psych Flashcards
what is delusion of guilt?
Also referred to as delusions of sin or worthlessness, this delusion is characterised by the belief that one deserves to be punished. Usually, the ‘sin’ is an innocent error out of proportion to the guilt felt. It is typically associated with severe depression
what is delusion of thought possession?
These are false beliefs around the ownership of your thoughts. They can be subdivided into insertion, withdrawal, and broad-casting. They are classically seen in schizophrenia. This patient is not displaying any signs of thought possession
what are delusions of grandeur?
This is characterised by exaggerated beliefs about one’s self-worth, power, or identity - for example, believing one is a king or queen. It is classically associated with mania. This patient is not displaying any signs of delusions of grandeur
what are delusions of persecution?
This is the most common type of delusion, also known as paranoid delusions. Patients believe they are being followed, spied on, or conspired against. This is classically seen in schizophrenia. This patient is not displaying any signs of paranoid delusions
what is cotard’s syndrome?
A rare syndrome seen in severe depression - patient’s believe that they are dead, decaying, or do not really exist (also known as ‘walking corpse syndrome’). This patient is not displaying any signs of Cotard’s syndrome
what is derailment?
Derailment is a type of formal thought disorder where the speech consists of a series of unrelated or remotely related ideas.
what is tangentiality?
Tangentiality is a type of formal thought disorder where the person diverts from the original train of thought to other topics but never returns to the original topic. There are still some associations between the sentences, but they are diverted from the original topic of discussion. This is mainly seen in patients with schizophrenia.
what is word salad?
Word salad is a formal thought disorder where the speech is a mixture of random words and phrases that is confused and lacks meaning. It may not be possible to understand the sentence at all. This may occur in patients with schizophrenia.
what is perseveration?
a person with perseveration may answer the first question correctly but continues to give the same answers to subsequent different questions. This is seen in several conditions, including psychosis, dementia, and organic brain diseases.
what is circumstantiality?
Circumstantiality is a formal thought disorder where the speech consists of many unnecessary and insignificant details as well as digressions, but will still return to the original point. This may occur in patients with psychosis or obsessional disorders.
how do you test cognition?
10-point cognitive screener (10-CS)
6-item cognitive impairment test (6CIT)
6-item screener
Memory Impairment Screen (MIS)
Mini-Cog
Test Your Memory (TYM).
what is risk of chlorphenamine in elderly?
A first generation H1 antagonist, it also has anticholinergic activity. It is able to cross the blood brain barrier and can lead to anti-depressant/anxiety effects. In the elderly however, there is a high risk of inducing acute delirium or other anti-cholinergic actions such as dry mouth and urinary retention
what indicated risk of going on to complete suicide?
wha indicated better prognosis in schizophrenia?
higher IQ/education level, sudden onset, presence of a precipitating factor, a strong support network, and predominance of positive symptoms
what are symptoms of methadone overdose?
decreased respiratory rate, decreased heart rate, drowsiness and constricted pupils
what is capgras syndrome?
In Capgras syndrome, patients believe that someone familiar to them (eg. a friend or relative) has been replaced by an exact clone.
features of schizoid personality disorder?
the absence of close friends, minimal contact with other people, including family, insensitivity to social norms and flattened affect.
what is a common cardiac complication of anorexia?
mitral valve prolapse with a pan systolic murmur and click which is a very common finding in anorexia and is caused by loss of cardiac muscle with the mitral valve remaining the same size
what indicates poor prognosis in schizophrenia?
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
what is the MOA of atomoxetine?
what is it used for?
Atomoxetine is a norepinephrine reuptake inhibitor
ADHD
what is the MOA of methylphenidate?
what is it used for?
Norepinephrine and dopamine reuptake inhibitor
adhd
what is the tuberoinfundibulnar pathway?
a dopaminergic pathway emanating from the hypothalamus to the median eminence
what does inhibition of the tuberoinfundibulnar pathway cause?
Inhibition of the tuberoinfundibular pathway by antipsychotics causes hyperprolactinaemia
what is the nigrostriatal pathway involved in?
pathophysiology of Parkinson’s disease
what is the mesolimbic pathway?
thought to be overactive in schizophrenia which causes a patient’s positive symptoms such as hallucinations
what is the mesocortiyal pathway?
thought to be abnormal in schizophrenia, which causes the negative symptoms e.g. avolition.
what are SSRI discontinuation symptoms?
which SSRI has higher incidence of discontinuation symptoms?
paroxetine
how does haloperidol work?
dopamine D2 receptor antagonist, blocking dopaminergic transmission in the mesolimbic pathways
what is true about brief psychotic disorder?
how does zopiclone work?
a non-benzodiazepine which stimulates the α-subunit of the GABA receptor to exert its effects
On the receptor, zopiclone binds to a different distinct site than benzodiazepines but has similar effects
what is zopiclone used for?
It is used for insomnia and anxiety and prolonged use should be avoided due to addiction and tolerance.
what ion flows through the GABA receptor?
chloride
what is the strongest risk factor for completion of sucicde?
A previous suicide attempt is one of the strongest risk factors for future suicide completion
what are reflex hallucinations?
when a normal sensory stimulus, in one modality, precipitates a hallucination in another e.g. the voices are only heard when the lights turn out.
what are autoscopic hallucinations?
a visual hallucination, which describes the experience of seeing oneself in external space
what are first person auditory hallucinations?
(audible thoughts) are where a person hears their own thoughts aloud.
what are elementary hallucinations?
simple, unstructured sounds e.g. buzzing or whistling.
what are haptic/tactile hallucinations?
the feeling of the skin being touched, pricked or pinched
What should be monitored at initiation and dose titration of venlafaxine?
BP
What should be monitored prior to starting citalopram in this patient?
ECG due to possible QT prolongation, and/or ventricular arrhythmias including torsade de pointes
What would you perform first to identify the cause of confusion in a patient’s taking sertraline?
For people at high risk, measure the serum sodium level before starting treatment, 2-4 weeks after starting treatment and every 3 months thereafter.
short term s/e of ECT?
cardiac arrhythmias
who does the mental health act apply to?
individuals over 16 years of age with serious mental health disorders, which threaten their health or safety or the safety of others, to facilitate assessment and treatment of their condition irrespective of their consent where it is necessary to prevent them from harming themselves or others
what is the criteria for the mental health act?
They must have a mental disorder
There must be a risk to their health/safety or the safety of others
There must be a treatment (however this can include nursing care, not just drugs)
what does assessment under the mental health act require?
what does MHA section 2 do?
what does MHA section 3 do?
what does MHA section 4 do?
what does MHA section 5(2) do?
Holding power which enables a doctor to legally detain a voluntary patient in the hospital for a period of 72 hours.
what does MHA section 5(4) do?
Section 5(4) is comparable to a Section 5(2) but is enacted by registered nurses and has a duration of 6 hours.
what does MHA section 17a do?
Allows for a Supervised Community Treatment (also known as a Community Treatment Order).
what does MHA section 135 do?
Court order enabling the police to enter a property to escort a person to a Place of Safety (either the police station or, more commonly, an Accident and Emergency Department (A&E)).
what does MHA section 136 do?
Provides police officers the authority to take an individual, who seems to be suffering from a mental disorder and is in a public place, to a Place of Safety.
5 principles of the mental capacity act?
when is the mental capacity act used?
The Mental Capacity Act (MCA) is used when a patient lacks capacity. It allows doctors (or less commonly, those with Lasting Power of Attorney) to make decisions in the best interests of their patient.
how do you assess capacity?
part 1
Is there an impairment of, or disturbance in, the functioning of the mind or brain?
If yes, then step 2) For a person to lack capacity they must show an ‘impairment of, or disturbance in, the functioning of the mind or brain’ AND they are unable to undertake any of the following:
Understand relevant information
Retain the relevant information
Weigh up the relevant information
Communicate a decision
If they are unable to do one of these things then they do not have capacity.
do you do if someone does not have capacity?
what is deprivation of liberty>
Used where it is necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm.
It safeguards for those who lack capacity and do not want to be somewhere and are not free to leave.
