Psych Flashcards
Personality Disorder definition
attitudes, beliefs, behaviours cause longstanding problem in daily life.
Sx of Personality Disorder
cant control emotions
struggle with friendships
type A Personality Disorder
suspicious
type B Personality Disorder
emotional and impulsive
type C Personality Disorder
anxious
causes of delirium
UTI, RTI, steroids/analgesics, dehydration, anaemia, metabolic disturbance, liver/kidney dysfn, alcohol/ drugs withdrawal, constipation
Sx of delirium
confusion [hypoactive] clouding of consciousness, decreased awareness/disorientation, drowsy/lethargic, speech difficulty vivid dreams [hyperctive] illusions/hallucination paranoia agitation/ restless anxious/frightened/irritable
difference between delirium and dementia
progressive vs fluctuating
chronic vs acute
management of delirium
treat the cause - hydration, Abx
re-orientate [clock, Xmove rooms]
reassurance, family presence
medical management of aggressive pateint
IM lorazepam
confusion, poor mobility, hemiparesis, recent fall. Ix? looking for?
CT head, subdural heamatoma
recent DM Dx, aggression & confusion. cause and Ix?
hypoglycaemia, blood glucose
76 yr old, ^confusion, urine incont. Ix?
mid stream urine culture
disregard for social obligations/ feelings of others. what type of PD?
type A (suspicious) - antisocial/dissocial
misinterpretation of ext stimuli
illusion
assault, says he felt an alien guide his movements. What type of delusion?
delusion of passivity
depression, Hx of cardiac arrythmia. amitryptilline or fluoxetine?
fluoxetine. Amitr. is cardiotoxic
weight loss, Xeating/drinking 3/7, psychomotor retardation, pov of speech, flat affect. Mx?
ECT
mania Tx
olanzapine
low mood 5yrs, tired, depressed, no other Sx, able to cope day to day. Dx?
dysthymia (doesnt fulfil criteria for depressive episode)
depression, started hearing the voice of the devil. Dx?
psychotic depression
Sx of lithium toxicity
anorexia, nausea, diarrhoea, muscle weakness, drowsy, ataxia, coarse tremor, muscle twitching
cheese + phenelzine (MAOI)
hypertensive crisis
overdose of diazepam causes what problem
resp depression
euphoria, hypervigilance, dilated pupils,cardiac arrhythmia. What drug?
amphetamine
apathy, pupil constrict, drowsy, slurred speech. drug?
opoid
labile mood, slurred speech, unsteady gait, nystagmus. drug?
alcohol
opoid agonist used in dependence management
methadone
alcohol dependence Tx, causes Rn when take alcohol
disulfiram
anxiolytic used for alcohol withdrawal Sx
chlordiazepoxide (librium)
name a recreational drug that is a CNS stimulant, and can cause paranoid psychosis
amphet
name a recreational drug that causes euphoria, sociability, death due to hyperthermia
ecstasy
name a recreational drug that is a hallucinogen, and causes synaesthesia
LSD
believes news is talking about him
delusion of reference
thoughts sucked out of head by alien
thought withdrawal
army satellites direct sun beams that make my arm move
somatic passivity
^antipsychotic dose, sustained contraction of one muscle group
acute dystonic reaction
haloperidol reaction. fever, fluctuating consciousness, rigidity, tachycardia, raised creat phos
neuroleptic malignant syndrome
abnorm chewing movements, grimacing, Hx haloperidol
tardive dyskinesia
define generalized anxiety disorder
excessive worrying for 6/12
and 3 of the following: sleep disturbance, poor concentration, muscle tension, fatigue, irritable, restless
Difference between GAD and panic disorder
Panic: Recurring and regular panic attacks often for no apparent reason. Nausea, sweating, trembling, SOB.
GAD: feel anxious all the time about everyday events
GAD risk factors/ aetiology
women 35-59 alcohol and drug use Family history/ Genetics Serotonin and noradrenaline imbalance Traumatic events – child abuse, domestic violence Chronic illness
describe the psychodynamic psychological theory
Conscious AND UNCONSCIOUS desires determine personality. Childhood experience shapes personality. Id [devil], superego [angel], ego [reality].
based on past
describes the cognitive behavioural psychological theory
thoughts determine behaviour. Dysfunctional thoughts lead to extreme emotions.
based on present
investigations for GAD
urine drug screen
TFTs
pheochromocytoma [BP, blood/urine metadrenaline/ normetadrenaline]
ECG
Mx for GAD
CBT, mindfulness, relaxation
SSRIs [sertraline], SNRIs, pregabalin
caffeine, alcohol, exercise
recurrent, multiple unexplained physical symptoms, with no medical cause found. Diagnosis?
somatisation disorder
young man who visited a prostitute on one occasion is convinced he has gonorrhoea despite recurrent tests being negative. Diagnosis?
hypochondriacal delusion
name 6 Sx of mania
mood elevation irritability grandiosity decreased sleep talkative flight of ideas ^sociability distractibility psychomotor agitation sexual disinhibition risk taking
name 6 Sx of depression
low mood anhedonia anergia poor sleep EMW decreased appetite feelings of worthlessness suicidal thoughts self harm poor concentration psychomotor retardation
risk factors for mood disorders
genes family member childhood trauma/abuse serotonin deficiency hypothyroidism stress Socio-economic status menopause COCP alcohol/drug use
bipolar disorder. Treatment mood stabiliser
lithium carbonate
Outline the categories of the Mental State Examination in psychiatry
ASEPTIC appearance and behaviour speech emotion [mood] perceptions thoughts insight cognition
components of the personal history in psychiatry
early development childhood behaviour education employment relationships
what are the 3 levels of psychiatric patient “insight”
- awareness of abnormal experience
- result of a disease process
- open to intervention
what are the components of a psychiatric risk assessment
risk to self [suicide/SH] thoughts of harming others accidental risk to self/others self-neglect vulnerability
3 core Sx of depression
Low mood
anergia
anhedonia
Sx of depression, other than the 3 core Sx
sleep disturbance(EMW) Change in appetite Change in libido Diurnal mood variation Agitation Loss of confidence poor concentration Guilt Hopelessness Suicidal ideation
describe some of the psychotic symptoms you might see in depression with psychosis
nihilistic and guilt delusions
derogatory voices
define bipolar 1 and 2
Bipolar I – mania + depression
Bipolar II – more episodes of depression, only mild hypomania
1st rank Sx of schizophrenia
Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception
secondary Sx of schizophrenia
Delusions 2nd person auditory hallucinations Hallucinations in any other modality Thought disorder Catatonic behaviour Negative symptoms
list 4 positive Sx [schizophrenia]
Hallucinations Delusions Passivity phenomena Thought alienation Lack of insight Disturbance in mood
list 4 negative Sx [schizo]
Blunting of affect Amotivation poverty of speech Poverty of thought Poor non-verbal communication Clear deterioration in functioning self neglect Lack of insight
name 5 physical Sx of panic disorder
Palpitations chest pain choking Tachypnoea Dry mouth Urgency of micturition Dizziness Blurred visions Parasthesiae
define hallucination
perceiving something that isnt there in the abscence of external stimuli
define illusion
perceiving something that isnt there with external stimuli
define delusion
abnormal belief, doesn’t follow societies norms
how do the auditory hallucinations differ between functional psychosis and depression
psychosis - 3rd person auditory
depresison - 2nd person auditory
name 2 organic causes of hallucinations
brain tumour
temporal lobe epilepsy
schizophrenia- auditory/visual halluinations?
auditory, NOT visual
differential diagnoses for schizophrenia
drug induced psychosis delusional disorder head injury schizoeffective disorder hyperthyroid
Ix for psychotic Sx
urine drug screen
CT
TFTs
section 5(2) of mental health act
Dr.s holding power
section 5(4) of mental health act
nurses holding power
progression of symptoms in neurology. Give an example of a condition which would present with gradual deterioration/ intermittent exacerabtions/ rapid onset
gradual deterioration (tumour) intermittent exacerbations (MS) rapid onset (stroke)
a headache worse on waking or coughing indicates?
raised intracranial pressure
describe the diff between Wernicke’s and Broca’s dysphasia
Wernicke’s - Receptive dysphasia/speech comprehension
Broca’s - Expressive dysphasia/speech production
tremor worse towards the end of movements suggests a problem with which part of the brain
cerebellum
causes of tremor at rest
PD
hyperthyroidism
benign essential tremor
alcohol withdrawal
name the 4 extrapyramidal symptoms of typical antipsychotics
tardive dyskinesia
dystonia
akathisia
parkinsonism
functions of dopamine
reward
pleasure
fine tuning motor
serotonin functions
^mood appetite sleep memory libido
dopamine hypothesis of schizophrenia
over activity -> hallucination/delusion
under activity -> blunted, apathy
what is the pharmacology of antipsychotics that causes tardive dyskinesia?
D2 recpetor antagonism
what receptors do newer antipsychotics target as opposed to D2 receptors targeted by typicals
serotonin
describe the monoamine theroy of depression
predicts that underlying pathophysiology of depression lies in depleted serotonin and noradrenaline levels
examples of SSRIs
fluoxetine
sertraline
citalopram
examples of SNRIs
venlafaxine
duloxetine
side effects of SSRIs
sexual dysfunction
weight gain
^bowel motility
agitation
dietary restrictions for MAOIs and why
aged cheese beer red wine smoked meat/fish contain tyramine [monoamine] -> HTN crisis
side effects of tricyclics for depression and why?
dry mouth
blurred vision
urinary retention
anticholinergic [block ACh]
lithium side effects
diarrhoea
tremor
dry mouth
thirsty
skin changes
teratogenic
features of lithium toxicity
coarse tremor drowsy vision disturbance D+V hypokal ataxia dysarthria coma
Mx of lithium toxicity
stop lithium
rehydrate
haemodialysis
[gastric lavage]
evidence required for a section 2 MHA
patient suffering from mental disorder that warrants detention for assessment
danger to self or others
evidence required for section 3 MHA
patient suffering from mental disorder that warrants detention for treatment
treatment in interest of self/ others safety
treatment is available
evidence required for section 4 MHA
patient suffering from mental disorder that warrants detention
best interests of self/others safety
not enough time/risk to great for 2nd Dr to attend
what kind of patient are section 5(2) and 5(4) for?
patient ALREADY admitted and wants to LEAVE
describe the theory of psychodynamic therapy
uncovering past trauma to resolve present day symptoms
psychodynamic therapy - how long and how often do you meet?
approx 1 yr. Weekly
describe 1st, 2nd and 3rd wave CBT approaches
1st wave: Behaviour therapy
2nd wave: Cognitive (behavioural) therapy
3rd wave: combines mindfulness and acceptance techniques with the above
Dialectic Behavioural Therapy mostly aimed at helping people with
personality disorder
how does ICD10 define dementia
decline in higher cortical function
name the 4 As of decline in cognitive function in alzheimers
amnesia
apraxia
agnosia
aphasia
neuroradiological findings in an alzheimers brain
shrinkage of cerebral cortex
shrinkage of hippocampus
enlarged ventricles
what kind of speech disturbance is seen in vascualr dementia
Expressive dysphasia
describe some personality changes in fronto-temporal dementia
Apathy, disinhibition, emotional blunting, coarsening of sociability
symptoms /disease course of lewy body dementia
fluctuating, rapid decline
visual hallucinations
parkinsonian signs
frequent falls
alzheimers treatment
Memantine (NMDA antagonist)
donepazil, rivastigmine, galantamine
what age constitutes late onset schoziphrenia
> 45
symptoms of late onset schizophrenia
paranoia
delusions (partition)
hallucinations
what symptoms are seen less in late onset schizophrenia than young
emotional blunting
personality decline
negative symptoms
formal thought disorder
define formal thought disorder and give 3 examples
disorganised thinking evidenced by disordered speech e.g. poverty of speech, derailment, perseveration
risk factors for late onset schizophrenia
Social Isolation
Sensory deficits
Reclusive and suspicious pre-morbid personality
Female
criteria for delusional disorder
long standing delusions
3 months
culturally appropriate
no persistent hallucination/ not 3rd person
no passivity
no blunting of affect
no organic cause
define Cotard delusion
delusional belief that they are already dead, do not exist, are rotting, or have lost their blood or internal organs.
name 2 somatic delusions of psychotic deperession
pain,
can’t swallow
main difference between charles bonnet and psychosis
INSIGHT
describe attachment theory in psych
infant needs to develop a relationship with at least one primary caregiver for successful social/ emotional development, and to learn how to effectively regulate their feelings
criteria for delusion
belief that is:
- firmly held
- not affected by rational argument /evidence to the contrary
- not a conventional belief
types of paranoid delusions
persecutory
grandiose
self-referential
lady started on fluoxetine now feels better and asks to stop it. Advice?
continue for 6 months after remission
Luria’s motor test is for which type of dementia
fronto-temporal/ picks
what is paraphrenia?
late onset schizophrenia with +ve symptoms and without -ve symptoms
tricyclic overdose investigation
ECG
side effect of citalopram on the heart/seen on ecg
prolonged QT
depression and insomnia. Best medication? [flouxetine, mirtazepine, diazepam]
mirtazepine - has drowsiness side effect
diazepam overdose drug mx
flumazenil
treatment for pcm overdose
n-acetyl-cysteine
A 57 year old man presents with an ataxic gait, nystagmus, urinary incontinence and memory impairment
normal pressure hydrocephalus
treatment of normal pressure hydrocephalus
shunt operation to improve the circulation of cerebrospinal fluid
A 33 year old unemployed gentleman was seen in hospital for assessment of recent memory loss. He appeared malnourished and apathetic. During the course of assessment there was evidence of confabulation and gait disturbance. His partner mentioned that he spent most of his evenings drinking with friends in the pub.
korsakoff’s syndrome
A 45 year old mother of two presented to her GP with a history of low mood and forgetfulness. She also complained of poor concentration, loss of interest, tiredness and poor sleep. Her Mini mental state examination score was 21 / 30. It was noticed that most of her answers were “I don’t know.”
pseudodementia
management of serotonin syndrome
fluids, benzos
Cyproheptadine
sx of serotonin syndrome
cognitive: confusion, agitation
autonomic: diarrhoea, tachycardia
fever
HTN
neuro: ^reflexes, clonus, tremor
seizure
ataxia
define mydriasis and miosis
mydriasis - dilated pupil
miosis - constricted
causes of serotonin syndrome
MAOI
SSRIs
ecstasy
Amphetamines
Ix for patients on lithium
tft [hypo]
u and e [excretion]
ECG
risk factors for schizophrenia
triggers
FH
social isolation
intrauterine infection
stress, drugs
schizophrenia type presentation- Ix
cultures MSU CT head FBC TFT glucose calcium cortisol alcohol/drug screen
NEUROLEPTIC MALIGNANT SYNDROME (reaction after starting an antipsychotic/ ↑ dose). Management?
benzodiazepines
fluids
bromocriptine
Ix in neuroleptic malignant syndrome and why
ABG [Met acidosis]
U and E (↑ Creatinine Kinase)
FBC [Leucocytosis]
ECG [prolonged QT]
differences between serotonin syndrome and neuroleptic malignant syndrome
rapid vs gradual
mydriasis vs normal
increased vs reduced relflexes
OCD management
CBT + SSRI
management of Acute Dystonic Reaction after starting haloperidol
stop drug
procyclidine
Ix to chelck before starting lithium
U+E
ECG
TFT
