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4th Year Psychiatry > Other Psych Topics > Flashcards

Other Psych Topics Flashcards

1
Q

What is supportive therapy?

A

Explanation and reassurance

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2
Q

What is counselling?

A

Can be more problem focused, aims to resolve current life difficulties

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3
Q

What is DBT?

A

Form of CBT developed specifically for people with PDs

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4
Q

What is IPT?

A

Interpersonal therapy - addresses relationships

Depression and bulimia

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5
Q

What is psychodynamic psychotherapy?

A

Brings unconscious feelings to surface - problems rooted in childhood experinces

Relationship in therapy mirrors that of patient with people in real life = transference

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6
Q

What is CBT?

A

Talking therapy - structured, practical and understandable.
Involves problem solving and goal definition.

Based on the cognitive model.

Based in the here and now and is based on scientific evidence.

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7
Q

What is the cognitive model?

A

Not the situation that causes problems but the way we appraise it.

How we think about something affects mood, physiology and behaviour - all interlinked.

Early experiences –> core beliefs –> rules for living –> thoughts/beliefs –> behaviours –> emotions –> situations

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8
Q

What does CBT involve?

A 
Problem definition
Goal formulation
Formulation
Homework
Feedback
Collaboration
Experiments
Monitoring
Summarising
Being active
Thought challenging
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9
Q

Name some unhelpful thinking styles?

A 
Jumping to conclusions
Catastrophisation
All or nothing thinking
Overgeneralisation
Labelling
Personalisation
Magnification and Minimisation
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10
Q

How does CBT apply to patients?

A

Helps identify a problem they wantto work on
Define problem in terms of thoughts, feelings, behaviours and body responses
Practical goal setting
Formulation

Look at how they can make changes in their lives

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11
Q

What can changes in CBT involve?

A

Identifying problematic thought patterns
Identifying problematic behaviours and learning to behave differently
Behavioural experiments
Stop being critical of oneself
Learning that thoughts are just strings of words with no factual basis

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12
Q

Conditions for detention under MHA?

A

o Must be suffering from mental disorder
o Must be at risk to self/others or serious exploitation
o Must be unwilling to go to hospital voluntarily
o Alternatives must have been considered
o Recommendation by 2 doctors to the applicant (AMHP)

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13
Q

Conditions of MCA?

A

o Weigh up the information
o Retain
o Understand
o Communicate

Time and decision specific
All persons assumed to have capacity
Practicable steps must be taken to help them make a decision
Any action taken on behalf of person lacking capacity must be in patient’s best interests

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14
Q

What do you need to consider when making best interests decisions?

A
  • Consider persons past/present/future wishes
  • Beliefs and values
  • Views of anyone named by person
  • Anyone engaged in caring for the person
  • Lasting power of attorney
  • Deputy appointed by the court
  • IMCA
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15
Q

Section 2 MHA?

A

Admission for assessment

AMHP + 2 registered doctors* (1 must be section 12 approved)
Maximum 28 days
Appeal within 14 days

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16
Q

Section 3 MHA?

A

Admission for treatment

AMHP + 2 registered doctors*
Maximum 6months
After 3months must obtain consent or recommendation of second doctor
Renewable – can detain people for life but must renew 6monthly
Appeal within first 6months on 2 occasions, then yearly then mandatory appeal every 3yr

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17
Q

Section 4 MHA?

A

Admission for assessment in cases of emergency

AMHP + 1 registered doctor
Can detain but not treat for up to 72hr

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18
Q

Section 5 MHA?

A

Detention of patients already in hospital

5(2): holding power so that MHA assessment can be carried out lasts 72hrs

5(4): registered mental health nurse for maximum 6hrs

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19
Q

Section 7 MHA?

A

Guardianship

Can require patient to
- live in a specified place
- attend specified places for training or medical assessment
- health worker can see them in their home
Doesn’t include treatment

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20
Q

Section 17 MHA?

A

Supervised community treatment order (CTO)

Aim to support patients detained on S3 and are likely to disengage from treatment on discharge
Ability to recall them to hospital if don’t meet agreed conditions

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21
Q

Section 135 MHA?

A

Warrant to search for and remove patients

Remove them to place of safety if concerns of neglect or issues of safety
Valid for 72hours

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22
Q

Section 136 MHA?

A

Mentally disordered persons found in public place

Police officers discretion
Valid for 72hours

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23
Q

Features of alcohol withdrawal?

A
  1. Compulsion to drink
  2. Primacy of drinking over other activities
  3. Stereotyped pattern of drinking (narrowing of repertoire)
  4. Increased tolerance to alcohol
  5. Repeated withdrawal symptoms
  6. Relief drinking to avoid withdrawal symptoms
  7. Reinstatement after abstinence
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24
Q

Biological consequences of alcohol dependence?

A

• Acute withdrawal symptoms
o Agitation, tremor, sweating, nausea, retching.
• Liver disease/pancreatitis
• Vitamin deficiency/Wernicke’s encephalopathy

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25
Q

Psychological consequences of alcohol dependence?

A

Anxiety

Depression

Memory problems (alcoholic dementia/Wernicke’s/Korsakoff’s)

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26
Q

Social consequences of alcohol dependence?

A
  • Financial problems
  • Housing
  • Family/relationships
  • Work
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27
Q

Forensic consequences of alcohol dependence?

A
  • Drink driving
  • Drunk-related offences
  • Other substance misuse
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28
Q

Risk in alcohol dependence?

A
  • Self-harm/suicide
  • Risk to others
  • Safeguarding – children!
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29
Q

Short term biological management of alcohol dependence?

A
  1. Oral thiamine + vitamin B
  2. Parenteral vitamins if concerned about Wernicke’s
  3. Detox with chlordiazepoxide 20-30mg QDS, reducing regime over 5-7 days – use lorazepam if significant liver disease.
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30
Q

Short term psychological management of alcohol dependence?

A
  1. Simple counselling and advice

2. Motivational interviewing (esp if in contemplation phase)

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31
Q

Short term social management of alcohol dependence?

A

• Support to access services – housing, citizens advice bureau etc.

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32
Q

Long-term biological management of alcohol dependence?

A
  1. Disulferam 200mg OD – aversive agent, blocks alcohol dehydrogenase enzyme – will vomit if ingest alcohol – 6 months to 1 year.
  2. Anti-craving agents
    o Acamprosate 666mg TDS – enhances GABA neurotansmission
    o Naltrexone 50mg OD – opitate antagonist
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33
Q

Long-term psychological management of alcohol dependence?

A

• Relapse prevention strategies

o CBT
o Social network and behavioural therapy  remove from social drinking, have a contact to call when cravings are severe.

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34
Q

Long-term social management of alcohol dependence?

A
  • Alcoholics anonymous

* Rehabilitation

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35
Q

What is a dissociative/conversiond disorder?

A

Traumatic event results in a disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment

36
Q

What is a dissociative amnesia?

A

Loss of memory commonly for a traumatic or stressful event

37
Q

What is a dissociative fugue?

A

Memory loss or confusion about personal identity or assumption of another identity

May last several months

When it ends the memory of the fugue is lost

38
Q

What is a dissociative stupor?

A

Motionless and mute, no response to stimulation

39
Q

What is a dissociative motor disorder?

A

Commonly involve paralysis of muscle groups

Atasia abasia: inability to stand or walk

40
Q

What is dissociative anaesthesia/sensory loss?

A

Commonly glove and stocking distribution

41
Q

What are dissociative convulsions?

A

Psuedoseizures with no organic basis

42
Q

What is Ganser’s syndrome?

A

Approximate answers (2+2=5), absurd statements, confusion, hallucintions, psychogenic Sx

Shows that they know what the question means but are answering incorrectly

43
Q

What is a somatoform disorder?

A

Physical symptoms which cannot be accounted for by a physical disorder or other psychiatric disorder and are thought to result from psychological factors

44
Q

What is a somatisation disorder?

A

Long history of multiple and severe physical symptoms that cannot be accounted for by a physical or psychiatric disorder

F > M

Briquet’s syndrome, St louis hysteria

45
Q

What is hypochondria disorder?

A

Fear or belief of having a serious physical disorder despite medical reassurance to the contrary

Includes body dysmorphic disorder

RF: male, medical students

46
Q

What is persistent somatoform pain disorder?

A

Chronic pain that cannot be accounted for by a physical disorder or other psychiatric disorder

47
Q

What is factitious disorder

A

Sx which are manufactured or exaggerated for the purpose of assuming the sick role

Munchausen Syndrome

48
Q

What is malingering?

A

Sx which are manufactured or exaggerated for a purpose other than assuming the sick role e.g. to evade to police, get compensation

49
Q

Features of lithium toxicity?

A 
Severe N+V
Severe diarrhoea
Reduced appetite
Fine tremor
Ataxia
Dysarthria 
Blurred vision 
Drowsy 
Confused 
Seizures
Collapse
50
Q

What can lithium toxicity be precipitated by?

A

Drugs: ACEi, NSAIDS, diuretics
Renal failure
UTI
Dehydration

51
Q

Investigations in lithium toxicity?

A

Lithium levels >1.5

Check renal function
U+E, eGFR and creatinine

52
Q

Management of lithium toxicity?

A

STOP LITHIUM
Fluid replacement to promote diuresis
Consider dialysis
Treat the cause

53
Q

Features of serotonin syndrome?

A 
Hyperthermia
Autonomic dysfunction 
Rigidity
Myoclonus
Encephalopathy
Diaphoresis
54
Q

What is serotonin syndrome precipitated by?

A

Serotonergic agents

Combination of agents which stimulate serotonin receptors e.g. SSRIs

55
Q

Investigations in serotonin syndrome?

A

No specific Ix

Check renal function

56
Q

Management of serotonin syndrome?

A 
STOP THE SEROTONERGIC AGENT
IV fluids
Close monitoring
Cooling blankets for hyperthermia
Anticonvulsants for seizures
Clonazepam for myoclonus
Nifedipine for HTN

Most recover in 24 hours

57
Q

Features of neuroleptic malignant syndrome?

A

Fever
Altered mental state
Muscle rigidity (lead pipe)
Autonomic dysfunction

58
Q

What can precipitate neuroleptic malignant syndrome?

A

Dopaminergic agents

Rapid antipsychotic inititation or dose increase
Withdrawal of antiparkinson meds

59
Q

Investigations in neuroleptic malignant syndrome

A

Creatine phosphokinase elevated in the 1000’s
ECG: tachycardia
ABG: metabolic acidosis

60
Q

Management of neruoleptic malignant syndrome?

A

STOP ANTIPSYCHOTIC

Benzodiazepines for agitation
Supportive measures: O2, fluids…
Cooling blankets for hyperthermia
IV sodium bicarbonate to prevent renal failure 
Dantrolene/lorazepam for rigidity
Close monitoring 
Bromocriptine prophylaxis
61
Q

Potential consequences of neuroleptic malignant syndrome?

A 
Respiratory failure
CV collapse
Renal failure
Seizures
Arrhythmias 
DIC 
20-30% mortality rate if untreated
62
Q

What is behavioural activation?

A

Behavioural activation is about not waiting till you feel better to start doing stuff or will never do anything and stay in viscious cycle

Treatment involves getting people to act according to a plan rather than how they feel and involves DOING things

63
Q

What is interpersonal therapy?

A

Focuses on interpersonal difficulties, roles and grief

Brief, pragmatic and highly structured

64
Q

What is psychodynamic therapy?

A

Based on Freud

Focus on past conflicts contributing to current difficulties – insight orientated

Neutral therapist, focus on patient – therapist relationship

  • Transference: bring past feelings to present interaction
  • Counter transference: feelings in therapist given by patient

Allow to work through problems in a safe relationship

65
Q

What is motivational enhancement therapy used for?

A

o Addictions
o Compliance
o Changing behaviour

66
Q

What is dialectical behaviour therapy (DBT)?

A

Borderline PD

Managing feelings and self-harm

67
Q

What is eye movement desensitisation used for?

A

PTSD

68
Q

What is family therapy used for?

A

Seeing and treating people in context

Children, eating disorders, psychosis

Improve communication within family

69
Q

What is group therapy used for?

A

Support/adjustment following diagnosis

Self help e.g. AA, weight watchers

CBT based groups: anxiety, depression, assertiveness

70
Q

Counselling on ECT?

A

Risks associated with GA

Adverse effects = memory impairment

Risks of not receiving ECT

Informed consent and right to withdraw consent at any time

71
Q

Cocaine

Class? Effects? Negative effects?

A

A

On top of the world, wide-awake, confidence, reduces hunger, short-acting.

Tachycardia, raised temperature, MI, HF, hypertension, seizure, depression, anxiety, panic attack, paranoia.

72
Q

Heroin

Class? Effects? Negative effects?

A

A

Warm feeling, mild euphoria, relaxed, drowsiness, analgesia, constricted pupils.

Constipation, addiction/dependency, respiratory depression, hallucination

73
Q

Withdrawal effects of heroin?

A

Sweating, malaise, anxiety, depression, akathisia, excessive yawning/sneezing, tears, rhinorrhoea, insomnia, cold sweats, chills, aching, nausea, vomiting, diarrhoea, involuntary limb spasms, cramps.

74
Q

MDMA

Class? Effects? Negative effects?

A

A

Energised, happy, alertness, increased affection, chatty, dilated pupils.

Anxiousness, panic attacks, confused episodes, paranoia, psychosis, tachycardia, hyperpyrexia, electrolyte disturbances, de- and over-hydration.

75
Q

Psilocybin mushrooms

Class? Effects? Negative effects?

A

A

Disorientation, lethargy, giddiness, relaxed, euphoria, perceptual and sensory changes, hallucinations.

Poisoning, death, nausea, disorientation, diarrhoea, stomach pains, depression, anxiety, paranoia, panic attacks, ‘bad trips’, flashbacks.

76
Q

Ketamine

Class? Effects? Negative effects?

A

B

NMDA antagonist. Relaxation, altered bodily sensations, floating feelings, dissociation, altered perceptions, hallucinations

Anaesthetic (injectable GA) – ulcerative cystitis, bladder pain, memory problems, dependency, panic attacks, confusion, agitation

77
Q

Cannabis

Class? Effects? Negative effects?

A

B

Chilled out, relaxed and happy, giggles, very talkative, hungry

Cravings & psychological dependency, anxiety, paranoia, poor concentration, poor memory, psychosis, precipitate schizophrenia.

78
Q

Amphetamine

Class? Effects? Negative effects?

A

B

Wide awake, excited, talkative, reduced hunger/appetite, more energy.

Dependency, insomnia, poor concentration, anxiety, depression, irritability, aggression and paranoia, psychosis, cardiac problems.

79
Q

Mephedrone

Class? Effects? Negative effects?

A

B

Feel alert, confident, talkative, euphoric, increased affection, reduced appetite.

Nausea, anxiety, headache, agitation, hallucinations, seizures, reduced peripheral circulation, epistaxis, addiction, paranoia, self-harm

80
Q

Benzodiazepines

Class? Effects? Negative effects?

A

C

Relaxed, calm, less anxious, sedated

Respiratory depression, falls, hangover, memory loss, sedation, death with injection

81
Q

GHB/GBL

Class? Effects? Negative effects?

A

C

Euphoria, reduced inhibitions and drowsiness.

Nausea, dizziness, drowsiness, agitation, visual disturbances, respiratory depression, unconsciousness, coma, death (esp if mixed with alcohol)

82
Q

Amyl nitrate

Class? Effects? Negative effects?

A

N/A

Rush/high

Hypotension, unconsciousness, nausea, headache, confusion, arrhythmia and death.

83
Q

What are acute dystonias? Treatment?

A

Often painful spastic contraction of certain muscles or muscle groups most commonly affecting the neck, eyes and trunk. For example, tongue protrusion, grimacing, torticollis.

May respond to anticholinergics (procyclidine).

84
Q

What is akasthisia? Treatment?

A

Distressed feeling of inner restlessness manifested by fidgety leg movements, shuffling of feet, pacing etc.

May respond to anticholinergics, propranolol, cyprohepatadine (antihistamine), benzodiazepines or clonidine.

85
Q

What is parkinsonism? Treatment

A

Parkinsonian triad of tremor, muscle rigidity and bradykinesia.

May respond to anticholinergics.

86
Q

What is tardive dyskinesia? Treatment?

A

Involuntary, repetitive, purposeless movements of the tongue, lips, face, trunk, and extremities that may be generalised or affect only certain muscle groups, typically orofacial muscle groups. TD occurs after several months or years of antipsychotic treatment and is often irreversible.

No consistently beneficial treatment and may be exacerbated by anticholinergics.

4th Year Psychiatry (12 decks)

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