psych Flashcards
anxiety- definition
what is a panick attack.
: 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.
GAD treatment
CBT
SSRI eg. sertraline
2nd line venlafaxine MR, escitalopram
3rd line: consider pregabalin.
benzoz short term only.
optimal duration at least a year.
what is agoraphobia
places and situations where there may be difficulties escaping e.g trains public placs
panic disorder treatment
CBT
SSRI, clomipramine or imipramine( similar to amytriptaline)
self help
exercise
support groups.
if no response to two consider refferal.
panic in a&e management
ask if already being treated
undergo minimum investigations necessary
not admitted usually.
refer to primary care
schizophrenia describe it
abnormal throughts and perceptons.
affects self experiance, cognition, volition, affect and behaviour
NOT SPLIT PERSONALITY. belongs to psychotic conditions.
how to treat agoraphobia, social phobia, simple phobia.
agoraphobia- desensitisation therapy. meds
social phobia- CBT, medication
simple phobia- systematic desensitisation.
avoidance does not work.
core features of schitsophrenia
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.
whats a delusion
thought echo
halucinations
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
how to diagnose schizophrenia + Risk factors
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-
management of schitzo
+vs symptoms-
chlorpromazine, haloperidol– typical
olanzapine, risperidone, clozapine- aka atypical or 2nd gen.
clozapine- 3rd line- causes agranulocytosis. - need monitoring.
all affect dopamine receptors.
forensic psychiatry
what is a violence risk assessment + what to consider
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.
diminished responsibility what is it.
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
self harm- definition + RF
umbrella term including suicide attempts.
intentional- expresion of emotional distress.
socioeconomic, isolation, life events, mental/ phys health problems. alcohol or drug misuse.
treamtent of depression or bipolar. stratagies/ what to avoid.
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.
bipolar (and explain what it is) vs EUPD
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.
how to diagnose mania
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.
eating disorders
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.
overview of anorexia nervosa
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.
managemnt of AN
-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)
bulemia nervosa
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
binge eating disorder
similar to bulaemia but without the compensatory behaviour
affects adults more than children
personality disorders vs difficulties.
become a disorder when meet the three ps
probematic
persistent
pervasive- several different aspects of the pts life.
how to diagnose personality disorders, how common
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.
define intellectual disability + RF
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,
obsessive compulsive disorder
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)
hypochondriacal disorders
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
