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YEAR 2 FCM Revision > Mental Health/Psychiatry > Flashcards

Mental Health/Psychiatry Flashcards

1
Q

Section 2

A

non-renewable section for admission up to 28days

2 doctors and AHMP - one doctor being a psychiatric consultant

treatment given against pts wishes

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2
Q

Section 3

A

renewable section for admission for up to 6 months of treatment

AHMP and 2 doctors who must have seen the pt within the past 24hrs

treatment given against the patients wishes

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3
Q

Section 4

A

section for 72hr assessment often used as an emergency - when section 2 will have a delayed

changed to section 2 on arrival to hospital

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4
Q

Section 5(2)

A

patient already voluntarily in hospital

section enables legal detainment by doctor 72hrs

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5
Q

Section 5(4)

A

patient already voluntarily in hospital

section enables nurse to detain pt for 6hrs in hospital

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6
Q

Section 17a

A

used to recall a pt who is usually under community treatment to hospital for treatment
often due to non-compliance with treatment given in community

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7
Q

Section 135

A

court order obtained to allow breaking into property and removing person to place of safety

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8
Q

section 136

A

removal of a person, who appears to have a mental disorder to a place of safety - found in public place

section for 24hrs - allows MHA assessment

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9
Q

What are cluster A personality disorders?

A

the odd and eccentric

  1. paranoid
  2. schizoid
  3. schizotypal
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10
Q

Characteristics of paranoid

A

hypersensitive and unforgiving
attitude when insulted

questions loyalty of friends

reluctance to confide in others

preoccupation with conspirational beliefs/hidden meanings

percieve attacks on their character

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11
Q

Characteristics of Schizoid

A

indifference to praise and criticism

prefer solitary activities

ack on interest in sexual relationships
& lack of desire for companionship

emotional coldness

few interests and friends/confidants - except family

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12
Q

Characteristics of Schizotypal

A

odd beliefs and magical thinking

unusual perceptual disturbances

paranoid ideation & suspciousness

odd and eccentric behaviou r

lack of close friends - except family

odd speech but coherent

inappropriate affect

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13
Q

What are Cluster B personality disorders?

A

dramatic, emotional and erratic

antisocial
borderline (emotionally unstable)
histrionic
narcissistic

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14
Q

Characteristics of Antisocial PD

A

failure to conform to social norms

deception - repetitive lying, conning of others for profit/pleasure

impulsiveness, failure to plan ahead

irritable and aggressive

reckless and disregards personal and other’s safety

consistent irresponsibility - failure to sustain work behaviour or honour financial obligations

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15
Q

Characteristics of Borderline (EU) PD

A

efforts to avoid real/imagined abandonment

unstable interpersonal relationships

unstable self image

impulsivity which are self-damaging (spending, sex, substance abuse)

recurrent suicidal behaviour

affective instability

chronic feeling of emptiness

difficulty controlling temper

partially psychotic thoughts

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16
Q

Characteristics of Histronic PD

A

inappropriate sexual seductiveness

need to be centre of attention

rapidly shifting & shallow expression of emotions

physical appearance used for attention seeking purpose

impressionistic speech lacking detail

self dramatization

relationship considered to be more intimate

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17
Q

Characteristics of Narcisstic PD

A

grandoise sense of self importance

fantasies - unlimited successm power or beauty

sense of entitlement

taking advantage of others - achieve own needs

lack of empathy

excessive need for admiration

chronic envy

arrogant and haughty attitude

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18
Q

What are Cluster C personality disorders?

A

anxious and fearful

obssessive-compulsive
avoidant
dependent

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19
Q

Charcateristics of Obssessive-Compulsive

A

occupied with details, rules, lists, order, organisation or agenda

demonstrates perfectionism

extremely dedicated to work & effeciency - eliminates spare time activities

meticulous, scrupulous, rigid on etiquettes, ethics, morality and values

unwilling to pass on tasks and work with others unless they abide by their ways

hoarding despite no sentimental meaning

stingy spending style towards themselves and others

stiffness and stubborness

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20
Q

Characteristics of avoidant PD

A

avoidance of occupational activities - fear of criticism/rejection
- often preoccupied by being criticised rejected in social situations

unwilling to be involved and certainty of being liked

restraint form intimate relationships - fear of being ridiculed

reluctance to take risks - fear of embarrasment

views self as inferior to others

social isolation accompanied by craving for social contact

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21
Q

Characteristics of Dependent PD

A

difficulty making everyday decisions without excessive reassurance

needs other to take responsibility with major areas of life

difficult expressing disagreement with other - fear of losing support

lack of initiative

unrealistic fears for being left to care for themself

urgent search for another relation when a close relation ends - need care and support

unrealistic feelings - cannot care for themselves

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22
Q

How are personality disorder managed?

A

psychological therapies - dialectal behaviour therapy

tx for any coexisting psychiatric conditions

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23
Q

What criteria is used in Depression diagnosis ?

A

depression diagnosed using the DSM-5 criteria

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24
Q 
main symptoms 
low mood & hopelessness 
disturbed sleep 
appetite/weight changes 
fatigue/low energy/enthusiasm/motivation 
poor concentration 
feeling worthless/hopeless
inappropriate guilt 
suicidal ideation and element of self-harm may also be present
A

depression

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25
Criteria for subthreshold depression
at least two but less than 5 symptoms of depression
26
criteria for mild depression
few symptoms out the 5 in excess | minor functional impairment
27
Criteria for moderate depression
symptoms or functional impairment between mild and severe
28
Criteria for severe depression
most symptoms of depression that markedly interferes with functioning - can have some psychotic symptoms
29
Investigations done in depression work up?
investigations not routinely indicated for ppl with depression basic bloods such as biochemistry (glucose, U&Es, creatinine, LFTs, TFTs and calcium levels haematology - FBC and ESR
30
Management of subthreshold or mild depression
general measures such as sleep hygiene and active monitoring for those refusing intervention not routinely given antidepressants but consider in hx of moderate-severe depression initial presentation present 2yrs and persistence after interventions low-intensity psychosocial interventions - CBT (behavioural activation and problem-solving techniques) or computerised CBT or group based CBT
31
Management of unresponsive, moderate and severe depression
SSRI - citalopram, fluoxetine, paroxetine or sertraline high-intensity psychological interventions - individual CBT - interpersonal therapy (IPT) - behavioural activation - behavioural couples therapy
32
Bipolar disorder
periods of mania/hypomania alongside eps of depression
33
Type 1 Bipolar includes
mania and depression
34
Type 2 Bipolar includes
hypomania and depression
35
Mania features....
``` abnormally elevated mood extremely mood, extreme irritable, agressive increased energy/activity restless decreased need for sleep/insomnia pressure of speech/incomprehensible speech racing thoughts or flight of ideas poor concentration delusions - grandoise hallucinations - usually voices ```
36
Hypomania
milder manic symptoms
37
diagnosis
abrupt onset of symptoms - manic episodes ~7days hypomanic are ~4days need confirmation from mental health service in adults or CAHMS in children
38
Management of bipolar:
bipolar specific psychological interventions lithium mood stabiliser - alternative is valproate mania hypomania mx - stop antidepressants - initiate antipsychotics (olanzapine or haloperidol) mx for depression - talking therapies, fluoxetine
39
``` reduced BMI bradycardia hypotension enlarged salivary glands hypokalaemic, low FSH/LH/oestrogens/testosterone - amenorrhea and menstrual irregularities raised cortisol and GH low T3 hypercholesterolaemia ```
Anorexia Nervosa
40
Diagnostic criteria for anorexia nervosa
DSM-5 criteria 1. restricting energy intake relative to requirements 2. intense fear of weight gain despite being underweight 3. Body dysmorphia - denies seriousness of the current low body weight
41
Management of Anorexia Nervosa
adults - eating disorder focused CBT - maudsley anorexia tx for adults (MANTRA) - specialist supportive management children - first line = family focus therapy - second line = CBT
42
episodes of binge eating followed by purgative behaviour and vomiting
Bulimia Nervosa
43
Examples of purgative behaviours
excessive laxative use diuretics excessive exercise
44
Diagnosis of bulimia Nervosa
DSM-5 criteria used binge eating and compensatory behaviour both occur on average weekly for 3/12 recurrent eps of binging and reporting a lack of control in during a binge followed by purgative bevaiours to prevent weight gain
45
Management of Bulimia Nervosa
referral to specialist care bulimia-nervosa-focused guided self help for adults - consider CBT-ED - children should be offered BN focused family therapy (FT-BN) - pharmacological tx: fluoxetine
46
recurrent eps of binge eating with the absence of compensatory behaviour lack of control during episodes
binge eating disorder
47
resembled anorexia, Bulimia nervosa and or binge eating - but not precisely meeting diagnostic criteria
Atypical eating disorders
48
when a person experiences things differently from those around them
Psychosis
49
How can psychosis present?
``` hallucinations (auditory) delusions disorganised thoughts and thought disorders agitated/aggressive neurocognitive impairment depression self-harm ```
50
causes of psychosis?
``` prescribed med - corticosteroids illicit drugs - cannabis, LSD and amphetamines depression/schizoaffective bipolar neuro conditions - PD or huntington's ```
51
How to manage Schizophrenia?
first line - oral atypical antipsychotics CBT offered to all pts monitor CVD risk factors - more at risk of CVD in SZ
52
``` tremor sweating tachycardia anxiety seizures - peaks at 36hrs ``` ~48-72hrs - altered mental status, delusions/hallucinations, fever, tachycardia, coarse tremor
Etoh withdrawal
53
Management of etoh withdrawal
first line = long-acting benzo (clordiazepoxide or diazepam) pabrinex- vitB12 replacement carbamazepine - used an adjunct
54
Outline the 5 stages of a normal grief reaction
1. denial - feeling numb, pseudohallucinations 2. anger - directed against family members or medical professionals 3. bargaining - acting particular ways makes us feel better 4. depression - sadness and longing 5. acceptance - pain eases and we accept what has happened not everyone goes through all 5 stages
55
atypical grief reactions
delayed grief - grief begins more than 2 weeks after passing prolonged grief - difficult to define some may take up to or go beyond 12months
56
Side effects of typical antipsychotics
hyperprolactinaemia | Extrapyramidal side effects
57
What are the 4 EPS?
1. parkinsonism 2. Akathisia 3. acute dystonia 4. Tardive dyskinesia
58
What is Neuroleptic Malignant syndrome (NMS)?
reaction to antipsychotic drugs - presents with fever, muscle rigidity, autonomic instability, delirium with muscle breakdown/raised CK risk factors - high doses/highly potent drugs, paraenteral admin
59
How would you manage NMS?
stop antipsychotic and supportive measures - IV fluids
60
What are side effects for atypical antipsychotic?
weight gain metabolic - hyperprolactinemia, lipid/glucose levels clozapine - Agranulocytosis/neutropenia and ECG changes due to myocarditis
61
What risks are associated with antipsychotic use
Stroke and VTE
62
Intrusive thoughts - flashbacks or nightmares, time being in a daze/dissociated negative mood avoidance arousal - hypervigilant or disturbed sleep 4 weeks or less
Acute reaction to stress
63
How is acute reaction to stress managed?
first-line trauma-focused CBT | Benzodiazepines - if agitated, sleep disturbance
64
What are the 5 stages of uncomplicated bereavement/Grief?
1. denial = numbness, pseudohallucinations of deceased 2. anger 3. bargaining - may feel better if they do certain things 4. depression = longing and upset 5. acceptance
65
Inattention - wandering off task, lacking persistence, difficulty focusing/organising hyperactivity - excessive motor activity, fidgeting, tapping or talkativeness impulsivity - hasty action, social intrusiveness
ADHD
66
criteria for ADHD
features of inattention, hyperactivity and impulsivity - persistent element of devlopmental delay 16yrs - need 6 features present 17yr+ - need 5 features present
67
Management of ADHD?
10 week watch and wait period - see if symptoms change/resolve secondary care referral - paediatric consultant or CAHMS last resort - drug therapy - methylphenidate is first line in children - alternative lisadexafetamine
68
What check/monitoring is required for ADHD medications?
cardiotoxic medications - perform a baseline ECG prior to treatment, refer to cardiologist if significant PMHs/FHx or ambiguity
69
If symptoms of ADHD are mild-moderate what can we also offer parents?
useful for parents to attend education and training programmes
70
Describe the 4 main symptoms of PTSD?
1. re-experiencing - flashbacks, nightmares, images 2. avoidance - people/situations and cicrumstances with resemble to event 3. Hyperarousal - hypervigilant difficulty sleeping/concentrating 4. Emotional numbing - lack feelings and is detached
71
Management of PTSD?
mild symptoms 4weeks - watchful waiting more severe cases - Trauma-focused CBT or EMDR Drug treatments venlafaxine or SSRI (sertraline) severe cases - risperidone
72
gradual loss of memory (episodic in particular), difficulty with executive function and nominal dysphasia
alzheimers dementia
73
assessment tools for Alzheimer's
1. 10 point cognitive screener - 10CS | 2. 6- item cognitive impairment test (6CIT)
74
Management of Alzheimer's
cognitive stimulation and cognitive rehabilitation meds - acetylcholinesterase Inhibitors = donepezil & rivastigmine - second line = memantine (intolerance to first line or severe disease) Antidepressants and antipsychotics = if having associated depression or psychotic symptoms
75
What can we do for Alzheimer's pts in primary care
Blood-screen - exclude any reversible causes for cognitive decline.
76
Generalised anxiety disorder characterised by
disproportionate, pervasive and uncontrollable and widespread worry Range of somatic, cognitive and behavioural symptoms
77
DSM-5 diagnostic criteria for GAD?
1. 6/12 months of excessive uncontrollable, disproportionate worry 2. not confined to any other mental/medical/substance diagnosis 3. 3 more symptoms - restless, easily fatigued, poor concentraton, irritable, muscle tension and sleep distrubance
78
ICD-10 diagnostic criteria?
generalised and persistent anxiety variable dominant symptoms expressions of fear - illness or accidents
79
What medications cause anxiety as a side effect?
``` salbutamol corticosteroids beta-blockers theophylline some antidepressants herbal medications ```
80
Physical signs of anxiety?
increased HR and SOB trembling exaggerated startle response
81
How to interpret GAD-7 questionnaire
5 -10 = mild anxiety disorder 10 - 15 = moderate anxiety disorder 15+ = severe anxiety
82
Management approach for GAD?
1. educate about GAD and active monitoring 2. Low-intensity psychological interventions 3. High-intensity psychological interventions or drug treatment 4. high specialist input
83
Drug treatment for GAD?
first line = SSRI - sertraline if unable to tolerate try alternative SSRI or SNRI e..g venlafaxine or duloxetine if not tolerating either - offer pregabalin
84
Side effects of SSRIs?
Gi symptoms - increased risk of GI bleed - PPI co-prescription Hyponatremia increased/worsened symptoms after initiaion
85
stopping SSRIs?
continue for 6months after remission of symptoms when cessating - down titrate gradually over a 4 week period
86
Citalopram associated risk?
prolongation of QT interval | be cautious in hepatic impairment - longer time taken to excrete
87
What is panic disorder?
recurrent eps of sudden onset anxiety | absence of multi-themed worry
88
How do panic attacks usually present?
``` shaking SOB palpitations/sometimes CP nausea hot/cold flushes dizziness fear of dying ```
89
How is panic disorder managed?
CBT or Drug Tx - SSRI (sertraline) first line - if ineffective after 12/52 of SSRI offer TCA (imipramine or clomipramine)
90
What to do if panic disorder is not being responsive to primary care?
review and consider alternative tx refer to specialist mental health services - they my receive more specialist care

YEAR 2 FCM Revision (8 decks)

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