psych

Question 1

what is an adjustment reaction?

Answer 1

distress/emotional disturbance interfering with social functioning arising in a period of adaptation to significant change

Question 2

what is organisational delusional disorder?

Answer 2

persistent/recurrent delusions dominant

±hallucinations

Question 3

how does post-stroke psychosis usually present?

Answer 3

delusions (persecutory, jealousy, environment)
hallucinations
more common in right hemisphere strokes

Question 4

what mental illnesses can thyrotoxicosis lead to?

Answer 4

anxiety

mania

Question 5

what mental illnesses can hypothyroidism lead to?

Answer 5

dementia

depression

Question 6

what is delirium?

Answer 6

organic cerebral syndrome
acute confusional state
psychiatric manifestation of a physical illness

Question 7

why is delirium a problem in hospital patients?

Answer 7

delays discharge and increases mortality

Question 8

what can cause delirium?

Answer 8

infection 
change in environment 
medication
alcohol withdrawal
surgery
pain 
constipation
dehydration
urine retention
stroke
organ impairment
hypoxia

Question 9

risk factors for delirium?

Answer 9

age
dementia
immobility
sensory impairment
catheterization
malnutrition 
alcohol
depression

Question 10

3 types of stigma?

Answer 10

interpersonal - internalised discrimination
intrapersonal - friends, family, colleagues
structural - poor resources and funding, lack of access to care

Question 11

what is psychosis?

Answer 11

difficulty interpreting and perceiving reality

Question 12

what are the 3 symptom domains in pyshcoiss?

Answer 12

postive & negative symptoms, disorganisation

Question 13

what are positiver symptoms?

Answer 13

hallucinations - percepts in absence of stimulus

delusions - fixed false beliefs out of keeping with social background

Question 14

what are negative symptoms?

Answer 14

alogia - poverty of speech
anhedonia -
aversion/apathy- poor self care/motivation
affective flattening

Question 15

what are disorganisation symptoms?

Answer 15

bizzarre behaviour

thought disorder

Question 16

what is assess in the mental state exam?

Answer 16

appearance & behaviour
insight
cognition 
speech
mood
thoughts
perceptions

Question 17

2 types of delusions?

Answer 17

primary - occur suddenly

secondary - arise from previous idea/experience

Question 18

name for delusion shared between people?

Answer 18

folie a deux

Question 19

what is an illusion?

Answer 19

misconception of real external sitmulus

Question 20

types of hallucinations?

Answer 20

hypnagogic (when falling asleep)
hypnopompic (when waking up)
auditory
visual
olfactory
gustatory
tactile

Question 21

what is Charles bonnet syndrome?

Answer 21

visual hallunctions when one starts to lose eyesight

Question 22

what is a hallucination?

Answer 22

perception ion absence of external stimulus

Question 23

management options for psychosis?

Answer 23

meidctaion - antipsychotics
psychological - CBT
social support

Question 24

what is the commonest class of antipsychotic?

Answer 24

dopamine antagonist

Question 25

what is the pathophysiology for psychosis?

Answer 25

increased presynaptic dopamine in striatum

Question 26

what main side effects can dopamine antagonists cause?

Answer 26

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

Question 27

difference between typical and atypical antipsychotics?

Answer 27

typical more likely to causes EPSEs

Question 28

other side effects ion antipsychotics?

Answer 28

``` sedation constipation agranulocytosis, neutropenia ↑prolactin ↑ appetite , weight gain diabetes dysrhytmia ```

Question 29

diagnostic criteria for a dpressive episode?

Answer 29

``` low mood for at least 2 weeks PLUS 4+ : anhedonia low energy sleep disturbances appetite changes ↓ concentration guilt agitation/retardation suicidal thoughts ```

Question 30

diagnostic criteria for major depressive disorder?

Answer 30

prolonged major depressive episode | no previous manic/hypomanic episodes

Question 31

subtypes of MDD?

Answer 31

atypical psychotic melancholic

Question 32

core symptoms of depression?

Answer 32

low mood low energy/anergia anhedonia

Question 33

diagnostic criteria for manic episode?

Answer 33

``` euphoric/irritable mood PLUS 3+ decrease sleep need with increased energy distractibility grandiosity racing thoughts/ideas ↑talking ↑goal-directed activities impulse behaviour ```

Question 34

diagnostic criteria for a type I bipolar?

Answer 34

manic episode for minimum 1 week with notable functional impairment

Question 35

diagnostic criteria for a hypomanic episode?

Answer 35

manic episode symptoms present for minimum 4 days without functional impairment

Question 36

diagnostic criteria for a type II bipolar?

Answer 36

only hypomanic episodes with at least one major depressive episode

Question 37

diagnostic criteria for unspecified bipolar disorder?

Answer 37

manic symptoms for less than 4 days or other thresholds not met for manic/hypomanic episodes

Question 38

can psychotic features present in hypomania?

Answer 38

no because these indicate functional impairment

Question 39

hospitliztaion indicates what type of mania?

Answer 39

manic episode NOT hypomanic (irrespective of duration of either symptoms)

Question 40

difference between mania and depression?

Answer 40

insight maintained in depression

Question 41

what kind of biases are seen I. depression?

Answer 41

attention - prolonged focus on negative stimuli memory - preferential recall of negative memories perceptual - increased recognition of unhappy faces

Question 42

what brain regions are seponsible for the attention bias seen in depression?

Answer 42

amygdala | prefrontal cortex - anterior cingulate cortex & lateral inferior frontal cortex

Question 43

what is the monamine deficiency hypothesis?

Answer 43

depressive symptoms arise from insufficient monoamine transmitters

Question 44

what are the monamine transmitters?

Answer 44

dopamine serotonin noradrenaline

Question 45

gold standard for measuring receptors and transmitters in the brain?

Answer 45

PET scan using radioactive tracers

Question 46

why is it important to distinguish between bipolar and unipolar?

Answer 46

therapeutics - more ineffective in bipolar depression and can cause mania/hypomania and can worsen rapid-cycling cases