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Year 5 > Psych 1 > Flashcards

Psych 1 Flashcards

1
Q

Acute and transient psychotic disorder: criteria

A
  • Sudden onset of symptoms (within 2 weeks or less)
  • Presence of syndrome which is changing and variable with schizophrenic symptoms
  • Prescence of associated acute stress (job loss, psychological trauma
  • Symptoms cant be described as depressive or manic
  • Individual must not have been using drugs or alcohol. And no proof of a metabolic or nervous system disorder
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2
Q

Acute and transient psychotic disorder

A

Tends to have sudden symptoms of psychosis that do not last more than a month. May have severe hallucinations and delirium symptoms

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3
Q

Early signs of acute and transient psychotic disorder

A
  • Seeming out of touch or aloof
  • Ignoring responsibilities
  • Having inappropriate emotional responses such as going into a rage over something small
  • Speaking to someone who is not there
  • Coming up with conspiracy theories
  • Obsession with religion or governmental involvement
  • Forgetting things or remembering things that did not happen
  • Lacking in emotions
  • Seeming to be on edge or paranoid
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4
Q

Signs and symptoms of acute and transient psychotic disorder

A
  • Hallucinations, which include hearing or seeing things that are not there
  • Delusions, which include believing in things that are not real.
  • Disorganized speaking and thinking, which includes speaking different (fake) languages or about strange topics
  • Not being able to make decisions
  • Not sleeping, having a weird sleep schedule, or sleeping too much
  • Being confused or disoriented
  • Attention and memory problems
  • Wearing strange clothes or dressing unusual in general
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5
Q

Management of transient psychosis

A
  • Antipsychotic medication therapy and rehabilitation
  • 70-80% chance of recurrence within a year
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6
Q

Acute stress reaction: definition

A

Symptoms can occur up to 4 weeks after the event and last for up to a month (later then that then PTSD)

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7
Q

Summary acute stress reaction

A
  • Condition following exposure to severe stress or traumatic events
  • Range of symptoms including disorientation, confusion, dissociation, intrusive memories, avoidance behaviours, negative mood alterations and difficulty sleeping.
  • Emotional reaction like overwhelming anxiety with physical symptoms of anxiety
  • Symptoms are rapid onset after the event and last up to a month
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8
Q

Acute stress reaction: management

A
  • First line: trauma focused CBT
  • Medication for management i.e. Benzodiazepines
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9
Q

Adjustment disorder definition

A
  • Significant emotional distress and disturbance which interferes with normal social functioning
  • Occurs during a period of adaption due to a stressful life event like bereavement or separation
  • Begins within 3 months of event and lasts up to 6 months
  • In acute stress reaction, the stressor is typically severe or life-threatening. While in adjustment disorder the stressor is not severe or outside normal human experience i.e. being made redundant
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10
Q

Adjustment disorder clinical features

A
  • Mood disturbance: depression or anxiety
  • Behaviour: impaired social or occupational functioning, irritability
  • Interpersonal disruption and avoidance behaviours
  • Cognitive alterations: preoccupation with the stressor, persistent negative outlook
  • Intensity and persistence disproportionate to stressor severity
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11
Q

Adjustment disorder: management

A
  • First line is psychotherapy including CBT, group therapy or family therapy
  • Meds: anti-anxiety and anti-depressants
  • Self care: stress management, regular physical activity, social support
  • Treatment is short term and not needed when stressor is removed
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12
Q

Generalised anxiety disorder (GAD)

A
  • A chronic condition caused by excessive worry across various life domains
  • Must be present for at least 6 months
  • Not due to another health condition or side effect of medication/substance
  • Associated symptoms: Restlessness, muscle tension, fatigue
  • Risk factors: female, middle age, lower socioeconomic status, unemployment, divorce
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13
Q

GAD clinical features

A
  • Psychological: Fears, worries, poor concentration, irritability, depersonalization, derealization, insomnia, night terrors
  • Motor symptoms: Restlessness, fidgeting, palpitations, butterflies in the stomach, loose stools, tremors
  • Muscle tension, difficult sleep
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14
Q

Organic differentials for GAD

A
  • Hyperthyroidism
  • Cardiac: palpitations/arrhythmias
  • Medication induced: salbutamol
  • Substance misuse: amphetamines, withdrawal, alcohol
  • Depression
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15
Q

GAD-7

A
  • Helps assess severity of anxiety disorder
  • 5-9 indicates mild anxiety
  • 10-14 indicates moderate anxiety
  • 15-21 indicates severe anxiety
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16
Q

GAD management

A
  • Early or mild: advice and reassurance. Self help strategies, diet, exercise and avoiding alcohol, caffeine and drugs
  • First line: low intensity psychological interventions (individual guided self help, psychoeducation)
  • Second line or marked impairement: CBT and SSRI/SNRI
  • Can use propranolol for palpitations
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17
Q

Panic disorder

A
  • A prevalent anxiety disorder with recurrent, unexpected panic attacks
  • Diagnosed when panic attacks are followed by at least one month of persistent worry about having another attack
  • Cause worries about future attacks and avoidant behaviour to prevent attacks
  • Onset in adolescence or early adulthood, typically female
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18
Q

Panic disorder criteria

A

Panic disorders criteria: they start abruptly and are discrete episodes of intense fear. They last some minutes and is a fear of catastrophic outcomes. It is random, not situational. Lasts for 20 minutes. They have the 4 symptoms of anxiety, the patient tends to think that they are going to die and lose control

It is diagnosed when it is not causes by substances/medication or another medical condition. It is not better explained by another medical disorder.

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19
Q

Panic disorder clinical features

A
  • Sudden episodes of intense fear which peaks within minutes
  • Difficulty in breathing, chest discomfort, palpitations, hyperventilation
  • Shaking, sweating, dizziness
  • Depersonalization/derealization
  • Development of fear of fear pattern
  • Diagnostically depression takes precedence if it predates panic disorder or fulfils diagnostic criteria
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20
Q

Panic disorder: management

A
  • First line: CBT
  • Medical: SSRI if no response after 12 weeks or contraindicated Clomipramine or Impramine (TCA)
  • propanol for symptoms
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21
Q

PTSD

A
  • A complex psychiatric condition due to exposure to a traumatic event i.e. childbirth or car accident. Symptoms tend to arise within 6 months of event
  • Clusters of Symptoms: Intrusion, avoidance, negative alterations in cognition and mood, arousal, and reactivity.
  • Duration: Persists for more than 1-6 months.
  • The Trauma Screening Questionnaire (TSQ) can be used as a screening tool
22
Q

PTSD symptoms

A
  • Intrusion symptoms: distressing memories and nightmares, problems recalling event
  • Functional impairment required
  • Deliberate avoidance of trauma related nightmares
  • Persistent negative emotions: distorted blame
  • Heightened arousal and reactivity: hypervigilance, exaggerated startle response and concentration difficulties
23
Q

Management of PTSD

A
  • Moderate/severe PTSD: refer to secondary care for psychological therapy and/or medication
  • First line psychotherapy: Trauma focused CBT with EMDR (eye movement desensitisation and reprocessing therapy) in more severe cases
  • Veterans with service related PTSD are referred to secondary care more quickly
  • Screen for other mental health conditions
  • Prevention: trauma focused CBT within month of event
24
Q

Medication for PTSD

A
  • Do not offer drugs to prevent TSD from occurring: particularly avoid Bensodiazepine
  • Venlafaxine or SSRI could be considered: If first time with PTSD or declining psychotherapy. Dont use routinely first line.
  • Risperidone or similar anti-psychotics could be offered if: there is severe hyperarousal, there is severe psychosis, other drug treatments have failed
25
Q

Complex PTSD

A
  • Severe and pervasive problems in affect regulation
  • Persistent negative beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event
  • Persistent difficulties in sustaining relationships and in feeling close to others.
  • Causing significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
26
Q

Social anxiety disorder

A
  • Fear and Anxiety of social situations and negative evaluation by others
  • Fear of scrutiny by others in relatively small groups (as opposed to crowds), resulting in the avoidance of social situations. I.e. groups of 5-6, usually 1-2 is tolerable
  • May be specific (public speaking) or generalized (any social setting).
  • Symptoms present for >6 months
  • Present for several months with functional impairment
  • Can progress to panic attacks.
27
Q

Symptoms of social anxiety

A
  • Physical symptoms include blushing, fear of vomiting.
  • Symptoms include blushing (characteristic), palpitations, trembling, sweating.
  • Can be precipitated by stressful or humiliating experiences, parental death, separation, chronic stress.
28
Q

Social anxiety disorder management

A
  • Management: individual CBT, self-help, SSRI (Escitalopram or Sertraline)
  • Adults: individual CBT. If rejected can offer short term psychodynamic psychotherapy
  • Children: individual or group CBT, consider involving parents or care givers
29
Q

Phobias

A
  • Excessive and irrational fears triggered by a specific object or situation i.e. animals heights
  • Usually apparent in early adulthood and leads to avoidance behaviour
  • Severity depends on effect on quality of life
30
Q

Agoraphobia

A
  • Anxiety around situations where escape maybe difficult or help unavailable.
  • Tends to be fear of open spaces and associated factors like crowds or perceived difficulty of easy escape
  • Tends to begin in 20s or mid thirties
  • Gradual onset or caused by a sudden panic attack
31
Q

Management of phobias

A
  • First line: CBT
  • Exposure techniques
  • If ineffective/severe functional impairment: SSRI are first line with propanol for physical symptoms
32
Q

OCD

A
  • Condition characterised by intrusive thoughts and repetitive behaviours
  • Onset: adolescence or early adulthood
  • Risk factors: pregnancy/postnatal period, history of abuse, bullying
  • Severity assessed by Y-BOCS scale
  • Either obsessions or compulsions that present on most days for a period of at least two weeks.
33
Q

OCD definition

A
  • Obsessions: Intrusive, unwanted thoughts or images causing distress.
  • Compulsions: Repetitive behaviours (washing hands) or mental acts (counting) aimed at reducing anxiety.
  • Must originate in the mind of the patient and be repetitive and unpleasant
  • The individual tries to resist them and carrying out the obsessive thought or act is not pleasurable
34
Q

OCD: types of obsessions or compulsions

A
  • Obsessions: contamination fear, harm related, unwanted sexual thoughts, religious/moral obsessions, perfectionism/symmetry
  • Compulsions: cleaning/washing, checking rituals (door locked), counting/repetitive rituals, ordering/arranging behaviour, mental neutralizing strategies (prayer)
35
Q

OCD diagnosis

A
  • Presence of obsessions, compulsions, or both.
  • Rituals consume significant time and impair daily functioning >1hr for diagnosis
  • Not explained by another medical condition
36
Q

OCD management

A
  • Mild: Low intensity CBT including exposure and response prevention (ERP)
  • Moderate: intensive CBT including ERP OR an SSRI
  • Clomipramine is an alternative to SSRI
  • Severe functional impairment: combined treatment with intensive CBT (including ERP) and an SSRI and refer to secondary care
  • If medication effective continue for 12 months can then review
37
Q

Bipolar affective disorder criteria

A
  • Characterized by at least two episodes, including one hypomanic or manic episode. Depressive episodes should be prominent lasting at least 2 weeks
  • BPAD Type 1: One or more manic episodes and one or more depressive episodes.
  • BPAD Type 2: Recurrent major depressive episodes and hypomanic episodes.
38
Q

Mania vs hypomania

A
  • Both have elevated mood or intense irritability. They can have physical symptoms with increased energy or decreased sleep.
  • Mania: Severe functional impairment or psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) persisting for at least seven days.
  • Hypomania: Increased or decreased function for at least four days without psychotic symptoms.
39
Q

Bipolar risk factors

A

genetics, stressful life event, substance misuse, a manic switch can be triggered by antidepressants

40
Q

Bipolar clinical features

A
  • Depressive Phase: Low mood, feelings of worthlessness, decreased energy, and suicidal ideation.
  • Manic Phase: Elevated or irritable mood, inflated self-esteem, decreased need for sleep/sleep disturbance (is both a feature of, and can precipitate manic episodes), impulsivity, pressured speech, and potential psychotic symptoms.
  • Additional Features: Psychotic symptoms (delusions, hallucinations) and risk-taking behaviours (sexual disinhibition, spending/gambling, violence).
41
Q

Bipolar investigations

A
  • Especially is first presentation important to rule out substance misuse (i.e. urine toxicology, amphetamine levels)
  • Delirium also needs to be ruled out, which can be secondary to infection, thyroid dysfunction (TFTs,), vitamin deficiencies (B12/folate)
42
Q

Bipolar management acute

A
  • If hypomania then routine referral to community mental health team (CMHT), if mania/severe depression urgent referral
  • Stop SSRI (taper down)
  • Mania with agitation: IM neuroleptic or benzodiazepine, potential psychiatric admission
  • Mania without agitation: Oral antipsychotic monotherapy (haloperidol, olanzapine, quetiapine, or risperidone). Addition of sedatives or mood stabilizers (lithium)ifantipsychoticsare unsuccessful. Electroconvulsive therapy (ECT) is a last resort.
  • Acute depression: increase mood stabiliser if taking otherwise SSRI (fluoxetine) and atypical antipsychotic (olanzapine) cover
43
Q

Bipolar management chronic

A
  • 4 weeks after resolution of acute episode
  • Maintenance therapy is with mood stabilizers such as Lithium (first line) or Valproate (second line), and psychotherapy.
  • High-intensity Psychological Therapies: Cognitive-Behavioral Therapy (CBT), Interpersonal Therapy.
44
Q

Management of bipolar disorder: Relapse of manic or hypomanic episode

A
  • Optimise current treatment
  • Check compliance
  • Antipsychotic – start with what works the last time
  • Mood stabilisers – choice of Lithium, Valprote, Carbamazepine
  • Do not offer Lamotrigine
  • ?use of alcohol/recreational substances
45
Q

Criteria for manic episode at least 1 week off

A
  • Euphoria, irritability, expansiveness
  • Increased activity/increase energy
  • Increase self-esteem/grandiosity
  • Rapid/pressure of speech
  • Flight of ideas
  • Decrease need for sleep
  • Distractibility
  • Impulsive/Reckless behaviour
  • Rapid changes between mood states (labile mood)
46
Q

Lithium side effects

A
  • Fine tremor
  • Weight gain
  • Chronic kidney disease
  • Hypothyroidism and goitre (it inhibits the production of thyroid hormones)
  • Hyperparathyroidism and hypercalcaemia
  • Nephrogenic diabetes insipidus
47
Q

Long term management of bipolar disorder: psychological

A
  • Educate patients and carers (with patients’ consent) about nature & severity of illness.
  • The aim is to empower patients to manage their illness – self-monitoring, recognition of early warning signs eg decrease need for sleep may trigger a manic relapse.
  • Discuss about future management according to patients’ preferences inc advance directive
  • Offer CBT/Interpersonal Therapy/Family Intervention according to patients’ needs & preferences.
48
Q

Delirium: definition and risk factors

A
  • An acute and fluctuating disturbance in attention and cognition often accompanied by change in consciousness, typically reversible
  • Risk factors: age, severity of illness, pre-existing cognitive impairment
49
Q

Delirium: types

A
  • Hyperactive Delirium: Marked by increased psychomotor activity, restlessness, agitation, and hallucinations.
  • Hypoactive Delirium: Characterised by lethargy, reduced responsiveness, and withdrawal.
  • Mixed Delirium: Combines features of both hyperactive and hypoactive delirium.
50
Q

Causes of Delirium (DELIRIUMS)

A
  • D: Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
  • E: Eyes, ears and emotional disturbances
  • L: Low Output state (Myocardial Infarction, Acute Respiratory Distress Syndrome, Pulmonary Embolism, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease)
  • I: Infection
  • R: Retention (of urine or stool)
  • I: Ictal (related to seizure activity)
  • U: Under-hydration/Under-nutrition
  • M: Metabolic disorders (Electrolyte imbalance, thyroid disorders, Wernicke’s encephalopathy)
  • (S): Subdural hematoma, Sleep deprivation

Year 5 (24 decks)

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