Psych 3 - Behaviour Flashcards by Lucy Searle

What are the characteristics of anorexia nervosa?

Marked distortion of body image
Pathological desire for thinness (over-valued idea)
Self-induced weight loss

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Give three risk factors for anorexia nervosa and bulimia nervosa

Low self-esteem
Family history of mental health conditions
Poor family relationships

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What are the physical consequences of anorexia nervosa?

Hypotension and bradycardia
Arrhythmias
Infertility
Arrested growth and delayed puberty
Dry scaly skin
Anaemia, leucopenia, thrombocytopenia

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What causes amenorrhoea in anorexia nervosa?

Low FSH and LH due to hypothalamic dysfunction, despite low oestrogen

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Give three physical signs of anorexia nervosa

Decreased muscle mass
Peripheral cyanosis
Russell sign - calloused skin over interphalangeal joints

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What occurs in the following blood tests in anorexia nervosa:
Thyroid function:
Cholesterol:
Growth hormone:
UEs:

Thyroid: low T3/T4
Cholesterol: high due to starvation
GH: Increased
UEs: Increased urea and creatinine (dehydration)
Metabolic alkalosis if vomiting, metabolic acidosis if laxative abuse. Decreased ions

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What are the risks of re-feeding in anorexia nervosa?

Cardiac decompensation

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What is bulimia nervosa?

Recurrent episodes of binge eating, with compensatory behaviours
Over-valued ideas about body shape and weight

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How do the physical signs of bulimia nervosa compare to the physical signs of anorexia nervosa?

Similar, but less severe

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What complications of bulimia nervosa relate specifically to purging?

Oesophageal erosions/perforation
Gastric ulcers
Dental erosion
Pancreatitis
Steatorrhoea

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What is the treatment of anorexia nervosa and bulimia nervosa in children?

First line: AN-FT or BN-FT

2nd line: ED-CBT

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What is the criteria for diagnosis of insomnia?

Insufficient quantity or quality of sleep for at least 3 days a week, for one month

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What are three risk factors for insomnia?

Shiftwork
Pregnancy
Anxiety

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What is sleep hygiene?

Preventative strategy for insomnia:
Comfortable bed
Low light and noise level
Regular daytime exercise
Realistic expectation of sleep length
Get up if can't sleep after 20 mins

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How is insomnia managed?

Sleep hygiene and regular exercise

Short term: short course of hypnotic drug
Long term: refer to IAPT and a sleep clinic, possibly melatonin

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What is the disorder characterized by sleep occurring at times out of synchrony with the environment and social cues?

Circadian rhythm disorder

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What are the three types of Circadian rhythm disorder?

Delayed sleep phase syndrome (asleep at 2am)
Advanced sleep phase syndrome (asleep at 7pm)
Irregular sleep wake pattern
Non-entrained type

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How can bright light therapy help Circadian rhythm disorders?

DSPS: early morning
ASPS: before bedtime to delay
Suppresses melatonin

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What hormones must be taken in gender dysphoria if transitioning?

MTF: ethinylestradiol, finasteride
FTM: testosterone injection or gel

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What are the negative side effects of gender dysphoria hormonal treatments?

MTF: increased risk of thromboembolic disease and breast cancer
FTM: Polycythaemia and osteoporosis
Both: abnormal liver function

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What are the tree types of Munchausen’s syndrome?

Wandering, non-wandering, by proxy

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How is Munchausen’s syndrome managed?

Reduce iatrogenic harm - no inappropriate treatments

Direct or indirect challenges

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What is meant by a personality disorder?

The enduring characteristics of an individual cause distress/difficulties for themselves or in their relationships with others.

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Define affect

Range, intensity, and appropriateness of emotional response

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Give three characteristics of paranoid personality disorder

Sensitive Suspicious Jealous Distrust

Which PD is associated with emotional coldness, detachment, lack of interest, shyness, and excessive introspection?

Schizoid

A history of what is common in patients with dissocial/antisocial PD?

Childhood conduct disorder

What are the characteristics of antisocial PD?

Callous lack of concern for others Irresponsible Aggressive

What are the characteristics of anankastic/obsessive-compulsive PD?

Preoccupation with orderliness and control Pedantic Perfectionism Doubtful

How is OCPD different to OCD?

No resistance in the personality disorder

Which PD is characterized by insecurity, timidness, and social discomfort

Anxious/avoidant

What are the characteristics of dependant PD?

``` Clinging Submissive Excess need for care Resourcelessness Individuals develop a passive role to life ```

What are the characteristics of borderline PD?

Unclear identity Unpredictable affect Impulsivity

Which PD is characterized by an inability to control anger/plan, unpredictable affect, and episodic loss of control of aggressive impulses?

Impulsive

What are the characteristics of histrionic PD?

Self-dramatization Shallow affect Attention seeking Manipulative

Give three characteristics of psychopathy

Lack of remorse Manipulative Superficial charm

What EEG finding is present in psychopaths?

Posterior temporal slow waves

How are personality disorders managed?

Treat comorbid psych conditions | DBT

Define learning disability

A condition of arrested or incomplete development of the mind, characterised by impairments of skills manifested in the developmental period.

What are the four classifications of learning disability?

Mild (IQ under 70), moderate, severe, profound

Give some genetic causes of LD

Down syndrome Neural tube defects MERRF

Give some pre and perinatal causes of LD

Pre - infection, exposure to alcohol/drugs, maternal illness | Peri - neonatal illness, asphyxia in delivery

Give some postnatal causes of LD

CNS infection | Head injury

What is a conduct disorder?

A repetitive and persistent pattern of anti-social, aggressive, or defiant behaviours

What are the risk factors for conduct disorder?

Social disadvantage Parental criminality Parental psychiatric disorder Low IQ

Give three symptoms of conduct disorder

Aggression and cruelty Deceitfulness Disobedience

What conditions are associated with conduct disorder?

ADHD Learning difficulties Anxiety

What is the management of conduct disorder?

Refer to CAMHS | Parent training programmes

What is oppositional defiant disorder?

An enduring pattern of negative/defiant behaviour without the serious violation of societal norms or the rights of others May occur in only one situation e.g. home

What condition is characterized by an effect on social and communication skills, and a restricted, stereotypes repertoire of interests and activities?

Autism spectrum

What are the risk factors for autism spectrum disorder?

Genetic - sibling risk Low birth weight and asphyxia Prenatal and postnatal infection

Give three symptoms of autism

Limited empathy Lack of awareness of social rules Obsessively pursued and unusual interests and routines

What is the pharmacological management of autism?

Sleep disturbance - melatonin | Aggression - risperidone

How does Asperger's syndrome compare with autism spectrum disorders?

IQ and language are normal or superior

For how long do motor and vocal tics have to be present for a diagnosis of Tourette's syndrome?

At least 1 year

At what age does Tourette's syndrome present?

5-6 years

What is a tic?

Sudden, purposeless, repetitive, stereotyped movement or vocalisation

Give one reason for an exacerbation of Tourette's syndrome

Emotional stress

What other features are seen in Tourette's syndrome?

Copralalia and coprapraxia Echolalia and echopraxia Difficult concentrating

What is the treatment of Tourette's syndrome?

Habit reversal training ERP If severe: refer to a specialist, low dose antipsychotic monotherapy - risperidone; stereotactic surgery

What is a risk factor for separation anxiety?

Anxious, inconsistent, or over-involved parenting

What are the three subtypes of ADHD?

Combined - ADHD Inattentive - ADD Hyperactive-impulsive

What are the features of ADHD?

``` Poor organization Poor concentration Fidgeting Interrupts Talks excessively Forgetful Easily distracted ```

What is the drug treatment of ADHD?

Stimulants - methylphenidate over 6y | 2nd line - lisdexamfetamine

What are the side effects of methylphenidate?

Dry mouth | Nausea and vomiting

What is the genetic cause of Down Syndrome?

95% trisomy 21 | 5% Robertson translocation

What are the signs of Down's syndrome?

Hypotonia and short stature Brachycephaly, epicanthic fold, eyes close together, low set ears, protruding tongue, strabismus Single palmar crease Sensorineural deafness Hypothyroidism Delayed puberty in males, ovulation problems in females

What grey spots can be seen on the iris in Down's syndrome?

Brushfield spots

What congenital conditions are common in Down's syndrome?

CV - ASD, VSD, PDA Hirschprung's disease Hernias

What are the common causes of death in Down's syndrome?

Dementia | Childhood leukaemia

What is the genetic abnormality in Fragile X syndrome?

Expansion of CGG triplet repeat within fragile X Mental Retardation gene on X-chromosome

What is the learning disability in Fragile X syndrome?

IQ less than 70, borderline to profound

What are the physical signs of Fragile X syndrome?

``` Large testicles High forehead Hand flapping Mannerisms Hyper-extensible fingers ```

What mutation causes Prader-Willi syndrome?

15q 11.2-13 microdeletion

What are the signs and symptoms of Prader-Willi syndrome?

Hyperhagia, excessive eating and food seeking, obesity | Hypogenitalism, LD, hypotonia, speech disorder

What is the treatment of Prader-Willi syndrome?

Growth hormone

How are genetic learning difficulty syndromes diagnosed?

Fluorescence in-situ hybridization (FISH)

Which syndrome is the complement to Prader Willi syndrome (same microdeletion)?

Angelman syndrome (happy puppet)

What gene is lacking in the brain, in Prader-Willi, and Angelman syndromes?

UBE3A

What are the symptoms of Angleman syndrome?

``` Happy demeanour and laughter Developmental delay Short attention span Decreased speech Affinity for water ```

What syndrome is caused by a partial deletion of the short arm of chromosome 5 (5p-)?

Cri-du-chat

What are the symptoms of Cri-du-chat syndrome?

"cat-like" cry, LD, feeding difficulties, microcephaly and micrognathia, gentle and affectionate, hypotonia

What is the deletion associated with DiGeorge syndrome?

22q11.2

What are the symptoms of DiGeorge Syndrome?

``` C - cardiac abnormalities A - abnormal facies T - thymic hypoplasia C - cleft palate H - hypocalcaemia secondary to hypoparathyroidism ``` Also - LD

Which deletion is associated with William's syndrome?

7q11.23

What are the stand-out features of William's syndrome?

Hoarse voice Premature sagging and wrinkling of the skin Hypercalcaemia

The syndrome associated with a port wine stain on the forehead and eyelids is known as?

Sturge-Weber syndrome

What mutation causes von-Hippel Lindau syndrome?

VHL tumour suppressor gene on chromosome 3p

What tumours are found in patients with VHL syndrome?

Angiomas, renal/pancreatic carcinomas, phaeochromocytoma

What symptoms are seen in Rett syndrome?

``` Hand wringing Loss of spoken language between 1-4 years Stereotyped hand movements Worsening gait Seizures and muscle weakness` ```

Which SSRI has the lowest risk of drug interactions?

Sertraline

When is urgent medical admission needed in eating disorders?

HR<40 BMI<15 Severe infection or electrolyte disturbances

Which SSRI is the drug of choice in children and adolescents?

Fluoxetine

What is erotomania?

Delusion of a famous person being in love with the patient

What is a common side effect of atypical anti-psychotics?

Weight gain

When are personality disorders allowed to be diagnosed?

Over the age of 18

What is an abnormal grief reaction?

Grief that lasts longer than 6 months

What is Othello syndrome?

Delusional jealousy/unfaithfulness

What is the risk of developing schizophrenia if one monozygotic twin, and one parent has it?

50% - twin | 10-15% - parent/sibling

What is the treatment of bulimia or anorexia in adults?

First line anorexia: CBT-ED, MANTRA or SSCM | First line bulimia: CBT-ED

Name some extra-pyramidal side effects associated with atypical anti-psychotics?

Parkinsonism Acute dystonia (sustained muscle contraction) Akathisia - severe restlessness Tardive dyskinesia - choreoathetoid movements.