psych

Question 1

anxiety- definition
what is a panick attack.

Answer 1

: a feeling of unease, such as worry or fear, can be mild or severe.

free floating- no environmental curcumstance.
several months for more days than not.

sudden onset of extreme anxiety, last anywhere from few mins to 30, often peak at 10.

Question 2

GAD treatment

Answer 2

CBT

SSRI eg. sertraline
2nd line venlafaxine MR, escitalopram
3rd line: consider pregabalin.

benzoz short term only.

optimal duration at least a year.

Question 3

what is agoraphobia

Answer 3

places and situations where there may be difficulties escaping e.g trains public placs

Question 4

panic disorder treatment

Answer 4

CBT
SSRI, clomipramine or imipramine( similar to amytriptaline)

self help
exercise
support groups.

if no response to two consider refferal.

Question 5

panic in a&e management

Answer 5

ask if already being treated
undergo minimum investigations necessary

not admitted usually.
refer to primary care

Question 6

schizophrenia describe it

Answer 6

abnormal throughts and perceptons.
affects self experiance, cognition, volition, affect and behaviour

NOT SPLIT PERSONALITY. belongs to psychotic conditions.

Question 7

how to treat agoraphobia, social phobia, simple phobia.

Answer 7

agoraphobia- desensitisation therapy. meds

social phobia- CBT, medication

simple phobia- systematic desensitisation.

avoidance does not work.

Question 8

core features of schitsophrenia

Answer 8

inability to distinguish reality from fantasy.

impaired reality testing with creation of a new reality.

delusions
abnormal perception
thought disorders.

positives- are additions to the experiance
negatives- subtractions from the experiance.

Question 9

whats a delusion
thought echo
halucinations

Answer 9

delulu- false fixed belief- firmly held despite evidence to contrary.
not in keeping with sociocultural background. (grandiose, persecutory etc)

echo- broadcasting, insertion, withdrawal.

halulu- perception without an external stimmy

Question 10

how to diagnose schizophrenia + Risk factors

Answer 10

major criteria- at least one clear or two less clear

2 or more minor criteria.

genetic risk factors
50% if both parents have schitzo
brain abnormalities.
maternal illness in pregnancy.
cannabis-

Question 11

management of schitzo

Answer 11

+vs symptoms-
chlorpromazine, haloperidol– typical
olanzapine, risperidone, clozapine- aka atypical or 2nd gen.

clozapine- 3rd line- causes agranulocytosis. - need monitoring.
all affect dopamine receptors.

Question 12

forensic psychiatry

what is a violence risk assessment + what to consider

Answer 12

assessment and management of mental disorder associated with offending behaviour.

how likely they are to commit violence.
consider- violence habits, relationship with mental state, relationships. impulsivity, early exposure to violence, passivity phenomena.

Question 13

diminished responsibility what is it.

Answer 13

if killing has taken place- cant be convicted of murder if abnormal mental functioning from a recognised mental condition, impairing ability to be rational etc

Question 14

self harm- definition + RF

Answer 14

umbrella term including suicide attempts.

intentional- expresion of emotional distress.

socioeconomic, isolation, life events, mental/ phys health problems. alcohol or drug misuse.

Question 15

treamtent of depression or bipolar. stratagies/ what to avoid.

Answer 15

unopposed antidepressants can cause manix switch

need mood staibiliser + antidepressant.

fluoxatine + olanzapine.
or quetiapine

2nd line: lamotrigine on its own.

3rd- long term- lithium/ valporate.

Question 16

bipolar (and explain what it is) vs EUPD

Answer 16

EUPD- hour to hour fluctuations in mood.

bipolar- chronic episodic. (4 hypo, 7/7 mania)

bipolar type 1 is mania
type 2 is hypo mania

can have rapid cycling in bi- 4 episodes in 12/12.

Question 17

how to diagnose mania

Answer 17

grandiose –> delulu beliefs
pressure of speech
excessive energy + dec need for sleep

racing flight of ideas
easily distracted
inc appetite
inc engagement with pleasurable activities (sex disinhib, spending)

bright unkempt clothing
some psychotic features- halulu + lack of insight.

need 3 of these.

Question 18

eating disorders

Answer 18

725000 in the country

claims more lives than any other mental illness.

0.5% women, 0.1% men. (anorexia) 18-20% death rate 20 years after diagnosis.

Question 19

overview of anorexia nervosa

Answer 19

bmi below 17.5 usually to emancipation.
leads to endocrine dysfunction.

specific: morbid/ irational fear of being normal weight, distorted body image.

after 7 years the disease character changes- sever and enduring. resistant to change.

1/3 recover, 1/3 remain ill, 1/3 fluctuate.

Question 20

managemnt of AN

Answer 20

-children –diatetic counselling
family therapy
1-1 therapy
inpatient treatment should not be delayed if weight gain stalled.

– adults-
diatetic councelling, psychological therapy for 6/12 CBT etc)

Question 21

bulemia nervosa

Answer 21

normal bmi

binge and then purge. - need to feel out of control

Binge episodes- 1x a week for 3/12 minumum.

need recurrent compensatory behaviour to prevent wt gain (vom, laxitives, restriction)

excessive concerns about body wt / shape.

has a later onset (18)- vomiting stars at 21

some association with PCOS. not sure what causes what.

Rx: psych interventions 15-20 sessions. better chances of recovery

Question 22

binge eating disorder

Answer 22

similar to bulaemia but without the compensatory behaviour

affects adults more than children

Question 23

personality disorders vs difficulties.

Answer 23

become a disorder when meet the three ps

probematic

persistent

pervasive- several different aspects of the pts life.

Question 24

how to diagnose personality disorders, how common

Answer 24

no clear onset, gradual notice that personality might be the problem.

SCID interview- need 4-5 out of 9 usually.

3 clusters
A- odd and eccentric, paranoid, schitzoid.
B- dramatic emotional and erratic.- antisocial, narc, boarderline (EUPD)

C- anxious and fearful- dependant, avoidant, OCD.

5-12% of people.

Question 25

define intellectual disability + RF

Answer 25

lower IQ (usually less than 70), impairment in social or adaptive functioning, onset in childhood.

mild, moderate or severe - depending on IQ emotional range etc.

RF: chromosomal abnormality, congen malformation, birth complication, childhood illness/ trauma, neglect.

Rx: refer to local disability support team, annual health checks, support phys health,

Question 26

obsessive compulsive disorder

Answer 26

obsessions- unwanted disturbing and intrusive thoughts images or impulses. - recognised as excessive and irrational

compulsions- repetitive stereotyped behaviours and mental acts which neutralise obsessions and dec emotional distress.

Rx: CBT or SSRI- dual if one fails

Clomipramine if 2 ssri fail.
(citalopram 20mg OD, fluox 20 OD, sert 50 OD)

Question 27

hypochondriacal disorders

Answer 27

persistent pre-occupation with having or developing a serious illness.
absent or mild somatic symptoms

assoc with anxiety or depressive disorders.

Dx: preoccupation with having illness, anxiety over health, excessive health related behaviours/ maladaptive avoidance behavs
6/12+
not better explained

Rx:
CBT
one primary care physician
rx other disorders