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Phase 3a > PSYCH > Flashcards

PSYCH Flashcards

1
Q

Psych History

A 
Intro 
HPC
Past psych history 
Personal history 
Family history 
Drug history 
Forensic history 
MSE
Physical examination 
Risk assessment 
Conclusion
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2
Q

What is included in the MSE?

A 
Appearance + Behaviour 
Speech 
Mood
Thought
Perception 
Cognition 
Insight
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3
Q

MSE: Appearance + Behaviour

A 
Eye contact
Rapport
Clothing 
Agitation 
Co-operation 
Hygiene
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4
Q

MSE: Speech

A 
The production of speech not what is being said 
Speed - Slow, fast, hesitant, pressured
Volume - loud, soft, muttered, shouting 
Language - accented, Dysphasia 
Neologisms, Punning
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5
Q

MSE: Mood

A

Mood

Affects

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6
Q

MSE: Thoughts

A

Content - Obsession, Preoccupied, Clang association, Delusions

Stream - Poverty, Racing, Withdrawal, Disinhibition

Form - Flight of idea, Looseness of association

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7
Q

MSE: Types of delusions

A 
Persecutory 
Reference - things have significance 
Grandiose
Worthlessness
Control 
Possession of though 
Over-valued ideas 
Obsessive 
Self-harm/ Suicide
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8
Q

MSE: What are delusions?

A

False unshakable beliefs ideas or beliefs firmly held despite evidence to the contrary and that are not consistent with the persons education, culture or social background

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9
Q

MSE: Mood?

A

Mood and Affects
Does what the patient is saying match how they are saying it

Euthymic, Elated, Depressed, Irritable, Anxious, Reactive, Flat

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10
Q

MSE: Perceptions + Hallucinations

A

5 sense - Auditory, Visual, Tactile, Gustatory, Olfactory

Dissociative - Derealisation (world not real) + Depresonalisation (Detached from the world)
Illusion (misinterpretation of stimuli)
Hallucinations (perceptions without external stimuli)

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11
Q

MSE: Cognition

A

Cognitively intact
or
MMSE - Orientation, Registration, Attention and Calculation, Recall, Language (3 stage command), Copy Shapes

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12
Q

MSE: Insight

A

Understanding they have an illness
Willing to take treatment
Understand the consequence of not taking treatment
willing to seek help

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13
Q

5Ps of formulation?

A 
Presenting problem 
Predisposing factors (factors that already exist)
Precipitating factors (factors that just made things worse)
Perpetuating factors (factors maintaining the illness, impending factors that could make things worse)
Protective factors (what is saving them)
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14
Q

What is phenomenology?

A

No theories
Not unconscious
What is visible and Observable in terms of the patient experience

Objective description of abnormal states of mind avoiding preconceived ideas and theories. limited to the description of conscious experiences and observable behaviour

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15
Q

Disorders of perception?

A

Sensory distortions

Sensory depictions

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16
Q

Sensory distortions?

A

Change in intensity
Change in quality
changes in spatial form
Distortion of experience of time -Physical time + personal time (time flying or time stopping)

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17
Q

Sensory depictions?

A

Illusions

Hallucinations

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18
Q

What is an illusion?

A

Misinterpretation of stimuli

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19
Q

What are hallucinations?

A

Perceptions without object/ external stimuli

Auditory

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20
Q

Difference between 2nd + 3rd person auditory hallucinations?

A

2nd person - you will die, you are a bad person

3rd - running commentary, voices discussing or commenting

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21
Q

What are visual hallucinations?

A

Commonly seen in organic conditions e.g. brain pathology

Elementary (flashes of light) or fully organised (people, animals)

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22
Q

Functional hallucination

A

Auditory stimulus causes hallucination

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23
Q

Reflex hallucination?

A

Stimulus in 1 sensory modality produces a sensory experience in another

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24
Q

Extracampine hallucination?

A

Hallucination that is outside the limits of the sensory field e.g. voices in Paris when you are in london

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25
Q

Hypnagogic?

A

Hallucinations when the patient is fallling asleep

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26
Q

Hypnopompic?

A

Hallucination when the patient is waking up

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27
Q

4 main groups of thought disorders?

A

Stream
Possession
content
form

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28
Q

Disorders of stream of thought?

A

Tempo - Flight of ideas, Inhibition/ slowness, Circumstantiality

Continuity if thought - Perseveration, Thought block

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29
Q

Flight of ideas?

A

Example of stream of thought disorder

Jumping from thought to thought with a common link

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30
Q

Circumstantiality?

A

Example of stream of thought disorder

Talking around the point but not actually about the point. Giving all the peripheral information

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31
Q

Disorders of possession of thought?

A

Obsession + compulsion - Still have own thoughts but intrusive thoughts enter and are only relieved by actions. Thoughts become worse the more you try to stop

Thought Alienation - Insertion, withdrawal or broadcast

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32
Q

What is a delusion?

A

Example of disorder of thought content

False unshakable belief that is out of character of the individual personal, cultural or social context

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33
Q

Difference between a primary and secondary delusion?

A

Primary - new meaning arises in connection with some other psychological event

Secondary - Arising from some other morbid experience

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34
Q

Nihilistic delusion?

A

Patient believes they are already dead

Patient denies the existence of their body, their mind, their loved ones and the world around them

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35
Q

Delusions of poverty?

A

Convinced that they are impoverished and believe destitution is facing them and their family

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36
Q

loosening of association?

A

There is lack of logical association between succeeding thoughts

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37
Q

Examples of disorders of memory?

A

Dissociative amnesia

Confabulations

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38
Q

Dissociative amnesia?

A

Sudden amnesia that occurs during the periods of extreme trauma and can last hours or days

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39
Q

Confabulations?

A

Falsifications of memory occurring in clear consciousness associated with organic pathology

Filling in gaps in memory with imagines or untrue experiences that have no basis in fact

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40
Q

Anhedonia?

A

Inability to experience pleasure of things that were usually enjoyable

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41
Q

Apathy?

A

Emotional indifference - lack of emotions

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42
Q

Incongruity of affect?

A

Emotional state and thought process are opposite

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43
Q

Blunting of affect?

A

Absence of emotional response

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44
Q

Conversion and Belle indifference?

A

Conversion - psychological conflict manifests into somatic symptoms (motor or sensory nature) that can’t be identified on neuro examination

Belle indifference - conversion disorder but remains emotionally indifferent

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45
Q

Depersonalisation?

A

Sense of detachment of one’s own body. A spectator of own activities

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46
Q

Derealisation?

A

Feeling the world isn’t real. the world is dull and grey

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47
Q

Passivity phenomena?

A

Actions/ Feelings/ drives are controlled by others

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48
Q

Somatic passivity?

A

Delusional belief that one is a passive recipient of bodily sensations from an external agency

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49
Q

Catatonia?

A

State of excited or inhibited motor activity in the absence of mood disorder or neurological disease

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50
Q

Waxy flexibility?

A

Patient’s limbs when moved feel like wax and remain in the position in which they are left

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51
Q

Echolalia (parrot)?

A

Automatic repetition of words heard

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52
Q

Echopraxia?

A

An automatic repetition by the patient of movements made by the examiner

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53
Q

Logoclonia?

A

Repetition of the last syllable of a word

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54
Q

Negativism?

A

Motiveless resistance to movement

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55
Q

Palilalia?

A

Repetition of a word over and over again with increasing frequency

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56
Q

Verbigeration (Brick)?

A

Repetition of one or several sentences or strings of fragmented word in a monotonous tone

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57
Q

Presentation order for psych?

A 
History 
MSE
Formulation (Presetting complaint, Predisposing, precipitating, Perpetuating (maintaining), Protective)
Risk assessment 
Management plan
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58
Q

Positive symptoms

A

Hallucination

Delusions

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59
Q

Negative symptoms?

A

flat
Cognitive difficulty
Poor motivation
Social withdrawal

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60
Q

Examples of disorders of form of thought?

A

Derailment/ Knight’s moving
Tangientality
Circumstantiality

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61
Q

Difference between Knight’s move thinking and Tangientality?

A

Knight’s move thinking - Jumping from topic to topic and each sentence is unrelated

Tangientality is when the patient diverts from one topic to another but it is a gradual shift from topic rather than a sudden jump

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62
Q

Examples of disorders of stream of thought?

A

Pressured
Poverty
Thought block

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63
Q

Capgrass syndrome?

A

Irrational belief that a familiar person has been replaced with a duplicate

64
Q

Fregoli?

A

Delusional misidentification - Thinking a total stranger is someone they are familiar with even if they look different

65
Q

Delusional perception?

A

Real percept with delusional interpretation

66
Q

Passivity phenomena/ Delusion of control?

A

Someone or something is controlling their body, mind and behaviour. They don’t want to do something but they are being forced to

67
Q

Ekbom Syndrome?

A

Delusional Parasitosis - believing they have skin infestations that can result in serious harm

68
Q

De Clérambault’s Syndrome?

A

Erotomania - Delusions that someone is in love with them

69
Q

Examples of delusions of thought interference?

A

Insertion, Withdrawal, Broadcast

70
Q

Folie à deux?

A

Shared delusions between 2 people

71
Q

Grandiose?

A

When a patient believes they have special powers, abilities or possessions

72
Q

Cotard’s syndrome?

A

Delusion of immortality, the patient believes they are already dead

73
Q

Nihilistic delusions?

A

Belief of being dead or decomposed or having lost ones internal organs

74
Q

What is personality?

A

Collection of characteristics/ traits that develop as we grow and it influences how we think, feel and behave

75
Q

ICD 10 personality disorder definition?

A

Severe disturbance in characterological condition and behavioural tendencies of the individual in several areas of personality affecting their personal and social life considerably

76
Q

DSM cluster A?

A

Odd/ Eccentric

  • Schizoid, Paranoid, Schizotypical
77
Q

DSM cluster B?

A

Dramatic/ Erratic/ Emotional

  • EUPD, Narcissistic, Dissocial
78
Q

DSM cluster C?

A

Anxious/ Fearful

  • OC, Dependant, Avoidant
79
Q

Clinical features of EUPD?

A 
Emotional Dysregulation
Impulsivity - sustenance, eating, exploitation, overspending 
Self-harm 
Interpersonal difficulty 
Lack of sense of self 
Abandonment issues 
Stress-induced paranoia 
Co-morbid mental health conditions
80
Q

Ddx of EUPD?

A

Bipolar Affective Disorder
ADHD
Schizophrenia
Complex PTSD

81
Q

Why would a patient with EUPD self-harm?

A

Not always suicidal but used to relieve psychic pain or feel something when feeling empty

82
Q

Management of EUPD?

A

Acute - Crisis admission or HT
Medium - CMHT, CPN, Support worker, Care coordinator
Long term - DBT, OT

83
Q

What is DBT?

A

Dialectical Behavioural Therapy - coping strategies as alternatives to self-harm
Review the situation from different perspectives and come to a conclusion

Develop coping skills to improve affective stability and impulse control

84
Q

GPD: Dependant?

A
  • Allowing others to make decisions for them
  • Putting the needs of others before their own
  • When alone, feel helpless and uncomfortable
  • Fears of abandonment
  • Requires excessive amount of advice
85
Q

GPD: Dissocial?

A
  • Callous unconcern for the feelings of others
  • Disregard for social norms, rules and obligations
  • Low threshold for discharge of aggression + violence
  • Incapacity to experience guilt
  • Prone to blame others
86
Q

GPD: Anankastic?

A
  • Obsessive behaviour associated with perfectionism and lack of flexibility
  • Excessive adherence of social conventions
  • Very conscientious
  • Rigid + Stubborn
  • Intrusive/ Unwelcomed thoughts
87
Q

GPD: Histrionic?

A
  • Dramatic + Theatrical AF, exaggerated expression of emotions
  • Easily Influences
  • Shallow + Labile
  • Aims to be the centre of attention for excitement
  • Inappropriate seductiveness in appearance and behaviour
  • Only concerned with physical attractiveness
88
Q

GPD: Anxious/ Avoidant?

A
  • Persistent + Pervasive feelings of apprehension
  • Feeling inferior to others
  • Excessive preoccupation with being criticised
  • Unwilling to get involved with people unless they are certain they will be liked or fear of being criticized
  • Restricted lifestyle so require phsyical security
89
Q

GPD: Schizoid?

A
  • Few activities provide pleasure
  • Emotionally cold
  • Limited capacity to express warm feelings towards others
  • Indifference to either praise or criticism
  • Excessive preoccupation with fantasy
  • Lack of close friend/ confiding relationships
90
Q

GPD: Emotional unstable?

A
  • Impulsive
  • Difficulty controlling emotions
  • Self-harm to relieve pain
  • Feel empty
  • Quick to make relationships but easily lose them
  • Severe experience auditory hallucinations
91
Q

GPD: Paranoid?

A
  • Suspicious of everything
  • Tendency to bear grudges
  • Combative and Tenacious sense of personal rights
  • Tendency to express excessive self-importance
92
Q

3 examples of assessments for personality disorders?

A
  • Minnesota Multiphasic Personality Inventory
  • Eysenck Personality Inventory/ Personality Diagnostic Questionnaire
  • Structured Psychometric Assessment
93
Q

Alzheimers dementia cause?

A

Build up of amyloid plaques and neruofibrillary tangles + decreased acetylcholine production = tau build up and enlarged ventricles

94
Q

Lewy body dementia?

A

Abnormal build up of alpha-synuclein

95
Q

Signs of Lewy body dementia?

A 
Parkinsonian features 
Hallucinations 
Shift in personality 
Syncope + falls 
Memory loss towards the end
96
Q

Vascular dementia?

A

History of cerebral infarcts or arteriopathies or leukoencephalopathy

97
Q

Signs of vascular dementia?

A 
Stepwise increase in severity of symptoms 
Visual field defects 
Impaired gait
Attention problems
Personality changes
98
Q

Frontal Temporal dementia?

A

Progressive degeneration of frontal/temporal lobe

Personality/ Behavioural changes

99
Q

Progressive supraocular palsy?

A

Affects part of the brain just above the nerve cells that control eye movement
Problems with balance + coordination + dementia symptoms

100
Q

Risk factors of dementia?

A 
Learning difficulties
Age
Downs syndrome 
Genetics
CVD
Parkinsons 
Strokes 
Depression 
Alcohol abuse
101
Q

Investigations used to diagnose dementia? HC3ABE

A

History, Consent, Capacity, Cognition, ADL, Examine

Examine - Gait, Balance, CVD sights, Weight loss, focal neurological signs, Visual fields, Hemiparesis, Urine

102
Q

Management of Dementia?

A

MDT + Orientation + Reassurance

Acetylcholinesterase
Memantine
Lorazepam

103
Q

MOA of Memantine?

A

NMDA receptor agonist - Blocks glutamine receptors to improve BPS of dementia e.g hallucinations, aggression + delirium

104
Q

What is delirium?

A

Acute, transient and reversible state of confusion as the result of an organic process. It is sudden onset and fluctuates

105
Q

Types of delirium?

A

Hyperactive, Hypoactive + Mixed

106
Q

Causes of delirium?

A 
Constipation 
Hypoxia
Infection/ Impaction/ Intracranial 
Metabolic disturbances/ Myocardial problems 
Pain
Sleepiness
Prescription 
Hyopthermia/ Pyrexia 
Nutrition 
Environmental changes 
Drugs
107
Q

Differences between delirium and dementia?

A

Delirium

  • Sudden onset
  • Fluctuations
  • Lasts hours to weeks
  • Disrupted sleep
  • Impaired alertness + orientations
  • Altered behaviour
  • Incoherent speech rather than word-finding problems
  • Disorganised/ Delusional thought
108
Q

2 ways of assessing the mental state of a patient?

A

MMSE

Addenbrooke’s cognitive assessment

109
Q

Schizoaffective disorder?

A

Where symptoms of schizophrenia and mood disorder and equally prominent

110
Q

Prodromal phase of schizophrenia?

A

Emotional and behavioural changes affecting personal functioning and social withdrawal
Anhedonia + decreased cognition
Transient Low intensity symptoms lasting <1 week proceeded by acute psychotic episode

111
Q

+ve symptoms of Schizophrenia?

A

Auditory hallucinations
Persecutory delusions
Disorganised speech/ thought alienation

112
Q

-ve symptoms of Schizophrenia?

A 
Emotional Blunting 
Reduced speech
Loss of Motivation 
Self-neglect 
Social Withdrawal
113
Q

Complications of schizophrenia?

A 
Premature death 
Increased risk of suicide 
CVD
T2DM
Smoking related illness 
Cancer
Infection 
Social exclusion
114
Q

Management of Schizophrenia?

A

Risk Assessment
Early intervention services or Home treatment team or Crisis resolution
Sectioning
Anti psychotic medication

115
Q

What medication is used to manage treatment resistance psychosis?

A

Clozapine

116
Q

Side effects of antipsychotics?

A 
Weight gain 
Dyslipidaemia 
Sedation
Hypertension 
Dry mouth
Blurred vision
Impotence
Urinary retention 
Constipation
Flushing 
Reduced seizure threshold  
QT prolongation 
Impaired glucose tolerance 
Neuroleptic Malignant Syndrome
117
Q

Neuroleptic Malignant Syndrome?

A 
Fever
Encephalopathy 
Vital dysregulation 
Enzyme elevation 
Rigidity + Hyperreflexia
118
Q

EPSE of antipsychotics?

A

Acute Dystonic reactions - Jaw jerk, oculogyric crisis
Pseudoparkinsons
Akathesia (Restlessness)
Tardive Dyskinesia

119
Q

Tardive Dyskinesia?

A

Late onset movement disorder due to long term antipsychotic use

Dopamine receptors become hypersensitive due to long term inhibition

Protrusion on the tongue, Tongue rolling, Chewing motion, Facial dyskinesia

Symptoms are persistent and worse with withdrawal

120
Q

What increases the metabolism of clozapine?

A

Smoking + grapefruit juice

121
Q

What decreases the metabolism of clozapine and causes it to be more potent?

A

Caffeine

122
Q

Side Effects of clozapine?

A 
Agranulocytosis 
Neutropenia 
Drooling 
Constipation 
QT prolongation 
Hyperprolactinaemia 
Myocarditis or Cardiomyoapthy
123
Q

What is the difference between a manic episode and a hypomanic episode?

A

Manic episode - 1 week, Persistent fluctuation in extreme mood, can lead to hospitalisation and delusions/ hallucinations may be present

Hypomanic - 4 days, no impairment in functioning or evidence of psychosis

124
Q

Bipolar I?

A

1 Manic episode + History of major depressive episodes

125
Q

Bipolar II?

A

1+ Major depressive episodes + 1 Hypomania but no mania

126
Q

4 types of Bipolar?

A

Mania
Hypomania
Depressive
Mixed

127
Q

Management of Bipolar disorder

A

HTT + CRT
Compulsory admission
Antipsychotic: Haloperidol, Olanazapine, Quetiapine or Risperidone

128
Q

What drugs can be added alongside antipsychotics to manage bipolar?

A

Lithium or Sodium Valporate

129
Q

MOA of lithium?

A

Stimulates NMDA receptors increasing excitatory glutamate for post-synaptic neurones

Chronically causes NMDA downregulation to modulate glutamate neurotransmission

130
Q

Which groups of people have the greatest risk of lithium toxicity?

A 
Hypertension 
DM
CCF
CKD
Schizophrenia
Addison's disease
131
Q

GAD?

A

Disproportionate, uncontrollable widespread worry + a range of cognitive and behavioural symptoms e.g. muscle tensions, trembling, nervousness, sweating

132
Q

Why are SSRI or SNRI CI in pregnancy?

A

Can cause persistent pulmonary hypertension in newborns

133
Q

PTSD key symptoms?

A

Re-experiencing, Hyperarousal and Avoidance

134
Q

Specific features of PTSD in children?

A

Re-living trauma while playing, Nightmares, Anhedonia, Expressing belief they will not live long enough to grow up, Stomach ache, Headache, Secondary enuresis, Separation anxiety

135
Q

Screening tool used for PTSD?

A

Trauma Screening questionnaire or Impacts of events scale

136
Q

Management of PTSD?

A

Trauma-focused CBT
Exposure therapy CBT
Trauma-Focused Cognitive Therapy
Eye movement Desensitization + Reprocessing therapy

137
Q

Pharmacological therapy used in PTSD?

A

SSRI or Venlaxafine or Risperidone

138
Q

OCD?

A

Recurrent obsessional thoughts or compulsive acts which can cause functional impairment + distress

139
Q

Diagnostic tool used for OCD?

A

Yale-Brown Obsessive Compulsive Scale

140
Q

Management of OCD?

A

Risk Assessment
CBT + Exposure response therapy
SSRI or TCA

141
Q

SSRI used for OCD?

A

Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine

142
Q

TCA used to manage OCD?

A

Clomipramine

143
Q

Section 2 duration and purpose?

A

28 days

Assessment

144
Q

Section 3 duration and purpose?

A

6 months

Treatment

145
Q

Section 4 duration and purpose?

A

72 hours and if there is no time to wait for a second doctor

146
Q

Section 5(4)?

A

6 hours

Patient already admitted to hospital and wanting to leave - Nurse waiting for doctor

147
Q

Section 5(2)?

A

72 hours
Patient already admitted but wanting to leave
Allow time for section 2 or 3

148
Q

Difference between S136 and S135?

A

S136 - person suspected of having mental disorder in public place

S135 - Needs court order to access patients’ home and remove them

149
Q

Generalised anxiety disorder?

A

Disproportionate, uncontrollable widespread worry + a range of cognitive and behavioural symptoms

150
Q

Eating disorder?

A

Persistent disturbance or eating related behaviour which leads to altered intake and absorption of food causing a significant impact on physical and psychological functioning

151
Q

Anorexia Nervosa?

A

Body image disturbance and fear of gaining weight

BMI <15 and denial of a sense of malnutrition

152
Q

Bulimia Nervosa?

A

Recurrent episodes of uncontrolled eating of large amounts of food followed by compensatory behaviour
once a week for 3 months

153
Q

Examples of compensatory behaviours of Bulimia Nervosa?

A

Vomiting, Purging, Fasting, Excessive exercise, Laxative intake, Diuretic, Diet pill use

154
Q

Finding on examinations that could indicate Bulimia Nervosa?

A

Russell sign - Knuckle calluses from induced vomiting
Dental Enamel Erosions
Salivary Gland Enlargement

155
Q

Difference between Binge Eating and Bulimia Nervosa?

A

Binge eating is the same as Bulimia Nervosa without the compensatory behaviour

156
Q

SCOFF Questions?

A

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you lost > One stone in 3 months?
Do you believe yourself to be fat when others say you are too thin?
Would you say Food dominates your life?

Phase 3a (8 decks)

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