Mental health across the lifespan Flashcards
1
Q
What is the average life expectancy reduction in people with drug/alcohol use?
A
9-24 years
2
Q
What are mental health presentations that may present in childhood/adolescence?
A
Disruptive/behavioural disorders
ADHD, ASD
Separation anxiety (SAD) and school refusal
Trauma and attachment disorders
3
Q
Autism is equally common in males and females TRUE/FALSE
A
FALSE
M:F ratio is 4:1
4
Q
What age group is separation anxiety normal in?
A
7 months through preschool years
5
Q
TRUE/FALSE
Puerperium is a period of increasing risk of new maternal illness and relapsing existing illness
A
TRUE
6
Q
What are the risk factors for puerperal psychosis?
A
Thyroid disorder Previous episode FH Unmarried 1st pregnancy C section Perinatal death
7
Q
What percentage of 65+ have a mental illness?
A
25%
8
Q
Demyelinating disorders typically affect functionally and anatomically related groups of neurones TRUE/FALSE
A
FALSE
Degenerative disorders affect functionally and anatomically related groups of neuornes
9
Q
What are degenerative disorders pathologically characterised as?
A
Simple neuronal atrophy and loss with subsequent gliosis
10
Q
Which degenerative disorders affect the cerebral cortex?
A
Alzheimer’s disease
Picks disease
CJD
11
Q
Which degenerative disorders affect the brainstem and basal ganglia?
A
Parkinson’s disease, progressive supra nuclear palsy, multiple system atrophy and Huntington’s
12
Q
Which degenerative disorders affect the spinocerebellar area?
A
Spinocerebellar ataxia (e.g. Friedreich Ataxia)
13
Q
Which degenerative disorder affects the motor neurones?
A
Motor Neurone disease
14
Q
What is dementia?
A
Progressive loss of neurones typically affecting functionally related groups, often symmetrical insidious impairment
15
Q
In dementia consciousness is clouded TRUE/FALSE
A
FALSE
16
Q
What are the primary dementias?
A
Alzheimers disease
Lewy body dementia
Pick’s disease (frontotemporal dementia)
Huntington’s disease
17
Q
What are other disorder that give risk to dementia?
A
Multi-infarct (vascular)
Infection (HIV, Syphillis)
Trauma
Metabolic
18
Q
If cognitive impairment then alongside a full screen what else should you check?
A
B12 and folate
19
Q
What is the most useful investigation for frontotemporal dementia?
A
SPECT
20
Q
true/false
dementia must be reported to the DVLA
A
TRUE
21
Q
With Alzheimers disease the later the onset the more severe and rapid changes TRUE/FALSE
A
TRUE
22
Q
How does a familial presentation of alzeimers disease differ from that of a regular presentation?
A
Early onset
Unusual presentation
More relatives affected
23
Q
A family history of which gene mutations would increase the risk of Alzheimers disease?
A
APP
Presenillin (PSEN) 1&2
ApoE4
24
Q
Which gene variant decreased the risk of alzheimers?
A
ApoE2
25
Why does Down syndrome increase the risk of Alzheimers disease?
As amyloid precursor protein (APP) is on chromosome 21
26
What 3 things would be found on histology of someone with Alzheimers disease?
Excess accumulation of extracellular B-amyloid plaques
Intracellular neurofibrillary tangles
Amyloid angiopathy
27
What is the central component of neuritic plaques produced by?
Cleavage of amyloid precursor protein (APP)
28
What protein are intracellular neurofibrillary tangles accumulations of?
Tau
29
Explain amyloid angiopathy
Extracellular eosinophilic accumulation in the walls of the arteriole which stiffens and thickens the vessel walls
Disrupts BBB leading to serum leaking, oedema and local hypoxia
30
In Alzheimers there is narrowing of the gyro and widening of the sulci TRUE/FALSE
TRUE
31
What are the 3 areas first to be affected in alzhimers?
Nucleus basalis of meynert
Enthorhinal cortex
Hippocampus
32
Clinically what does alzhimers look like?
Insidious, progressive onset of worsting memory (esp short term), dysphagia, dyspraxia and agnosia
33
With alzheimers disease all tasks are affected including well practised tasks TRUE/FALSE
FALSE- Well practised tasks are not affected
34
All dementias are associated with behavioural or personality changes in the early stages of the disease?
FALSE
AD- not associate din the early stages. however as it progresses these become more prominent
Frontotermporal and vascular dementia are
35
What do CSF markers in Alzheimers disease show?
Increased in phosphorylated tau protein
| Decrease in B-amyloid
36
What drug is used for patients with mild-moderate AD?
Acetylcholinesterase (AChE) inhibitors
37
When would you not used acetylcholinesterase inhibitors?
Active peptic ulcer
Severe asthma
COPD
38
What is used if AchE is contraindicated in the treatment of AD?
Memantine
39
What drugs would be given if someone was having visual hallucinations?
Cholinesterase inhibitors
| Antipsychotics
40
Give some examples of BPSD (behavioural and psychological problems of dementia)
```
Hallucinations
Delusions
Insomnia
Depression
Anxiety
Aggression
Agitation
anxiety
Disinhibition
```
41
In Alzheimer's what is haemorrhage stroke due to?
B-amyloid deposits weakening cerebral blood vessels (cerebral amyloid angiopathy)
42
Frontotemporal dementia presents late in life TRUE/FALSE
FALSE
| It presents early in life (one of the most common <65)
43
What is frontotemporal dementia characterised by?
Progressive changes in character and social deterioration leading to impairment of intellect, memory and language
44
What are the 3 variants of frontotemporal dementia?
BEHAVIOURAL VARIANT
| Primary progressive aphasia (split into SEMANTIC DEMENTIA and PROGRESSIVE NON-FLUENT APHASIA)
45
What is the most common variant of FTD?
Behavioural variant (frontal lobe)
46
What does the behavioural variant look like?
Causes loss on inhibition and social skills
47
What does semantic dementia look like?
Impaired word comprehension and object naming
48
What does progressive non-fluent aphasia look like?
Slow hesitant speech
| Word-finding difficulties and agrammatism
49
What are the histological hallmarks of frontotemporal dementia?
Swollen Neurones (Picks cells) and intracytoplasmic filaments (picks bodies)
Picks bodies are enriched in the protein Tau and Tau mutations are one of the causes of this dementia
50
What should you not use to treat frontotemporal dementia and why?
Cholinesterase inhibitors - they make it worse
51
How do you treat picks disease?
SSRIs
| Trazodone
52
What is used to distinguish picks disease from Alzheimers?
Lumbar puncture
53
What is the second most common dementia in the west?
Multi-Infarct dementia
54
What is multi-infarct dementia caused by?
Vascular changes secondary to cerebrovascular disease
55
Why are suffers of multi-infarct dementia prone to depression and anxiety?
As they have insight
56
Name 5 characteristic symptoms of multi-infant dementia?
```
Executive/attentional difficulties
Cognitive slowing
Behavioural changes (disinhibition)
Focal neurological problems
Difficulty walking/falls
```
57
Multi-infarct dementia is difficult to distinguish from alzhimers however it has...
Abrupt onset
Stepwise progression
History of hypertension or stroke
58
What are large vessel infarcts related to?
Atheroma of large cerebral arteries provoke thromboembolism
59
What are small vessel infarcts related to?
Longstanding hypertension and atherosclerosis of small vessels
60
MRI scans show the presence of lacunar infarcts TRUE/FALSE
TRUE
61
What is Creutzefeldt-Jacob disease?
Transmissible prion neurodegenerative disease, causes cell death (spongiform changes in the cortex) and astrocytosis
62
How does Creutzfeldt-Jacob disease present?
Rapidly progressing dementia, ataxia and myoclonic jerks
63
What is the difference between explicit and implicit memory?
Implicit- performance of task facilitated in absence of conscious recollection
Explicit- Performance of test requires conscious recollection of past experiences
64
What is Antegrate amnesia?
Difficulty in acquiring new material
65
What is retrograde amnesia?
Difficulty in remembering information prior to the onset of the illness/injury
66
What are classic reports of a memory problem?
```
Forgetting a message
Inability to remember a familial place
Losing track of a conversation
Increased misplacing of things
Forgetting to do things
Struggling to remember names
```
67
How does the onset of dementia, delirium and depression differ?
Dementia- insidious
Delirium- Acute
Depression- Gradual
68
What is 4AT a rapid test for?
Delerium
69
What are the 4 things tested for in 4AT?
ALERTNESS
AMT-4
ATTENTION
ACUTE OR FLUCTUATING COURSE
70
What is MoCA a test for?
mild cognitive dysfunction
71
MMSE is used in the diagnosis of what?
Dementia
72
What are the 6 questions used in GP land in order to test cognitive ability
1- More trouble remembering things that happened recently used to?
2-Trouble recalling conversations a few days later?
3-Difficulty in finding the right words or tend to use the wrong words more often?
4- Less able to manage money and financial affairs?
5-Less able to manage medication?
6- Need more assistance with transport?
73
What does clock drawing test?
Fronto-parietal functioning
- Executive function (planning)
- Visuospatial ability
- Abstraction (ability to use symbols)
74
What is the ICD-10 criteria for dependence?
```
A strong desire to take the substance
Difficulties in controlling substance use
A physiological withdrawal state
Tolerance
Neglect of alternative pleasures
Persistence despite evidence of harm
```
75
What are the CAGE signs of addiction?
Cut down
Annoyed
Guilty
Eye-opener
76
What is incentive salience due to?
Dopimanergic activity in the mesolimbic pathway- it is a motivating signal
77
When someone takes lots of drugs a tolerance develops. Why?
Downregulate the dopamine receptors
| (OVERSTIMULATION--> DESENSITISATION)
78
What is addiction driven by?
Initial stages- driven by reward (positive reenforcement)
| Eventually becomes a thirst (negative reenforcement)
79
How is the pre-frontal cortex involved in the neurobiology of addiction?
Helps intention guide behaviour
| Modulates effects of the reward pathway, keeps emotions/impulses under control to achieve long-term goal
80
When is the pre-frontal cortex fully developed?
Not until mid-20s (as cortical maturation is in a back to front direction, vulnerable while developing)
81
TRUE/FALSE
| Frontal lobe areas mature later than limbic (emotional) symptoms
TRUE
82
What 3 things does dopamine release effect?
1. Ability to update info in PFC
2. Goal setting
3. Ability to avoid compulsive repetition
83
What part of the brain makes the decision about whether to carry out an activity?
Orbitofrontal cortex (provides internal representation of the saliency of events and assigns value to them)
84
Addicted brains shows increased activation of OFC TRUE/FALSE
TRUE
85
Which three parts of the brain are critical in acquisition, consolidation and expression of drug stimulus learning?
Hippocampal
Striatum
Amygdala
86
What is the most heritable psychiatric condition?
Addiction
87
How does stress motivate drug seeking in dependent individuals?
Triggers release of dopamine in neural reward pathway
88
What does chronic stress lead to?
Dampening of dopaminergic activity through down regulation fo D receptors (reduces sensitivity to normal receptors)
89
How do you make heroin?
Opium--> Morphine --> Diamorphine (Heroin)
90
What are the two most common ways of taking heroin?
IV & Smoking (fastest way to enter bloodstream)
91
How can opiate misuse lead to poor dentition?
The analgesic effect means that they don't realise when pain
92
How long does it take for withdrawal symptoms to appear?
within 6-8h (therefore tend to use 3x a day to avoid)
93
What are the withdrawal symptoms of opiates?
Dysphoria and craving, agitation, tachycardia and hypertension, piloerection
Diarrhoea, N&V
Dilated pupils
Joint pains
Yawning, Running nose (rhinorrhoea) and watery eyes (lacrimation)
Insomnia
BP + HR^
94
Opiate withdrawal may cause psychosis or harm TRUE/FALSE
BIG LIFE
| Opiate withdrawal does not cause psychosis or harm
95
What it opiate substitution therapy (OST)
Replace short acting opiod with long acting opiod
| Either Buprenorphine or Methadone
96
What is opiate detoxify?
Achieve complete abstinence from ALL opiates
97
Why is there a huge risk of death with opiate detoxification?
As when detoxify decrease tolerance
| BUT 70-80% relapse within 1y as although physically not dependent, psychologically dependent
98
What is the definition of an alcoholic?
Someone whose repeated drinking leads to harm in work or social life. Lifetime prevalence ~10%
99
How much is 1 unit?
10ml of alcohol
100
How do you calculate the number of units?
%*volume/ 10
101
What is used to identify someone with a harmful use of alcohol?
AUDIT (FAST is the quicker version)
| CAGE
102
What channels does alcohol affect?
Inhibits the action of excitatory NMDA- gutamate controlled ion channels
ALSO
Potentiate the actions of GABA type A controlled ion channels
103
What does alcohol withdrawal lead to
Excess glutamate activity (toxic to nerve cell)
| Reduced GABA activity
104
When does withdrawal syndrome start to appear?
10h after the last drink
105
What is the weekly allowance of alcohol?
14u/ week spread over 3 days with alcohol free days
106
The first symptoms of withdrawal syndrome start to occur within hours and peak at 24-48h. When do they resolve?
5-7 days
107
When does Delirium tremens peak?
within 2 days of abstinence
108
What is the mortality of delirium tremens?
Mortality 2-5%
109
What does delirium tremens look like?
```
Night time confusion
disorientation
Agitation
Hypertension
Fever
Visual/auditory hallucination
Paranoid ideation
Epileptic seizures can occur
```
110
How do you treat withdrawal syndrome?
Chlordiazepoxide
111
Lab tests are useful for screening and monitoring response for alcohol related problems TRUE/FALSE
FALSE
| Useful for monitoring but not useful for screening
112
What treatment can be used in alcoholics to detox?
Reassurance
Advice (adequate hydration, analgesia, antiemetics, treat infections and environment)
Benzodiazepines
Vitamin supplementation
113
Name 3 symptoms of Wernickes encephalopathy?
Ataxia
Nystagmus
Ophthalmoplegia
114
NO BENZODIAZEPINES BEYOND THE DETOXIFICATION PERIOD
tis a fact of life
115
What percentage of people will relapse?
50%
116
Name 3 drugs used to prevent relapses
Disulfiram (deterrent)
Acamprosate (reduce craving)
Naltrexone (reduces the reward)
117
What are some of the CNS effects of alcohol?
```
Self-neglect
Decrease memory/cognition
Cortical atrophy
Retrobulbar neuropathy
Fits
Falls
Wide-based gait
Wericke-Korsakoff's encephalopathy
```
118
What are alcohol contraindications?
```
Driving
Hepatitis, Cirrhosis
Peptic Ulcer
Drugs (e.g. antihistamines, metronidazole)
Carcinoid
Pregnancy
```
119
What is the treatment for alcoholic hepatitis?
Supportive + prednisolone
120
What is the criteria for diagnosing anorexia nervosa?
```
BMI <17.5
Self-induced wt loss
Body image disturbance
Fear of fatness
Amenorrhoea
```
121
What are some of the physical signs of anorexia nervosa?
```
Muscle wasting
Hair loss
Cold dry peripheries, dry skin
Hypercartenaemia
Bradycardia, hypotension
Bruising
Osteopenia/Osteoporosis
```
122
What is referring syndrome?
Caused by depletion of already inadequate stores of nutrients (Use marsipan guidelines)
123
What are the criteria for bulimia?
```
Persistent preoccupation with eating
Irresistible craving for food
Binges
Attempts to counter the effects of binges
Morbid dread of fatness
```
124
Physical signs of bulimia?
Calluses on knuckles (Russels sign)
Parotid Hypertrophy
Dental caries
U+Es
125
What can be some medical complications of bulimia?
```
Hypokalaemia (common and problematic)
Oesophageal reflux
Oesophageal tears/rupture
Subconjunctival haemorrhage
Dehydration
Seizures
```
126
What is psychosis?
A loss of contact with reality
127
What does psychosis look like?
Hallucinations
Delusions
Disorder of the form of thought
Agitation/aggression
128
What is a hallucination?
A perception that occurs in the absence of visual stimulus
129
What is a delusion?
Fixed, falsely held belief with unshakable conviction (misinterpretation of real sensory stimuli w/o evidence to support)
130
You can be swayed from an overvalued idea TRUE/FALSE
true
131
What are functional hallucinations?
Hallucinations triggered by a stimulus in the same modality, can co-occur with it
132
What is paranoia?
Belief that external events are related to ones self (vary in intensity, be aware of colloquialism)
133
What are ideas of reference?
Innoculus or coincidental events ascribed meaning by the person e.g. thinking the TV is talking to them directly
134
Is primary or secondary delusions more common?
Secondary (trying to explain why weird stuff is happening)
135
A formal thought disorder cannot be directly observesd therefore has to be inferred from patterns of speech TRUE/FALSE
TRUE
136
What is neologisms?
Coining of a new word or expression
137
What are the 5 types of thought interference?
```
Thought insertion
Thought withdrawl
Thought broadcasting
Thought blocking
Thought echo
```
138
What is passive phenomena?
Not having control of your body, emotions changed by others
139
What increased the risk of schizophrenia by 50%?
Childhood viral CNS infection
140
What is heritability?
Proportion of observable differences in a trait between individuals in a population
141
What drugs are most and least likely to cause a drug induced psychosis?
Heroin least likely
| Cannabis most likely
142
3rd person auditory hallucinations are most likely...
Schizophrenia
143
Self-referential delusions are most likely...
tbh not specific
| delirium?
144
What is depressive psychosis typified by?
Mood congruent of psychotic symtpoms
145
What is this describing?
Delusions of grandeur/special ability/persecutory/religiosity
2nd person hallucinations/auditory
Symptoms of 1st rank present in 20% manic episode
Mania with psychosis
146
What is an indictor of poor outcome in brain structural abnormalities?
Decreased frontotemporal volume/ frontal lobe grey matter
| Enlarged lateral ventricle
147
In schizophrenics what are the grey matter reductions due to?
Arborisations, not neuron loss
148
With psychosis there is progressive ventricle enlargement TRUE/FALSE
FALSE
| There is ventricle enlargement but it is not progressive
149
What is the neurobiology of schizophrenia?
Overactivity of dopamine pathways in the brain
150
Dopamine is inhibitory to what?
Prolactin
151
Of the dopamine receptor subtypes which is most abundant and which is most important?
D1- Most abundant (stimulate cAMP)
| D2-Most important
152
How do typical antipsychotics work?
Work by D2 inhibition
153
TRUE/FALSE
With typical antipsychotics there is a strong correlation between average antipsychotic dose required to improve clinical symptoms and D2 receptor binding activity
true
154
How do atypical (2nd generation work)?
Many are 5-HT2A antagonists
155
Typicals often have extrapyramidal side effects TRUE/FALSE
true
156
name 4 of the anticholinergic side effects of typical antipsychotics
Acute dystonic reaction
Parkinsonism
Akathisia
Tardive dyskinesia
157
How long does tar dive dyskinesia take to develop?
years
158
What are side effects of atypicals?
Wt gain, sedation & metabolic syndrome
159
Why are never atypical not sedating?
They do not cross the BBB
160
Why is clozapine 3rd line in treatment of psychosis?
Response is great (50%)
BUT
small risk of agranulocytosis
161
What is a functional disorder?
Symtpoms where one cannot easily associate the symptoms with classically identifiable organic disease processes
162
What are common symptoms of functional disorders?
```
pain
altered sensation
dizziness
movement disorders
weakness
seizures- v common to have functional background
cognitive symptoms
```
163
define dissociation
detachment from reality
164
Define depersonalisation
Feeling that your body does not quite belong to you or is disproportionate from you
165
What is derealisation?
A feeling that you are disconnected from the world around you or "spaced out"
166
What percentage of functional symptoms have a good response to treatment?
60%
167
What is the standard treatment of choice for functional problems?
CBT
168
Define personality
Cluster of relatively predictable patterns of thinking, feeling and behaving, generally consistent across time, space and context
169
What are the 5 things that the structure of personality consists of?
Openess, neuroticism, agreeableness, extraversion and conscientiousness
170
What is a personality disorder?
Enduring pattern of inner experiences and behaviour that deviate markedly from the expectations of the individuals culture. The pattern is inflexible and pervasive.
171
The first access of people with personality disorder to the services tends to be around age...
14
172
Personality disorder is more common than asthma TRUE/FALSE
true
173
What is in cluster A personality disorder?
Paranoid
| Schizoid
174
What is in cluster B personality disorder?
Antisocial
Bordeline
Histrionic
175
What is in cluster C personality disorder?
Avoidant
Dependent
Obcessive-Compulsive
176
What are some of the traits of antisocial personality disorder?
```
Disregard for and violation of the rights of others
Impulsive
Deceitfully charming
Fearless
Bad at reading emotional Qs
Tend not to learn from punishement
Blame the victim
```
177
What are the three subtypes of schizophrenia?
Paranoid
Hebephrenic
Catatonic
178
What is the peak onset of schizophrenia in men?
15-25
179
What is schizophrenia?
A group of brain disorders characterised by disorders of thought, behaviour, perception and emotion
180
What are the main symptoms of schizophrenia?
Delusions
Disorders of the form of thought
3rd person auditory hallucinations
181
RF for schizophrenia?
```
Genes
Birth complications
Winter/spring birth
Drug use
Urban dwelling
Social adversity/deprivation
Neurodevelopmental changes
Neurochemical changes
```
182
What are 4 good prognostic indicators for schizophrenia
Older age of onset
Female gender
Marked mood disturbance especially elation
Fix of mood disorders
183
What is there an increased risk of suicide in schizophrenic patients?
In the 1st week post discharge
184
What medication does post schizophrenic depression respond well to?
SSRIs
185
What are the 3 main parts of ADHD?
Inattention
Hyperactivity
Impulsivity
186
What is the most common neurobehavioral disorder of childhood?
ADHD
187
Cause of ADHD
Genetic-80% genetically inherited
Perinatal factors-Tobacco/drug/alcohol use in pregnancy, prem, hypoxia, short/long labour, viral infections, forceps
Psychosocial adversity-Parenting styles, marital discord, maltreatment, trauma, criminality, low SES
188
What is the neurobiology of those with ADHD
Underactive frontal lobe function
Excessively efficient dopamine-removal system
Reduction in norepinephrine
189
Why is the diagnosis of ADHD delayed until school entry/later?
Most children will have hyperactivity as a toddler but this will abate with time
190
What are the non-pharmacological treatment options for those with ADHD?
```
Parent training
social skill training
sleep
diet
behavioural classroom management strategies
specific educational interventions
```
191
What are the pharmacological treatment for those with ADHD?
```
1st line (stimulants)- Methylphenidate
2nd line (SNRI)- Atomoxetine
```
192
How long does it take Atomoxetine to reach its full efficacy?
6 weeks
193
What is autism?
Persistent deficits in social communication and interaction across multiple contexts with restrictive repetitive pattern of behaviour, interests and activities
194
How is social communication I someone with autism impaired?
Hard to understand underlying meaning of conversation
Difficulties understanding jokes
Monotonous voice
Pedantic and idiosyncratic language
Narrow interests
Difficulties sharing thoughts and feelings
195
How is social imagination impaired in those with autism?
Difficulties thinking flexibly
Takes things literally
Difficulty goal planning
196
How is social interaction more difficult for someone with autism?
Difficulties with non-verbal clues
| Struggle to make/sustain personal and social relationships
197
What are the repetitive behaviours of someone with autism?
Stereotyped/repetitive motor movements
| Ritualised patterns of behaviour
198
What is the 3 criteria for autism diagnosis?
Present in early developmental period
Cause significant impairment in functioning
Not explained by mental health, intellectual disability or global developmental delay
199
What is a larger amygdala associated with?
More severe anxiety and worse social and communication skills
200
What is the aim of non-pharmacological treatment for someone with autism?
Lessen associated deficits/ family distress
Increases QOL
Functional independence
201
What pharmacological management can be used for those with autism?
Risperidone- aggression
Metatonin- Sleep
SSRIs-Repetative behaviour
