Mental Health Flashcards
What are the core symptoms of depression?
- Persistent low mood
- Anhedonia
- Fatigue
How long should a patient have had the core symptoms of depression for in order to classify it as depression?
Longer than 2 weeks
What are some other symptoms of depression?
Social - loss of interest, social withdrawal, affecting relationships
Physical - sleep disturbance, appetite, libido
Intellectual - concentration, cognition
Spiritual - self-esteem, pessimism about future, self-critical
Suicide - ideation, plans, previous attempts
What are some examples of drug treatments for depression?
SSRIs - fluoxetine, citalopram, sertraline
Tricyclic antidepressants - amitryptiline, lofepramine
NaSSA - mirtazapine
What is generalised anxiety disorder?
A high level of background anxiety (excessive uneasiness, worrying and apprehension)
What is agoraphobia?
The fear of being in situations where escape might be difficult or help won’t be available if things go wrong
What are some symptoms typical of PTSD?
Flashbacks
Emotional blunting
Detachment from other people or surroundings
Anhedonia
Avoidance of certain activities/situations
What is a panic attack?
A sudden overwhelming intense fear and anxiety, associated with physical symptoms, for a short duration (5-20min)
What are some mental symptoms of anxiety?
Worry, apprehension, fear, nervousness, irritability Restlessness Increased startle response Insomnia Poor concentration
What are some physical symptoms of anxiety?
‘Fight or flight’ response
Cardio - palpitations, angina Respiratory - hyperventilation GI - dry mouth, dysphagia Neuro - dizzy, nausea, tingling Motor - trembling, muscle tension Other - sweating, flushing
What is the management of anxiety?
Psychological therapy - CBT
Self help - reduce caffeine and alcohol, exercise, good diet, support groups
Medication - propanolol, benzodiazepines (PRN), SSRIs
What is psychosis defined by?
A loss of touch with reality
What are some psychological causes of psychosis?
Schizophrenia Delusional disorder Mood affective disorder Dementia Delirium Substance use - alcohol, cannabis, MDMA, mushrooms
What are the main clinical features of psychosis?
Thought disturbances
Lack of insight/self-awareness
Hallucinations
Delusions
What are the differences between hallucinations, delusions and illusions?
Hallucinations = false perception without a physical stimulus (patient is not aware that it is not real)
Illusions = misinterpreted perception/distortion of the senses e.g. mistaking a shadow for a person
Delusions = fixed belief that is false or fanciful
Name some drug treatments for psychosis
Typical anti-psychotics = chlorpromazine, haloperidol
Atypical anti-psychotics = clozapine, respiridone
Which medications can cause psychosis?
Anti-epileptics
Anti-depressants
Levadopa
What is the definition of alcohol dependency?
A craving, tolerance and preoccupation with alcohol and continued drinking despite harmful consequences
What are the 4 questions of CAGE questionnaire?
- Do you ever feel you should CUT DOWN your drinking?
- Do you ever feel ANGRY/ANNOYED when people comment on your drinking?
- Do you ever feel GUILTY as a consequence of drinking?
- Have you ever had an EYE OPENER - do you need a drink in the morning to get going?
What are the 7 clinical features of alcohol dependency?
- Tolerance
- Narrowing of repetoire
- Compulsive drinking
- Withdrawal symptoms
- Drinking to alleviate withdrawal symptoms
- Continued drinking despite harm i.e. inability to stop
- Saliency - preocupation with drinking
What is the presentation of acute alcohol withdrawal?
Delirium tremens = acute confusional state associated with hallucinations and seizures
Nausea + vomiting
Pyrexia, tachycardia, hypertension
What CNS conditions can develop from acute alcohol withdrawal?
Wernicke’s encephalopathy = ophthalmaplegia, ataxia, confusion
Korsakoff’s psychosis = persistent + dense cognitive impairment
What 3 medications are used in the management of alcohol dependency?
- Disulfaram = antabuse = acetylaldehyde dehydrogenase inhibitor
- Acamprosate = calcium acetyl-homotaurinate - it reduces cravings
- Naltrexone = opioid receptor blocker - affects pleasure of drinking
What medications are used in the management of acute alcohol withdrawal?
Benzodiazepines (specifically chlordiazepoxide)
Pabrinex = vitamin B complex injection
What score is used to assess severity of acute alcohol withdrawal?
CIWA score (Clinical Institutes Withdrawal Assessment) - it is measured based on common signs and symptoms e.g. hypertension, seizures, insomnia, hallucinations, nausea
What LFTs are raised in alcohol abuse?
GGT = best indicator
Triglycerides
What changes would be seen in FBC in alcohol abuse?
High MCV - due to direct toxicity on bone marrow (it is reversible after a few months of abstinence) or folate/B12 deficiency
Low platelets
What is the pathophysiology of Alzheimer’s Disease?
Accumulation of beta-amyloid peptide (product of amyloid precursor protein) results in amyloid plaque formation and neurofibrillary tangles and loss of acetylcholine neurotransmitter
This leads to degeneration of the cerebral cortex
What is the pathophysiology of vascular dementia?
Cerebrovascular disease with single/multiple infarcts
What is the pathophysiology of Lewy-body dementia?
Deposition of abnormal proteins within neurons in the brainstem and neocortex
Which dementia type is most common and what is second most common?
- Alzheimer’s disease - 50%
2. Vascular dementia - 25%
What can cause a treatable dementia?
Substance abuse Hypothyroidism Syphilis Vitamin B12 deficiency Pellagra
Which gene can predispose you to Alzheimer’s disease?
ApoE4 on chromosome 19
In which genetic condition is Alzheimer’s inevitable?
Down’s syndrome
What is fronto-temporal dementia? What is it also known as?
Frontal and temporal atrophy with 70% loss of spindle neurons
Also known as Pick’s disease (they specifically have Pick inclusion bodies on histology)
How does dementia usually present?
MALEV
Memory
Attention
Language - receptive/expressive dysphasia
Executive function - difficulties planning/problem solving
Visuospatial ability - disorientation
What is the classic presentation of Alzheimer’s?
Early impairment of episodic memory and a progressive decline
How does vascular dementia present?
Stepwise deterioration is characteristic
May get focal neurological signs e.g. visual field defect
What characterises Lewy-body dementia?
Fluctuating cognitive impairment (can be a differential for delirium)
Detailed visual hallucinations
Parkinsonism
How does frontotemporal dementia present?
Personality change
Behavioural disturbance
What are the questions in an AMTS?
- How old are you?
- What is the time?
- What year is it?
- Give address (42 West Street) and ask them to repeat it at the end.
- Where are you now?
- What is my job?
- What is your date of birth?
- When did WW2 start?
- What’s the name of the monarch/PM?
- Count backwards from 20-1
What drugs are used in Alzheimer’s disease?
Memantine = NMDA (glutamate)-receptor blocker
Donepezil/galantamine/rivastigimine = acetylcholinesterase inhibitors
What is delirium?
An acute confusional state
Fluctuating syndrome of disturbed consciousness, attention, cognition and perception
What are the main causes of delirium?
PINCH ME
Pain Infection Nutrition Constipation Hydration Medication Electrolytes/environment
How does delirium present?
DELIRIUM
Disordered thinking Euphoria/fearful/angry Language impairment Illusions/delusions Reversed sleep-wake cycle Inattention Unaware/disorientated Memory problems
What are the 3 types of delirium?
Hypoactive
Hyperactive
Mixed
How does hypoactive delirium present?
Lethargy Reduced concentration Reduced appetite Quiet Withdrawn
Can be confused with depression
How does hyperactive delirium present?
Inappropriate behaviour
Hallucinations
Agitation
Wandering
Confused with schizophrenia
Which type of dementia can present similarly to delirium?
Lewy-body dementia - it has a fluctuating course
How do you manage someone with delirium?
- Treat underlying condition
- Supportive - staff consistency, clock in sight
- Environmental - don’t restrain, control excess noise and light
- Medication - antipsychotics in aggressive patients
What is the mnemonic for mental state exam?
All Sane Men Think That Pizza Is Italian
• Appearance and behaviour
• Speech
• Mood
• Thought forms/processes
• Thought content
• Perception
• Insight
- IQ (cognitive function)
