia for which cholinesterase's may be useful
alzheimer's
dementia with lewy bodies
parkinson's
69
what is the prevalence of generalised depression in the UK?
a) 1%
b) 5%
c) 15%
d) 20%
b) 5%
70
mutations in serotonin transporter genes could indicate a ____ cause of depression
genetic
71
which part of the brain is smaller in patients with recurrent depression?
hippocampus
72
anhedonia is what?
suicidal thoughts
73
how long must symptoms last to be classed as depression?
at least 2 weeks
| Significant loss of capacity to do activity of daily living
74
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
75
what depressive disorder follows a patterns of relapse and remittance?
dysthymia
76
what is SAD characterised by and what are the symptoms?
Recurrent depression in winter months
| Causing increase appetite, weight gain, fatigue and hypersomnia
77
give 2 treatments for SAD
bright light therapy
| SSRIs
78
what is the most common type of puerperal affective disorder?
maternity blues= Tearful, emotional and irritable
79
When does maternal blues occur and how is it resolved?
50% of women 2-3 days postpartum and resolves spontaneously
80
what puerperal affective disorder occurs in 1 in 500-1000 births?
post partum psychosis
81
what percentage of mothers experience non-psychotic postnatal depression during the first year?
a) 1%
b) 10%
c) 40%
d) 60%
b) 10%
82
what scale is used to diagnose post natal depression?
Edinburgh postnatal depression scale
83
which mental disorder increases the risk of suicide when coupled with depression?
bipolar
84
what percentage of primary care depression patients commit suicide?
a) 1%
b) 5%
c) 15%
d) 20%
b) 5%
85
what percentage of hospitalised depression patients commit suicide?
a) 1%
b) 5%
c) 15%
d) 20%
c) 15%
86
what gender is more likely to commit self harm and at what age?
male and peaks at 60/70 yrs old
87
90% of self harm cases are what
poisoning with 1/3rd being paracetamol overdose
88
what is self-harm defined as?
un-successful suicide attempt
89
what is the main cause of somatisation?
chronic fatigue
fibromyalgia
IBS
90
give 2 infectious conditions that can trigger somatisation
infectious mononucleosis
| viral hepatitis
91
what are the three types of factors which can cause somatisation?
predisposing
precipitating
perpetuating
92
what is the estimated pathophysiology to somatisation?
inappropriate sensory response to stimuli
93
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
94
what is a characteristic of chronic somatisation disorders
multiple, recurrent, unexplained symptoms
| Starts early in adult life
95
what is the recommended treatment for chronic fatigue?
programme of increased activity
96
what is the recommended treatment for fibromyalgia?
analgesia
TCA
anti-convulsants (pregabalin, gabapentin)
97
what percentage of somatisation patients recover with CBT and rehab therapy
a) 10%
b) 20%
c) 40%
d) 60%
d) 60%
98
What are psychatric DD of anxiety?
OCD, Depression, substance misuse and withdrawel, presensile dementia
99
Is general anxiety acute or chronic?
Chronic
100
What causes phobic disorder and what are the actions of the patient?
Caused by a stimuli and often avoidance of the stimuli
101
What is the treatment for abnormal grief? (excessive, prolonged and denail)
Guided mourning
102
What is ODC and what is it linked to?
Pattern obsession, with belief of disaster if failed
| Linked to depression and torture
103
How quick do SSRi's act?
Delayed response take weeks, acts on the CNS
104
Give example of SSRi's that can be used in
Citulopram, Escitalopram, setraline, flouxetine and paroxetine
105
What is a complication of anxiety?
Hyperventilation panic disorders
106
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
```
107
How do you manage panic disorder?
Breath into paper bag and breathing techniques
108
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
```
109
What are the physiological signs and symptoms of anxiety?
```
irritability
Lack of concentration
Depersonalization
Apprehension
fear
```
110
What the social symptoms of alcohol dependence
```
Crime
Domestic violence
Child abuse
Difficulty with job
Financial problems
```
111
What are the drinking problems with drinking dependancy
```
Increase tolerance
Drinking in morning
Trembling without a drink
Memory loss
Missing meals
```
112
What are the psychological symptoms of drinking?
```
Depression
Anxiety
Memory problems
Delirium
Suicide attempts
Pathological jealousy
```
113
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
```
114
What is the physiological intervention for alcohol dependent drinkers?How succesful
early intervention and CBT
| 30-50% small drinkers/absent 2 years afterwards
115
What drug reduces the craving effects of alcohol by blocking GABA and NMDA receptors?
Acamprsotae
116
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
117
What is the triad of symptoms caused by Wernicke–Korsakoff Syndrome?
Ataxia, nystagmus and confusion
118
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
119
What drug is given for acute alcohol withdrawal?
Benzodiazepine
120
What type of seizure can occur as a complication of alcohol withdrawal ?
Grand mal convulsion--> general tonic clonic seizures
121
Common complications of alcohol withdrawal?
```
Tachycardia
Palpitations
Sweating
Headaches
Hallucinations
Nausea
2-3* more likely to die from the seizures
```
122
What 3 vitamin deficiencies cause delirium?
Vitamin B1 and 12
| Nicotinic acid
123
What drug intoxication cause delirium?
```
Anticonvulsants
Antimuwcarinics
Hypnotics
TCA's
Digoxin
Drug/alcohol withdrawel
Dopamine antagonist
```
124
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
```
125
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
```
126
What are the DD for delirium?
lewy body dementia, delirium tremens
127
Does having dementia increase chance of delirium?
yes
128
What are the 3D's for confusion in elderly?
Depression
Dementia
Delirium
129
Is delirium reversible?
Yes
130
What two drugs do you give in delirium?
Olanzapine and haloperidol
131
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
```
132
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
133
If a first degree relative has dementia, how much does your chance of developing the disease increase by?
Doubles
134
How do you differentiate between dementia and delirium?
In dementia you have clear consciousness and its chronic disease
135
MMSE is used for diagnosing dementia what is the limitations of this test?
Not sensitive to Mild cognitive impairment or frontal lobe dysfunction
136
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
137
What are two physical causes of depression?
Reduced sleep and childhood trauma
138
Chronic depletion in what compound can cause depression?
Monoamines
139
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
```
140
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
141
What are common risk factors for depression?
```
Unemployment
Divorce/ separation
Bereavement
Lack of social support
Excessive and chronic use of alcohol and drug
```
142
What are psychiatric DD of depression?
```
Dementia
Delirium
Grief
Alcohol and amphetamine misuse
Personality disorder
Schizophenia
```
143
What are organic DD of depression?
Cushings, hyperparathyroidism, hypothyroidism, long term corticosterioid use and tumour
144
What are the symptoms of post partum psychosis
80% depression
Think child is deformed/devil
Might try to commit suicide or kill child
145
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
146
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
147
Which gender is self harm more common in under 35's?
Females
148
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
```
149
What are the signs and symptoms of chronic fatigue?
Muscle pain
Altered sleep
Impaired memory
Poor concentration
150
What are the signs and symptoms of fibromyalgia?
Fatigue
Sleep disturbance
Muscle and joint pain
Abnormal sensory processing
151
What are the predisposing factors to somatisation?
Fhx
Perfectionist
Introverted
Childhood trauma
152
What are the precipitating factors for somatisation?
Trauma
Physical problem
Infection
Blaming other people for incidents
153
What factors act as perpetuating somatisation?
```
Avoidance behaviour
Excessive restrictive diet
Stimulant drugs
Sleep disturbance
Mood disorder
Unresolved acceptance
Inactivity
```
154
What gender is somatisation commonly seen in?
Females
155
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
156
What genetic condition is linked to alzheimers?
Down syndrome
| Link between trisomy 21 and increase production of amyloid precursor protein
157
What causes thiamine deficiency:?
Excessive alcoholic drinking
Crohn disease
Anorexia,
