psych Flashcards
questionaires to assess depression
PHQ-9 or HAD
features of depression (DSM-IV)
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in most activities, nearly every day
Significant weight loss/ gain when not dieting, or decrease/ increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness nearly every day
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
mild depression
Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
moderate depression
Symptoms or functional impairment are between ‘mild’ and ‘severe’.
severe depression
Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.
suspicious personality disorders
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
emotional and impulsive personality disorders
Antisocial personality disorder (ASPD)
Borderline personality disorder (BPD)
Histrionic personality disorder
Narcissistic personality disorder
anxious personality disorders
Avoidant personality disorder
Dependent personality disorder
Obsessive compulsive personality disorder (OCPD)
borderline personality disorder features
Efforts to avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealisation/ devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts
ADHD features
group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
≥ 5 symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.
Several symptoms were present before the age of 12 years.
Several symptoms must be present in ≥2 settings (e.g. at home, school, or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with the quality of social, academic, or occupational functioning.
Symptoms are not better explained by another mental disorder
increased prevalence of adhd
people born preterm
looked-after children and young people
children and young people diagnosed with oppositional defiant disorder or conduct disorder
children with mood disorders & adults with a mental health condition
people with a close family member diagnosed with ADHD
people with epilepsy
people with other neurodevelopmental disorders
people with a history of substance misuse
people known to the Youth Justice System or Adult Criminal Justice System
people with acquired brain injury.
alzheimers dementia
Most common form of dementia in the UK. Onset may be from 40 years or earlier.
Abnormal phosphorylation of tau protein leads to build-up as B-amyloid plaques in the neural cortex (neuritic plaques) and vessel walls (amyloid angiopathy). Tau protein would usually protect the neurones against calcium influx.
Neurofibrillary Tangles cause necrosis to neural tissue.
A deficit of acetylcholine develops, due to damage to the forebrain.
vascular dementia
Caused by vascular damage to the brain, so should be suspected in patients with signs of cerebrovascular disease e.g. hypertension, IHD and PVD.
Often starts suddenly, following a TIA/ CVA.
Similar to Alzheimer’s, but there are also focal neurological signs e.g. aphasia or weakness.
Can be static, or have a step-wise deterioration.
frontotemporal dementia
Also known as ‘Pick’s Disease’. It is mainly early-onset and 10% is familial.
Involves atrophy of the frontal and temporal lobes. Neurones in this area have abnormal swelling: Pick’s bodies – due to a mutation in the tau gene of the microtubules.
Causes early changes in personality and behaviour. Relative preservation of memory and visuo-spatial functioning.
Stereotypical, repetitive and compulsive behaviour; emotional blunting; abnormal eating; language problems.
lewy body/parkinsons dementia
If dementia symptoms 12-months before motor symptoms = Lewy Body Dementia.
Accounts for >0-15% of dementias.
Caused by alpha-synuclein protein deposits in the brainstem and neocortex, known as ‘Lewy bodies’. Lewy bodies lead to reduced levels of acetylcholine and dopamine in the brain.
These patients may also have tangles and plaques present on histology.
Fluctuating cognitive impairment.
Classically, there are visual hallucinations, gait and sleep disturbances. Patients may be restless at night.
anorexia nervosa features
3 core features:
Intense fear of gaining weight: dread becoming “fat.”
Food intake restriction: this may lead to significantly low body weight.
Distorted body image: generally view themselves as overweight, even if dangerously underweight.
Anorexia nervosa is also associated with physiological abnormalities; summarised below.
Physical Features: reduced body mass index (can be normal in atypical cases), bradycardia, hypotension, enlarged salivary glands
Physiological Abnormalities: Hypokalaemia; low FSH, LH, oestrogens and testosterone; Low T3, Raised cortisol and growth hormone;, hypercholesterolaemia, Impaired glucose tolerance
bulimia nervosa features
recurrent episodes of binge eating, and a sense of lack of control over eating during the episode.
recurrent inappropriate compensatory behaviour in order to prevent weight gain.
recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting.
behaviours occur, on average, at least once a week for three months.
self-evaluation is unduly influenced by body shape and weight.
the disturbance does not occur exclusively during episodes of anorexia nervosa.
mx bulimia nervosa
referral for specialist care is appropriate in all cases.
NICE recommend bulimia-nervosa-focused guided self-help for adults. Otherwise, NICE recommend individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
children should be offered bulimia-nervosa-focused family therapy (FT-BN).
pharmacological treatments have a limited role.
section 2
Admission for assessment for up to 28 days. An Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors. One of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist).
Treatment can be given against a patient’s wishes.
section 3
Admission for treatment for up to 6 months, can be renewed. AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours.
Treatment can be given against a patient’s wishes.
section 5(2)
A patient who is in hospital can be legally detained by a doctor for 72 hours.
section 5(4)
similar to section 5(2), allows a nurse to detain a patient for 6 hour
section 135
A court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
section 136
Someone found in a public place who appears to have a MH condition can be taken by the police to a Place of Safety. Can only be used for 24 hours, whilst an assessment is arranged
atypical antipsychotics
clozapine
olanzapine
risperidone
quetiapine
amisulpride
aripiprazole
illusion
a type of false perception of a real world object is combined with internal imagery to produce a false internal percept
hallucination
an internal percept without a corresponding external object. Perceived as in external space, distinct from imagined images, outside conscious control and as possessing relative permanence.
over valued idea
ideas which are reasonable and understandable in themselves but which come to unreasonably dominate a patient’s life
delusion
an abnormal belief which is held with absolute subjective certainty and requires no external proof and which is held in the face of contradictory evidence. Excluded are those beliefs which can be understood as part of the subject’s cultural or religious background. While the content is usually demonstrably false and bizarre in nature this is not invariably so
delusional perception
this is a primary delusion which is recalled as having arisen as a result of a perception. In which the percept is a real external object not a hallucinatory experience. i.e. seeing two white cars pull up outside and thinking they are about to be wrongly accused of being a paedophile
thought alienation
patient feels that their own thoughts are not within their control. It includesthoughtinsertion,thoughtwithdrawal, andthoughtbroadcast. Any form ofthought alienationis a Schneiderian first-rank symptom, highly indicative of schizophrenia
thought insertion
delusional belief that thoughts are being placed in the patient’s head fro, outside. It is a first rank symptom of schizophrenia.
thought withdrawal
the belief that thoughts are being removed from their mind
thought broadcast
the delusional belief that one’s thoughts are accessible directly to others
depersonalisation
An unpleasant subjective experience where the patient feels as if they have become ‘unreal’. A non-specific symptom occurring in many psychiatric disorders as well as in normal people.
derealisation
An unpleasant subjective experience where the patient feels as if the world has become unreal. Like depersonalization it is a non- specific symptom of a number of disorders
conversion
The development of features suggestive of physical illness but which are attributed to psychiatric illness or emotional disturbance rather than organic pathology. Originally described in terms of psycho analytic theory where the presumed mechanism was the ‘conversion’ of unconscious distress to physical symptoms rather than allowing its expression in conscious thought.
dissociation
The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory. Conversion and dissociation are related concepts. In conversion the emotional abnormality produces physical symptoms; while in dissociation there is impairment of mental functioning (e.g. in dissociative fugue and dissociative amnesia).
stereotype
A repetitive and bizarre movement which is not goal-directed (in contrast to mannerism). The action may have delusional significance to the patient. Seen in schizophrenia.
mannerism
Abnormal and occasionally bizarre performance of a voluntary, goal directed activity (e.g. a conspicuously dramatic manner of walking.
obssession and compulsion
An obsession is an idea, image, or impulse which is recognized by the patient as their own, but which is experienced as repetitive, intrusive, and distressing. The return of the obsession can be resisted for a time at the expense of mounting anxiety. In some situations the anxiety accompanying the obsessional thoughts can be relieved by associated compulsions (e.g. a patient with an obsession that his wife may have come to harm feeling compelled to phone her constantly during the day to check she is still alive
neologism
a made up word or normal word used in an idiosyncratic way – found in psychosis
incongruity of affect
Refers to the objective impression that the displayed affect is not consistent with the current thoughts or actions (e.g. laughing while discussing traumatic experiences). Occurs in schizophrenia.
blunting of affect
Loss of the normal degree of emotional sensitivity and sense of the appropriate emotional response to events. A negative symptom of schizophrenia.
belle indifference
: A surprising lack of concern for, or denial of, appar- ently severe functional disability. It is part of classical descriptions of hysteria and continues to be associated with operational descriptions of conversion disorder. It is also seen in medical illnesses (e.g. cerebrovascular accident [CVA]) and is a rare and non-specific symptom of no diagnostic value.
thought echo
the experience of an auditory hallucination in which the content is the individual’s current thoughts – a first rank symptom of schizophrenia
thought block
patient experiences a sudden break in the chain of thought – it could be explained as due to thought withdrawal. In the absence of such explanation it is not a first rank symptom
concrete thinking
the loss of the ability to understand abstract concepts and metaphorical ideas leading to a strictly literal form of speech and inability to comprehend allusive language. Seen in schizophrenia and in dementing illness.
loosening of association
this is a symptom of formal thought disorder in which there is a lack of meaningful connection between sequential ideas
circumstantial thinking
a disorder of the form of thought where irrelevant details overwhelm the direction of the thought process. It is seen in mania and in anankastic personality disorder.
perseveration
continuing with a verbal response or action which was initially appropriate after it ceases to be appropriate. (e.g. ‘Do you know where you are?’—‘in the hospital’; ‘do you know what day it is?’—‘in the hospital’. Associated with organic brain disease and is occasionally seen in schizophrenia
confabulation
the process of describing plausibly false memories for a period for which the patient has amnesia. It occurs in Korsakoff psychosis, dementia and following alcoholic palimpsest
catatonia
Increased resting muscle tone which is not present on active or passive movement (in contrast to the rigidity associated with Parkinson’s disease and extra-pyramidal side-effects). A motor symptom of schizophrenia.
psychomotor retardation
decreased spontaneous movement and slowness in instigating and completing voluntary movement. Usually associated with subjective sense of actions being more of an effort. Occurs in moderate to severe depressive illness.
flight of ideas
subjective experience of one’s thoughts being more rapid than normal with each thought having a greater range of consequent thoughts than normal. Meaningful connections between thoughts are maintained.
poverty of speech
aka alogia – not speaking much or being monosyllabic
poverty of thought
The mental state of being devoid ofthoughtand having a feeling of emptiness.
pressure of speech
The speech pattern consequent upon pressure of thought. The speech is rapid, difficult to interrupt, and, with increasing severity of illness, the connection between sequential ideas may become increasingly hard to follow. Occurs in manic illness
anhedonia
The feeling of absent or significantly diminished enjoyment of previously pleasurable activities. A core symptom of depressive illness, also a negative symptom of schizophrenia.
flattening of affect
Diminution of the normal range of emotional experience. A negative symptom of schizophrenia
Autochthonous delusion
A primary delusion, which appears to arise fully formed in the patient’s mind without explanation
capgras delusion
Delusional manifestation in which patient believes a known person to them has been replaced by a double who is to all external appearances identical, but is not the real person
De Clérambault syndrome
Delusion of love, May have persecutory delusion that people are conspiring to keep them apart
Delusion of control (passivity phenomena):
First rank sx of schizophrenia. Delusional belief that one is no longer in control of one’s own body → body being forced by external agent to:. Feel emotion = passivity of affect. Desire to do things = passivity of impulse. To perform actions = passivity of volition. To experience bodily sensations = somatic passivity
Delusion of reference
Belief that external events or situations have been arranged in a way to have particular significance for, or to convey a message to, the affected individual
Grandiose delusion
Exaggerated sense of one’s own importance or abilities e.g., mania
Nihilistic delusion
Belief that patient has died or no longer exists or that the world has ended or is no longer real
SSRI e.g.
Sertraline, Fluoxetine (can prescribe to <18s), Citalopram
SRI MOA
Increase free serotonin by blocking reuptake pumps, stopping serotonin from being recycled in the synapse
SSRI SE/interactions
Hyponatraemia, GI sx, citalopram can prolong QT, increased suicide ideation first 4w. NSAIDs (need PPI), Warfarin/heparin=avoid, Aspirin, Triptans and MAOIs: increased risk of serotonin syndrome
stoping AD
the dose should be gradually reduced over a 4 week period, continue for 6m after recovery
SSRI in pregnancy
SSRI use in first trimester - small increased chance of congenital heart defects.
SSRI use during third trimester - risk of persistent pulmonary hypertension of the newborn. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
SNRI e.g.
Venlafaxine, Duloxetine
SNRI MoA
Inhibit reuptake of serotonin and noradrenaline
SNRI SE
Venlafaxine needs monitoring for CV SE as can exacerbate arrythmias + development of HTN
what is mirtazapine
Noradrenaline and specific serotonergic antidepressants (NASSAs)
SE mirtazapine
Causes drowsiness and increased appetite
TCA e.g.
Amitriptyline, Clomipramine
TCA MOA
Inhibit reuptake of serotonin and noradrenaline but act as anticholinergics
TCA SE
SE such as dry mouth, blurred vison and urinary retention (overflow incontinence), weight gain
They also have a high risk of OD and can cause arrythmias
MAOI e.g.
Phenelzine, Moclobemide, Rasagiline
MAOI MOA
Block monoamine oxidase enzyme so block breakdown of monoamine neurotransmitters.
MAOI SE
Dietary restrictions due to risk of hypertensive crisis with tyramine.
MOA typical antispchotics
D2 antagonists
e.g. typical antipsychotics
Chlorpromazine, Haloperidol, Promazine, Flupentixol and Zuclopenthixol
SE typical antipsychotics
Extrapyramidal SE parkinsonism ), acute dystonia , akathisia, tardive dyskinesia
features parkinsonism
Tremor, rigidity and bradykinesia >1 weeks after admission.
tx parkinsonism
Decrease dose or change to SGA, Procyclidine 5mg TDS
featues acute dystonia
Usually occurs within 1 week of commencing or rapidly increased dose . Contraction of muscle group to maximal limit – Oculogyric spasm, Opisthotonos, Torticollis
mx acute dystonia
Procyclidine IM/IV
features akathisia
Restlessness with a drive to engage in motor activity (especially involving the LL and trunk). Occurs >1m after initiation
mx akathisia
Lowest possible dose or change to SGA, Propranolol +/- cyproheptadine
