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2. General adult psychiatry > Neurotic disorders > Flashcards

Neurotic disorders Flashcards

1
Q

Percentage of adults in the UK with any kind of neurosis at any one time

A

15%

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2
Q

Percentage of GP consultations which are for anxiety related disorders

A

25%

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3
Q

Mean age of onset for generalised anxiety

A

30

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4
Q

Mean age of onset for panic disorder

A

22-25

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5
Q

Mean age of onset for OCD

A

20

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6
Q

Mean age of onset for social phobia

A

15

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7
Q

Median age of onset for blood-injection-injury phobias

A

5-6

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8
Q

Life time prevalence for blood-injection-injury phobias

A

3.5%

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9
Q

Sex distribution of OCD

A

Boys > girls
Men = women in clinical samples
Women > men in community samples

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10
Q

Point prevalence of OCD among adults

A

1-3%

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11
Q

Point prevalence of OCD among children and teenagers

A

1-2%

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12
Q

Lifetime prevalence of OCD

A

2-3%

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13
Q

Sex with earlier age of onset of OCD symptoms

A

Men

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14
Q

Four broad categories of symptoms in OCD

A

Aggressive, sexual, and religious obsessions with checking compulsions
Symmetry and ordering obsessions and compulsions
Contamination obsessions with cleaning compulsions
Hoarding obsessions and compulsions

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15
Q

Findings in brain imaging of patients with OCD

A

Hypermetabolism of caudate/orbitocingulate region

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16
Q

Infection which can lead to PANDAS

A

Streptococcal infection

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17
Q

Criteria for PANDAS

A

Presence of OCD or a tic disorder
Age of onset between 3 and the start of puberty
Abrupt onset or a disease course with dramatic exacerbations
Onset occurring after Streptococcal infection
Abnormal neurological exam during an exacerbation

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18
Q

First line treatment for mild OCD

A

Self help
Low intensity CBT with exposure response prevention

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19
Q

Second line treatment for mild OCD

A

Higher intensity CBT with exposure response prevention OR
SSRI

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20
Q

First line treatment for moderate OCD

A

SSRIs or CBT with exposure response prevention

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21
Q

First line treatment for severe OCD

A

SSRIs and CBT with exposure response prevention

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22
Q

Second line treatment for severe OCD

A

Alternative SSRI or clomipramine

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23
Q

Percentage of patients who show improvement in OCD symptoms after SSRI treatment

A

60-70%

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24
Q

Four symptom categories seen in PTSD

A

Intrusion
Avoidance
Negative alterations to cognition and mood
Alterations to arousal and reactivity

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25
Q

Point prevalence of PTSD

A

1%

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26
Q

Lifetime prevalence of PTSD among American adults

A

6.8%

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27
Q

Lifetime prevalence of PSTD among American women

A

9.7%

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28
Q

Lifetime prevalence of PSTD among American men

A

3.6%

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29
Q

Percentage of males exposed to traumatic events

A

60%

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30
Q

Percentage of females exposed to traumatic events

A

50%

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31
Q

Type of trauma where men are more likely than women to develop PTSD

A

Rape

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32
Q

Pre-traumatic factors which increase the likelihood of developing PTSD

A

Psychiatric disorder
Female sex
Personality type with an external locus of control
Lower socioeconomic status
Lower educational status
Ethnic minority status
Cluster B personality disorders

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33
Q

Peri-traumatic factors which increase the likelihood of developing PTSD

A

Higher severity of trauma
Perceived threat to life
Peritraumatic dissociation

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34
Q

Post-traumatic factors which increase the likelihood of developing PTSD

A

Perceived lack of support
Subsequent life stress
Physical illness

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35
Q

Protective factors which decrease the likelihood of developing PTSD

A

High IQ
High socioeconomic status
Having an opportunity to grieve for the loss

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36
Q

Length of time of symptoms where watchful waiting should be considered for PTSD

A

Up to four weeks

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37
Q

Interventions for PTSD with symptoms present within three months of the trauma

A

Trauma focussed CBT
Non benzodiazepine hypnotic medication for short term use after four consecutive nights of sleep disturbance
Antidepressant medication

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38
Q

Number of sessions of trauma focussed CBT usually used for PTSD

A

8-12

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39
Q

Number of sessions of trauma focussed CBT usually used if treatment starts within one month of the trauma

A

Five

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40
Q

Interventions used for PTSD where symptoms are present for more than three months after a trauma

A

Trauma focussed CBT
EMDR
Paroxetine, mirtazapine, amitriptyline or phenelzine

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41
Q

Antidepressants which are second line in NICE guidelines for PTSD after psychological therapies

A

Mirtazapine
Paroxetine

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42
Q

Antidepressant which is licensed for females but not males with PTSD in the UK

A

Sertraline

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43
Q

Effectiveness of trauma focussed CBT compared to EMDR for PTSD

A

Likely equal

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44
Q

Psychological intervention which may increase the risk of PTSD after trauma

A

Psychological debriefing

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45
Q

Psychologist who discovered EMDR

A

Shapiro

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46
Q

Percentage of people with PTSD who experience remission after two years

A

50%

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47
Q

Percentage of people with PTSD who have ongoing symptoms after six years

A

33%

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48
Q

Time after stressor when symptoms of an acute stress reaction start

A

Usually within minutes

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49
Q

Time after stressor when symptoms of an acute stress reaction should resolve

A

Within 2-3 days - often within hours

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50
Q

Lifetime prevalence of generalised anxiety disorder

A

5%

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51
Q

Point prevalence of generalised anxiety disorder

A

2-3%

52
Q

MZ concordance of generalised anxiety disorder

A

41%

53
Q

DZ concordance of generalised anxiety disorder

A

4%

54
Q

Number of items in the Hamilton anxiety scale

A

14

55
Q

Score on the Hamilton anxiety scale suggestive of clinical recovery

A

<7

56
Q

SSRIs used for acute treatment of generalised anxiety disorder

A

Escitalopram
Paroxetine
Sertraline

57
Q

TCA used for acute treatment of generalised anxiety disorder

A

Imipramine

58
Q

Medications used for acute treatment of generalised anxiety disorder apart from SSRIs and TCAs

A

Venlafaxine
Duloxetine
Buspirone

59
Q

Medications used for long term treatment of generalised anxiety disorder

A

Paroxetine
Escitalopram
Venlafaxine
Pregabalin

60
Q

Antipsychotics used as adjuncts for generalised anxiety disorder

A

Olanzapine
Risperidone

61
Q

First line medication class for generalised anxiety disorder

A

SSRIs

62
Q

First line psychological treatment for generalised anxiety disorder

A

CBT

63
Q

Herbal treatment which shows most evidence for treatment of generalised anxiety disorder

A

Kava shrub (Piper methysticum)

64
Q

Reason for withdrawal of the kava shrub from the UK market for anxiety treatment

A

Hepatotoxicity

65
Q

Interaction between evening primrose oil and phenothiazides

A

Can cause seizures

66
Q

Point prevalence of social phobia

A

2.8%

67
Q

First line treatments for social phobia

A

SSRIs
CBT

68
Q

Second line medication for social phobia

A

Phenelzine

69
Q

Third line medications for social phobia

A

SSRI + clonazepam combination
Gabapentin
Pregabalin

70
Q

Point prevalence of panic disorder

A

0.9%

71
Q

Lifetime prevalence of panic attacks without panic disorder

A

28%

72
Q

Lifetime prevalence of panic disorder

A

4.7%

73
Q

Mean age of onset of panic attacks

A

22

74
Q

Heritability of panic disorder

A

30-40%

75
Q

First line treatments for panic disorder

A

CBT
SSRIs
Self help

76
Q

Length of time to continue treatment with SSRI for panic disorder to assess efficacy

A

12 weeks

77
Q

SSRI with most evidence for body dysmorphic disorder

A

Fluoxetine

78
Q

Prevalence of somatisation disorder

A

1-2%

79
Q

Percentage of adults with dissociative disorder

A

10%

80
Q

Antidepressants which are licensed for treatment of PTSD

A

Sertraline
Paroxetine

81
Q

Blood tests in patients with PANDAS which indicate prior streptococcal infection

A

ASO
Anti-DNAse B

82
Q

Percentage reduction in YBOCS score which suggests treatment response in OCD

A

35% reduction

83
Q

Length of time before its effects are needed when propranolol should be taken

A

1 hour

84
Q

Male:female ratio for generalised anxiety disorder

A

1:2

85
Q

Male:female ratio for agoraphobia

A

1:3

86
Q

Options for treatment resistant OCD

A

Clomipramine and SSRI combination
Antipsychotic and SSRI combination
Refer to specialist team

87
Q

Subtypes of OCD which have a poor response to both SSRIs and CBT

A

Hoarding rituals
Sexual and religious obsessional thoughts

88
Q

Subtype of OCD which has a higher risk for first degree relatives to be affected

A

Symmetry and ordering rituals

89
Q

Benzodiazepine of choice in severe hepatic impairment

A

Oxazepam

90
Q

Features of adjustment disorder

A

A maladaptive reaction to a psychological stressor
Excessive preoccupation with the stressor
Once the stressor has ended symptoms resolve within 6 months

91
Q

Length of time symptoms of adjustment disorder last once the stressor is removed

A

Up to 6 months

92
Q

Examples of stressors which may cause adjustment disorder

A

Divorce
Buying a house
Loosing a job
A new illness or disability

93
Q

Additional features required for a diagnosis of complex PTSD compared with PTSD

A

Problems with affect regulation
Persistent negative self-beliefs
Persistent difficulties in sustaining relationships

94
Q

First line treatments for PTSD in adults

A

Trauma focused CBT
EMDR
Trauma focused computerised CBT

95
Q

Length of time SSRIs should be continued for in OCD if effective

A

At least 12 months

96
Q

Length of time antidepressants should be continued in panic disorder before a switch is considered

A

12 weeks

97
Q

Most common anxiety disorder in the epidemiological catchment area study

A

Phobia

98
Q

Brain structure implicated in the development of PTSD

A

Amygdala

99
Q

Description of the nature of the traumatic event in PTSD as per ICD 11

A

Extremely threatening or horrific nature

100
Q

Core symptoms which must be present for a diagnosis of PTSD

A

Re-experiencing the event
Deliberate avoidance of reminders of the event
Persistent perception of heightened current threat

101
Q

Medication recommended by NICE for PTSD but which is not licensed

A

Mirtazapine

102
Q

Two main somatoform disorders in ICD 11

A

Bodily distress disorder
Body integrity dysphoria

103
Q

Features of bodily distress disorder

A

Presence of physical symptoms that are distressing
Usually involving multiple body systems
Excessive attention towards the symptoms
No organic pathology found to explain symptoms
Often repeated contact with medical professionals about the symptoms despite reassurances given

104
Q

Features of body integrity dysphoria

A

An intense and persistent desire to become physically disabled
Results in harmful consequences either through physical harm or functional impairment due to the preoccupation
Desire starts by early adolescence

105
Q

Difference between bodily distress disorder and hypochondriasis

A

For bodily distress disorder the main concern is the symptoms, not a diagnosis
For hypochondriasis the main concern is that there is a serious medical diagnosis which is not being found

106
Q

Dissociative disorders seen in ICD 11

A

Dissociative neurological symptom disorder
Dissociative amnesia
Trance disorder
Possession trance disorder
Dissociative identity disorder
Partial dissociative identity disorder
Depersonalisation derealisation disorder
Other specified dissociative disorders

107
Q

Features of dissociative neurological symptom disorder

A

Involuntary disturbance to one or more motor, cognitive, or sensory functions, lasting at least several hours
Not consistent with a recognised medical condition, substance misuse or another psychiatric diagnosis
Results in significant impairment

108
Q

Features of depersonalisation

A

Someone experiences themselves as feeling strange or unreal
They may feel detached from their own body
Can have a sense of emotional numbing
Distressing
Usually acute onset

109
Q

Features of derealisation

A

Someone experiences the world around them as strange or unreal
They may feel detached from their surroundings
Distressing
Usually acute onset

110
Q

Medications used for pathological gambling disorder

A

SSRIs
Naltrexone
Mood stabilisers

111
Q

Medication preferred for pathological gambling where there is comorbid impulse control

A

Naltrexone

112
Q

Syndrome characterised by symptoms of heart disease with no organic cause found

A

Da Costa’s syndrome

113
Q

Length of time medication should be continued in body dysmorphic disorder to prevent relapse

A

12 months

114
Q

Body area most commonly perceived to be abnormal in patients with body dysmorphic disorder

A

Skin

115
Q

Maximum length of time benzodiazepines should be prescribed for anxiety according to the Maudsley guidelines

A

4 weeks

116
Q

Sedatives recommended in hepatic impairment

A

Lorazepam
Oxazepam
Temazapem
Zopiclone

117
Q

First line treatment for long term insomnia

A

CBT-I

118
Q

Longest treatment with z-drugs should be given for insomnia

A

2 weeks

119
Q

First line treatment for simple phobia

A

Graded exposure

120
Q

Examples of non-REM sleep disorders

A

Sleep walking
Sleep terrors
Confusion arousals

121
Q

Examples of REM sleep disorders

A

REM behavioural disorder
Sleep paralysis
Nightmares

122
Q

Most common comorbid condition with hyperchondriasis

A

Generalised anxiety disorder

123
Q

Medication which can be used to augment SSRIs in body dysmorphic disorder

A

Buspirone

124
Q

Common medical comorbidities of panic disorder

A

HTN
Migraine
COPD
IBD

125
Q

Alternative name for PTSD relating to veterans

A

Combat neurosis

126
Q

Common precipitants for transient global amnesia

A

Exertion
Cold
Pain
Emotional stress
Sex

127
Q

Benzodiazepine with the shortest half life

A

Oxazepam

2. General adult psychiatry (9 decks)

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