Psych 3 Flashcards
What is problem-focused coping in regards to stress?
Efforts directed at modifying stressor
Eg studying or interview practice
What is emotion-focussed coping in regards to stress?
Modify emotional reaction to stressor
Eg denial, relaxation training
What are the psychological reactions of stress producing anxiety?
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
What are the features of anxiety disorders?
Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour
What are the symptoms of anxiety?
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
What can hypervenntilation lead to?
CO2 deficit (hypocapnia) >Numbness/tingling in extremities can lead to carpopedal spasm due to hypocalcaemia
How can sleep be disturbed in anxiety?
Initial insomnia
Frequent waking
Nightmare/night terrors
What is generalised anxiety disorder?
Persistent symptoms of anxiety not confined to a situation/object
All symptoms of human anxiety can occur
What are the differentials for anxiety disorder?
Depression
Schizophrenia
Dementia
Substance misuse
Tyrotoxicosis
Phaenochromocytoma
Hypoglycaemia
Asthma/arrythmias
How do you manage GAD?
Counselling
Relaxation training
Medication
CBT
What are phobic anxiety disorders?
Same core features as GAD
Only in specific circumstances
Also feel anxiety if percieved threat of encountering feared objects
What the clinically important phobic disorders?
Specific phobias
Social phobia
Agoraphobia
How do you manage social phobia?
CBT
Education and advice
Medication SSRIs
What is OCD?
Experience of recurrent obsessional thoughts and or compulsive acts
What are characteristics of the obesssive thoughts in OCD?
Ideas, images or impulses Occuring repeated and not willed Unpleasant and distressing Recognised as their own thoughs Usual key anxiety symptoms arise because of them
What are the characteristics of the compulsive acts of OCD?
Sterotypical behaviours repeated again and again
Not enjoyable
Not helpful
Often viewed by sufferer as
>Viewed as pointless and when resisted anxiety symptoms
>Or viewed as preventing some harm to self/others
Who gets OCD?
Prevelance 2%
Men and women equally
How do you manage OCD?
Education/explanation
Serotonergic drugs - eg SSRIs
CBT
Psychosurgery
What is PTSD
Delayed and or protracted reaction to a stressor of exceptional severity
Eg combat, rape, assault, torture etc
What are the key elements to PTSD?
Hyperarousal
Re-experiencing phenomena
Avoidance of reminders
What are the symptoms of hyperaraousal in PTSD?
Persistant anxiety
Irritability
Insomnia
Poor concentration
What is the re-experiencing phenomena in PTSD?
Intense intrusive images
>Flashbacks when awake
>Nightmares during sleep
What are the symptoms of avoidance in PTSD?
Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests (like anadonia)
Who is likely to get PTSD?
Often after exposure to disaster 104% prevelance Women 2x men Partially genetic Life-threatening stressor = greater risk
How do you manage PTSD?
Watchful waiting and review first
Trauma focused CBT if more severe
Eye movement desensitisation and reprossesing
Risk of dependance with any sedative, but could consider SSRI or TCA
How do you diagnose dementia? (ABCD)
Is a clinical syndrome A - activities of daily living impaired B - behavioural and psychiatric symptoms of dementia C - cogntive impairment D - decline
Need collateral histor
Cognitive testing
What are the cognitive features of dementia?
Memory (dysmnesia) Plus one of: Dysphasia >Expressive (can tell function of object, not its name) >Receptive (difficulty understanding) Dyspraxia Dysgnosia (Not recognising objects) Dysexectutive function
Along with functional decline
How likely are the different dementias in the elderly?
Alzeihmers - 50%
Vascular - 25%
Lewy body - 5%
Rest mixed/other
What are the differentials to dementia?
Delerium
Depression
reversible causes of dementia (hydrocephalus eg)
How is dementia distinguished from delirium?
Delerium is abrupt (known date) + acute presentation + reversible
, dementia is insidious + chronic onset + irreversible
Disorientation + psychomotor early in illness for delirium, late for dementia
Delerium variable hour by hour, dementia only small variations
How does a spect scan differ in dementia?
How does an MRI scan differ in frontotemporal dementia?
1) Spect scan
In normal, activity roughly equal across brain
In frontotemporal dementia, activity at back. In Alzheimers, near front
2) MRI
MRI in frontotemporal dementia has shrunk gyri, especially seen on coronal view
What is dementia with lewy bodies?
Dementia where amnesia is not prominent
Deficits of attention, frontal executive, visospatial
2+ of following:
Fluctuation
Visual hallucinations
Parkinsonism
What symptoms supports the diagnosis of lewy bodies dementia?
Falls Syncope Loss of conciousness Autonomic dysfunction Some scans REM sleep disorder Abnormal DAT scan
How does a DAT scan differ in lewy body dementia?
Instead of the reutake of dopamine transporter having a “comma” shape, it has a “full-stop” instead
What are the features of frontotemporal dementia?
Behavioural disorder - marked personality change
Can be early onset
Often emotional blunting early in disease
Speech disorders -
Frontal dysexecutive syndrome
Neuroimagery has abnormalities in frontotemporal lobes
Neurological signs often absent in early disease
What are the features of subcortical vascular dementia?
Gradual deterioration in executive function
Mood changes (apathy/irritation)
Memory often spared
Additional neurological features such as falls, incontinence or seizures
How do you treat dementia?
Acetylcholinesterase Inhibitors (AChI) Antipsychotics Antidepressants Anxiolytics Hypnotics Anticonvulsants
What are the ACh inhibitors?
donepezil,
rivastigmine,
galantamine
Memantine (if severe)
How do ACh inhibitors change dementia disease?
Improves cognitive function
Still declines, however slows it
Improves some non-cognitive symptoms as well
>Reduces carer stress + keeps at home longer
What are the side effects of ACh inhibitors?
Nausea, vomiting, diarrhoea
Fatigue, insomnia
Muscle cramps
Headaches, dizziness
Syncope
Breathing problems
What are the SCOFF questions?
Sick becuase of being full? Control lost over eating? One stone + lost of weight? Fat belief even though others say thin? Food dominating life?
What is anorexia nervosa?
Restriction of intake to reduce weight
Compulsive compensatory behaviours when food cannot be avoided
When below BMI 17.5
Fear of weight gain
What are the signs/symptoms of anorexia nervosa?
Low pulse + blood pressure Lose skeletal muscle Eventually cardiac muscle Loss of bone Cold intolerance GI problems (due to thinning of the walls) Delayed puberty Fainting Scalp hair loss Early satiety Weakness, fatigue Short stature
What is bulimia nervosa?
Episodes of binge eating with a sense of loss of control
Followed by compensatory behaviours
Must occur 2x a week for 3 months
Dissatisfaction with body shape and weight
What are the compensatory behaviours for eating disorders?
purging behaviour
>Vomiting, laxative abiuse, diuretic abuse
Or non-puring abuse
>Excessive exercise, fasting, strict diets
What are the signs /symptoms of bulimia nervosa?
Mouth sores Pharyngeal trauma Dental cavities Heartburn/ chest pain Muscle cramps Swollen parotid glands Irregular periods Hypotension
What is binge eating disorder?
Binge eating, like bulimia but without purging behaviours
How do patients who avoid calorie intake behave?
Diets - vegan/vegetarian
Not touching food/grease
Developing dislikes, pickiness or “allergies”
Interprets any symptoms as an allergy or indegestion
Has to be last to finish
Avoids parties/social occasions
Must eat least
How do patients get rid of calories?
Self-induced vomiting Chewing then spitting out Over-exercise Overactivity Cooling (inadequate dress, open windows etc) Blood letting Medication abuse
What are other behaviours associated with eating disorders?
Body checking
Displaying emancipation to elicit reassuring shocked attention
Cruising “pro-ana” websites for support
Competing with self/others to attain lower and lower targets
Deliberate self-harm if rules are broken
What are the psychological consequences of eating disorders?
Malnourished brains experience depression Anxiety Obesessions Loss of concentration on anything but food
What are the physical consequences of eating disorders?
Physical damage Poor repair/resistance Heart damage Reduced immunity Anaemia Bone loss Fertility problems Growth stunting (in younger)
Purging can cause neurochemical disruptions (causing seizures/arrhythmias)
What are the causes of anorexia?
Genetic predisposition (OCD, anxiety, perfectionism)
Perinatal factors
Life events
What are the rpecipitating facotrs for eating disorders?
Puberty
Dieting/non-deliberate weight loss
Increased exercise
Stressful life events
What are the perpetuating factors of eating disorders?
Consequences of starvation syndrome Delayed gastric emptying Narrowing focus Obesssionality (phobia of fat, body checking) Families
What are the common features of cognitive impairment?
Disorientation Impaired attention/concentration Memory (anterograde +/- retrograde amnesia) Language Judgement Insight
What are the common features of behavioural abnormalities?
Agitation, aggression
Slowing, psychomotor retardation
Abnormal social conduct
What are the acute/subacute organic mental disorders?
Delirium (acute organic confusional state)
Organic mood disorder
Organic psychotic disorder
What are the chronic organic mental disorders?
Dementia
Amnesic syndrome
Organic personality change
What is delerium?
Transient organic mental syndrome
of acute or subacute onset which
is characterised by
global cognitive impairment
What are the presenting features of delerium?
Impaired attention/concentration
Anterograde memory impairment
Disorientation in time, place or person
Fluctuating levels of arousal (often nocturnal exacerbations)
Disordered sleep/wake cycle
Increased/decreased psychomotor activity
Disorganised thinking as indicated by rambling, irrelevant or incoherent speech
Perceptual distortions, leading to misidentification, illusions, and hallucinations
Changes in mood such as anxiety, depression and lability
What can cause delerium?
Infections Medications Alcohol/drug withdrawal Drug abuse Metabolic Vitamin deficiencies Endocrinopathies Neurological causes Toxins/industrial exposures SLE Cerebral vasculitis Paraneoplastic syndromes
What are the features of amnesic syndrome?
Preserved global intellectual abilities Anterograde amnesia Retrograde amnesia (temporal gradient) Preserved registration/working memory (e.g. digit span) Preserved procedural (implicit) memory
What are the causes of amnesic syndrome (that cause hippocampal damage)?
Herpes simplex virus encephalitis Anoxia Surgical removal of temporal lobes Bilateral posterior cerebral artery occlusion Closed head injury Early Alzheimer’s disease
What are the causes of amnesic syndrome (that cause diencephalic damage)?
Korsakoff’s syndrome (alcoholic and non-alcoholic)
3rd ventricle tumours and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage, especially from anterior communicating artery aneurysms
What areas of the brain being damaged can lead to amnesic syndrome?
Hippocampus
Diencephalon
What are the criteria for a learning disability?
Intelelctual impairment
Social/adaptive dysfunction
Delayed onset in developmental period
How does schizophrenia/psychosis differ in patients with learning difficulties?
3x more likely to get it
Associated with change in personality and reduction in functional abilities
Self talk common in learning difficulties, especially down’s syndrome
How are mood disorders changed in learning difficulties?
Increased incidence
Less likely to complain of mood changes
>Noted by change in behaviour
How is OCD affected by learning difficulties?
Ritualistic behaviour and obesssional themes increased
Obsessions hard o describe
Compulsions more readily observed
How is challenging behaviour/self injury affected by learning difficulties?
Manerisms, head banging and rocking common in severe learning difficulties
General trend is the worse the learning difficulty, the more likely to have problem behaviour
What is diagnostic overshadowing? (with learning difficulties)
Presenting symptoms put down to learning difficulties, rather than another, more treatable, cause
Consider social, psychological, physical and psychiatric causes first
How can substance misuse present?
physical complications intoxication Withdrawal (includes delirium, ARBD) trauma/accident drug-induced psychosis (e.g. legal highs) feigned illness in order to obtain drugs
What drugs are used to treat panic disorders?
SSRIs (But not fluoxetine) Consider clomipramine (off label)
What is good sleep hygiene?
Avoid stimulating activities before bed
Avoiding alcohol/caffeine/smoking before bed
Avoid heavy meals or strenuous exercise before bed
Regular day time exercise
Same bedtime each day
Ensure bedroom environment promotes sleep
Relaxation
