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Y3 CORE CONDITIONS > MENTAL HEALTH > Flashcards

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%

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2
Q

what percentage of the population suffer from phobias?

a) 1%
b) 8%
c) 20%
d) 40%

A

b) 80%

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3
Q

anxiety disorders are generally more common in what gender?

A

female

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4
Q

sympathetic nervous system over activation in anxiety disorders lead to what 2 things?

A

hyperventilation

increased muscle tension

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5
Q

give 2 risk factors for anxiety

A

first degree relative

bullying

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6
Q

what are the 2 classifications for anxiety?

A

persistant (generalised) or episodic

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7
Q

give 2 endocrine differential diagnoses for anxiety

A

hyperthyroidism
hypoglycaemia
phaeochromocytoma

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8
Q

what is the most common form of anxiety?

A

anxiety and depression

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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

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10
Q

panic disorder is often associated with severe ____ symptoms

A

physical

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11
Q

stimuli in panic disorders is often followed by

A

avoidance

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12
Q

give 2 triggers for acute stress disorders

A

trauma

bereavement

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13
Q

acute stress reaction is ___-lived, with numbness followed by ____ or _____

A

short
withdrawal
anxiety

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14
Q

adjustment disorder follows which other anxiety disorder?

A

acute stress

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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

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16
Q

what are the 5 stages of normal grief post bereavement?

A 
shock
disbelief
emotional stage
acceptance
resolution
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17
Q

flashbacks, insomnia, emotional blunting, avoidance, detachment and hyper vigilance are all features of what condition?

A

post-traumatic stress disorder

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18
Q

cognitive analytical therapy is a combination of what two therapies?

A 
CBT (behaviour therapy)
psychodynamic therapy ( symptomatic relief and personality change)
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19
Q

give 2 examples of anxiogenic substances

A

caffeine

alcohol

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20
Q

where in the CNS do benzodiazepines work?

A

GABA receptors

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21
Q

what effect do BZDP’s have?

A

sedative and have withdrawal symptoms

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22
Q

give 2 examples of anti-psychotics

A

aripiprazole

olanzapine

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23
Q

when are anti-psychotics given in anxiety?

A

severe, refractive cases

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24
Q

what are beta blockers given for in anxiety?

A

peripheral symptoms only e.g. tremor, palpitation

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25
Q

__% of men and __% of women report withdrawal symptoms following drinking alcohol

a) 4, 2
b) 2, 4
c) 10, 15
d) 15, 10

A

a) 4, 2

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26
Q

1 in __ male admissions to AMU are alcohol related?

A

5

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27
Q

what kind of drinker is described by this?:

causes or experiences physical, psychological and social harm when drinking

A

problem

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28
Q

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

A

binge drinker

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29
Q

what type of drinker is described by this?:

physical addiction with repeated self administration, characterised by tolerate, withdrawal and compulsive taking

A

dependant

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30
Q

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

a) 3, 2

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31
Q

why is naltrexone prescribed for alcohol dependance?

A

opiod antagonists prevents endogenous opoid release to act on receptor
Reduces relapse risk and pleasurably effect

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32
Q

what would you give a patient with wernicke korsakoff syndrome?

A

thiamine

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33
Q

patients with alcohol dependance are __ times more likely to die

a) 0
b) 2-3
c) 7-8
d) 10

A

b) 2-3

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34
Q

what type of seizure can occur upon withdrawal from alcohol?

A

grand mal convulsions

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35
Q

what 3 factors make up delirium tremens in an alcoholic?

Rapid onset of confusion from alcohol withdrawel

A

dehydration
liver disease
Wernicke-Korsakoff syndrome

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36
Q

how many alcoholics go on to have chronic dependancy?

a) 10%
b) 25%
c) 50%
d) 75%

A

b) 25%

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37
Q

__% of general hospital patients and __% of intensive care patients have delirium

a) 10, 50
b) 20, 80
b) 40, 40
c) 5, 15

A

b) 20, 80

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38
Q

give a systemic cause of delirium

A

systemic infection and fever

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39
Q

give 2 metabolic causes of delirium

A

liver failure
kidney failure
hypoxia
Dehydration

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40
Q

what two conditions that are caused by thiamine deficiency which can lead to delirium?

A

Wernicke-Korsakoff

beriberi

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41
Q

what can cause nicotinic acid deficiency that can lead to delirium?

A

pellagra

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42
Q

what other vitamin deficiency can cause delirium?

A

vitamin B12

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43
Q

give 2 endocrine causes of delirium

A

hypothyroidism

cushing’s

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44
Q

give 3 intracranial causes of delirium

A 
tumour
trauma
abscess
haemorrhage
epilepsy
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45
Q

give 3 examples of drugs that can cause delirium

A 
hypnotics
TCAs
digoxin
drugs/alcohol withdrawal
antimuscarinics
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46
Q

give 3 environmental factors that can cause delirium

A 
change of environment
extremes of sensory stimuli
sleep deprivation
immobilisation
visual/auditory impairment
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47
Q

at what time of the day is confusion most common in delirium?

A

night

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48
Q

‘toxic confusional state’ and ‘acute organic psychosis’ are used to describe which mental health condition?

A

delirium

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49
Q

what alcohol related condition is a differential diagnosis for delirium?

A

delirium tremens

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50
Q

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

A

change
short
fluctuates

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51
Q

give an example of a drug which may be given to calm a patient with delirium

A

haloperidol

olanzapine

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52
Q

what is the most common form of dementia?

A

alzheimer’s

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53
Q

what is the pathophysiology of Alzheimer’s?

A

beta amyloid deposition in plaques in cerebral cortex

damages synapses

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54
Q

give 6 examples of degenerative dementias

A 
alzheimer's
lewy body 
frontotemporal
huntington's
parkinson's
CJD (prion)
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55
Q

give an example of vascular dementia

A

vascular dementia

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56
Q

give 2 examples of metabolic causes of dementias

A

uraemia

liver failure

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57
Q

give 2 examples of toxic causes of dementia

A

alcohol
solvent abuse
heavy metals

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58
Q

give 2 examples of vitamin deficiency causes of dementia

A

B12

thiamine

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59
Q

give 2 examples of intracranial causes of dementia

A

tumour
subdural haematoma
hydrocephalus

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60
Q

give 3 examples of infective causes of dementia

A

HIV
syphillis
TB
Whipple’s

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61
Q

give 2 examples of endocrine causes of dementia

A

hypothyroid

hyperparathyroid

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62
Q

what is the distinguishing feature between dementia and delirium?

A

clear consciousness

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63
Q

which mental health condition is defined as “acquired loss of higher mental function in at least 2 cognitive domains”?

A

dementia

64
Q

what is the addenbroke’s cognitive examination used to test for?

A

dementia

65
Q

clock drawing test for dementia test which lobe?

A

parietal

66
Q

naming/reading tasks for dementia test which function?

A

language

67
Q

verbal fluency and stop-go tasks for dementia test which lobe?

A

frontal

68
Q

give 3 examples of types of dementia for which cholinesterase’s may be useful

A

alzheimer’s
dementia with lewy bodies
parkinson’s

69
Q

what is the prevalence of generalised depression in the UK?

a) 1%
b) 5%
c) 15%
d) 20%

A

b) 5%

70
Q

mutations in serotonin transporter genes could indicate a ____ cause of depression

A

genetic

71
Q

which part of the brain is smaller in patients with recurrent depression?

A

hippocampus

72
Q

anhedonia is what?

A

suicidal thoughts

73
Q

how long must symptoms last to be classed as depression?

A

at least 2 weeks

Significant loss of capacity to do activity of daily living

74
Q

describe the duration of dysthymia and the symptoms?

A

Intermittent for 2 or more years

Lack of pleasure, low mood, low self-esteem, discouragement and tiredness

75
Q

what depressive disorder follows a patterns of relapse and remittance?

A

dysthymia

76
Q

what is SAD characterised by and what are the symptoms?

A

Recurrent depression in winter months

Causing increase appetite, weight gain, fatigue and hypersomnia

77
Q

give 2 treatments for SAD

A

bright light therapy

SSRIs

78
Q

what is the most common type of puerperal affective disorder?

A

maternity blues= Tearful, emotional and irritable

79
Q

When does maternal blues occur and how is it resolved?

A

50% of women 2-3 days postpartum and resolves spontaneously

80
Q

what puerperal affective disorder occurs in 1 in 500-1000 births?

A

post partum psychosis

81
Q

what percentage of mothers experience non-psychotic postnatal depression during the first year?

a) 1%
b) 10%
c) 40%
d) 60%

A

b) 10%

82
Q

what scale is used to diagnose post natal depression?

A

Edinburgh postnatal depression scale

83
Q

which mental disorder increases the risk of suicide when coupled with depression?

A

bipolar

84
Q

what percentage of primary care depression patients commit suicide?

a) 1%
b) 5%
c) 15%
d) 20%

A

b) 5%

85
Q

what percentage of hospitalised depression patients commit suicide?

a) 1%
b) 5%
c) 15%
d) 20%

A

c) 15%

86
Q

what gender is more likely to commit self harm and at what age?

A

male and peaks at 60/70 yrs old

87
Q

90% of self harm cases are what

A

poisoning with 1/3rd being paracetamol overdose

88
Q

what is self-harm defined as?

A

un-successful suicide attempt

89
Q

what is the main cause of somatisation?

A

chronic fatigue
fibromyalgia
IBS

90
Q

give 2 infectious conditions that can trigger somatisation

A

infectious mononucleosis

viral hepatitis

91
Q

what are the three types of factors which can cause somatisation?

A

predisposing
precipitating
perpetuating

92
Q

what is the estimated pathophysiology to somatisation?

A

inappropriate sensory response to stimuli

93
Q

name a chronic somatisation disorder and its symptoms?

A

hypochondriasis= believe you are suffering from a serious illness and need constant medical treatment for proof/reassurance

94
Q

what is a characteristic of chronic somatisation disorders

A

multiple, recurrent, unexplained symptoms

Starts early in adult life

95
Q

what is the recommended treatment for chronic fatigue?

A

programme of increased activity

96
Q

what is the recommended treatment for fibromyalgia?

A

analgesia
TCA
anti-convulsants (pregabalin, gabapentin)

97
Q

what percentage of somatisation patients recover with CBT and rehab therapy

a) 10%
b) 20%
c) 40%
d) 60%

A

d) 60%

98
Q

What are psychatric DD of anxiety?

A

OCD, Depression, substance misuse and withdrawel, presensile dementia

99
Q

Is general anxiety acute or chronic?

A

Chronic

100
Q

What causes phobic disorder and what are the actions of the patient?

A

Caused by a stimuli and often avoidance of the stimuli

101
Q

What is the treatment for abnormal grief? (excessive, prolonged and denail)

A

Guided mourning

102
Q

What is ODC and what is it linked to?

A

Pattern obsession, with belief of disaster if failed

Linked to depression and torture

103
Q

How quick do SSRi’s act?

A

Delayed response take weeks, acts on the CNS

104
Q

Give example of SSRi’s that can be used in

A

Citulopram, Escitalopram, setraline, flouxetine and paroxetine

105
Q

What is a complication of anxiety?

A

Hyperventilation panic disorders

106
Q

What are the signs and symptoms of panic disorders?

A 
Dysponea
Palpitations
Chest pain
Chest pain
Sweating
Dizziness
Increase breathing, decrease Co2  which cause increase in PH and hypocalcaemia
107
Q

How do you manage panic disorder?

A

Breath into paper bag and breathing techniques

108
Q

What are the physical signs and symptoms of anxiety?

A 
Palpitations
Chest pain 
Sweats
Dry mouth
Difficulty swallowing
Diarrhoea
hyperventilation
Sleep distrubance
Tremor
Restlessness 
fatigue
Lack of libido
109
Q

What are the physiological signs and symptoms of anxiety?

A 
irritability
Lack of concentration
Depersonalization
Apprehension
fear
110
Q

What the social symptoms of alcohol dependence

A 
Crime
Domestic violence
Child abuse
Difficulty with job
Financial problems
111
Q

What are the drinking problems with drinking dependancy

A 
Increase tolerance
Drinking in morning
Trembling without a drink
Memory loss
Missing meals
112
Q

What are the psychological symptoms of drinking?

A 
Depression
Anxiety
Memory problems
Delirium
Suicide attempts
Pathological jealousy
113
Q

What are the risk factors for alcohol dependency?

A 
Coming from a non alcoholic family 1 in 10
From alcoholic family 1 in 4
Genetic
Social surroundings
Psychiatric illness
Alcohol dehydrogenase abnormalities
114
Q

What is the physiological intervention for alcohol dependent drinkers?How succesful

A

early intervention and CBT

30-50% small drinkers/absent 2 years afterwards

115
Q

What drug reduces the craving effects of alcohol by blocking GABA and NMDA receptors?

A

Acamprsotae

116
Q

How does alcoholism cause thiamine (B1) deficiency?

A

Malnourishment causing inadequate thiamine intake
Reduce absorption of thiamine from the GI tract
Poor utilisation of thiamine by cells

117
Q

What is the triad of symptoms caused by Wernicke–Korsakoff Syndrome?

A

Ataxia, nystagmus and confusion

118
Q

How does Wernicke–Korsakoff Syndrome develop? Thiamine deficiency

A

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
Q

What drug is given for acute alcohol withdrawal?

A

Benzodiazepine

120
Q

What type of seizure can occur as a complication of alcohol withdrawal ?

A

Grand mal convulsion–> general tonic clonic seizures

121
Q

Common complications of alcohol withdrawal?

A 
Tachycardia
Palpitations
Sweating
Headaches
Hallucinations
Nausea 
2-3* more likely to die from the seizures
122
Q

What 3 vitamin deficiencies cause delirium?

A

Vitamin B1 and 12

Nicotinic acid

123
Q

What drug intoxication cause delirium?

A 
Anticonvulsants
Antimuwcarinics
Hypnotics
TCA's
Digoxin
Drug/alcohol withdrawel
Dopamine antagonist
124
Q

What is the PINCH ME stand for in terms of causes of delirium?

A 
Pain
Infection--> v common 
Nutrition
Constipation --> common
Hydration --> common 
Medication
Electrolysis and environment
125
Q

What are the 4 key aspects of diagnosing delirium?

A 
Acute onsent
Change in consciousness levels
Altered attention
Fluctuates over 24 hours 
Not eating or drinking properly
126
Q

What are the DD for delirium?

A

lewy body dementia, delirium tremens

127
Q

Does having dementia increase chance of delirium?

A

yes

128
Q

What are the 3D’s for confusion in elderly?

A

Depression
Dementia
Delirium

129
Q

Is delirium reversible?

A

Yes

130
Q

What two drugs do you give in delirium?

A

Olanzapine and haloperidol

131
Q

Name the cognitive domains that can be affected in dementia? At least 2 must be affected

A 
Episodic memory
Visuospatial function
Language function
Frontal executive function
Apraxia, agnosia
132
Q

What is the pathology of alzheimer’s?

A

The deposition of B amyloid in amyloid plaque in the cortex and the formation of tau
Damaging the synapse and causing neuronal death

133
Q

If a first degree relative has dementia, how much does your chance of developing the disease increase by?

A

Doubles

134
Q

How do you differentiate between dementia and delirium?

A

In dementia you have clear consciousness and its chronic disease

135
Q

MMSE is used for diagnosing dementia what is the limitations of this test?

A

Not sensitive to Mild cognitive impairment or frontal lobe dysfunction

136
Q

What are the purposes of doing a blood test and brain imaging in a patient with potential dementia?

A

Blood test –> to exclude treatable causes

Brain imaging–> to identify the location of the dementia and any signs of cerebral lesions

137
Q

What are two physical causes of depression?

A

Reduced sleep and childhood trauma

138
Q

Chronic depletion in what compound can cause depression?

A

Monoamines

139
Q

What are common signs and symptoms of a depressive patient?

A 
World looks grey
Irritable
Weight loss
Self harm
Insomnia
Fatigue
Headache
Misserable
Quiet 
Libido loss and erectile dsyfunction
140
Q

What is pseudodementia and what group of patients commonly have it?

A

It’s usually the elderly

Patient has dementia and cognitive impairment similar to dementia

141
Q

What are common risk factors for depression?

A 
Unemployment
Divorce/ separation
Bereavement 
Lack of social support
Excessive and chronic use of alcohol and drug
142
Q

What are psychiatric DD of depression?

A 
Dementia
Delirium
Grief
Alcohol and amphetamine misuse
Personality disorder
Schizophenia
143
Q

What are organic DD of depression?

A

Cushings, hyperparathyroidism, hypothyroidism, long term corticosterioid use and tumour

144
Q

What are the symptoms of post partum psychosis

A

80% depression
Think child is deformed/devil
Might try to commit suicide or kill child

145
Q

What are the risk factors of non physchosis postnatal depression and what is the potential outcome?

A

RF are 1st pregnancy, poor relationship with father and ambivalence about pregnancy
Outcome is lack of bonding with baby

146
Q

What are common drug and non drug treatment for depression?

A

Drug: SSRI’s and TCA’s

Non drug: CBT, counselling, regular excercise and stop depressive drugs

147
Q

Which gender is self harm more common in under 35’s?

A

Females

148
Q

What is included in the assessment of a patient who self harmed?

A 
Cause?
Impulsive or planned?
Intent to repeat?
Psychiatric problems 
Left a note?
Secretive
149
Q

What are the signs and symptoms of chronic fatigue?

A

Muscle pain
Altered sleep
Impaired memory
Poor concentration

150
Q

What are the signs and symptoms of fibromyalgia?

A

Fatigue
Sleep disturbance
Muscle and joint pain
Abnormal sensory processing

151
Q

What are the predisposing factors to somatisation?

A

Fhx
Perfectionist
Introverted
Childhood trauma

152
Q

What are the precipitating factors for somatisation?

A

Trauma
Physical problem
Infection
Blaming other people for incidents

153
Q

What factors act as perpetuating somatisation?

A 
Avoidance behaviour
Excessive restrictive diet
Stimulant drugs
Sleep disturbance
Mood disorder
Unresolved acceptance 
Inactivity
154
Q

What gender is somatisation commonly seen in?

A

Females

155
Q

What is the general pathophysioligy of somatisation?

A

No obvious patholigcal/anatomical changes
Inappropriate sensory response to stimuli.
Over time the brain adapts to the inappropriate response and central changes occur

156
Q

What genetic condition is linked to alzheimers?

A

Down syndrome

Link between trisomy 21 and increase production of amyloid precursor protein

157
Q

What causes thiamine deficiency:?

A

Excessive alcoholic drinking
Crohn disease
Anorexia,

Y3 CORE CONDITIONS (15 decks)

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