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Neurosis Flashcards

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1
Q

What is an acute stress disorder

A

Acute stress reaction that occurs within 4 weeks of an incident

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2
Q

Presentation of acute stress disorder

A

Intrusive thoughts- nightmares, flashbacks
Negative mood
Avoidance of trigger
Hypervigilance
Dissociation

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3
Q

Features of hyperarousal

A

Sleep disturbance
Hypervigilance- on edge looking for potential threats

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4
Q

What are features of dissociation

A

Being in a daze
Time slowing

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5
Q

First line for acute stress disorder

A

If very mild can use waitful watching
Trauma focused CBT

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6
Q

When use benzodiazepines in acute stress disorder

A

For acute symptoms like agitation and sleep disturbance
Use with caution

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7
Q

Presentation of PTSD

A

Intrusive thoughts- nightmares, flashbacks
Avoiding circumstances resembling the event
Hyperarousal
Emotional numbing
Turned to alcohol, drugs
Depressed
Anger

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8
Q

Management of PTSD

A

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

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9
Q

How is the severity of GAD determined

A

GAD-7 questionnaire out of 21
Mild- over 5
Moderate- over 10
Severe- over 15

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10
Q

How is GAD diagnosed

A

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

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11
Q

How is GAD managed

A

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

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12
Q

What should do if pregnant woman reaches step 3 of GAD

A

First line CBT
Medication wise discuss the issues associated- pregabalin best option as no documented risks

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13
Q

How long should benzos be prescribed for

A

Max 2-4 weeks

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14
Q

Diagnosis of OCD

A

Either compulsions or obsession or both
- cause marked distress
- take more than hour out of day
- interfere with normal life

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15
Q

How is OCD categorised

A

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

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16
Q

How should mild OCD be managed

A

Either refer for CBT or via IAPT
Exposure and response prevention is used

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17
Q

How should moderate OCD be managed

A

CBT with ERP OR SSRI
1 of them
If unsuccessful after 12 weeks either change SSRI or change to clomipramine

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18
Q

What is alternative to SSRI if is not tolerated in OCD

A

Clomipramine

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19
Q

What should do if severe OCD

A

Refer to secondary care mental health team
Consider in meantime offering CBT with ERP and SSRI/clomipramine

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20
Q

What SSRIs can be used in OCD

A

Escitalopram
Paroxetine
Fluoxetine
Fluovoxamine
Sertraline

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21
Q

How long should SSRI/clomipramine be given for after remission in OCD

A

12 months and then consider

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22
Q

What are 2 types of benzodiazepam

A

Short acting
- lorazepam
- temazepam
Longer acting
- diazepam
- nitrazepam
- chlordiazepoxide

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23
Q

MOA of benzodiazepams

A

Bind to specific benzo receptors on the GABAa receptor complex which hyperpolarises neurones

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24
Q

Side effects of benzos

A

Drowsiness and tiredness
headaches
Slurred speech
Paradoxical effects including talkativeness and excitement
Dependance

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25
Q

Withdrawal symptoms of benzos

A

Insomnia
Anxiety
Loss of appetite
Tremor
Weight loss
Sweating
Tinnitus

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26
Q

Risk factors for GAD

A

Aged 30-55
Living alone
Divorced
Being a lone parent

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27
Q

What is conversion disorder

A

Where psychological stress is mainfested as physical neurological symptoms- like loss of motor or sensory function

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28
Q

How do people view their conversion disorder

A

It is not factitious nor malingering

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29
Q

What is post concussion syndrome

A

When hit head can get symptoms of headache, fatigue, dizziness and anxiety depression for a few weeks following the event

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30
Q

What are the Z drugs

A

Zoplicone
Zolpidem
Zalepon

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31
Q

How long should Z drugs be given for

A

Up to 4 weeks

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32
Q

Side effects of Z drugs

A

GI
Headache
Memory problems
Dependance
High risk of falls

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33
Q

What are unexplained symptoms

A

Psychiatric terms for patients who have symptoms with no organic cause

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34
Q

What is somatisation disorder

A

Where mental problem can manifest as frequent and negative physical symptoms which must exist for at least 2 years

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35
Q

What is illness anxiety disorder (hypochondriasis)

A

Persistent belief in the presence of an underlying disease
Refuse to accept reassurance or negative test result

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36
Q

What is factitious disorder (munchausen syndrome)

A

Intentional production of physical or psychological to appear sick

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37
Q

What is malingering

A

Fraudulent simulation or exaggeation for financial or other gain

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38
Q

What is dissociative disorder

A

Where separate off from certain memories
Struggle with identity and can even forget certain things which happened to you

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39
Q

What is diagnosis if develop compulsions after a traumatic ordeal

A

Although are showing signs of OCD
Diagnosis is PTSD

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40
Q

What do if someone from the military comes in with PTSD symptoms

A

Refer to specialist service within the military

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41
Q

How is chronic insomnia defined

A

Trouble falling asleep or staying asleep at least 3 nights a week for 3 months

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42
Q

Risk factors for chronic insomnia

A

Alcohol and substance abuse
Stimulant usage
Corticosteroid use
Poor sleep hygiene
Chronic pain and illnesses
Female
Age increased
Unemployed
Divroced

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43
Q

What drugs can use for insomnia

A

Benzos
- tamazepam
Z-drugs
- zopiclone
- zoplidem
- zalepon

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44
Q

Side effects of sleeping pills

A

Dependance
Daytime sedation
Cogntive impairment
Poor motor coordination

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45
Q

What can be presentation of sleep paralysis

A

When wake up are paralysed in skeletal muscles
Can get hallucinations either auditory or visual

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46
Q

Management of sleep paralysis if needed/very severe

A

Clonazapem

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47
Q

What class of drugs can cause memory loss

A

Benzodiazepams

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48
Q

How to withdraw a benzo

A

Reduce the dose by 1/8th every forntight
Can consider switching to longer term from short term

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49
Q

What is a panic disorder

A

When have sudden attacks of fear/panic that something bad will happen

50
Q

What is management of a panic disorder

A

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

51
Q

How are panic disorders diagnosed

A

Recurrent panic attacks
With either persistent worry or change in behaviour
Not better explained by another anxiety disorder of substance use

52
Q

When should you use benzos in GAD

A

Never unless in instance of crisis

53
Q

What is agoraphobia

A

A fear of and wanting to leave a situation/space such as an enclosed or public space

54
Q

What is an adjustment disorder

A

An excessive reaction to a life event or psychological stressor

55
Q

What is it when have fear of scrutiny from others or embarassing self

A

Social phobia

56
Q

What is used to treat benzo overdose

A

Flumenazil

57
Q

What is flumenazil

A

A GABA antagonist

58
Q

How do benzo overdoses present

A

Drowsy
Ataxia
Dysarthria
Nystagmus
Resp depression
Bradycardia

59
Q

Once tranquilise somone what need to do

A

Monitor closely for signs of benzo overdose
Have flumenazil at ready

60
Q

Tinnitus, tremor, sweating and hyperarousal, what drug are being withdrawn from

A

Benzos

61
Q

Management of short term insomnia

A

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

62
Q

What is management of chronic insomnia

A

First line CBT-I
If symptoms extremely severe or acute exacerbation use Z-drug
If over 55 consider modified release melatonin

63
Q

What hypnotic can be considered in patients aged over 55

A

Melatonin for 3 weeks but if works consider further 10 weeks

64
Q

What tool is used to screen for social phobia

A

SPIN
Social phobia inventory

65
Q

What is it called when patient disappears for a period with no memory and end up in a different area

A

Dissociative fugue

66
Q

Difference between a pain disorder and somatisation

A

Pain disorder- 1 symptoms
Somatisation- constellation of sx

67
Q

What is only time EMDR is not appropriate in PTSD

A

Combat related trauma

68
Q

What is it called when start repeating actions of a dead person

A

Identification
Is a defense mechanism

69
Q

How are benzos withdrawn

A

Reduce by 2.5mg every 2 weeks

70
Q

What is important thing to ask before prescribing benzos

A

Alcohol dependance as can synergise to cause resp depression

71
Q

What is fear of pain

A

Algophobia

72
Q

What is fear of heights

A

Acrophobia

73
Q

What is fear of marriage/commitment

A

Gamophobia

74
Q

What is difference between emotional and problem focused management of coping

A

Emotional- managing the meotions
Problem- managing a stress by identifying the causes of it and dealing with those

75
Q

Management of low libido

A

Rule out physical cause
Refer for psychosexual counselling

76
Q

Causes of erectile dysfunction

A

Anxiety
Hypthyroidism
Hyperprolactinaemia
Post TURP
Alcohol
DM
Cholesterol

77
Q

What suggests psych cause of erectile dysfunction as opposed to organic

A

Morning erection is maintained in psych but not in organic

78
Q

Criteria for adjustment disorder

A
  • identifiable stressor
  • symptoms within 3 months of stressor
  • last less than 6 months
  • does not meet criteria for other disorders
79
Q

What is flooding

A

When expose patinet directly to their phobia as soon as possible

80
Q

What is neurosis

A

Inappropriate behaviour or emotional response to every day stimulus

81
Q

What is management of phobias (social, agoraphobia, simple phobias)

A

CBT with exposure therapy to desensitise people
Create hierarchy of exposures and work through to highest part

82
Q

What is habituation

A

Where exposure to stimuli over time reduces anxiety to the stimuli

83
Q

Difference between adjustment disorder versus acute stress reaction

A

Adjustment disorder- reaction to psychosocial stressor such as losing job, breakup
Acute stress reaction is traumatic experience

84
Q

Management of adjustment disorder

A

Group therapy
Crisis counselling

85
Q

Management of dissociative disorder

A

Psychotherapy
DBT

86
Q

What is the questionnaire for OCD

A

Yale and Brown

87
Q

Drugs which cause low libido

A

Anti-histamines
Blood pressure
Anti-epileptics
SSRI

88
Q

Main problem of Z drugs in elderly

A

Falls

89
Q

What is depersonalisation

A

Feeling of being outside of oneself

90
Q

What is derealisation

A

Where feel world around isnt real

91
Q

Whar are depersonalisation and derealisation seen in

A

Acute stress reaction and PTSD

92
Q

What does modelling refer to

A

When during social learning someone may develop a phobia after watching their mother do it

93
Q

What does conditioning refer to

A

Form of learning where a stimulus becomes increasingly effective in evoking a response

94
Q

Difference in prognosis of phobia starting in childhood and one which started in adulthood after life event

A

Starting in childhood have poor prognosis

95
Q

Who is agoraphobia seen in

A

Married young women who are unempolyed or hourse wives

96
Q

If person has social phobia what consider as other diagnosis

A

If long term- anxious personality disorder

97
Q

Can you use benzos for phobias and panic disorders

A

NO not recommended

98
Q

Management options used for panic disorder

A

CBT/relaxation techniques
Can use SSRI/venlafaxine

99
Q

Investigating initial panic disorder

A

Rule out organic causes
- thyroid
- alcohol screen
- ECG

100
Q

What are 3 clusters of symptoms for PTSD

A

Hyperarousal
Avoidance
Reliving experience

101
Q

What is technique used in psychotherapy for dissociative disorders

A

Abreaction

102
Q

What is abreaction

A

Encourage person to relive experience to help repressed memories return

103
Q

Management of somatisation

A

CBT/psychodynamic therapy
Medication for mood disorder or pain
Make sure always seen by same physician

104
Q

How is hypochondrial disorder managed

A

CBT/psychodynamic therapy
Medication for mood disorder or pain
Make sure always seen by same physician

105
Q

Features of a prolonged grief reaction

A

Persistent over 6 months
Preoccupation with the deceased
Clearly exceeds expected religious/cultural response
Pervasive- causes impairment in other aspects of life

106
Q

What is shoulds thinking

A

Thinking error where use should in critical manner

107
Q

What is all or nothing

A

Where think very black or white
“My alarm didnt go off, I’ll cancel the meeting”

108
Q

What is mind reading

A

Make conclusions about what others think
“Everyone thinks im boring”

109
Q

What is filtering

A

ONly paying attention to your failures not positives

110
Q

What is disqualifying the positive

A

Where something positive hapens but convince self it is bad

111
Q

What are functional symptoms

A

Complex issues people experience without a clear structural or physiological cause

112
Q

Main aims for dealing with functional symptoms

A

Make sure patient knows you understand symptom and taken seriously
Patient has a reassuing explanation
Understands factors which contributed
Know that symptoms can resolve

113
Q

What is SSRI for agoraphobia

A

Sertraline

114
Q

If sertraline fails for agoraphobia, what use

A

Venlafaxine

115
Q

If SSRI or SNRI CI in agoraphobia what use

A

Pregabalin

116
Q

What is an orgasmic disorder

A

Where cant climax

117
Q

What is sexual side effect of trazodone and chlorpromazine

A

Priapism- anti histamines have this effect

118
Q

What is frotteurism

A

Where rub genitals againsts someone

119
Q

What is it when binge eat and then period of long sleep

A

Kleine-levin syndrome

120
Q

Which SSRI for PTSD

A

Sertraline
Paroxetine

121
Q

Which NT most associated with anxiety

A

Low levels of GABA

Psych (Owen) (9 decks)

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