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Psych Flashcards

1
Q

Illusion

A

Perception when a sensory stimulus is present but is incorrectly perceived

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2
Q

Hallucination

A

Sensory perception occurs in absence of stimulus

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3
Q

Pseudo-hallucination

A

Externalised sensory image vivid enough to be a hallucination but recognised as unrea

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4
Q

Overvalued idea

A

Solitary abnormal belief neither delusional nor obsessional in nature but preoccupying to the extent of dominating the sufferers life

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5
Q

Delusion

A

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

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6
Q

Delusional perception

A

A true perception to which a patient attributes a false meaning

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7
Q

Loosening of association

A

Disorganised speech due to a lack of connectivity between ideas

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8
Q

Perseveration

A

Continual repetition of thought or behaviour e.g. finger wiggling

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9
Q

Confabulation

A

Memory error in which gaps are unconsciously filled with fabricated information

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10
Q

Somatic passivity

A

Experience of bodily sensations imposed by external agency

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11
Q

Pressure of speech

A

Rapid and frenzied speech

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12
Q

Anhedonia

A

Inability to experience plasure in normally pleasurable acts

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13
Q

Incongruity of affect

A

Mismatch between experienced emotions and its expression

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14
Q

Blunting of affect

A

Diminished facial expressions, expressive gestures and vocal expressions, Difficulty expressing emotions

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15
Q

Belle indifference

A

Absence of psychological distress despite serious illness

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16
Q

Depersonalisation

A

Dissociative disorder = persistant or recurrent feelings o being detatched

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17
Q

Thought alienation

A

Feel own thoughts are no longer own

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18
Q

Thought insertion

A

Experiencing one’s own thoughts as someone elses

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19
Q

Thought withdrawal

A

Believe a person or entity has removed thought from mind

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20
Q

Thought broadcast

A

Believe people can hear thoughts

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21
Q

Thought echo

A

Hearing own thoughts aloud after thinking them

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22
Q

Thought block

A

Unable to think, speak or move

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23
Q

Akathisia

A

Movement disorder = hard to stay still

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24
Q

Clouding of consciousness

A

Inattention and reduced wakefulness

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25
Depression definition
Persistent low mood +/- loss of pleasure in activities Emotional, cognitive, physical and behavioural Sx
26
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
27
Depression Ix
Bloods CXR = infections ECG = metabolic
28
Mx depression
Mild-moderate = CBT or psychotherapy Moderate-severe = psychotherapy and antidepressant 1st episode = generic SSRI = citalopram, sertraline Recurrent = antidepressant with previous good response
29
GAD definition
Disproportionate, pervasive, uncontrollable and widespread worry
30
S+S GAD
Restlessness Fatigue Irritability Poor concentration Sleep disturbance Muscle tension
31
Physical features of GAD
Dry mouth Diarrhoea Chest constriction Palpitations Urinary frequency Libido loss
32
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
33
GAD Mx
active monitoring Psychological interventions = CBT = with marked functional impairenent = high intensity psychological intervention and drug treatment
34
GAD drugs
SSRI 1st line SNRI Pregabalin
35
OCD definition
Recurrent obsessional thoughts or compulsive acts Obsessions = unwanted intrusive thoughts Compulsions = behaviours that result from obsessive thoughts
36
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
37
MX OCD
CBT Supportive psychotherapy SSRI Clomipramine Specialist referral
38
Bipolar 1
Underlying depression, interspersed with mania
39
Bipolar 2
Depression more dominant
40
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
41
Bipolar hypomanic sx
4 days Mildly elevated mood Increased energy Sociability No psychotic
42
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
43
Positive psychosis sx
Delusions Held Firmly Think Psycho Delusions Hallucinations (3rd, auditory) Formal Thought disorder = form, possession, content Thought interference Passivity Lack of insight
44
Negative Sx psychosis
A6C Asocial Avolition Alogia Affect blunted Anhedonia Attention deficit Catatonia
45
Psychosis
Schizophrenia = most common form
46
Schizophrenia prodrome
Deterioration in social functioning + transient/attenuated psychotic Sx
47
1st rank schizophrenia S+S
Auditory hallucinations 3rd person Thought withdrawal, insertion and broadcast Delusional perception Somatic passivity (external agents imposed)
48
Specifics of the voices heard in 1st rank sx
- Own thoughts spoken aloud - auditory 3rd person hallucinations - running commentary - not commanding
49
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
50
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
51
PTSD
Following traumatic event characterised by involuntary re-experiencing of elements with Sx of hyperarousal, avoidance and emotional numbing
52
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
53
PTSD Mx
CBT EMDR SSRIs
54
Borderline personality disorder
Act impulsively Intense short lived emotional attachments Chromic internal emptiness Frequent SH Transient pseudo psychotic featires FHx
55
Paranoid PD
Extreme sensitivity Suspicious Self important Preoccupation with conspiracy theories
56
Schizoid PD
Emotionally cold and detatched Limited capacity to express emotions Indifference to praise or criticism Preference for solitary activities
57
Antisocial PD
Callous inconcern for feelings of others Incapacity to maintain enduring relationships Low tolerance of frustration Incapacity to experience guilt Blame others
58
Histrionic PD
Self dramatisation, theatricality Shallow and liable emotions Continual seeking for excitement and appreciation Inappropriately sedutive appearance an behaviour
59
Suicide risk assessment in adolescents
Home and environment Education Activities Drugs and alcohol Sexuality Suicide and depression
60
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
61
Screening for alcohol dependency
CAGE AUDIT Increased MCV and GGT
62
FRAMES principles
Feedback Responsibility Advice Menu Empathy Self efficacy
63
Opiates sx
Pinpoint pupils Low BP Venepuncture marks
64
Stimulants Sx
Rapid speech Large pupils Agitation Restlessness High BP
65
Opiate withdrawal Sx
Dialte pupils High BP Sweaty Rhinorrhoea Cramps Goose bumps
66
Mx phobias
Behavioural therapy Flooding Cognitice BDZ if severe
67
Serotonin syndrome
Iatrogenic syndrome resulting from excess serotonin levels in central and peripheral nervous system
68
Medications that cause serotonin syndrome
SSRIs SNRIs MAOIs TCA Tramadol Stimulants
69
S+S serotonin syndrome
Agitation and confusion Hypomania Seizures Tone increased Tremor Hyperreflexia and clonus HTN Diarrhoea hyperthermia
70
Mx serotonin syndrome
Cease offending drugs Cyproheptadine
71
S+S OCPD
Perfectionism Rigid mannersisms Extreme attention to detail Excessive devotion Doubt, indecisiveness, caution called anankastic
72
Sx alcohol withdrawal
Mild = HTN, tachy, anorexia, anxiety Moderate = worsening mild plus agitation and coarse tremor Severe = delerium tremens = confusion, TC seizures, hallucinations, hyperthermia
73
Sx wernickes encephalopathy
Confusion Ataxia Eye paralysis Nystagmus Memory disturbance Hypothermia and hypotension Caused by thiamine deficiency therefore prescribe thiamine
74
Delerium tremens
Acute confusional state secondary to alcohol withdrawal Clouding consciousness Disorientation Amnesia for recent events Psychomotor agitation Hallucinations (liliputian)
75
Opiate detoxification
Methadone Moderate = aches, dialted pupils, yawning = 10-20mg methadone Severe = vomiting, HTN = 20-30mg methadone
76
Conversion disorder
Loss of motor or sensory function Doesn’t consciously feign symtpoms or seek material gain Belle indifference
77
Somatisation
Multiple physical symptoms present for at least 2 years Refuses to accept reassurance or negative test results
78
benzodiazapine used for alcohol withdrawal
chlordiazepoxide
79
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
80
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
81
Anorexia Mx
Treat psychological disorder Encourage weight gain Family therapy
82
Anorexia complication
Cardioac = brady, hypotn, ECG changes CNS = impaired concentration Derm = brittle skin, nails and hair loss Haem = anaemia Met = hypok, hypona, hypogly Amenorrhoea
83
Refeeding syndrome
Potentially fatal shift in fluids and electrolytes High risk = give thiamine, vit B, daily bloods
84
Metabolic consequences of refeeding syndrome
Hypophosphataemia Hypokalaemia Hypomagnesium = torsades de points Abnormal fluid balance
85
NICE recommendation for refeeding
If not eaten >5 days, refeed at no more than 50% of requirements for 2 days
86
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
87
Bulimia ICD10
Persitent preoccupation with eating Irresistable craving for food Binges Attempts to counter food effects Morbid dread of fatness
88
Complications of purging
Arrhythmia Cardiac failure Electrolyte disturbance Oesophageal erosions or gastric perforation Ulcers Pancreatitis
89
Acute dystonic reaction
After new ATAP or and increased dose recently Torticollis, trismus, jaw opening Procyclidine given
90
Neuroleptic malignant syndrome
Reaction to APs Fever, rigidity, autonomic dysfunction, confusion, tachy, tremor Raised CK and leukocytosis Stop AP BZD Supportive
91
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
92
features opioid overdose
- pinpoint - decreased RR - altered status - response to naloxone
93
Opiod detox
Methadone/buprenorphine/dihydrocoedine Lofexidine to relieve withdrawals Naltrexone to prevent relaps Overdose = naloxone
94
Pathophysiology alcohol abuse
Up regulation NMDA receptors Downregulation GABA receptors Cessation causes CNS hyperexcitability
95
Alcohol wdrawal
6hrs = malaise, tremor, nausea 36hrs = seizures 72hrs = delirium tremens
96
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
97
Delirium tremens
72hrs after Cog impairement, liliputian, paranoid delusion, sweating, dehydration Mx = pabrinex and lorazepam
98
Wernicke
Delirium, nystagmus, hypothermia, ataxia Mx = pabrinex
99
mechanism of paracetamol overdose
More paracetamol shunted to CP450 system so more NAPQO produced
100
Mx paracetamol OD
within 1hr = activated charcoal > 8hrs IV N acetylcysteine = 3 consecutive IV infusions 1st infusion is 1hr
101
Give NAC if
- past line 4hrs post - Staggered overdose - 8-24hrs after >150mg/kg - >24hrs jaundiced, tender, ALT
102
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
103
absolute contraindication for ECT
raised intracranial pressure
104
relatice contraindications for ect
cerebral tumour/aneurysm phaeochromocytoma pregnancy recent MI
105
Indications for ECT
catatonia no medication has worked psychotic
106
Drug induced psychosis
cannabis corticosteroids opioids cocaine amphetamines levodopa anti-malaria
107
mech of action of trypical antipsychotics
dopamine receptor blockade = D2 antagonists
108
Acute dystonia
- AP adverse reaction - abnormal msucle contraction - IV procyclidine
109
SE of typical APs
- hyperprolactinaemia - extrapyradimal = pd, akathasia, dystonia - Metabolic = weight gain, T2 - Anticholinergic = tachy, vision, constipation - Neuro = NMS, seizures
110
MoA atypical APs
- Blocl 5HT2 serotonin receptors - More selective
111
Clozapine SE
- agranulocytosis - Lowers seizure threshold - FBC weekly then 2 monthly
112
the 4 dopamine pathways
- mesolimbic (+ve sx) - Mesocortical (-ve Sx) - Nigrostriatal (EPS and TD) - Tuberinfundibular (prolactin)
113
which pathway causes hyperprolactinaemia
tuberoinfindibular
114
which pathway causes EPS and TD
- nigrostriatal
115
SE SSRI
- N+V - Headache - Anxiety - Sexual dysfunction - Insomnia - Hypona
116
SNRI SE
- nausea - dry mouth - dizzy - sweat - htn
117
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
118
Lithium SE
- Nausea - diarrhoea - muscle weajness - hypo/hyperthyroid - tremor fine - weight gain - polyuria and dipsia - hyper PTH - nephro
119
lithium toxicity
- drowsy - N+V - blurred vision - coarse tremor - delirium - dysarthria
120
what tool to screen for depression post partum
- Edinburgh postnatal depression scale
121
Baby blues
- 3-7 days following birth - anxious, tearful, irritable - reassurance, support, health visitor
122
postnatal depression
- 1-3m after - support, SSRI, CBT
123
puerperal psychosis
- 2-3w - severe mood swings - auditory hallucinations, delusions - specialist mother and baby unit

FINALS (32 decks)

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