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Alice's finals cards > Psych 2 > Flashcards

Psych 2 Flashcards

1
Q

Psychiatric assessment: what is modification?

A

Recognising when a process needs to be modified and how to modify e.g. distressed patient, reduced cognitive capacity, non-native speaker.

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2
Q

What is a forensic history?

A

Asking the patient about past juvenile crime, court appearances or convictions.

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3
Q

What 4 things are you assessing throughout a mental state examination?

A
  1. Appearance and behaviour.
  2. Speech.
  3. Mood.
  4. Thoughts, delusions and hallucinations.
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4
Q

Psychiatric assessment: what is a risk assessment?

A

Consideration of how likely an event will occur, when it will occur and how bad will it be. E.g. harm to self, harm to others, suicide, self-neglect.

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5
Q

Formulation: what are the 5 P’s?

A
  1. Presenting problem.
  2. Predisposing factors.
  3. Precipitating factors.
  4. Perpetuation factors.
  5. Protective factors.
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6
Q

What is psychopathology?

A

The study of abnormal experience, cognition and behaviour.

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7
Q

What are the 2 essential components of psychopathology?

A
  1. Observation of behaviour.

2. Empathic assessment of subjective experience.

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8
Q

What is a concrete concept?

A

Real objects or situations e.g. tremor.

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9
Q

What is a defined concept?

A

Classes of concept e.g. delusions.

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10
Q

What are concept systems?

A

Sets of related concepts e.g. schizophrenia.

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11
Q

Give 3 examples of perceptual symptoms.

A
  1. Illusion.
  2. Hallucination.
  3. Pseudo-hallucination.
  4. Delusion.
  5. Over-valued idea.
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12
Q

Define illusion.

A

A misperception of real external stimuli.

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13
Q

What is a hallucination?

A

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.

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14
Q

Define pseudo-hallucination?

A

Pseudo-hallucinations appear to arise in the subjective inner space of the mind, not through one of the external sensory organs - this is how they differ from hallucinations.

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15
Q

What is meant be the term ‘over-valued idea’?

A

An over-valued idea is a false or exaggerated belief sustained beyond logic or reason e.g. I am the best employee ever.

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16
Q

Define delusion.

A

A false, unshakable idea which is out of keeping with the patients educational, cultural and social background; it is held with extraordinary conviction and certainty.

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17
Q

Give 5 examples of different types of delusion.

A
  1. Persecutory.
  2. Grandiose.
  3. Self-referential.
  4. Nihilistic (Cotard’s syndrome).
  5. Misidentification.
  6. Religious.
  7. Hypochondriacal.
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18
Q

What is the Capgras delusion?

A

The idea that someone has been replaced by an impostor.

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19
Q

What is the Fregoli delusion?

A

The idea that various people are in fact the same person.

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20
Q

Thoughts are a common psychiatric sign. Name 5 types of thoughts patients may report/describe.

A
  1. Thought insertion.
  2. Thought withdrawal.
  3. Thought broadcast.
  4. Thought echo.
  5. Thought block.
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21
Q

What is concrete thinking?

A

A lack of abstract thinking, in adults this may be due to organic disease or schizophrenia.

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22
Q

Define loosening of association.

A

A lack of logical association between succeeding thoughts, often leads to incoherent speech. It is impossible to follow the patients train of thought.

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23
Q

Define circumstantiality.

A

Irrelevant wandering in conversation.

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24
Q

What is perseveration?

A

Repetition of a word, theme or action.

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25
Q

What is confabulation?

A

Giving a false account to fill a gap in memory. This is often seen in dementia patients.

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26
Q

Define somatic passivity.

A

The delusional belief that one is a passive recipient of bodily sensations from an external agency.

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27
Q

Define catatonia.

A

Excited or inhibited motor activity in the absence of a mood disorder or neurological disease.

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28
Q

What is psychomotor retardation and in what conditions would it be present?

A

Slowing of thoughts and movements.

It can be seen in depression, Parkinson’s disease etc.

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29
Q

Presentation: describe incongruity of affect.

A

Emotional responses that seem grossly out of tune with the situation or subject being discussed.

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30
Q

Presentation: what is blunting of affect?

A

An absence of normal emotional responses.

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31
Q

Presentation: what is depersonalisation?

A

Feelings of detachment from one’s own body; the patient feels like a spectator of his own activities.

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32
Q

Presentation: describe derealisation.

A

A sense of one’s surroundings lacking reality, surroundings may appear dull, grey, lifeless.

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33
Q

Presentation: describe dissociation.

A

When a person feels disconnected from his/herself and/or their surroundings.

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34
Q

Psychiatric signs: what is obsession?

A

A recurrent persistent thought, image or impulse; it remains despite efforts to resist.

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35
Q

Psychiatric signs: what is compulsion?

A

Repetitive, purposeful behaviour accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and resistance.

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36
Q

Psychiatric signs: what is akathisia?

A

Motor restlessness, ranging from anxiety to the inability to lie/sit still.

37
Q

Phenomenology: what is projection?

A

What is emotionally unacceptable in the self is unconsciously rejected and projected to others e.g. mother projects her anxiety onto her children claiming they are anxious instead.

38
Q

Give 3 signs/symptoms of mania.

A
  1. Pressured speech.
  2. Lots of projects/things going on.
  3. Delusions.
  4. Increased energy/activity.
  5. Overfamiliarity.
  6. Impulsivity.
39
Q

Give 2 examples of affective disorders.

A
  1. Depression.

2. Bipolar disorder.

40
Q

Give 3 symptoms of depression.

A
  1. Low mood.
  2. Lacking energy.
  3. Loss of pleasure.
  4. Sleep disturbance.
  5. Appetite change.
  6. Feelings of guilt, hopelessness.
  7. Suicidal thoughts.
41
Q

Give 3 symptoms often seen in bipolar disorder.

A
  1. Increased energy.
  2. Pressured speech.
  3. Recklessness.
  4. Impaired judgement.
  5. Inflated self-esteem.
  6. Elevated mood.
42
Q

When is the onset of schizophrenia most typical?

A

In the 2nd or 3rd decade.

43
Q

Give a characteristic sign of schizophrenia.

A

Characteristic splitting of thoughts or a loss of contact with reality. Thoughts, perceptions, mood, personality, speech can all be affected.

44
Q

Give 3 first rank symptoms of schizophrenia.

A
  1. Thought alienation.
  2. Passivity phenomena (one’s thoughts or actions are influenced or controlled by an external agent).
  3. 3rd person auditory hallucinations.
  4. Delusional perception. (traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land.)
45
Q

Give 3 second rank symptoms of schizophrenia.

A
  1. Delusions.
  2. 2nd person auditory hallucinations.
  3. Thought disorder.
  4. Negative symptoms.
46
Q

Name 3 types of psychoses.

A
  1. Schizophrenia.
  2. Delusional disorder.
  3. Schizotypal disorder.
  4. Depressive psychosis.
  5. Manic psychosis.
  6. Organic psychosis.
47
Q

Give 3 physical signs and 3 psychological signs of panic disorder.

A 
Physical:
1. Palpitations.
2. Chest pain.
3. Tachypnoea.
4. Dry mouth.
5. Dizziness.
Psychological:
1. Feeling of impending doom.
2. Fear of dying.
3. Fear of losing control.
4. Derealisation.
48
Q

Give 3 positive signs/symptoms of schizophrenia.

A
  1. Hallucinations.
  2. Delusions.
  3. Passivity phenomena.
  4. Thought alienation.
  5. Lack of insight.
  6. Mood disturbance.
49
Q

Give 3 negative signs/symptoms of schizophrenia.

A
  1. Blunting of affect.
  2. Amotivation.
  3. Poverty of speech and/or thought.
  4. Self-neglect.
  5. Lack of insight.
  6. Poor non-verbal communication.
50
Q

What 2 classification systems are used for psychiatric conditions?

A
  1. DSM5.

2. ICD10.

51
Q

Give 2 pros and 2 cons of using classification systems for psychiatric conditions.

A 
Pros:
1. Allows for population study and health planning.
2. Aids education.
Cons:
1. Over generalised.
2. Ignores individual characteristics. 
3. Diagnostic labels may lead to stigma.
52
Q

Define personality disorder.

A

Long-lasting, rigid patterns of thought and behaviour. Behaviour that differs from ‘normal’. Present in a range of situations and causes considerable distress. Tends to begin in adolescence.

53
Q

What are the essential diagnostic features of a personality disorder?

A
  1. Impairments in self and interpersonal functioning.
  2. Impairments in personality functioning.
  3. Impairments are relatively stable across time and consistent across situations.
54
Q

What daily life tasks might someone with a personality disorder struggle with?

A
  1. Forming/maintaining friendships and work relationships.
  2. Struggle to control feelings and behaviours.
  3. Struggle to trust others.
55
Q

What is the main type of personality disorder?

A

Emotionally unstable personality disorder.

56
Q

Give 3 symptoms of a borderline type personality disorder.

A
  1. Emotional instability.
  2. Difficult, intense relationships.
  3. Feelings of emptiness.
  4. Impulsive.
  5. Self injurious behaviour.
  6. Fear of abandonment/rejection.
57
Q

Why might someone with a borderline personality disorder self-harm?

A
  • Relieve psychic pain.
  • Express anger.
  • Reduce anxiety.
  • Feel in control.
  • Feel something when numb.
  • Communicate how they feel.
58
Q

How would you treat/manage someone with a personality disorder?

A
  1. Psychological therapies - dialectical behavioural therapy.
  2. Structured clinical management.

Medication is not mainstay.

59
Q

What principles underly the Mental Health Act?

A
  1. Respect for patients’ wishes and feelings.
  2. Minimise restrictions on liberty.
  3. Public safety.
  4. Patient well-being and safety,
  5. Involving patients in planning, developing and delivering care.
60
Q

Describe Section 2 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: assessment, treatment can be given without consent.
  2. Duration: 28 days.
  3. Professionals involved: 2 doctors, AMHP.
61
Q

Describe Section 3 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: treatment.
  2. Duration: 6 months.
  3. Professionals involved: 2 doctors, AMHP.
62
Q

Describe Section 4 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: emergency order.
  2. Duration: 72 hours.
  3. Professionals involved: 1 Dr and 1 AMHP.
63
Q

Lithium is an effective treatment for many psychiatric conditions including mania, bipolar disorder, depression etc. Why should it be used with care?

A

Lithium has a narrow therapeutic range which can lead to renal failure.

64
Q

What is dementia?

A

A progressive neurological disorder impacting cognition which causes functional impairment.

65
Q

Name 3 types of Dementia.

A
  1. Alzheimer’s.
  2. Vascular.
  3. Lewy Body.
66
Q

Give 3 differential diagnoses for dementia.

A
  1. Old age.
  2. Depression.
  3. Physical health problems e.g. DM, hypothyroid, vitamin deficiencies.
67
Q

What is the main investigative screening tool used for dementia?

A

ACE-III screening tool.

68
Q

Dementia: what 5 cognitive domains does the ACE-III screening tool assess?

A
  1. Attention.
  2. Memory.
  3. Fluency.
  4. Language.
  5. Visiospatial.
69
Q

What drugs can be used in the treatment of dementia?

A
  1. Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine.
  2. NMDA antagonist e.g. Memantine.
  3. RF reduction in vascular dementia is important too.
70
Q

What is pseudo-dementia?

A

Cognitive impairments secondary to a mental illness e.g. depression/anxiety.

71
Q

Give one way that you could distinguish between pseudo-dementia and dementia.

A

Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.

72
Q

What is delirium?

A

Delirium is an acute confusional state often with changes in consciousness. It is a medical emergency but is often reversible.

73
Q

Give 3 causes of delirium.

A
  1. Infection e.g. UTI.
  2. Dehydration.
  3. Iatrogenic e.g. medication changes or surgery.
  4. Constipation.
  5. Urinary retention.
74
Q

Patients with what psychiatric disorder may be more prone to delirium?

A

Patients with dementia - bidirectional relationship.

75
Q

How can you treat delirium?

A

Treat the underlying cause and consider environmental support. Antipsychotics can be used in extreme cases if the patient is suffering from hallucinations.

76
Q

Give 5 potential causes of depression.

A
  1. Drugs e.g. beta-blockers, opioids.
  2. Metabolic e.g. anaemia, B12/folate def, cancer.
  3. Infective e.g. post-viral, UTI.
  4. Inflammatory e.g. temporal arteritis.
  5. Intracranial e.g. post-stroke, Parkinson’s, Delirium, Dementia.
77
Q

Give 3 treatment/management strategies for depression.

A
  1. Antidepressants e.g. SSRI’s.
  2. Talking therapies.
  3. Social inclusion and community support.
  4. ECT.
78
Q

What type of depression often responds poorly to antidepressants?

A

Vascular depression.

79
Q

What is Charles Bonnet Syndrome?

A

A condition characterised by visual hallucinations.

80
Q

What is the recovery model?

A

A non-pharmacological, psychosocial approach to treatment e.g. supporting housing, living, money, social inclusion, therapy, counselling, family work.

81
Q

What is formulation?

A

A meaningful narrative - summarising a patients condition.

The 5 P’s demonstrates a good formulation model.

82
Q

Give examples of psychosocial therapies.

A
  1. Psychotherapy.
  2. CBT.
  3. Counselling.
  4. Cognitive analytic therapy.
  5. Interpersonal therapy.
  6. Dialectic behaviour therapy.
  7. Family therapy.
83
Q

What is attachment disorder?

A

When a child is unable to develop relationships with parents/carers.

84
Q

What are DOLS?

A

Deprivation of Liberty Safeguards are a part of the MCA (2005). They are a set of rules that apply when a patient can’t make decisions about how they’re cared for.

85
Q

When do DOLS apply?

A
  1. When a patient is in a hospital or care home.
  2. When the staff keep the patient under continuous supervision.
  3. The patient or the family members are unhappy about the care/limitations of the care.
86
Q

Describe the treatment for bipolar disorder.

A
  1. Mood stabilisers e.g. Lithium, sodium valporate or aripiprazole.
  2. Psychological therapies e.g. CBT.
87
Q

What do you need to monitor for when treating a patient with Lithium?

A

Kidney function and Thyroid function.

88
Q

A 27 year old man has a long history of interpersonal difficulties. He has feelings of doubt and caution, is preoccupied with detail and is pedantic. These features cause him considerable distress and dysfunction.
Which personality disorders best describes this man?

A

Anankastic Personality Disorder (Obsessive).

89
Q

Who can release someone from their section?

A
  1. RMO.
  2. Consultant psychiatrist.
  3. MH Tribunal.

Alice's finals cards (23 decks)

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