Psych Flashcards
Illusion
Perception when a sensory stimulus is present but is incorrectly perceived
Hallucination
Sensory perception occurs in absence of stimulus
Pseudo-hallucination
Externalised sensory image vivid enough to be a hallucination but recognised as unrea
Overvalued idea
Solitary abnormal belief neither delusional nor obsessional in nature but preoccupying to the extent of dominating the sufferers life
Delusion
Abnormal belief which is held with absolute subjective certainty which requires no external proof, which may be held in the face of contradictory evidence, and which has personal significance to person involved.
Absolute certainty, cant be rationalised away, held in face of contradictory evidence, not part of cultural or religious background
Delusional perception
A true perception to which a patient attributes a false meaning
Loosening of association
Disorganised speech due to a lack of connectivity between ideas
Perseveration
Continual repetition of thought or behaviour e.g. finger wiggling
Confabulation
Memory error in which gaps are unconsciously filled with fabricated information
Somatic passivity
Experience of bodily sensations imposed by external agency
Pressure of speech
Rapid and frenzied speech
Anhedonia
Inability to experience plasure in normally pleasurable acts
Incongruity of affect
Mismatch between experienced emotions and its expression
Blunting of affect
Diminished facial expressions, expressive gestures and vocal expressions, Difficulty expressing emotions
Belle indifference
Absence of psychological distress despite serious illness
Depersonalisation
Dissociative disorder = persistant or recurrent feelings o being detatched
Thought alienation
Feel own thoughts are no longer own
Thought insertion
Experiencing one’s own thoughts as someone elses
Thought withdrawal
Believe a person or entity has removed thought from mind
Thought broadcast
Believe people can hear thoughts
Thought echo
Hearing own thoughts aloud after thinking them
Thought block
Unable to think, speak or move
Akathisia
Movement disorder = hard to stay still
Clouding of consciousness
Inattention and reduced wakefulness
Depression definition
Persistent low mood +/- loss of pleasure in activities
Emotional, cognitive, physical and behavioural Sx
Core depression sx
Depressed mood
Anhedonia
Weight change
Insomnia
Others
Psychomotor agitation
Low energy
Guilt
Reduced concentration
Mild = 2 typical +2 core
Moderate = 2 typical + 3+ core
Severe = 3 typical and 4+ other core
Severe = all
Depression Ix
Bloods
CXR = infections
ECG = metabolic
Mx depression
Mild-moderate = CBT or psychotherapy
Moderate-severe = psychotherapy and antidepressant
1st episode = generic SSRI = citalopram, sertraline
Recurrent = antidepressant with previous good response
GAD definition
Disproportionate, pervasive, uncontrollable and widespread worry
S+S GAD
Restlessness
Fatigue
Irritability
Poor concentration
Sleep disturbance
Muscle tension
Physical features of GAD
Dry mouth
Diarrhoea
Chest constriction
Palpitations
Urinary frequency
Libido loss
ICD 10 GAD
At least 4 of
- Symptoms of autonomic arousal = palpitations, sweating, shaking, dry mouth
- Physical = breathing difficulty, choking, chest pain, nausea
- Mental state sx = dizzy, derealisation, fear of losing control
- General = hot flushes, chills, numb, tingling
- Sx tension = muscle tension, aches and pains, restlessness
- Other – exaggerated response to minor surprises
At least 6 months present most of the time
GAD Mx
active monitoring
Psychological interventions = CBT
= with marked functional impairenent = high intensity psychological intervention and drug treatment
GAD drugs
SSRI 1st line
SNRI
Pregabalin
OCD definition
Recurrent obsessional thoughts or compulsive acts
Obsessions = unwanted intrusive thoughts
Compulsions = behaviours that result from obsessive thoughts
S+S OCD
Often sudden onset
ICD10
Obsessional thoughts = enter mind repeatedly, invariably distressing, own thoughts
Compulsive = stereotyped behaviours that are repeated, not enjoyable, performed to prevent an unlikely event and recognised as pointless
MX OCD
CBT
Supportive psychotherapy
SSRI
Clomipramine
Specialist referral
Bipolar 1
Underlying depression, interspersed with mania
Bipolar 2
Depression more dominant
Bipolar Manic Sx
Elevated mood
Increased energy –> over activity, reduced sleep
Pressured speech
! week
Flight of ideas
Grandiosity
Reduced attention span
Reckless
Psychotic Sx = aud 2nd person
Bipolar hypomanic sx
4 days
Mildly elevated mood
Increased energy
Sociability
No psychotic
Mx bipolar
Acute manic
- 1st line = atypical antipsychotic = olanzapine, risperidone
- 2nd line = valproate, lamotrigine, lithium
Depressive= avoid ADs, atypical AP instead
General maintenance = lithium, mood diary, education
Positive psychosis sx
Delusions Held Firmly Think Psycho
Delusions
Hallucinations (3rd, auditory)
Formal Thought disorder = form, possession, content
Thought interference
Passivity
Lack of insight
Negative Sx psychosis
A6C
Asocial
Avolition
Alogia
Affect blunted
Anhedonia
Attention deficit
Catatonia
Psychosis
Schizophrenia = most common form
Schizophrenia prodrome
Deterioration in social functioning + transient/attenuated psychotic Sx
1st rank schizophrenia S+S
Auditory hallucinations 3rd person
Thought withdrawal, insertion and broadcast
Delusional perception
Somatic passivity (external agents imposed)
Specifics of the voices heard in 1st rank sx
- Own thoughts spoken aloud
- auditory 3rd person hallucinations
- running commentary
- not commanding
ICD10 schizophrenia
At least 1 of
- thought echo, broadcasting, insertion, alienation
- delusions
- Delusions of control
- 3rd aud hall
Or at least 2 of
- persistant hall in any modality
- Irrevalent speech or neologism
- Catotonic
- neg sx
- significant and consistent change in personal behaviou
Schizophrenia Mx
Early intervention = CBT or family intervention
No 1st line AP= choice depends on personal choice, medication hx, degree of sedation required, risk of adverse effects and negative sx
Clozapine usually offered to those who don’t respond to 2 other Aps due to SEs
Atypical usually 1st line (risperidone, olanzapine, quietpaine, aripiprazole
PTSD
Following traumatic event characterised by involuntary re-experiencing of elements with Sx of hyperarousal, avoidance and emotional numbing
S+S PTSD
2 or more persistent Sx of increased psychological sensitivity and arousal = sleep, irritable, reckless
Persistent remembering of stressor
avoidance
inability to recall aspects
PTSD Mx
CBT
EMDR
SSRIs
Borderline personality disorder
Act impulsively
Intense short lived emotional attachments
Chromic internal emptiness
Frequent SH
Transient pseudo psychotic featires
FHx
Paranoid PD
Extreme sensitivity
Suspicious
Self important
Preoccupation with conspiracy theories
Schizoid PD
Emotionally cold and detatched
Limited capacity to express emotions
Indifference to praise or criticism
Preference for solitary activities
Antisocial PD
Callous inconcern for feelings of others
Incapacity to maintain enduring relationships
Low tolerance of frustration
Incapacity to experience guilt
Blame others
Histrionic PD
Self dramatisation, theatricality
Shallow and liable emotions
Continual seeking for excitement and appreciation
Inappropriately sedutive appearance an behaviour
Suicide risk assessment in adolescents
Home and environment
Education
Activities
Drugs and alcohol
Sexuality
Suicide and depression
The dependence syndrome
Primacy of drug seeking behaviour
Narrowing of repertoire = preference
Increased tolerance
Loss of control of consumption
Sx withdrawal on attempted abstinence
Drug taking to avoid withdrawal Sx
Continued use despite consequences
Rapid reinstatement of previous pattern after abstinence
Screening for alcohol dependency
CAGE
AUDIT
Increased MCV and GGT
FRAMES principles
Feedback
Responsibility
Advice
Menu
Empathy
Self efficacy
Opiates sx
Pinpoint pupils
Low BP
Venepuncture marks
Stimulants Sx
Rapid speech
Large pupils
Agitation
Restlessness
High BP
Opiate withdrawal Sx
Dialte pupils
High BP
Sweaty
Rhinorrhoea
Cramps
Goose bumps
Mx phobias
Behavioural therapy
Flooding
Cognitice
BDZ if severe
Serotonin syndrome
Iatrogenic syndrome resulting from excess serotonin levels in central and peripheral nervous system
Medications that cause serotonin syndrome
SSRIs
SNRIs
MAOIs
TCA
Tramadol
Stimulants
S+S serotonin syndrome
Agitation and confusion
Hypomania
Seizures
Tone increased
Tremor
Hyperreflexia and clonus
HTN
Diarrhoea
hyperthermia
Mx serotonin syndrome
Cease offending drugs
Cyproheptadine
S+S OCPD
Perfectionism
Rigid mannersisms
Extreme attention to detail
Excessive devotion
Doubt, indecisiveness, caution
called anankastic
Sx alcohol withdrawal
Mild = HTN, tachy, anorexia, anxiety
Moderate = worsening mild plus agitation and coarse tremor
Severe = delerium tremens = confusion, TC seizures, hallucinations, hyperthermia
Sx wernickes encephalopathy
Confusion
Ataxia
Eye paralysis
Nystagmus
Memory disturbance
Hypothermia and hypotension
Caused by thiamine deficiency therefore prescribe thiamine
Delerium tremens
Acute confusional state secondary to alcohol withdrawal
Clouding consciousness
Disorientation
Amnesia for recent events
Psychomotor agitation
Hallucinations (liliputian)
Opiate detoxification
Methadone
Moderate = aches, dialted pupils, yawning = 10-20mg methadone
Severe = vomiting, HTN = 20-30mg methadone
Conversion disorder
Loss of motor or sensory function
Doesn’t consciously feign symtpoms or seek material gain
Belle indifference
Somatisation
Multiple physical symptoms present for at least 2 years
Refuses to accept reassurance or negative test results
benzodiazapine used for alcohol withdrawal
chlordiazepoxide
ICD 10 anorexia
Low body weight - 15% below expected BMI 17.5 or less
Self-induced weight loss
Body image distortion
Endocrine
Delayed/arrested puberty
Anorexia Ix
FBC
ESR
U+E, phosphate, magnesium, bicarbonate, LFTs
Glucose = hypo
TFTs = low T3/4
ECG = sinus brady, raised QTc
Hypokalaemia, hyponatraemia, hypoglycaemias, hypothermia, increased cortisol
Anorexia Mx
Treat psychological disorder
Encourage weight gain
Family therapy
Anorexia complication
Cardioac = brady, hypotn, ECG changes
CNS = impaired concentration
Derm = brittle skin, nails and hair loss
Haem = anaemia
Met = hypok, hypona, hypogly
Amenorrhoea
Refeeding syndrome
Potentially fatal shift in fluids and electrolytes
High risk = give thiamine, vit B, daily bloods
Metabolic consequences of refeeding syndrome
Hypophosphataemia
Hypokalaemia
Hypomagnesium = torsades de points
Abnormal fluid balance
NICE recommendation for refeeding
If not eaten >5 days, refeed at no more than 50% of requirements for 2 days
High risk refeeding
1 or more of the following:
- BMI < 16 kg/m2
- unintentional weight loss >15% over 3-6 months
- little nutritional intake > 10 days
- hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
2 or more of the following:
- BMI < 18.5 kg/m2
- unintentional weight loss > 10% over 3-6 months
- little nutritional intake > 5 days
- history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids
Bulimia ICD10
Persitent preoccupation with eating
Irresistable craving for food
Binges
Attempts to counter food effects
Morbid dread of fatness
Complications of purging
Arrhythmia
Cardiac failure
Electrolyte disturbance
Oesophageal erosions or gastric perforation
Ulcers
Pancreatitis
Acute dystonic reaction
After new ATAP or and increased dose recently
Torticollis, trismus, jaw opening
Procyclidine given
Neuroleptic malignant syndrome
Reaction to APs
Fever, rigidity, autonomic dysfunction, confusion, tachy, tremor
Raised CK and leukocytosis
Stop AP
BZD
Supportive
Lithium toxicity
> 1.5mmol/l = toxic
- therapeutic range 0.5-1
- Tremor (coarse), Renal failure, Hyperreflexia, convulsions, N+V, vision
- Stop lithium, fluids and NaCl, dialysis if severe
features opioid overdose
- pinpoint
- decreased RR
- altered status
- response to naloxone
Opiod detox
Methadone/buprenorphine/dihydrocoedine
Lofexidine to relieve withdrawals
Naltrexone to prevent relaps
Overdose = naloxone
Pathophysiology alcohol abuse
Up regulation NMDA receptors
Downregulation GABA receptors
Cessation causes CNS hyperexcitability
Alcohol wdrawal
6hrs = malaise, tremor, nausea
36hrs = seizures
72hrs = delirium tremens
Withdrawal alcohol treatment
Chlordiazepoxide
IV thiamine (B1) pabrinex
Disulfiram = bad se when drink = build-up of acetaldehyde
acamprosate = reduce cravings = enhances GABA transmission
naltrexone = reduced pleasure = opioid antagonist
Delirium tremens
72hrs after
Cog impairement, liliputian, paranoid delusion, sweating, dehydration
Mx = pabrinex and lorazepam
Wernicke
Delirium, nystagmus, hypothermia, ataxia
Mx = pabrinex
mechanism of paracetamol overdose
More paracetamol shunted to CP450 system so more NAPQO produced
Mx paracetamol OD
within 1hr = activated charcoal
> 8hrs IV N acetylcysteine = 3 consecutive IV infusions
1st infusion is 1hr
Give NAC if
- past line 4hrs post
- Staggered overdose
- 8-24hrs after >150mg/kg
- > 24hrs jaundiced, tender, ALT
Kings college hospital criteria
For liver transplant post paracetamol OD if
- Arterial PH <7.3 24hrs post
Or all 3 of
- PT >100
- Creatinine >300
- Grade 3 or 4 encephalopathy
absolute contraindication for ECT
raised intracranial pressure
relatice contraindications for ect
cerebral tumour/aneurysm
phaeochromocytoma
pregnancy
recent MI
Indications for ECT
catatonia
no medication has worked
psychotic
Drug induced psychosis
cannabis
corticosteroids
opioids
cocaine
amphetamines
levodopa
anti-malaria
mech of action of trypical antipsychotics
dopamine receptor blockade = D2 antagonists
Acute dystonia
- AP adverse reaction
- abnormal msucle contraction
- IV procyclidine
SE of typical APs
- hyperprolactinaemia
- extrapyradimal = pd, akathasia, dystonia
- Metabolic = weight gain, T2
- Anticholinergic = tachy, vision, constipation
- Neuro = NMS, seizures
MoA atypical APs
- Blocl 5HT2 serotonin receptors
- More selective
Clozapine SE
- agranulocytosis
- Lowers seizure threshold
- FBC weekly then 2 monthly
the 4 dopamine pathways
- mesolimbic (+ve sx)
- Mesocortical (-ve Sx)
- Nigrostriatal (EPS and TD)
- Tuberinfundibular (prolactin)
which pathway causes hyperprolactinaemia
tuberoinfindibular
which pathway causes EPS and TD
- nigrostriatal
SE SSRI
- N+V
- Headache
- Anxiety
- Sexual dysfunction
- Insomnia
- Hypona
SNRI SE
- nausea
- dry mouth
- dizzy
- sweat
- htn
lithium monitoring
- 0.6-1
- 1 after start, 1s after dose change and weekly until stable then 3m
- 12 hrs post dose
- 6m thyroid, parathyroid, renal
- weekly plasma
Lithium SE
- Nausea
- diarrhoea
- muscle weajness
- hypo/hyperthyroid
- tremor fine
- weight gain
- polyuria and dipsia
- hyper PTH
- nephro
lithium toxicity
- drowsy
- N+V
- blurred vision
- coarse tremor
- delirium
- dysarthria
what tool to screen for depression post partum
- Edinburgh postnatal depression scale
Baby blues
- 3-7 days following birth
- anxious, tearful, irritable
- reassurance, support, health visitor
postnatal depression
- 1-3m after
- support, SSRI, CBT
puerperal psychosis
- 2-3w
- severe mood swings
- auditory hallucinations, delusions
- specialist mother and baby unit
