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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
Q

Criteria for subthreshold depression

A

at least two but less than 5 symptoms of depression

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26
Q

criteria for mild depression

A

few symptoms out the 5 in excess

minor functional impairment

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27
Q

Criteria for moderate depression

A

symptoms or functional impairment between mild and severe

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28
Q

Criteria for severe depression

A

most symptoms of depression that markedly interferes with functioning - can have some psychotic symptoms

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29
Q

Investigations done in depression work up?

A

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

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30
Q

Management of subthreshold or mild depression

A

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

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31
Q

Management of unresponsive, moderate and severe depression

A

SSRI - citalopram, fluoxetine, paroxetine or sertraline

high-intensity psychological interventions

  • individual CBT
  • interpersonal therapy (IPT)
  • behavioural activation
  • behavioural couples therapy
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32
Q

Bipolar disorder

A

periods of mania/hypomania alongside eps of depression

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33
Q

Type 1 Bipolar includes

A

mania and depression

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34
Q

Type 2 Bipolar includes

A

hypomania and depression

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35
Q

Mania features….

A 
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
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36
Q

Hypomania

A

milder manic symptoms

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37
Q

diagnosis

A

abrupt onset of symptoms - manic episodes ~7days
hypomanic are ~4days

need confirmation from mental health service in adults
or CAHMS in children

38
Q

Management of bipolar:

A

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
Q 
reduced BMI 
bradycardia
hypotension 
enlarged salivary glands 
hypokalaemic, low FSH/LH/oestrogens/testosterone - amenorrhea and menstrual irregularities 
raised cortisol and GH
low T3 
hypercholesterolaemia
A

Anorexia Nervosa

40
Q

Diagnostic criteria for anorexia nervosa

A

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
Q

Management of Anorexia Nervosa

A

adults

  • eating disorder focused CBT
  • maudsley anorexia tx for adults (MANTRA)
  • specialist supportive management

children

  • first line = family focus therapy
  • second line = CBT
42
Q

episodes of binge eating followed by purgative behaviour and vomiting

A

Bulimia Nervosa

43
Q

Examples of purgative behaviours

A

excessive laxative use
diuretics
excessive exercise

44
Q

Diagnosis of bulimia Nervosa

A

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
Q

Management of Bulimia Nervosa

A

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
Q

recurrent eps of binge eating with the absence of compensatory behaviour
lack of control during episodes

A

binge eating disorder

47
Q

resembled anorexia, Bulimia nervosa and or binge eating - but not precisely meeting diagnostic criteria

A

Atypical eating disorders

48
Q

when a person experiences things differently from those around them

A

Psychosis

49
Q

How can psychosis present?

A 
hallucinations (auditory)
delusions 
disorganised thoughts and thought disorders 
agitated/aggressive 
neurocognitive impairment 
depression 
self-harm
50
Q

causes of psychosis?

A 
prescribed med - corticosteroids 
illicit drugs - cannabis, LSD and amphetamines 
depression/schizoaffective
bipolar
neuro conditions - PD or huntington's
51
Q

How to manage Schizophrenia?

A

first line - oral atypical antipsychotics
CBT offered to all pts

monitor CVD risk factors - more at risk of CVD in SZ

52
Q 
tremor
sweating 
tachycardia 
anxiety 
seizures - peaks at 36hrs

~48-72hrs - altered mental status, delusions/hallucinations, fever, tachycardia, coarse tremor

A

Etoh withdrawal

53
Q

Management of etoh withdrawal

A

first line = long-acting benzo (clordiazepoxide or diazepam)
pabrinex- vitB12 replacement

carbamazepine - used an adjunct

54
Q

Outline the 5 stages of a normal grief reaction

A
  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
Q

atypical grief reactions

A

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
Q

Side effects of typical antipsychotics

A

hyperprolactinaemia

Extrapyramidal side effects

57
Q

What are the 4 EPS?

A
  1. parkinsonism
  2. Akathisia
  3. acute dystonia
  4. Tardive dyskinesia
58
Q

What is Neuroleptic Malignant syndrome (NMS)?

A

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
Q

How would you manage NMS?

A

stop antipsychotic and supportive measures - IV fluids

60
Q

What are side effects for atypical antipsychotic?

A

weight gain
metabolic - hyperprolactinemia, lipid/glucose levels

clozapine - Agranulocytosis/neutropenia and ECG changes due to myocarditis

61
Q

What risks are associated with antipsychotic use

A

Stroke and VTE

62
Q

Intrusive thoughts - flashbacks or nightmares, time
being in a daze/dissociated
negative mood
avoidance
arousal - hypervigilant or disturbed sleep

4 weeks or less

A

Acute reaction to stress

63
Q

How is acute reaction to stress managed?

A

first-line trauma-focused CBT

Benzodiazepines - if agitated, sleep disturbance

64
Q

What are the 5 stages of uncomplicated bereavement/Grief?

A
  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
Q

Inattention - wandering off task, lacking persistence, difficulty focusing/organising

hyperactivity - excessive motor activity, fidgeting, tapping or talkativeness

impulsivity - hasty action, social intrusiveness

A

ADHD

66
Q

criteria for ADHD

A

features of inattention, hyperactivity and impulsivity - persistent
element of devlopmental delay

16yrs - need 6 features present
17yr+ - need 5 features present

67
Q

Management of ADHD?

A

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
Q

What check/monitoring is required for ADHD medications?

A

cardiotoxic medications - perform a baseline ECG prior to treatment,
refer to cardiologist if significant PMHs/FHx or ambiguity

69
Q

If symptoms of ADHD are mild-moderate what can we also offer parents?

A

useful for parents to attend education and training programmes

70
Q

Describe the 4 main symptoms of PTSD?

A
  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
Q

Management of PTSD?

A

mild symptoms 4weeks - watchful waiting

more severe cases - Trauma-focused CBT or EMDR

Drug treatments
venlafaxine or SSRI (sertraline)
severe cases - risperidone

72
Q

gradual loss of memory (episodic in particular), difficulty with executive function and nominal dysphasia

A

alzheimers dementia

73
Q

assessment tools for Alzheimer’s

A
  1. 10 point cognitive screener - 10CS

2. 6- item cognitive impairment test (6CIT)

74
Q

Management of Alzheimer’s

A

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
Q

What can we do for Alzheimer’s pts in primary care

A

Blood-screen - exclude any reversible causes for cognitive decline.

76
Q

Generalised anxiety disorder characterised by

A

disproportionate, pervasive and uncontrollable and widespread worry

Range of somatic, cognitive and behavioural symptoms

77
Q

DSM-5 diagnostic criteria for GAD?

A
  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
Q

ICD-10 diagnostic criteria?

A

generalised and persistent anxiety

variable dominant symptoms

expressions of fear - illness or accidents

79
Q

What medications cause anxiety as a side effect?

A 
salbutamol 
corticosteroids
beta-blockers
theophylline 
some antidepressants 
herbal medications
80
Q

Physical signs of anxiety?

A

increased HR and SOB
trembling
exaggerated startle response

81
Q

How to interpret GAD-7 questionnaire

A

5 -10 = mild anxiety disorder
10 - 15 = moderate anxiety disorder
15+ = severe anxiety

82
Q

Management approach for GAD?

A
  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
Q

Drug treatment for GAD?

A

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
Q

Side effects of SSRIs?

A

Gi symptoms - increased risk of GI bleed - PPI co-prescription

Hyponatremia

increased/worsened symptoms after initiaion

85
Q

stopping SSRIs?

A

continue for 6months after remission of symptoms

when cessating - down titrate gradually over a 4 week period

86
Q

Citalopram associated risk?

A

prolongation of QT interval

be cautious in hepatic impairment - longer time taken to excrete

87
Q

What is panic disorder?

A

recurrent eps of sudden onset anxiety

absence of multi-themed worry

88
Q

How do panic attacks usually present?

A 
shaking 
SOB 
palpitations/sometimes CP
nausea 
hot/cold flushes 
dizziness 
fear of dying
89
Q

How is panic disorder managed?

A

CBT or Drug Tx

  • SSRI (sertraline) first line
  • if ineffective after 12/52 of SSRI offer TCA (imipramine or clomipramine)
90
Q

What to do if panic disorder is not being responsive to primary care?

A

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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