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
What is a panic disorder
When have sudden attacks of fear/panic that something bad will happen
What is management of a panic disorder
Step 1: recognising and diagnosis
Step 2: treat in primary care
Step 3: review and consider other treatments
Step 4: refer to specialist mental health services
Step 5: Care in mental helath services
In primary care
CBT and SSRI
If no response then use imipramine or clomipramine
How are panic disorders diagnosed
Recurrent panic attacks
With either persistent worry or change in behaviour
Not better explained by another anxiety disorder of substance use
When should you use benzos in GAD
Never unless in instance of crisis
What is agoraphobia
A fear of and wanting to leave a situation/space such as an enclosed or public space
What is an adjustment disorder
An excessive reaction to a life event or psychological stressor
What is it when have fear of scrutiny from others or embarassing self
Social phobia
What is used to treat benzo overdose
Flumenazil
What is flumenazil
A GABA antagonist
How do benzo overdoses present
Drowsy
Ataxia
Dysarthria
Nystagmus
Resp depression
Bradycardia
Once tranquilise somone what need to do
Monitor closely for signs of benzo overdose
Have flumenazil at ready
Tinnitus, tremor, sweating and hyperarousal, what drug are being withdrawn from
Benzos
Management of short term insomnia
Assess if daytime dysfunction
If no
- sleep hygiene measures
If yes or sleep hygiene fails
- then assess if insomnia is due to a short term stressor so will resolve quickly
If yes can consider Z-drug
If no CBT-I with perhaps Z-drug or modified release melatonin if over 55
What is management of chronic insomnia
First line CBT-I
If symptoms extremely severe or acute exacerbation use Z-drug
If over 55 consider modified release melatonin
What hypnotic can be considered in patients aged over 55
Melatonin for 3 weeks but if works consider further 10 weeks
What tool is used to screen for social phobia
SPIN
Social phobia inventory
What is it called when patient disappears for a period with no memory and end up in a different area
Dissociative fugue
Difference between a pain disorder and somatisation
Pain disorder- 1 symptoms
Somatisation- constellation of sx
What is only time EMDR is not appropriate in PTSD
Combat related trauma
What is it called when start repeating actions of a dead person
Identification
Is a defense mechanism
How are benzos withdrawn
Reduce by 2.5mg every 2 weeks
What is important thing to ask before prescribing benzos
Alcohol dependance as can synergise to cause resp depression
What is fear of pain
Algophobia
What is fear of heights
Acrophobia
What is fear of marriage/commitment
Gamophobia
What is difference between emotional and problem focused management of coping
Emotional- managing the meotions
Problem- managing a stress by identifying the causes of it and dealing with those
Management of low libido
Rule out physical cause
Refer for psychosexual counselling
Causes of erectile dysfunction
Anxiety
Hypthyroidism
Hyperprolactinaemia
Post TURP
Alcohol
DM
Cholesterol
What suggests psych cause of erectile dysfunction as opposed to organic
Morning erection is maintained in psych but not in organic
Criteria for adjustment disorder
- identifiable stressor
- symptoms within 3 months of stressor
- last less than 6 months
- does not meet criteria for other disorders
What is flooding
When expose patinet directly to their phobia as soon as possible
What is neurosis
Inappropriate behaviour or emotional response to every day stimulus
What is management of phobias (social, agoraphobia, simple phobias)
CBT with exposure therapy to desensitise people
Create hierarchy of exposures and work through to highest part
What is habituation
Where exposure to stimuli over time reduces anxiety to the stimuli
Difference between adjustment disorder versus acute stress reaction
Adjustment disorder- reaction to psychosocial stressor such as losing job, breakup
Acute stress reaction is traumatic experience
Management of adjustment disorder
Group therapy
Crisis counselling
Management of dissociative disorder
Psychotherapy
DBT
What is the questionnaire for OCD
Yale and Brown
Drugs which cause low libido
Anti-histamines
Blood pressure
Anti-epileptics
SSRI
Main problem of Z drugs in elderly
Falls
What is depersonalisation
Feeling of being outside of oneself
What is derealisation
Where feel world around isnt real
Whar are depersonalisation and derealisation seen in
Acute stress reaction and PTSD
What does modelling refer to
When during social learning someone may develop a phobia after watching their mother do it
What does conditioning refer to
Form of learning where a stimulus becomes increasingly effective in evoking a response
Difference in prognosis of phobia starting in childhood and one which started in adulthood after life event
Starting in childhood have poor prognosis
Who is agoraphobia seen in
Married young women who are unempolyed or hourse wives
If person has social phobia what consider as other diagnosis
If long term- anxious personality disorder
Can you use benzos for phobias and panic disorders
NO not recommended
Management options used for panic disorder
CBT/relaxation techniques
Can use SSRI/venlafaxine
Investigating initial panic disorder
Rule out organic causes
- thyroid
- alcohol screen
- ECG
What are 3 clusters of symptoms for PTSD
Hyperarousal
Avoidance
Reliving experience
What is technique used in psychotherapy for dissociative disorders
Abreaction
What is abreaction
Encourage person to relive experience to help repressed memories return
Management of somatisation
CBT/psychodynamic therapy
Medication for mood disorder or pain
Make sure always seen by same physician
How is hypochondrial disorder managed
CBT/psychodynamic therapy
Medication for mood disorder or pain
Make sure always seen by same physician
Features of a prolonged grief reaction
Persistent over 6 months
Preoccupation with the deceased
Clearly exceeds expected religious/cultural response
Pervasive- causes impairment in other aspects of life
What is shoulds thinking
Thinking error where use should in critical manner
What is all or nothing
Where think very black or white
“My alarm didnt go off, I’ll cancel the meeting”
What is mind reading
Make conclusions about what others think
“Everyone thinks im boring”
What is filtering
ONly paying attention to your failures not positives
What is disqualifying the positive
Where something positive hapens but convince self it is bad
What are functional symptoms
Complex issues people experience without a clear structural or physiological cause
Main aims for dealing with functional symptoms
Make sure patient knows you understand symptom and taken seriously
Patient has a reassuing explanation
Understands factors which contributed
Know that symptoms can resolve
What is SSRI for agoraphobia
Sertraline
If sertraline fails for agoraphobia, what use
Venlafaxine
If SSRI or SNRI CI in agoraphobia what use
Pregabalin
What is an orgasmic disorder
Where cant climax
What is sexual side effect of trazodone and chlorpromazine
Priapism- anti histamines have this effect
What is frotteurism
Where rub genitals againsts someone
What is it when binge eat and then period of long sleep
Kleine-levin syndrome
Which SSRI for PTSD
Sertraline
Paroxetine
Which NT most associated with anxiety
Low levels of GABA
