MH fifth yr Flashcards

Question

Features of bulimia nervosa?

Answer 1

Alkalosis, due to vomiting hydrochloric acid from the stomach Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers Gastro-oesophageal reflux and irritation Calluses on the knuckles where they have been scraped across the teeth. This is called Russell’s sign.

Answer 2

characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.

Answer 3

A planned binge involving “binge foods” Eating very quickly Unrelated to whether they are hungry or not Becoming uncomfortably full Eating in a “dazed state”

Answer 4

people that have been in a severe nutritional deficit for an extended period, when they start to eat again higher risk if they have a BMI below 20 and have had little to eat for the past 5 days metabolism slows during periods of malnutrition. As starved cells start to process glucose, protein and fats again, they use up magnesium , potassium and phosphorus. Leads to: hypomagnesaemia hypokalaemia hypophosphotaemia risk of: cardiac arrhythmias, heart failure, fluid overload Tx: slowly reintroducing food with restricted calories Magnesium, potassium, phosphate and glucose monitoring along with other routine bloods Fluid balance monitoring ECG monitoring may be required in severe cases Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine

Answer 5

Long-term MH problem affecting thinking, perception and affect

Answer 6

Affects 1 in 100 people M=F ages 15-35 earlier in men high incidence in urban areas and among migrants, lower SES

Answer 7

combination of psychological, environmental, biological and genetic factors. emotional life experiences can be trigger physical changes to brain hypothesis - hypoxic brain injury, temporal lobe epilepsy, smoke cannabis while brain still developing = enlarged ventricles, small amounts of grey matter loss, smaller lighter brains Neurotransmitter hypothesis - excessive of dopamine in mesocorticolimbic thought to cause positive Sx, less dopamine in mesocortiyal tracts causing negative Sx - why psychotic Sx are seen in people with Parkinsons overtreated with levodopa Also increase in serotonin activity and decrease in glutamate activity

Answer 8

Paranoid - paranoid delusions and auditory hallucinations Hebephrenic - adolescents and young adults - mood changes, unpredictable behaviour, shallow affect and fragmentary hallucinations, negative Sx develop rapidly Simple - characterised by -ve Sx, no +ve Sx Catatonic - psychomotor Sx - posturing, rigidity, stupor Undifferentiated - don't fit into other subtypes Residual - -ve Sx, +ve Sx burnt out

Answer 9

FHx Malnutrition and viral infections during pregnancy. Also pre-eclampsia and emergency C-section Drug abuse - cannabis, particularly as a teenager. Also, amphetamines, cocaine, LSD Social and environmental - lower SES Stressful life experiences - migrants, abuse as child Ethnicity - Afro-Caribbean

Answer 10

First rank - thought echo, thought insertion/withdrawal, thought broadcasting, 3rd person auditory hallucinations, delusional perception, passivity and somatic passivity Odd behaviour Thought disorder Lack of insight

Answer 11

Blunted affect Apathy Social isolation Poverty of speech Poor self-care

Answer 12

Referred to local CMHT Labs: Baseline bloods - FBC, TFTs, U&Es, LFTs, CRP, fasting glucose Urine culture - rule out UTI causing delirium Urine drug screen - rule out drug intoxication HIV testing Syphilis serology Serum lipids - before starting anti-psychotics CT head - organic neurological cause

Answer 13

1 - first rank Sx or persistent delusion present for at least one month 2 - no other cause for psychosis such as drug intoxication or withdrawal, brain disease, or extensive depressive or manic Sx

Answer 14

Several MDT teams - early intervention team (first psychotic episode), CMHT (day-to-day support/Tx), crisis resolution team (acute psychotic episode) Biopsychosocial model!! Care programme approach - addressing health+social needs, care plan, appointing a key worker, reviewing treatment Voluntary and compulsory hospital admission Antipsychotic medication

Answer 15

D2 (dopamine) receptor antagonists Typical - generalised dopamine receptor - examples = haloperidol, chlorpromazine, depot injection. SE = extra-pyramidal side effects (Parkinsonism, akathisia, dystonia) hyperprolactinaemia metabolic SE (WG, T2DM, hyperlipidaemia, metabolic syndrome) anticholinergic side effects (tachycardia, blurred vision, dry mouth, constipation, urinary retention) Neurological SE - seizures, neuroleptic malignant syndrome) Atypical - more selective dopamine blockage, also block 5-HT2 receptors - less likely to cause EPSEs and hyperprolactinaemia - e.g. olanzapine, risperidone, clozapine, amisulpride, quetiapine - aripirazole is a partial dopamine agonist so less likely to cause EPSEs Clozapine used when both typical and atypical antipsychotics have been ineffective - require regular blood tests to check neutrophil levels as can cause agranulocytosis Single episode - medication for 6-24 months 2nd - 5 years 3rd - lifelong Psychological Tx - CBT, family therapy Social support

Answer 16

Suicide CVD - and pt's with schizophrenia are more likely to smoke Cancer - delayed diagnosis and late presentation Substance abuse Social isolation SE from antipsychotics

Answer 17

hallucinations (e.g. auditory) delusions thought disorganisation alogia: little information conveyed by speech tangentiality: answers diverge from topic clanging word salad: linking real words incoherently → nonsensical content

Answer 18

schizophrenia: the most common psychotic disorder depression (psychotic depression, a subtype more common in elderly patients) bipolar disorder puerperal psychosis brief psychotic disorder: where symptoms last less than a month neurological conditions e.g. Parkinson's disease, Huntington's disease prescribed drugs e.g. corticosteroids certain illicit drugs e.g. cannabis, phencyclidine

Answer 19

strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant

Answer 20

strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant

Answer 21

a delusion which is characterised by a false belief of death

Answer 22

erotomania, it is a delusion about love

Answer 23

The patient believes that their spouse is being unfaithful without any real proof

Answer 24

When symptoms of a delusional belief, transmitted from one individual to another

Answer 25

acute confusional state which is characterised by rapid onset of a global but fluctuating dysfunction of the CNS due to a variety of insults on the brain. people >65 those with diffuse brain disease

Answer 26

P – Pain In – Infection (often a UTI in elderly) C – Constipation H – Hydration M – Medication (drugs) E – Electrolytes (e.g. hyponatraemia) E – Environment

Answer 27

Hypoactive - withdrawn, quiet, sleepy - reduced activities, in a daze Hyperactive - restless, agitated, aggression - strong emotions, fearfulness, hallucinations Mixed - signs of hypo- and hyperactive delirium

Answer 28

Hypoactive - withdrawn, quiet, sleepy - reduced activities, in a daze Hyperactive - restless, agitated, aggression - strong emotions, fearfulness, hallucinations Mixed - signs of hypo- and hyperactive delirium

Answer 29

Anxiety is unpleasant emotional state involving subjective fear, discomfort and physical symptoms Causes autonomic hyperarousal and impairs function F>M 2:1

Answer 30

Idiopathic Hyperthyroidism Heart disease Drugs - salbutamol, SSRIs, caffeine, steroids

Answer 31

long-lasting worry that is not focused on any one object or situation. Symptoms for at least 6 months

Answer 32

Insomnia Subjective worry Increased vigilance Autonomic hyperactivity

Answer 33

GAD-7 - out of 21 – Mild = 6-10 – Moderate = 11-15 – Severe = 16-21

Answer 34

If mild –> Low intensity interventions e.g. individual guided self-help, group therapy If moderate/severe –> CBT or SSRI (sertraline is first-line SSRI) – Be careful in young people as the SSRI increases anxiety initially and can lead to suicidal thoughts – If acutely anxious –> Benzodiazepine (but not for > 4 weeks)

Answer 35

characterised by short episodes of intense anxiety which occur unpredictably

Answer 36

– Brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. – Attacks last a few minutes and patients have “anticipatory fear” of getting attacks

Answer 37

– 1st line is CBT or SSRI – If SSRI not tolerated or no response after 3 months, then offer imipramine or clomipramine

Answer 38

heightened fear of specific stimuli characterised by avoidance

Answer 39

Agoraphobia – fear of crowded situation from which escape is difficult Management – 1st line is CBT or SSRI

Answer 40

– Single isolated phobias (e.g. injection/spiders) Management – 1st line is graded exposure therapy and response prevention

Answer 41

in children fear of being apart from a caregiver

Answer 42

– Persistent fear of social situations due to fears that they will be embarrassed Management – 1st line is CBT –> if unresolving add on an SSRI

Answer 43

characterised by recurrent episodes of altered mood and activity involving up/downswings Peak age of onset is in early 20s and it is equally seen in males and females. – 90% of patients have recurrence of manic or depressive episodes

Answer 44

Depression - low mood, anhedonia, low energy for >2 weeks Mania - elevated or irritable mood: lasting 7 days or more, less sleep, flight of ideas, lack of inhibition, high energy, grandiosity, marked impairment of social functioning, no psychotic symptoms in absence of mood disturbance, no organic factor (Type I) Hypomania - lasts for 4 days, no marked impairment, no psychotic Sx (Type II)

Answer 45

– If patient has symptoms of mania, they need an urgent referral to the community mental health team – For maintenance therapy –> Offer psychological intervention to patients (CBT) and mood stabalising drug – 1st line is Lithium –> 2nd line is Sodium Valproate, Olanzapine or Quetiapine Mania - stops any antidepressants, treat with antipsychotics (1st line = olanzapine, haloperidol, quetiapine, risperidone) Depression - Treat with antipsychotics alone or in combination with SSRI’s, 1st line is Quetiapine, Olanzapine or Lamotrigine or Quetiapine and Fluoxetine

Answer 46

Abnormal thought process and unstable mood Diagnosis is made when person has symptoms of schizophrenia and a depression/bipolar but does not meet the diagnostic criteria for either condition individually Can either be bipolar type (bipolar + schizophrenia) or depressive type (depression + schizophrenia)

Answer 47

– Main criterion is presence of psychotic symptoms for at least two weeks without any mood symptoms – If only experiences psychosis during mood episode –> this is a mood disorder with psychotic symptoms – If psychosis without mood symptoms > 2 weeks –> this is either Schizophrenia or Schizoaffective disorder

Answer 48

Antipsychotics + (mood-stabiliser or anti-depressant) + CBT

Answer 49

Characterised by the presence of obsessions and compulsions which cause distress Associated with parental overprotection and Streptococcal infection in children, Tourette’s syndrome

Answer 50

– Mild = 2 core symptoms + 2 or more other symptoms – Moderate = 2 core symptoms + 4 or more other symptoms – Severe = 3 core symptoms + 5 or more other symptoms Core Symptoms: – Low Mood (often worst in morning) – Anhedonia = loss of interest in activities – Reduced energy (fatigue) Other symptoms: – Less concentration/attention – Increases guilt and unworthiness – Changes in appetite with weight change – Sleep disturbance (early morning waking) – Suicidal ideation – Psychomotor activity changes

Answer 51

family history age: peak onset is between 10-20 years pregnancy/postnatal period history of abuse, bullying, neglect

Answer 52

Presence of obsessions and compulsions >1 hour a day for >2 weeks – Must cause emotional distress or interfere with activities of daily living

Answer 53

– If mild –> 1st line is CBT and exposure and response prevention (ERP) – If moderate/severe –> Combined treatment with CBT with exposure and response prevention (ERP) and SSRI compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response Also clomipramine if SSRI contraindicated If severe - refer to the secondary care mental health team for assessment

Answer 54

> an unwelcome, persistent intrusive thought which is recognised as absurd (egodystonic) – Patients are aware that this is a product of their own mind e.g. doubts, ruminations, believing they are always dirty

Answer 55

a repetitive action that a patient performs with reluctance to neutralise an obsession e.g. hand-washing, checking, arranging objects in a certain way.

Answer 56

GI Sx - bleeding Hyponatraemia increased anxiety and agitation after starting a SSRI fluoxetine and paroxetine have a higher propensity for drug interactions Citalopram - prolonged QT interval Interactions - NSAIDs, warfarin/heparin, aspirin, triptans

Answer 57

difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality despite adequate time and opportunity for sleep and results in impaired daytime functioning. Acute - related to life event, self resolves Chronic - trouble falling asleep or staying asleep at least three nights per week for 3 months or longer Sx - decreased daytime functioning, decreased periods of sleep RFs - female, increased age, low educational attainment, unemployment, economic inactivity, widowed, divorced, separated status, alcohol+substance abuse, stimulant usage, corticosteroids, poor sleep hygiene, chronic pain, chronic illness, psychiatric illness Ix - clinical Hx, sleep diaries, actigraphy, Short term Tx - identify causes, advise not to drive, advise sleep hygiene,ONLY consider use of hypnotics if daytime impairment is severe.

Answer 58

adverse effects e.g. daytime sedation, poor motor coordination, cognitive impairment and related concerns about accidents and injuries. And tolerance to BDZ's short-acting BDZs or non-benzodiazepines (zopiclone, zolpidem and zaleplon). It is important to review after 2 weeks and consider referral for cognitive behavioural therapy (CBT).