Psych Flashcards
1
Q
Risk factors/ aetiology for Anorexia nervosa
A
Bio: Genetics Female (mid-adolescence Early menarche Starvation (endocrine) perpetuates Psycho: Sexual abuse Dieting in adolescence Low self esteem Premorbid anxiety or depression Perfectionism/ anankastic personality Criticism regarding eating/body shape/weight Social: Western society Stress Bullting at school involving weight Occupatione.g. ballet, models
2
Q
Clinically defining features of Anorexia nervosa as defined by ICD10 and other features
A
Fear of weight gain
Amenorrhoea and loss of sexual interest and impotence in male.
BMI 15% below expected weight
Deliberate weight loss (food or exercise)
Distorted body image
All features present for 3 months and must be absence of binge eating and a preoccupation with eating/ craving to eat. (if not consider bulimia or EDNOS.
Other
Physical: Fatigue, hypothermia, bradycardia, arrhythmias, peripheral oedema, headache, lanugo hair.
Preoccupation with food: Dieting, making meals for ohers
Socially isolated, sexuality feared
Symptoms of depression and obsession
3
Q
Thought in MSE of Anorexia nervosa
A
Preoccupation with food and overvalued ideas concerning dieting, appearance and weight loss (preoccupation differs from obsession in that with severe difficulty the thought can be put out of the mind).
4
Q
Complications of Anorexia nervosa
A
Osteoporosis (DEXa), Proximal myopathy (upper and lower limbs)
Arrhythmias e.g. brady, Prolonged QT, changed caused by hypokalemia.
Hypoglycaemia, Hypercholesterolaemia, Hypothyroidism (TFTs)
Hepatitis/ LFTs Pancreatitis (amylase) Renal failure/ stones Enlarged salivary glands Constipation Peptic ulcers
Anaemia (iron), thrombocytopenia, leucopenia
Dry slin, brittle nairs, infections, suicide
5
Q
Management of anorexia
A
Risk assessment for suicide and medical comps.
CBT, psychotherapy, DBT, mindfulness, groups, meal plannning, psychoeducation, interpersonal psychotherapy, family therapy
Treat medical complications. SSRIS for dep or OCD.
Volunatary organisations or Self-help groups.
Graded exposure to food.
Gain 0.5-1kg per week as inpatient and .5kg as outpatient
6
Q
Risks of gaining weight in anorexia
A
Refeeding syndrome:
After prolonged starvation or malnourishment due to changes in phosphate, magnesium and potassium.
Insulin surge
Hypokalaemia, hypomag,, hypophos, abnormal glucose metab.
Phosphate depletion causes cardiac failure
7
Q
How to prevent refeeding syndrome
A
Dailey bloods, start at 1200cals and gradually increase every 5 days, monitor for tacchycardia and oedema.
If low then oral or IV electrolyte replacement
8
Q
When to hospitalise Anorexia nervosa
A
BMI
9
Q
Define Bulimia nervosa
A
Repeated episodes of binge eating followed by compensatory weight loss behaviours with overvalued ideas regarding ideal body shape/ weight
10
Q
How does BN aetiology and epidemiology differ from AN?
A
Less clear role of genetics
Vicous cycle of compensatory weight loss behaviours, sense of compulsion to eat, binge eating, fear of fatness.
AN in higher social class, BN in all.
11
Q
Common psychiatric diseases with BN
A
Depression Anxiety DSH Substance misuse Emotionally unstable personality disorder
12
Q
Clinical features of BN
A
ICD 10:
Compensatory behaviours - vomiting, starvation, drugs, omit insulin, exercise
Preoccupation with eating - compulsion followed by regret and shame.
Fear of fatness
Overeating - x2 per week for 3 months.
Other:
Normal weight
Depression/ low self esteem
irregular periods
dehydration - low bp, increased cap refil, low turgor, sunken eyes.
Hypokalaemia -
13
Q
Subtypes of BN (not ICD10)
A
Purging and non purging (drugs/ vomiting vs diet and exercise)
14
Q
Signs of BN
A
Russell’s sign - calluses on back of hands from repeated self-induced vomiting
Parotid swelling
Sunken eyes
Dental erosion
ECG - Increased PR, depressed/ inverted T, U wave
15
Q
Complications of repeated vomiting
A
Arrythmias, mitral valve prolapse, peripheral oedema
Mallory-Weiss tears of the oesophagus, increased parotid
Dehydration, renal stones, renal failure
Erosion of teeth
Russells sign
Aspiration pneumonitis
Cognitive impairment, peripheral neuropathy, seizures.
16
Q
Management of BN
A
Bio: Fluoxitine can reduce binge
Psycho: CBT, Psychoeducation, interpersonal therapy
Social: Food diary, techniques to avoid binging (eat with others, distractions), small regular meals, self-help programs
Monitor electrolytes.
If suicide risk or electrolyte imbalance then admit to hospital
17
Q
Out of interest, improvement in eating disorders?
A
50% full recovery in BN
20% in AN.
18
Q
Describe the cluster C personality disorders
A
Dependent: Seeks companionship Low self confidence Difficulty expressing disagreement Reassurance requred Needs other to assume responsibility
Anxious/avoidant: Approval needed before getting involved Social inhibition Embarrasment potential inhibits involvement in activites Restriction in life to maintain security Inadequacy felt
Anankastic: Perfectionism Loses purpose of tasks and focuses on detail Workaholic at expense of lesure Subborn Inflexible Fussy Rigid
19
Q
Define Personality disorder
A
Deeply ingrained enduring pattern of behaviour that deviates markedly from a persons culture, is pervasive and inflexible, present from adolescenece/ early adulthood (as brain still develops until 17). Leads to distress or impairment
A pervasive inflexible pattern of behaviour and inner experience that deviates from an individuals’ cultural norms. Present from adolescence/ early adulthood. Stable over time and leads to distress or impairment
20
Q
Clinical features of panic disorder
A
Severe, unpredictable, episodic panic attacks not associated with a specific situation or object.
Must last more than a couple of minutes (most peak at 10 and last less than one hour).
Starts abruptly.
Intense fear (fear of death often)
1 autonomic manifestation: palpitations, sweating, shaking/ tremor, dry mouth,
Other anxiety symptoms of GAD
21
Q
Clinical features of GAD (ICD10)
A
Persistent feeling of worry, agitation for greater than 6 months. Presence of four symptoms including one autonomic. Autonomic: Palpitations, sweating, tremor, CVS/ GI: Butterflies/ abdominal discomfort Palpitations Lump in throat Loose stools Mind and brain: Lightheaded/ Dizzy Fear of dying/ losing control Derealisation and depersonalisation General symptoms: Hot flushing or cold chills numbness or tingling Headache Symptoms of tension: Muscle tensions Restlessness Feeling n edge Difficulty swallowing Sensation of lump in throat Non specific: Startled Poor concentration Sleep problems Irritability Mind blacks
22
Q
Risk factors for panic disorders
A
Bio: Asthma, Benzo withdrawal, age 20-30, , female, white, cigarette smoking,
Psycho:adverse life event
Social: Fx
23
Q
What is catatonia
A
State of ultered posure, immobility and stupor.
Seen in severe schizophreni.
It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism.
24
Q
What is stupor
A
Inability to respond to internal (e.g. hunger) and external stimuli
25
What is catalepsy
State of the body which is in a trace with loss of sensation and consciousness and is rigid.
26
Pathophysiology of Schizo and drugs that could mimic this
Overactivity of D2 mesolimbic pathway - amphetamines, parkinsonism medications.
27
Describe dopamine pathways in the brain
```
Mesolimbic/ mesocortical:
Addiction
Reward
Memory
Motivation
Emotional response
(Mesolimbic positive in Schiz and mesocortical = neg)
```
```
Nigrostriatal:
Motor control (Parkinson's)
```
Tuberoinfundibular:
Regular of hormones (particularly prolactin), pregnancy, maternal stuff
28
Term for low motivation
Avolition
29
Term for a quanitative and qualitative decrease in speech
Alogia or poverty in speech
30
Describe the negative symptoms of schizophrenia
```
Avolition
Asocial behaviour
Anhedonia
Affect blunted
Alogia
Attention deficit
```
31
Describe the indications for ECT
Depression that is treatment resistant
Depression with high risk e.g. suicidal ideation or serious risk to others.
Life threathening depression when patient refuses to eat or drink
Catatonia
Prolonged, treatment resistant, manic period
Can only be used under the MHA if an emergency to save life or
32
How long should a seizure last in ECT?
30 seconds
33
Contraindications to ECT?
MI
Severe resp or CVS disease (anaesthetic)
Heart failure/ arrhythmia (hypertension)
History of status
34
Describe the sympathetic and parasympathetic activity after ECT
Transient parasympathetic followed by sympathetic resulting in raised BP hence contraindications
35
How many drugs are given during ECT?
2
A general anaesthetic (etomidate or propofol
A Muscle relaxant (suxamethonium)
36
How is ECT monitored
EEG. Pulse and BP both increase
37
Describe drugs that affect seizure threshold
Minimum electrical stimulus required to induce a seizure,
Increase threshold: Antiepileptics (mood stab), Benzos, anaesthetics
Decrease threshold: Antipsychotics, antidepresants, lithium
38
Side effects of ECT
```
Short term:
N/V, Constipation, laryngospasm, sore throat
Damaged teeth
Muscular aches, headaches
Mania in a depressed patient
Cardiac arrythmias
Confusion
Peripheral erve palsies
Short term memory impairment
Status epilepticus
```
Long term:
Antereograde and reterograde memory loss
39
How can agrophobia and social phobias be differentiated
Agrophobia = fear of a public place whereby immediate escape would be difficult in the event of a panic attack. Fear of crowds, large spaces, leaving the house alone.
Social phobia is fear of social situations which may lead to embarrassing oneself, criticism or humiliation. Fear of being the focus of attention.
40
Describe the treatment of GAD
```
Bio:
SSRI, SNRI, Pregabalin
Psycho:
Psychoeducation (low intensity)
CBT and applied relaxation
Social:
Self help - writing things down and analysing, support groups, exercise
```
41
Treatment for phobias
CBT - graduated exposure (also homework)
Pharmacological interventions - SSRIs (not for specific).
Social phobia can benefit from psychodynamic therapy
Benzos for specific in emergency
42
3 differences between GAD and phobias and panic disorder
Response to stimulivs random ep vs most the time
2 Avoidance in phobias vs worry and agitation vs fear of death
3 Cognition - Constant worry about everyday life events vs fear about a particular situation
43
Organic DDX for panic disorder
```
Pheocromocytoma
Hyperthyroidism
Carcinoid syndrome (neuroendocrine tumours)
Arrythmias
Hypoglycaemia
Alcohol/ substance withdrawral
```
44
Differences between PTSD and Adjustment
Catastophic vs non catastrophic event.
Symptom onset within 6 months vs within 1 month.
Symptoms less severe.
Adjustment disorder symptoms end within 6 months.
45
Treatment for PTSD
Within 3 months:
- Watch and wait
- Zopiclone for sleep
- Risk assess
>3 months:
- CBT
- EMDR - Eye movement desensitisation and reprocessing
- Drugs - Paroxetine, Mirtazapine, amitryptilline and phenelzine. Only consider if therapy is not working.
46
What is an acute stress reaction
```
Exposure to an acute stressor.
Symptom onset within 1 hour.??
Symptoms:
- Any of GAD
- Agitation/ aggression
- Narrowing of attention
- Disorientation
- Despair or hopelessness
- Uncontrollable or excessive grief.
Transient stressors then symptoms must begin to diminish within 1 month
```
Dissociative symptoms unlike PTSD - e.g. detatchment/ derealisation
Avoidance of triggers e.g. people/ conversations
Flashbacks
Reaction <48hrs, Disorder >48hrs (DSM IV) <1 month
More stressful event that adjustment
47
Describe obsessions and compulsions
Obsessions = Unwanted intrusive thoughts, images or urges that repeatedly enter the mind. Cause distress. Inidiviual tries to resist them and knows them as absurd (egodystonic) and a product of their own mind.
Compulsion: Repetitive, sterotyped behaviours or mental acts that a person feels driven into performing. Overt or Covert. Gives some relief to anxiety. Exacerbates obsession (operant conditioning)
48
Epidemiology of OCD
M=F
Early adulthood
Fx
Abuse in childhood
49
Clinical features of OCD
Obsessions, compulsions or both most days for 2 weeks.
Cause distress or interfere with the patient's social or indiviual functioning e.g. waste time.
Features of O/C:
Failure to resist (at least 1)
Originate from patient's mind
Repetitive and distressing
Carryout reduces anxiety
50
Investigations into OCD
Questionnaires
51
DDX of OCD
```
O & C:
Anorexia, Bulimia, body dysmorphia
Anankastic PD
O:
Anxiety disorder, depressive disorder, hypochondriacal disorder, schizophrenia
C:
Tourette's
Kleptomania (stealing things)
Organic:
Dementia
Epilepsy
Head injury
```
52
Treatment of OCD
CBT in the form of ERP (exposure and response prevention)
SSRIs (can add cloripramine or an antipsychotic)
Psychoeducation, self help material, distracting techniques
53
Describe Wernike's and Kosakoffs psychosis
```
Caused by a thiamine deficiency (B1)
Wernike's encephalopathy:
Ataxia
Ophthalamoplegia
Nystagmus
Delerium
Hypothermia
Korsakoff psychosis:
Short term memory loss
Confabulation (making up things to explain current events)
DIsorientation to time
```
54
Define delerium
An acute, organically caused impairment of the CNS causing decreased cognition and attention
55
Presentation of conduct disorder
```
Sleep problems.
Feeding problems - faddiness (fussy)
Behaviour problems:
Uncooperative
Temper tantrums
Aggressive, defiant, wilful.
```
Conduct disorder is different to oppositional defiance disorder as it is more severe and more common in children beyond 10 years old.
Socialised and unsocialised types. (socialised tends to be phasic- only wiht friends). Unsocialised tends to lead to antisocial PD
Commonly have comorbid mental health problems
core conduct disorders symptoms including:
patterns of negativistic, hostile, or defiant behaviour in children aged under
11 years
aggression to people and animals, destruction of property, deceitfulness or theft
and serious violations of rules in children aged over 11 years.
Associated with poor education performance, social isolation, substance misuse.
56
Management of conduct disorders
Parenting programmes
Systemic therapy
Agency imput
Psychoeducation and support
57
Prevalence of conduct disorders
Most common child psychiatric issue
58
Describe common emotional disorders in child psych
```
GAD
Separation anxiety disorder
Phobic dis
OCD
PTSD
Depressive disorders
```
59
Presentation of GAD in children
Anxiety
Fears of death of themselves or others
Somatic manidestations - Nausea, abdopain, sickness, headaches, sweating, palpitations, tension
Panic attacks - sudden, extreme fear, physical symptoms, faintness
60
Presentation of separation anxiety
Fear of or anxity with separation from attachment figure
Somatic manifestation
Nightmares
School refusal.
61
Management of anxiety disorders in children
Behaviour - systemic desensitisation, flooding, response prevention
Psychotherapy - brief dynamic, family and cognitive therapy
Anxiolytics (last respore include beta blockers and diaepam)
62
Management for Depression in children
CBT, Fluoxitine
63
Medacation for psychosis and severe resistant behavioural disturbance with LD
Risperidone
| can use lithium in Bipolar but very rare
64
Define somatoform disorder
An illness with a group of symptoms that closely resembles physical illness however there is no underlying physiological explaination.
65
Define a dissociative disorder and list types
```
A group of symptoms which cannot be explained by a medical disorder associated with stressful events.
Include
Dissociative...
..amnesia (of stressful events)
..Fugue (journey, good self care)
... motor disorder
... stupor
... convulsions
... Anaesthesia and sensory loss
Trance and possession disorder
```
66
List some somatoform disorders
```
Somatotization disorder (Briquet's syndrome)- multiple, recurrent and frequently changing physical symptoms not explained by illness. GI, CVS, GU, skin, muscles, headache.
Somatoform autonomic disorder. Autonomic symtoms only - patients attribute to illness e.g. palp, tremor, hypervent, flush, dry mouth, IBS.
Hypochondriacial (body dysmorphic disorder) - misinterprets normal body sensations - non delusional preoccupation that they have a serious physical disease e.g. cancer. BDD = with small defects in physical appearence.
Persistant somatoform pain disorder
```
67
List epidemiology of somatoform and dissociative
Female
Abuse
Psych history e.g. PTSD
68
General findings in somatoform disorders
Use of analgesics
Long history of contact with services
Causes physcial distress due to preoccupation with symptoms.
Refusal by patients to accept reassurance.
69
Describe the management of medically unexplained symptoms
```
Bio:
SSRIs for mood disorder
Exercise
Psycho:
CBT
Coping skills
Social:
Family (if reinforcing sick role)
Stress relief - walks, meditation e.c.t.
```
70
Briefly explain psychosexual disorder presentation
sexual dysfunction, paraphilias and gender identity disorders
Dysfunction is a sexual problem characterized by decreased desire, arousal or orgasm and lack of enjoyment or satisfaction derived from sex
unusual or abnormal sexual behavior that does not follow the normal standards. e.g. fetishism, paedophillia, zoophillia, necrophillia
Gender identity disorders exhibit variation between one’s sense of sexual identity and the biological one
May be linked with guilty conscience, stress, anxiety, nervousness, worry, fear, depression, physical or emotional trauma, abuse, rape, religious values, relationship with partner.
71
Treatment of psychosexual disorderder
Sex therapy, behaviour therapy, systemic therapy, psychodynamic therpay (both partners).
Androgen blockers (for paraphilias) and SSRIs
Groups e.g. sex addicts annonomous
Hormones and sex change surgery
72
What is a learning disability vs learning difficulty?
Learning disability = IQ
73
What causes a learning disability?
Insult to the brain
74
Describe Fagile X syndrome
```
Distinctive face
Learning disability
20-30 autism
Hyperactvity - behavioural
Risk of other diseases
```
75
Link between Downs and psychiatry
20-30% autism
25-30years dementia (at 60 35% have dementia)
LD
76
Classifications of LDs
Mild IQ 49-69 (mental age 8-12)
Moderate IQ 30-49 (mental 4-8)
Severe mental age
77
Co morbidities with LD
```
20-30 ADHD
30 epilepsy
30-40 behavioural disorder
20-30 mobility problems
Sensory impairment
3x risk of schio (3%)
Depression de to adversity
Phobias
Abuse
Metabolic syndrome
```
78
Describe the 4 principles of ethics and law
Non malefice
Benefice
Justice
Autonomy
79
Psychosis vs autism vs OCD
OCD - compulsions/ obsessions are egodystonic (dont want them) and they realsie they are from their own head.
Autism - Obsessions/ compulsions are enjoyable
Psychosis - No insight
80
Symptoms of asberges
Hypersensitive - firm but not light
Higher functioning autism.
Out of the ABC only A and B present and no impairment in cognition or intelligence.
81
Epidemiology of autism
```
Male
Genetics
Parental age
Fx psych
Premature
Valporate
```
82
Define intellectual disability
Intellectual disability means a significantly reduced ability to understand new or complex information and to learn and apply new skills (impaired intelligence). This results in a reduced ability to cope independently (impaired social functioning), and begins before adulthood, with a lasting effect on development.
83
Clinical presentation of autism
Present
84
Describe Rett's syndrome
```
Severe, progressive
Language impairment.
Repetitive hand movements.
Loss of motor skill
Irregular breathing.
Seizures
Girls only
Genetics
```
85
Describe Heller's syndrome (Childhood disintegrative disorder.
2 years of normal developments
Loss of previously learned skills (lang, social and motor)
Repetitive, sterotyped interests and behaviours and cognitive deterioration.
86
Management of autism
Local autism teams with key worker
CBT if possible and engagment
Daily life skills, coping strategies, and enabling access to education and community facilities
All physical mental and behavioural issues addressed
Social and emotional support
Self help - NAS
Special schooling
Melatonin for sleep
Social-communication intervention e..g play based
No pharmacology
For behaviour:
Modify environment things that create/ maintain behaviour
Antipsychotics when psychosocial interventions are insufficient
87
Describe management of LDs
MDT approach - psychiatrist, speech and lang, specialist nurse, psychologist, OT, social worker, teachers
Physical health followed up by GP
Antipsychotics for challenging behaviour
Behavioural techniques e.g. positive behaviour support and CBT
Family education- programmes and organisations
Prevention via genetic counselling and antenatal diagnosis.
88
Presentation of hyperkinetic disorder
Inattention
Hyperactivity
Impulsitity
Early onset before 7, persisent (>6 months), present in more than one situation(home and school or nursery), IQ above 50
89
Management of hyperkinetic disorder
Bio
If severe then give methylphenidate (ritalin)
Atomoxetine second line.
Monitor side effects:
CNS - headache, insomina, loss of appetite, weight loss.
Psycho
Psychoeducation and CBT, social skills training
Social
Food diary - may be linked
Support for parent and teahers including groups.
Parent training and eductation
90
Side effects of SSRIs
```
Mania in bipolar
N/V
Constipation/ diorrhea
Suicide (motivation)
Sleep disturbance
Dyspepsia
Weight loss
```
```
STRESS:
Sweating
Tremor
Rash
Extrapyradimal side effects (uncommon)
Sexual dysfunction
Somnolence
Discontinuation syndrome
```
Serotonin syndrome
91
Contraindications for SSRIs
Warfarin, heparin, NSAIDs, NAC
```
Epilepsy
Cardiac disease
Glaucoma
DM
Bleeding
```
92
What is serotonin syndrome
Within minutes of taking medication (SSRIs, TCAs, Lithium)
Cognitive - headache, agitation, hypomania confusion, hallucinations, coma
Autonomic - shivering, sweating, hyperthermia, hypertension, tachycardia
Somatic - myoclonus, hyperreflexia, tremor
Manage: stop drugs and supportive
93
Mirtazapine indications and side effects
Second like, good for weight gain and insomnia.
Postural hypotension
94
Describe a NARI and side effets
Reboxetine
| CAnt see, cant wee, cant shit cant spit.
95
Describe Trazodone use and side effects
Sedation!! (weight gain)
SARI - serotonin antagonist and reuptake inhibitor
Used in anxiety, dementia, with agitation and insomnia
96
TCA side effects/ contraindication
Cardiotoxicity -arrhythmias, postural hypotension, tachycardia, syncope
Convulsions
Anti cholinergic
Weight gain
97
MoA of TCAs
INhibit reuptake of adrenalin and serotonin - affinity fr cholinergic receptors
98
Side effects of MAOIs
CVS - arrythmias
Drowsi/ insomnia
Weight gain
Seual dysfunction
LFTs
Tyramine rich foods such as chees, herring, liver, marmite can cause a hypertensive crisis
Headache, palpitations, fever, convulsions, coma
99
Name typical antipsychotics
Haloperidol
Chlorpromazine
Flupentixol
Sulpiride
100
Difference between typical and atypical antipsychotics
EPSE
101
When should clozapine be prescribed?
Failure to respond to two other antipsychotics (treatment resistant schizophrenia)
102
MoA of antipsychotics
Blocking dopamine receptorsl
| Atypicals have speciic dopaminergic properties (less nigostriatal. Atypicals also have serotonergic effects
103
Side effects of antipsychotics and explainatios
Antidopaminergic - nigostriatal:
- EPSE
- Bradykinesia
- Hypertonia/ cogwheel rigidity
- Tardive dyskinesia (years)
- Tremor
- Akathisia (restlessness)
- Dystonia - spasms of neck jaw and eyes
Antidopaminergic - tuberoinfundibular
- Osteoporosis
- Gyneaocomastia
- Lactation
- Amennorhea/ menstrual disturbance
- Sexual dysfunction
Antimuscurinic
- cant see, cant wee, cant spit, cant shit
Serotinergic
- Glucose intolerance/ hyperglycaemia?
- N/V
Antihistaminergic:
- Sedation
- Weight gain
Anit-adrenergic
- Postural hypotension
- Tachycardia
- Ejaculation failure
Haloperidol - Prolonged QT
Clozapine- Agranulocytosis and hypersalivation
```
Atypicals = anticholin/ metab
Typical = EPSE and hyperprolactinaemia
```
Neuroleptic malignant syndrome
Metabolic syndrome, diabetes and stroke more likely in atypical.
CIs also include epilepsy (lower seizure threshold)
104
Describe neuroleptic malignant syndrome
```
Dopamine causes so also levodopa.
Within 10 days of taking antipsychotics
Rigidity, hyperthermia, delerium, convulsions, confusion, autonomic instabolity.
CK, FBCs, LFTs
Stop anti and supportive
C: Renal failure, shock, PE.`
```
105
Antipsychotics that need glucose monitoring?
Clozapine and Olanzapine
106
Baseline investigations for antipsychotics
```
ECG
LFTs
FBCs, Us and Es
Glucose (some)
CK (incase of neurepileptic)
Full physical
Weight
BP
Blood lipids
```
107
Which antipsychotics can be given via depot?
Flupentixol, haloperidol, risperidone, olanzapine and aripiprazole
Chlorpromazine
108
Describe clinical presentation of dementia
Hyperactive, hypoactive or mixed.
Global disturbance in cognition
Impairment of consciousness and attention
Psychomotor disturbance
Emotional disturbance
Disordered sleep/ waking - hypervigilant in night, drowsiness in day
Other symptoms include visual hallucinations and fleeting delusions.
109
Describe the management of delerium
Bio:
Treat underlying cause
Antipsychotics if challenging behaviour
Psycho:
Reassurance and de-escalation techniques e.g. re directing
Social:
Move to quiet well lit room
110
Explain a capacity assessment
Understand
Retain
Weigh up positives and negatives
Communicate decision
111
Describe clinical features of dementia (ICD10) and Alz
Decrease in cognitive abilities e.g. judgement and thinking
Decrease in memory (tends to be short term at first then later somantic and episodic) (for 6 months)
Decrease in emotional control, motivation or social behaviour:
Emotional liability, irritation, apathy
Alz: slow gradual onset, predominance of memory loss over intellectual impairment.
112
Describe clinical features of vascular dementia
Decreases in stepwise fashion
CVS risk factor/ conditions often present
Emotional and personality changes earlier
Neuro signs/ symptoms as focal
113
Describe clinical presentation of dementia with Lewi Bodies
```
Daily fluctuations
EPSE
Visual hallucinations
Falls, syncope, depression
Protein buildup in neurones
After 50
Life expectancy 8 years
Cognitive function first unlike altzheimers which is memory first
```
114
How to differentiate between Dementia and depression
Which came first
| Depression can cause memory loss
115
Management of Alz
Bio:
Acetylcholinesterase inhibitors early/mide.g. Galantamine, donepezil, rivastigmine
Non competitive antagonism at NMDA e.g. Memantine - late
SSRI/ antipsychotic for dep/behaviour
Modifiable RFs for vasc dementia
Psycho:
Education
Alternative therapies - music, aromatherapy, animal association
Support:
Groups - alzheimers society
Home support - OT
Future planing e.g. Lasting power of attourney and advanced directives
116
CIs and side effects of acetylcholinesterase inhibitors
Arrythmias (brady), myoclonus, EPSE,
| CI: arrythmias, Peptic ulcer asthma
117
Describe types of memory
Short term
Long term:
- Proceedural/ implicit (knowing how to do things)
- Declarative (explicit
- Semantic (knowing things about the world)
- Episodic (remembering specific events)
118
Describe Memantine use and moa
NMDA receptor antagonist *glutamate and glycine)
119
Memantine side effects
• Hypertension, dyspnoea, headache, dizziness, drowsiness
120
Best therapies for EUPD
Dialectical behaviour therapy - coping and control, change pattern of behaviour
Group therapy
121
What is the difference between asperger's syndrome and autism?
No impairment in language, cognition and normal IQ
122
Difference between mood disorder and normal mood?
Impairment in activities of daily living
123
Core symptoms of depression
Anhedonia
Low mood persistant (2 weeks)
lack of energy (anergia)
124
Cognitive symptoms of depression
Lack of motivation
Negative thoughts
Excessive guilt
Suicidal ideation
125
Biological symptoms of depression
Psychomotor retardation
Weight loss and appetite music
Loss of libido
Early morning waking
Diurnal variation in mood (usually morning is worse)
(may get hallucinations and delusions too)
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Stages of depression
Mild = 2 core + 2 other
Mod = 2 core +3-4
Sev = 3 core and >4 other
Sev with psychosis = sev + psychosis
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Describe cyclothymia
Chronic mood fluctuations over 2 years with elation and depression insufficient to met bipolar
128
Most common presentation of baby blues
primiparae
- reassure and support
3-7 days following birth
Anxious, tearful, irritable
129
Treatment of depression
Drugs only if moderate/ severe unless chronic, , history of mild-severe depression, failure of other interventions. In severe it may be augmented with lithium or antipsyhcotics. ECT. SSRI or SNRI 2nd. continue for 6 months in first, 2 years in second,
Self help, psychotherapy, physical activity
Social - support groups.
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What is perseveration
Uncontrollable and inappropriate repetition of a particular response, word, phrase or gesture
131
Aetiology of bipolar
```
Stressful life events
Genetic
19 years is average age of onset
Higher in minorites
Anxiety, depression
Substance misus
```
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Difference between hypomania and mania
Mildly elevated or iritable mood present for >4 days. No severe disruption. Partial insight
Mania: Symptoms >1 week, complete disruption of work, grandiose, sexual disinhibition, exhaustion
Also mania with psychosis
133
What is rapid cycling?
More than 4 mood swings in a 12 month eriod with no asymptomatic periods, poor prognosis
134
Treatment for bipolar
Bio: Antipsychotic (rapid onset, stop after 4 weeks for lithium), mood stabaliser (lamotrigene or lithium- lam in depress, lith inbetween and in mania).
Can add other stabalisers or atypicals if lithium does not work.
Psycho: psychoeducation, CBT
Social: Groups, self help, calming activities
135
Tests before starting lithium
TFTs, pregnancy, Us Es, ECG (arr
136
Side effects of lithium
polydipsia, polyuria, tremor, weight gain, oedema, hypothyroid, memory. tetatorogenic. Dehydration
Toxicity: N/V, coarse tremor, ataxia, muscle weakness, apathy, nystag, dysarthria, hyperreflexia, oligouria, hypotensio, convulsions, coma
137
Describe monitoring of lithium
12 hours first dose, weekly until .5-1mmol/L. Stable 4 weeks. Check every 3. UE every 6, tft every 12
138
Treatment for cyclothymia
Lithium and sodium valporate
139
Describe why DOLS might be used instead of a section
Treatment in best interest involves limiting freedoms e.g. locked wards if they lack capacity. Ensures no innappropriate restriction of freedom
140
What is a community treatment order
Person on section can leave hiospital to be treatd in the community, can be recalled if they do not comply with treatment and detained for 72hrs for assessment
141
Who needs to be present to do a section 2/3
AMHP - Approved medical health proffessional (not doctor) or NR (nearest relative)
AC: Section 12 approved clinician
Another doctor
142
What is an IMCA
Independent mental capacity advocate, appointed to peak on behalf if there is no next of kin or lasting power of attourney)
143
Why do you get sedation and increased appetite with mirtazapine?
Histamine
144
Tardive dyskinesia more commonly affects hands or feet?
Hands
145
Drugs excreted in breast milk?
Mood stabalisers, antipsychotics, benzos
146
Anti-adrenergic side effects of antipsychotics
postural hypo, tachycardia, ejaculatory failure
147
How long does it take for SSRIs to work?
2-3 days but not noticed until 2-6 weeks
148
Name TCAs
amitryptilline, lofepramine, doxepin, dosulepin, clomipramine
149
4 groups of symptoms in PTSD
Avoidance
Re living - nightmares and flashbacks
Hyperarousal - hypervigilance, insomnia, startle
Emotional blunting
150
What are the withdrawral symptoms of cocaine, MDMA, amphetamine
Dysphoric mood, lethargy, psychomotor agitations, insomnia/ hypersomnia, dreams, craving
151
What classifies withdrawral
3 signs needed
152
Withdrawral symptoms of opiates
```
Pilarerection
Lacrimation
Rhinnorrhea
N/V
Diarrhoea
Myalgia
Cramps
Increased HR and BP
```
153
Withdrawal synptoms of cannabis use
```
Tremor when outstreched
Myalgia
Anxiety
Irritability
Sweating
```
154
Withdrawal symptoms of sedatives/ hypnotics
```
Agitation
Grand mal convulsions
Tremor
Low BP (postural)
Increased HR
Paranoid
Hallucinations
```
155
What can be used in Bio treatment opiod dependence
Bupramorphine or methadone (partial) for detox and maintainance.
Naltrexone (antagonist) after (Naloxone is for OD) to prevent relapse
156
Alchol withdrawral symptoms
```
Irritation
Agitation
Seizure
Coma
Death
Tremor
Nausea
Insomina
Autonomic overactity
transient hallucinations
6-12 hours after abstinence
COg impairment
Paranoid delusions
Sweating
```
157
What is a binge and recommended limits
>8 uits men or 6 female (twice daily allowance
| 14 units per week (Jan 16)
158
Treatment for delirium tremens
```
Chlordiazepoxide
Haloperidol for any psychotic features
IV Pabrinex (vitamins)
```
159
Long term treatment for alcohol dependence
Disulfram (mod or severe)
Naltrexone or
Acamprosate - reduces GABA transmission (craving)
Psycho: MI, CBT
SOcial: AA
160
types of delusion seen in severe depression with psychosis
Nihilistic (worthless/ everything is non-existent), Guilt, hypochondriacal
161
What is Capgras' syndrome
A familiar person or place has been replaced with an exact duplicate
162
What are schindler's first rank symptoms
Hallucination
Delusion
Passivity phenomoenon
THought intertherence
163
Describe presentation of frontotemporal dementia
```
50-60
FX in 50%
Early personality chnages e.g. disinhibition, apathy, restlessness
Worsening of social behaviour
Repetitive behaviour
Language problems
Memory is preserved
```
164
What is dysthymia
Persistent mild depression for at least 2 years which is not depression or the reslult of partially treated depression
165
Define neurosis
Group of psychiatric disorders characterised by distress, non-organic, discrete onset, psychosis absent
166
Define personality disorder
X
167
What is transference?
redirection of a patient's feelings for a significant person to the therapist
168
What is paraphrenia?
araphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality
169
What is an encapsulated delusion?
a delusion that usually relates to one specific topic or belief but does not pervade a person's life or level of functioning
170
Features of delerium tremens
```
Cognitive impairment
Hallucinations and/ or illusions - vivid perceptual abnormalities
paranoid delusions
Tremor
Autonomic
```
171
When may you get symptoms of alc withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
