psych Flashcards
what is an adjustment reaction?
distress/emotional disturbance interfering with social functioning arising in a period of adaptation to significant change
what is organisational delusional disorder?
persistent/recurrent delusions dominant
±hallucinations
how does post-stroke psychosis usually present?
delusions (persecutory, jealousy, environment)
hallucinations
more common in right hemisphere strokes
what mental illnesses can thyrotoxicosis lead to?
anxiety
mania
what mental illnesses can hypothyroidism lead to?
dementia
depression
what is delirium?
organic cerebral syndrome
acute confusional state
psychiatric manifestation of a physical illness
why is delirium a problem in hospital patients?
delays discharge and increases mortality
what can cause delirium?
infection change in environment medication alcohol withdrawal surgery pain constipation dehydration urine retention stroke organ impairment hypoxia
risk factors for delirium?
age dementia immobility sensory impairment catheterization malnutrition alcohol depression
3 types of stigma?
interpersonal - internalised discrimination
intrapersonal - friends, family, colleagues
structural - poor resources and funding, lack of access to care
what is psychosis?
difficulty interpreting and perceiving reality
what are the 3 symptom domains in pyshcoiss?
postive & negative symptoms, disorganisation
what are positiver symptoms?
hallucinations - percepts in absence of stimulus
delusions - fixed false beliefs out of keeping with social background
what are negative symptoms?
alogia - poverty of speech
anhedonia -
aversion/apathy- poor self care/motivation
affective flattening
what are disorganisation symptoms?
bizzarre behaviour
thought disorder
what is assess in the mental state exam?
appearance & behaviour insight cognition speech mood thoughts perceptions
2 types of delusions?
primary - occur suddenly
secondary - arise from previous idea/experience
name for delusion shared between people?
folie a deux
what is an illusion?
misconception of real external sitmulus
types of hallucinations?
hypnagogic (when falling asleep) hypnopompic (when waking up) auditory visual olfactory gustatory tactile
what is Charles bonnet syndrome?
visual hallunctions when one starts to lose eyesight
what is a hallucination?
perception ion absence of external stimulus
management options for psychosis?
meidctaion - antipsychotics
psychological - CBT
social support
what is the commonest class of antipsychotic?
dopamine antagonist
what is the pathophysiology for psychosis?
increased presynaptic dopamine in striatum
what main side effects can dopamine antagonists cause?
extrapyradimal side effects
- parkinsonism = rigidity, slow gait, lack of arm swing, pill-rolling tremor
- dystonia = increased motor tone
- tardive dyskinesia = repetitive oral, facial movements
- akathisia = inner restlessness
difference between typical and atypical antipsychotics?
typical more likely to causes EPSEs
other side effects ion antipsychotics?
sedation constipation agranulocytosis, neutropenia ↑prolactin ↑ appetite , weight gain diabetes dysrhytmia
diagnostic criteria for a dpressive episode?
low mood for at least 2 weeks PLUS 4+ : anhedonia low energy sleep disturbances appetite changes ↓ concentration guilt agitation/retardation suicidal thoughts
diagnostic criteria for major depressive disorder?
prolonged major depressive episode
no previous manic/hypomanic episodes
subtypes of MDD?
atypical
psychotic
melancholic
core symptoms of depression?
low mood
low energy/anergia
anhedonia
diagnostic criteria for manic episode?
euphoric/irritable mood PLUS 3+ decrease sleep need with increased energy distractibility grandiosity racing thoughts/ideas ↑talking ↑goal-directed activities impulse behaviour
diagnostic criteria for a type I bipolar?
manic episode for minimum 1 week with notable functional impairment
diagnostic criteria for a hypomanic episode?
manic episode symptoms present for minimum 4 days without functional impairment
diagnostic criteria for a type II bipolar?
only hypomanic episodes with at least one major depressive episode
diagnostic criteria for unspecified bipolar disorder?
manic symptoms for less than 4 days or other thresholds not met for manic/hypomanic episodes
can psychotic features present in hypomania?
no because these indicate functional impairment
hospitliztaion indicates what type of mania?
manic episode NOT hypomanic (irrespective of duration of either symptoms)
difference between mania and depression?
insight maintained in depression
what kind of biases are seen I. depression?
attention - prolonged focus on negative stimuli
memory - preferential recall of negative memories
perceptual - increased recognition of unhappy faces
what brain regions are seponsible for the attention bias seen in depression?
amygdala
prefrontal cortex - anterior cingulate cortex & lateral inferior frontal cortex
what is the monamine deficiency hypothesis?
depressive symptoms arise from insufficient monoamine transmitters
what are the monamine transmitters?
dopamine
serotonin
noradrenaline
gold standard for measuring receptors and transmitters in the brain?
PET scan using radioactive tracers
why is it important to distinguish between bipolar and unipolar?
therapeutics - more ineffective in bipolar depression and can cause mania/hypomania and can worsen rapid-cycling cases
