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Psych - C.U > Mental state examination and psychiatric assessment > Flashcards

Mental state examination and psychiatric assessment Flashcards

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1
Q

A&B - looking for? (9)

A 
Age / ethinicity 
Clothes and accessories 
Self care and hygiene 
Evidence of self harm 
Eye contact 
Posture 
Facial expression 
Psychomotor - retardation / agitation 
Ability to establish a rapport
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2
Q

3 aspects to affect

A

Quality
Range
Intensity

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3
Q

Speech 3 parts

A

Rate, Volume and tone

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4
Q

Thought form 2 parts

A

Speed and flow / coherence

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5
Q

Circumstantial thought form =

A

get to the point but takes a while

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6
Q

Tangential =

A

flight of ideas with little connection

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7
Q

Thought content, what things to look out for? (5)

A 
Delusions / abnormal beliefs 
Obsessions 
Over valued ideas 
Suicidal thoughts 
Homicidal / violent thoughts
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8
Q

Two aspects to abnormal perceptions

A

subjective and objective

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9
Q

types of hallucinations (4)

A

Auditory
Visual
Tactile
Olfactory / gustatory

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10
Q

Risk assessment section

A

Harm to self
Harm to others
Vulnerability

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11
Q

Quantify the risk in 3 ways

A

How iminent?
How likely?
Severity

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12
Q

What to screen for in a psychiatric history?

A
  • low mood
  • elevated mood and increased energy
  • dellusions and hallucinations
  • anxiety
  • obsessions / compulsions
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13
Q

3 important points for PMH?

A

Head injury / surgery
Neuroconditions
Endocrine abnormalities

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14
Q

How long does generalised anxiety have to last for a formal diagnosis?

A

For at least 6m around a range of events / activities

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15
Q

Physical causes to exclude in anxiety

A

Hypertension
Angina
Asthma
Excessive caffeine

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16
Q

How long should benzodiazepines be used in generalised anxiety?

A

2-4 weeks

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17
Q

First line medication in generalised anxiety?

A

SSRIs

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18
Q

3 core symptoms of depression

A

Low mood
Loss of interest / pleasure
Fatiguability

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19
Q

5 biological symptoms of depression

A 
Early morning waking 
Depression worse in the morning 
Marked loss of appetite 
Psychomotor retardation / agitation 
loss of libido
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20
Q

5 cognitive symptoms of depression

A 
Reduced concentration / memory 
Poor self esteem 
Guilt 
Hopelessness
Suicidal thoughts / self harm
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21
Q

Minimum duration of depression for a diagnosis?

A

2 weeks

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22
Q

How many core symptoms needed for a diagnosis of depression?

A

2

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23
Q

ICD - 10 scoring for depressive disorder

A

Mild - 4
Moderate - 5-6
Severe - 7+

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24
Q

7 non core symptoms of depression

A 
Disturbed sleep 
Poor concentration / decisiveness
Low self confidence 
Poor / increased appetite 
Suicidal thoughts / acts 
Agitation or slowing of movement 
Guilt or self blame
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25
Q

diagnosis of a major depressive disorder requires what from a DSM-5

A

5< over a two week period with at least one of

1) depressed mood
2) diminished interest or pleasure

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26
Q

Definition of schizoaffective disorder?

A

Mood symptoms + schizophrenic symptoms in the same episode

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27
Q

Neurological conditions involving depression (2)

A

MS and Parkinsons

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28
Q

3 endocrine conditions that can manifest like depression

A

HypoT
Cushings
Addisons

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29
Q

Infections causing secondary depression (2)

A

HIV and hepatitis

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30
Q

First line for mild depression

A

CBT

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31
Q

First line for moderate to severe depression

A

CBT and SSRIs

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32
Q

5 aspects to psychotic psychopathology

A 
Perception 
Abnormal beliefs 
Thought disorder 
-ve symptoms 
Psychomotor functions
33
Q

A delusion is false because of…

A

False reasoning

34
Q

Neologisms =

A

New words created by the patient

35
Q

8 negative symptoms of schizophrenia

A 
Apathy 
Absent / blunted  
Decrease in speech 
Social withdrawl 
Impaired attention 
Anhedonia 
Sexual problems 
Lethargy
36
Q

Key differentials in psychosis (7)

A 
Schizophrenia/ Schizoaffective 
Secondary to mood disorder 
Secondary to medical conditions 
Secondary to psychoactive substance use 
Delirium / dementia 
Personality disorder 
Neurodevelopmental disorder
37
Q

Medical conditions associated with psychosis

A 
Cerebral neoplasm
Infarcts 
Trauma 
Infection 
Endocrine 
SLE 
HyperT 
HyperCa2+
38
Q

What needs to be ruled out in psychosis?

A

Substance abuse

39
Q

Neuroleptic malignant syndrome characterised by?

A 
Altered mental state 
Increased muscle tone / frank rigidity 
Alterations in autonomic NS 
Hyperthermia 
Hyperactivity
40
Q

How to reverse the effects of neuroleptic malignant syndrome?

A

Use dopamine agonists

41
Q

Levels of the pyramid of differentials for psychiatry

A

1) organic disorders
2) psychotic disorders
3) mood disorders
4) anxiety disorders
5) personality disorders

42
Q

4 L’s of harmful substance abuse

A

Love
Livelihood
Liver
Law

43
Q

3 elements of substance dependence

A

Physiological
Behavioural
Psychological

44
Q

6 signs of dependence syndrome

A 
Strong compulsion to take 
Lack of control 
Physiological withdrawl 
Signs of tolerance 
Neglect of other interests 
Persistance with substance use
45
Q

Units =

A

ABV x Vol

46
Q

Mean time taken for delirium after alcohol withdrawl?

A

48hrs

47
Q

3 characteristics of wernicke’s encephalopathy

A

Delirium, opthalmopelgia and ataxia

48
Q

How to treat wernicke’s encephalopathy

A

Parenteral thiamine

49
Q

CAGE questionnaire

A

Ever thought about cutting down?
Have people ever annoyed you by criticising your drinking?
Have you ever felt guilty about your drinking?
Ever needed an eye opener?

50
Q

3 key parts to the history in suspected personality disorder

A

Source of distress
Co-morbid mental illness
Specific impairment

51
Q

3 types of drugs used in personality disorder

A

SSRIs
Mood stabalisers
Benzodiazepines

52
Q

Preferred psychological therapy

A

Direct behavioural therapy

53
Q

4 types of schizophrenia?

A

Paranoid
Hebephrenic
Catatonic
Residual

54
Q

6 sections to MMSE

A 
Orientation
 Registration 
Attention 
Recall 
Language 
Copying
55
Q

Reversibe causes of confusion (5)

A 
VitB12 / folate deficiency 
TSH 
Calcium 
Cushings 
Addisons
56
Q

Where should someone with suspected dementia be sent?

A

Memory clinic

57
Q

Above what score of the MMSE can cholinesterase inhibitors be used?

A

10

58
Q

3 cholinesterase inhibitors used in dementia

A

Donepezil
Rivastigmine
Galantamine

59
Q

When are NMDA receptor antagonists recommended?

A

1) moderate to severe dementia

2) ACh inhibitors not tolerated

60
Q

example of an NMDA receptor antagonist used in dementia?

A

Memantine

61
Q

Anxiolytic recommended in dementia?

What should be avoided?

A

Trazdone

Benzodiazepine

62
Q

Complete contraindication for those with Lewy body dementia and why?

A

Antipsychotics

  • 50% have catastrophic results
  • precipitates potentially irreversible Parkinsonism
  • impaired consciousness, severe autonomic symptoms
  • 2-3x increase in mortality
63
Q

Average survival from diagnosis in dementia

A

4 yrs

64
Q

3 types of dementia and their examples

A

1) Cortical
- Alzheimers
- Frontotemporal dementia

2) Subcortical dementia
- Parkinsons
- Lewybody
- Huntingtons
- HIV related

3) Mixed
- vascular
- infection induced

65
Q

Early onset dementia defined as

A

Before 65

66
Q

Molecules involved in alzheimers

A

Tau protein and Beta amyloid

67
Q

4 risk factors for alzheimers

A

genetic
vascular
head injury
low educational attainment

68
Q

pathology of vascular dementia

A

death of neurones due to blood flow disruption

69
Q

Symptoms of lewy body dementia a combo of …..

A

Alzheimers and Parkinsons disease

70
Q

secondary prevention of risk factors in vascular dementia (2)

A

stop smoking

aspirin / clopidogrel

71
Q

Section 2 of the MHA =

A

admission for assessment - 28 days

72
Q

Section 3 of MHA =

A

admission for treatment - 6m

73
Q

to put a section 2/3 in place you need 2 doctors one of which needs to be…

A

section 12 approved

74
Q

Section 4 =

A

emergency admission for assessment - 72hrs

no time to wait for a section 2

75
Q

Section 17 =

A

community treatment order

76
Q

Section 17 =

A

community treatment order

pt liable to a section 3 order
supervised treatment in the community
must obey the conditions set on them - or can be recalled into hospital.

77
Q

Presenting back risk

A

Risk to self, others and risk of neglect

short term
medium term
long term

78
Q

Long term risk assessment

A

Biological - drugs / alcohol / medication

Social - their social situation

Psychological - their state of mind and how you can support them

79
Q

how long does lithium take for patients to feel the full benefit?

A

6-12m

Psych - C.U (2 decks)

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