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YEAR 3 & 5 CORE CONDITIONS > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What are the core symptoms of depression?

A
  1. Persistent low mood
  2. Anhedonia
  3. Fatigue
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2
Q

How long should a patient have had the core symptoms of depression for in order to classify it as depression?

A

Longer than 2 weeks

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3
Q

What are some other symptoms of depression?

A

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

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4
Q

What are some examples of drug treatments for depression?

A

SSRIs - fluoxetine, citalopram, sertraline
Tricyclic antidepressants - amitryptiline, lofepramine
NaSSA - mirtazapine

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5
Q

What is generalised anxiety disorder?

A

A high level of background anxiety (excessive uneasiness, worrying and apprehension)

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6
Q

What is agoraphobia?

A

The fear of being in situations where escape might be difficult or help won’t be available if things go wrong

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7
Q

What are some symptoms typical of PTSD?

A

Flashbacks
Emotional blunting
Detachment from other people or surroundings
Anhedonia
Avoidance of certain activities/situations

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8
Q

What is a panic attack?

A

A sudden overwhelming intense fear and anxiety, associated with physical symptoms, for a short duration (5-20min)

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9
Q

What are some mental symptoms of anxiety?

A 
Worry, apprehension, fear, nervousness, irritability
Restlessness
Increased startle response
Insomnia
Poor concentration
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10
Q

What are some physical symptoms of anxiety?

A

‘Fight or flight’ response

Cardio - palpitations, angina
Respiratory - hyperventilation
GI - dry mouth, dysphagia
Neuro - dizzy, nausea, tingling
Motor - trembling, muscle tension
Other - sweating, flushing
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11
Q

What is the management of anxiety?

A

Psychological therapy - CBT
Self help - reduce caffeine and alcohol, exercise, good diet, support groups
Medication - propanolol, benzodiazepines (PRN), SSRIs

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12
Q

What is psychosis defined by?

A

A loss of touch with reality

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13
Q

What are some psychological causes of psychosis?

A 
Schizophrenia
Delusional disorder
Mood affective disorder
Dementia
Delirium 
Substance use - alcohol, cannabis, MDMA, mushrooms
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14
Q

What are the main clinical features of psychosis?

A

Thought disturbances
Lack of insight/self-awareness
Hallucinations
Delusions

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15
Q

What are the differences between hallucinations, delusions and illusions?

A

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

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16
Q

Name some drug treatments for psychosis

A

Typical anti-psychotics = chlorpromazine, haloperidol

Atypical anti-psychotics = clozapine, respiridone

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17
Q

Which medications can cause psychosis?

A

Anti-epileptics
Anti-depressants
Levadopa

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18
Q

What is the definition of alcohol dependency?

A

A craving, tolerance and preoccupation with alcohol and continued drinking despite harmful consequences

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19
Q

What are the 4 questions of CAGE questionnaire?

A
  1. Do you ever feel you should CUT DOWN your drinking?
  2. Do you ever feel ANGRY/ANNOYED when people comment on your drinking?
  3. Do you ever feel GUILTY as a consequence of drinking?
  4. Have you ever had an EYE OPENER - do you need a drink in the morning to get going?
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20
Q

What are the 7 clinical features of alcohol dependency?

A
  1. Tolerance
  2. Narrowing of repetoire
  3. Compulsive drinking
  4. Withdrawal symptoms
  5. Drinking to alleviate withdrawal symptoms
  6. Continued drinking despite harm i.e. inability to stop
  7. Saliency - preocupation with drinking
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21
Q

What is the presentation of acute alcohol withdrawal?

A

Delirium tremens = acute confusional state associated with hallucinations and seizures
Nausea + vomiting
Pyrexia, tachycardia, hypertension

22
Q

What CNS conditions can develop from acute alcohol withdrawal?

A

Wernicke’s encephalopathy = ophthalmaplegia, ataxia, confusion

Korsakoff’s psychosis = persistent + dense cognitive impairment

23
Q

What 3 medications are used in the management of alcohol dependency?

A
  1. Disulfaram = antabuse = acetylaldehyde dehydrogenase inhibitor
  2. Acamprosate = calcium acetyl-homotaurinate - it reduces cravings
  3. Naltrexone = opioid receptor blocker - affects pleasure of drinking
24
Q

What medications are used in the management of acute alcohol withdrawal?

A

Benzodiazepines (specifically chlordiazepoxide)

Pabrinex = vitamin B complex injection

25
Q

What score is used to assess severity of acute alcohol withdrawal?

A

CIWA score (Clinical Institutes Withdrawal Assessment) - it is measured based on common signs and symptoms e.g. hypertension, seizures, insomnia, hallucinations, nausea

26
Q

What LFTs are raised in alcohol abuse?

A

GGT = best indicator

Triglycerides

27
Q

What changes would be seen in FBC in alcohol abuse?

A

High MCV - due to direct toxicity on bone marrow (it is reversible after a few months of abstinence) or folate/B12 deficiency
Low platelets

28
Q

What is the pathophysiology of Alzheimer’s Disease?

A

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

29
Q

What is the pathophysiology of vascular dementia?

A

Cerebrovascular disease with single/multiple infarcts

30
Q

What is the pathophysiology of Lewy-body dementia?

A

Deposition of abnormal proteins within neurons in the brainstem and neocortex

31
Q

Which dementia type is most common and what is second most common?

A
  1. Alzheimer’s disease - 50%

2. Vascular dementia - 25%

32
Q

What can cause a treatable dementia?

A 
Substance abuse
Hypothyroidism
Syphilis
Vitamin B12 deficiency
Pellagra
33
Q

Which gene can predispose you to Alzheimer’s disease?

A

ApoE4 on chromosome 19

34
Q

In which genetic condition is Alzheimer’s inevitable?

A

Down’s syndrome

35
Q

What is fronto-temporal dementia? What is it also known as?

A

Frontal and temporal atrophy with 70% loss of spindle neurons

Also known as Pick’s disease (they specifically have Pick inclusion bodies on histology)

36
Q

How does dementia usually present?

A

MALEV

Memory
Attention
Language - receptive/expressive dysphasia
Executive function - difficulties planning/problem solving
Visuospatial ability - disorientation

37
Q

What is the classic presentation of Alzheimer’s?

A

Early impairment of episodic memory and a progressive decline

38
Q

How does vascular dementia present?

A

Stepwise deterioration is characteristic

May get focal neurological signs e.g. visual field defect

39
Q

What characterises Lewy-body dementia?

A

Fluctuating cognitive impairment (can be a differential for delirium)
Detailed visual hallucinations
Parkinsonism

40
Q

How does frontotemporal dementia present?

A

Personality change

Behavioural disturbance

41
Q

What are the questions in an AMTS?

A
  1. How old are you?
  2. What is the time?
  3. What year is it?
  4. Give address (42 West Street) and ask them to repeat it at the end.
  5. Where are you now?
  6. What is my job?
  7. What is your date of birth?
  8. When did WW2 start?
  9. What’s the name of the monarch/PM?
  10. Count backwards from 20-1
42
Q

What drugs are used in Alzheimer’s disease?

A

Memantine = NMDA (glutamate)-receptor blocker

Donepezil/galantamine/rivastigimine = acetylcholinesterase inhibitors

43
Q

What is delirium?

A

An acute confusional state

Fluctuating syndrome of disturbed consciousness, attention, cognition and perception

44
Q

What are the main causes of delirium?

A

PINCH ME

Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes/environment
45
Q

How does delirium present?

A

DELIRIUM

Disordered thinking
Euphoria/fearful/angry
Language impairment
Illusions/delusions
Reversed sleep-wake cycle
Inattention
Unaware/disorientated
Memory problems
46
Q

What are the 3 types of delirium?

A

Hypoactive
Hyperactive
Mixed

47
Q

How does hypoactive delirium present?

A 
Lethargy
Reduced concentration
Reduced appetite
Quiet
Withdrawn

Can be confused with depression

48
Q

How does hyperactive delirium present?

A

Inappropriate behaviour
Hallucinations
Agitation
Wandering

Confused with schizophrenia

49
Q

Which type of dementia can present similarly to delirium?

A

Lewy-body dementia - it has a fluctuating course

50
Q

How do you manage someone with delirium?

A
  1. Treat underlying condition
  2. Supportive - staff consistency, clock in sight
  3. Environmental - don’t restrain, control excess noise and light
  4. Medication - antipsychotics in aggressive patients
51
Q

What is the mnemonic for mental state exam?

A

All Sane Men Think That Pizza Is Italian

	• Appearance and behaviour
	• Speech
	• Mood
	• Thought forms/processes
	• Thought content
	• Perception
	• Insight
         - IQ (cognitive function)

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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