Miscellaneous Conditions in Psychiatry Flashcards
What are the 2 main types of eating disorder?
Anorexia nervosa
Bulimia nervosa
List some physical symptoms which may be seen in anorexia
Yellow and dry skin Emaciation Fine lanugo hair on face and trunk Bradycardia Hypotension Anaemia Leucopenia Hypokalaemia, alkalosis Pitted teeth Parotid swelling Scarring of dorsum of hand (Russell’s sign) Ankle oedema due to low plasma proteins Slow to relax tendon reflexes Osteopenia
What is the diagnostic criteria for bulimia nervosa?
- Persistent preoccupation with eating
- Pathological ‘fear of fatness’
- Periods of significant overeating (binges)
- Behaviour to avoid weight gain e.g. purging, vomiting, laxative abuse, periods of starvation
- Irresistible cravings for food
What are the ‘SCOFF’ questions?
Used as a screening tool for eating disorders:
- Do you ever make yourself SICK from feeling too full?
- Do you worry you have lost CONTROL over your eating habits?
- Have you lost more than ONE stone within 3 months?
- Do you feel you are FAT when others call you ‘too thin’?
- Do you feel that FOOD controls your life?
When are woman at highest risk of developing a perinatal psychiatric illness?
In the first month after childbirth
Give 5 types of anxiety disorders
Generalised anxiety disorder Obsessive compulsive disorder Panic disorder Phobias Post Traumatic Stress Disorder
What is the treatment for generalised anxiety disorder?
1st line = CBT and SSRIs
Also recommended = Benzodiazepines for short-term use in acute anxiety, beta-blockers for autonomic dysfunction (tachycardia)
What is panic disorder?
A disorder characterised by unpredictable episodes of severe anxiety and pronounced autonomic symptoms which are unrelated to a particular stimulus. For diagnosis, the person must have experienced at least 3 panic attacks within a 3 week period.
What is the treatment for panic disorder?
CBT
SSRIs
What is agoraphobia?
Fear of places or situations which might be difficult to escape from or which might be embarrassing e.g. crowds, public places
What is social phobia?
Fear of being in social situations which are unfamiliar to the patient as they fear embarrassment and are concerned others will scrutinise them
What is an ‘obsession’?
An intrusive, unwanted, invasive, recurrent thoughts, images or urges. The person recognises these as being unwanted and generally tries to resist them.
What is a ‘compulsion’?
Repetitive, purposeful act (physical or mental) which the person will perform in response to an obsession. This is usually to neutralise the feared consequence of the obsession. Checking and cleaning rituals are the most common.
What is the treatment for OCD?
CBT (then SSRIs)
What are the 4 ‘subtypes’ of OCD?
- Obsessions and compulsions related to cleaning
- Checking compulsions associated with an obsession with potential harm
- Hoarding
- Obsession without associated compulsive acts
What are the ‘cluster A’ personality disorders?
[Odd / Eccentric class]
Schizoid
Schizotypal
Paranoid
What are the ‘cluster B’ personality disorders?
[Flamboyant / Dramatic class] Borderline / Emotionally unstable Antisocial / Dissocial Histrionic Narcissistic
What are the ‘cluster C’ personality disorders?
[Fearful / Anxious class]
Anxious / Avoidant
Dependent
Anankastic / Obsessive Compulsive
What is persistent somatoform pain disorder?
Persistent, severe, distressing pain which is not fully explained by a physical process or disorder. The pain associated with emotional conflict or psychosocial problems and there may be an existing physical condition.
What is hypochondriasis?
Persistent preoccupation (over-valued ideas, not delusions) with the possibility of a serious disorder, despite repeated evidence that this is not the case. The patient will often undergo lots of investigation. Symptoms are often an elaboration of normal sensation / appearance
What is body dysmorphic disorder?
Preoccupation with an imagined defect in appearance, or excessive concern over a slight physical abnormality.
What is factitious disorder?
The conscious feigning of symptoms and signs of disease to deceive doctors. May involve self-harm (with injury or poisoning).
What is Munchausen’s Syndrome?
An extreme form of factitious disorder. The person usually presents as an emergency with a completely made up history (and often false name) with the aim of getting an intervention e.g. major surgery.
What is ‘Fabricated or Induced Illness’ also known as?
Munchausen’s by proxy
What is fabricated or induced illness (Munchausen’s by proxy)?
A type of factitious disorder where a carer fabricates symptoms about a child or vulnerable adult, resulting in the child having a number of medical investigations. It is a form of child abuse.
What are the 4 types of ‘Somatoform Disorder’?
Somatisation disorder
Persistent somatoform pain disorder
Body dysmorphic disorder
Hypochondriasis
When is a woman most at risk of developing a mental health condition in the perinatal period?
In the first month after the birth
List some risk factors for post partum psychosis
History of bipolar disorder Family history of PPP Previous episode of PPP Discontinuation of mood stabilisers during pregnancy Obstetric complications Primiparity
What are the key principles of treatment for post partum psychosis?
- Admit to mother and baby unit as separation makes situation much worse
- Mood stabilising medication
What is the most common psychiatric disorder of the perinatal period?
Post partum depression
What is the treatment for postpartum depression?
Same as the treatment of depression at any other period
Give some features of schizoid personality disorder
Social withdrawal Limited range of emotional expression Lack of interest in friends / relationships Preoccupied with fantasy Emotionally cold Few (if any) activities provide pleasure Indifference to praise or criticism
Give some features of schizotypal personality disorder
Socially anxious Peculiar ideas, perceptions etc. Superstitious Preoccupied with fantasy Interpersonal discomfort - few friends
Give some features of paranoid personality disorder
Distrustful and suspicious
Tendency to misconstrue other’s behaviours as hostile
Suspicious of spousal sexual infidelity
Excessive sensitivity to criticism
Give some features of antisocial personality disorder
Callous unconcern for feelings of others Irresponsible attitude Impulsivity Disregard for safety Incapacity to maintain enduring relationships, although no difficulty in forming them Lack of guilt - places blame on others
Give some features of borderline personality disorder
Multiple, intense, unstable relationships
Emotional crises
Self-harm and suicide attempts
Emotionally unstable
Lack of impulse control - spending, reckless driving etc.
Fear of abandonment
What is the treatment for borderline personality disorder?
Psychotherapies, especially dialectical behaviour therapy and CBT
Give some features of histrionic personality disorder
Grandiose, vain Attention seeking Shallow, labile affect Crushes and fads Excessive concern over physical attractiveness
Give some features of narcissistic personality disorder
Grandiose sense of self importance Excessive need for attention Rarely acknowledges mistakes Sense of entitlement Exploitative - takes advantage of others Arrogant Lack of empathy
Give some features of anxious / avoidant personality disorder
Avoidance of social interaction due to fear of being rejected / criticised
Preoccupation with being criticised
Belief they are socially inadequate
Give some features of dependent personality disorder
Need for others to make decisions for them
Unable to make even reasonable demands on others
Lack of expressing disagreement for fear of losing support
Need for close relationships
Limited ability to make everyday decisions
Need for excessive reassurance
Give some features of anankastic personality disorder
Excessive preoccupation with lists, order, organisation, schedule
Insistence that others come round to their way of doing things
Inflexible, stubborn
Lack of humour
Perfectionism which interferes with tasks
What is the 1st line choice of drug for rapid tranquillisation?
Lorazepam PO (or IM)
Consider anti-psychotic as well e.g. haloperidol
What is the difference between somatisation and ‘medically unexplained symptoms’?
Both involve a patient presenting with symptoms for which no underlying physical cause can be found. However, in somatisation there is an underlying psychological distress.
What is hypochondriasis?
Persistano preoccupation with the possibility of having a serious medical disease / disorder e.g. cancer, despite repeated evidence that this is not the case. Lots of investigations carried out. Symptoms are often an elaboration of normal stimulus.
What is body dysmorphic disorder?
Preoccupation with an imagined physical defect in appearance, or an exaggeration and excessive concern over a slightly physical abnormality.
What is factitious disorder?
Conscious feigning of symptoms to deceive doctors. Might involve self-harm e.g. poisoning or injury. The patient is aware of the deception but has little insight into their motive, which is usually to stay in the ‘sick role’.
What is the difference between Munchausen’s syndrome and factitious disorder?
They are similar, but Munchausen’s is much more severe. It usually presents as an emergency and the patient may entirely fabricate a story. The aim here is to receive an intervention.
What is Munchausen’s by proxy?
Similar to factitious disorder, but this time the carer feigns symptoms in a child or vulnerable adult. It is a type of child abuse and will result in the child having several investigations and procedures which might result in serious consequences and even death.
What is malingering?
Fabricating of illness with a known intent e.g. money, drugs, compensation
How are psychosexual disorders classified?
Disorder of sexual function
Disorder of sexual preference
Disorder of sexual identity
What is the prevalence of generalised anxiety disorder?
About 4%
List some symptoms of post-traumatic stress disorder
Persistent, intrusive re-experiencing e.g. flashbacks, nightmares
Avoidance of associations e.g. location of the accident, conversations surrounding the topic
Hyperarousal
Numbing, detachment from others
Loss of pleasure in activities
What is the treatment for post-traumatic stress disorder?
CBT
Self-help
Eye movement desensitisation and reprocessing therapy
Anti-depressants
What is the diagnostic criteria for OCD?
Obsessions or compulsions should be present on most days of the week for at least 2 weeks
Which tool helps to diagnose post partum depression?
Edinburgh postnatal depression scale
