Neurosis Flashcards
What is an acute stress disorder
Acute stress reaction that occurs within 4 weeks of an incident
Presentation of acute stress disorder
Intrusive thoughts- nightmares, flashbacks
Negative mood
Avoidance of trigger
Hypervigilance
Dissociation
Features of hyperarousal
Sleep disturbance
Hypervigilance- on edge looking for potential threats
What are features of dissociation
Being in a daze
Time slowing
First line for acute stress disorder
If very mild can use waitful watching
Trauma focused CBT
When use benzodiazepines in acute stress disorder
For acute symptoms like agitation and sleep disturbance
Use with caution
Presentation of PTSD
Intrusive thoughts- nightmares, flashbacks
Avoiding circumstances resembling the event
Hyperarousal
Emotional numbing
Turned to alcohol, drugs
Depressed
Anger
Management of PTSD
First line- trauma based CBT
Drug treatment not recommended first line but if its use- SNRI or SSRI
In severe cases can use risperidone or eye movement desensitisation
How is the severity of GAD determined
GAD-7 questionnaire out of 21
Mild- over 5
Moderate- over 10
Severe- over 15
How is GAD diagnosed
Excessive anxiety and worrying over at least the last 6 months over various topics
3 of following physical symptoms
- restless
- easily fatigued
- irritability
- muscle tension
- insomina
- can’t concentrate
Not explained by a substance or another mental disorder
How is GAD managed
Step 1- offer a period of active waiting unless functional impairment
Step 2- if symptoms not improved offer low intensity psychological intervention guided by preferances
- individual non-facilitated self-help
- individual guided self help
- psychoeducation groups
Step 3- for marked functional impairment as well as failed past 2 steps
- CBT or applied relaxation
- sertraline, if not tolerated offer SNRI or escitalopram/paroxetine
- if neither SSRI or SNRI not tolerated then pregabalin
Step 4- if severe functional impairment or step 3 refractory, high risk self harm
- refer for specialist
What should do if pregnant woman reaches step 3 of GAD
First line CBT
Medication wise discuss the issues associated- pregabalin best option as no documented risks
How long should benzos be prescribed for
Max 2-4 weeks
Diagnosis of OCD
Either compulsions or obsession or both
- cause marked distress
- take more than hour out of day
- interfere with normal life
How is OCD categorised
Using the Yale Brown Obsessive compulsive scale
Main categorisation is by how long spend each day occupied by thoughts or performing the acts
Mild- less than 1 hour
Moderate- 1-3 hours
Severe- more than 3 hours
How should mild OCD be managed
Either refer for CBT or via IAPT
Exposure and response prevention is used
How should moderate OCD be managed
CBT with ERP OR SSRI
1 of them
If unsuccessful after 12 weeks either change SSRI or change to clomipramine
What is alternative to SSRI if is not tolerated in OCD
Clomipramine
What should do if severe OCD
Refer to secondary care mental health team
Consider in meantime offering CBT with ERP and SSRI/clomipramine
What SSRIs can be used in OCD
Escitalopram
Paroxetine
Fluoxetine
Fluovoxamine
Sertraline
How long should SSRI/clomipramine be given for after remission in OCD
12 months and then consider
What are 2 types of benzodiazepam
Short acting
- lorazepam
- temazepam
Longer acting
- diazepam
- nitrazepam
- chlordiazepoxide
MOA of benzodiazepams
Bind to specific benzo receptors on the GABAa receptor complex which hyperpolarises neurones
Side effects of benzos
Drowsiness and tiredness
headaches
Slurred speech
Paradoxical effects including talkativeness and excitement
Dependance
Withdrawal symptoms of benzos
Insomnia
Anxiety
Loss of appetite
Tremor
Weight loss
Sweating
Tinnitus
Risk factors for GAD
Aged 30-55
Living alone
Divorced
Being a lone parent
What is conversion disorder
Where psychological stress is mainfested as physical neurological symptoms- like loss of motor or sensory function
How do people view their conversion disorder
It is not factitious nor malingering
What is post concussion syndrome
When hit head can get symptoms of headache, fatigue, dizziness and anxiety depression for a few weeks following the event
What are the Z drugs
Zoplicone
Zolpidem
Zalepon
How long should Z drugs be given for
Up to 4 weeks
Side effects of Z drugs
GI
Headache
Memory problems
Dependance
High risk of falls
What are unexplained symptoms
Psychiatric terms for patients who have symptoms with no organic cause
What is somatisation disorder
Where mental problem can manifest as frequent and negative physical symptoms which must exist for at least 2 years
What is illness anxiety disorder (hypochondriasis)
Persistent belief in the presence of an underlying disease
Refuse to accept reassurance or negative test result
What is factitious disorder (munchausen syndrome)
Intentional production of physical or psychological to appear sick
What is malingering
Fraudulent simulation or exaggeation for financial or other gain
What is dissociative disorder
Where separate off from certain memories
Struggle with identity and can even forget certain things which happened to you
What is diagnosis if develop compulsions after a traumatic ordeal
Although are showing signs of OCD
Diagnosis is PTSD
What do if someone from the military comes in with PTSD symptoms
Refer to specialist service within the military
How is chronic insomnia defined
Trouble falling asleep or staying asleep at least 3 nights a week for 3 months
Risk factors for chronic insomnia
Alcohol and substance abuse
Stimulant usage
Corticosteroid use
Poor sleep hygiene
Chronic pain and illnesses
Female
Age increased
Unemployed
Divroced
What drugs can use for insomnia
Benzos
- tamazepam
Z-drugs
- zopiclone
- zoplidem
- zalepon
Side effects of sleeping pills
Dependance
Daytime sedation
Cogntive impairment
Poor motor coordination
What can be presentation of sleep paralysis
When wake up are paralysed in skeletal muscles
Can get hallucinations either auditory or visual
Management of sleep paralysis if needed/very severe
Clonazapem
What class of drugs can cause memory loss
Benzodiazepams
How to withdraw a benzo
Reduce the dose by 1/8th every forntight
Can consider switching to longer term from short term