Psych Flashcards
Define the term ‘psychosis’
A mental state in which reality is greatly distorted
Name and define symptoms associated with psychosis
Delusions - a fixed, false belief firmly held despite evidence to the contrary, against normal social and cultural beliefs
Hallucinations - perception in the absence of external stimulus
Thought disorder - impaired ability to form thoughts from logically connected ideas
List some differentials for psychosis
Organic - drug induced, iatrogenic (levodopa, steroids), SLE, delirium, temporal lobe epilepsy, SOL, Lewy body dementia, cushing’s syndrome, vitamin B12 deficiency, syphillis
Functional - schizophrenia, schizotypal disorder, schizoaffective disorder, acute psychotic episode, mood disorder (+ psychosis), puerperal (post partum), delusional disorder
List different types of delusions
Grandiose Persecutory Reference Guilt Nihilistic Hypochondriacal Infestation De clérambault's syndrome (erotomania) Othello syndrome (jealousy, unfaithful) Capgras' syndrome (misidentification)
List different types of hallucinations
Visual (*organic brain disease/substance misuse)
Auditory (second/third/running commentary)
Olfactory
Gustatory
Somatic (bodily sensations)
List different types of thought disorder
Loosening of association (derailment, tangential, word salad
Neologisms
Describe how to undertake a psychiatric interview (history taking)
Sociodemographic details - name, age, gender, marital status, children, occupation, religious and ethnic background
HPC - onset, severity, duration, progression, precipitating events/aggravating/relieving factors, associated symptoms
PPH - diagnoses (date, duration), previous admissions (informal, MHA), treatments (medication, psychological, ECT) and response/side effects
PMH - head injury, cranial surgery, neurological conditions (epilepsy), endocrine abnormality (thyroid, cushing’s)
DH - medication (+ psychotropic), allergies
FH - +quality of family relationships
PH - early childhood (birth complications, milestones, childhood illness, family dynamics, home atmosphere, abuse), education (attendance, enjoyment, bullying, qualifications, higher education), employment (chronological list, duration, redundancy/choice, work environment), relationships (sexual orientation, major relationships, current relationships, children), forensics (offences, sentences, arrested)
SH - accommodation, social support, finances, hobbies, alcohol (units, type), illicit drugs (cannabis), smoking (pack years)
Premorbid personality (collateral)
Describe how to undertake a mental state examination (examination)
ASEPTIC:
Appearance and behaviour - physical state (unkempt, weight, EPSE, posture), clothing and accessories, personal hygiene, eye contact, facial expression, motor activity/abnormal movements, arousal, ability to build rapport, disinhibition
Speech - rate, rhythm, volume, content, quantity, tone, dysarthria
Emotion (mood and affect) - objective, subjective, labile
Perception (hallucination) - visual/auditory/olfactory/gustatory/somatic, pseudohallucination, depersonalisation, derealisation
Thought - content (delusion, overvalued idea, obsession, compulsion), form, stream, suicide and self harm/harming others
Insight - intact, partial, non existent
Cognition - mentation to time, place and person, tools (MMSE/AMT/ACE)
List Schneider’s first rank symptoms of schizophrenia
Delusional perception
Third person auditory hallucination
Thought interference
Passivity phenomenon
Define the terms ‘mood’, ‘affect’, ‘insight’
Mood - sustained, subjective, experienced emotion over a period of time
Affect - observe a patient’s posture, facial expression, emotional reactivity and speech
Insight - extent to which the patient understands the nature of the problem and if they are in agreement with treatment
Give an example of a MSE for a patient with paranoid schizophrenia
A&B - appropriate, normal, able to build rapport
S - normal rate, rhythm, tone, no formal thought disorder
E - subjectively good, objectively euthymic, appropriate affect
P - delusion, auditory third person hallucination (reacting to stimulus)
T - persecutory delusion
I - none - no presence of illness, no desire for treatment
C - orientated to TPP, cognition normal
List risk factors for depression
FAPS: Female Family history Alcohol Adverse events Past depression Physical comorbidities Low social support/socioeconomic background
List the core symptoms of depression
Low mood
Anergia
Anhedonia
>2 weeks
List cognitive symptoms of depression
Lack of concentration, negative thoughts, excessive guilt, suicidal ideation
List biological symptoms of depression
DVM, EMW, loss of libido, psychomotor retardation, weight loss, loss of appetite
Describe how you would classify severity of depression
Mild - 2 core, 2 other
Moderate - 2 core, 3-4 other
Severe - 3 core, >4 other
What is Beck’s triad of depression?
Sad thoughts about self, World and the future
List investigations you would perform in a patient with suspected depression
Questionnaire - PHQ-9
Bloods - FBC, TFTs, calcium, glucose
Describe management of depression
Biological - antidepressants (SSRI, SNRI, TCA etc.), adjuvants, ECT
Psychological - psychotherapy, self help programmes, physical activity
Social - social support groups
List indications for ECT in depression
Life threatening severe depression Rapid response required Depression with psychotic features Severe psychomotor retardation/stupor Failure of other treatments
Give an example of a MSE for a patient with depression
A&B - unkempt, poor personal hygiene, difficulty establishing rapport, psychomotor retardation, poor eye contact, hunched position
S - slow rate, monotonous, no formal thought disorder
E - objectively and subjectively low, blunted affect
P - delusions of guilt, hallucinations
T - poverty of thought, suicidal ideation, self harm
I - good insight - accepts diagnosis and treatment
C - poor concentration
List symptoms of mania
I DIG FASTER: Irritability Distractibility, disinhibition (sexual, social, spending) Insight impaired, increased llbido Grandiose delusions Flight of ideas Activity/appetite increased Sleep decreased Talkative (pressured speech) Elevated mood, energy increased Reduced concentration, reckless, restless
List investigations you would perform in a patient with suspected bipolar disorder
Mood disorder questionnaire
Bloods - FBC, TFTs, U&E, LFT, glucose, calcium
Urine drug screen
CT head
Describe management of mania
Biological - mood stabiliser, benzodiazepine, antipsychotics, ECT
Psychological - psychoeducation, CBT
Social - social support groups, self help groups, calming activities
List ADRs of lithium
Polydipsia, polyuria (diabetes insipidus), metallic taste in mouth, fine tremor, weight gain, hypothyroidism, decreased renal function, oedema, teratogenic
*ECG - T wave flattening, widened QRS
List symptoms of lithium toxicity
Toxicity (1.5-2.0) - nausea, vomiting, coarse tremor, ataxia, muscles weakness Severe toxicity (>2.0) - nystagmus, dysarthria, hyperreflexia, oliguria, reduced consciousness, convulsions, coma, death
What investigations are required before commencing a patient on lithium therapy?
U&Es
TFTs
Pregnancy status
ECG
Give an example of a MSE for a patient with mania
A&B - flamboyantly dressed, psychomotor agitation
S - pressured speech, increased intonation, excessive punning, clang association, disinhibition
E - objectively and subjectively elated in mood, labile
P - no hallucinations, delusions of grandeur
T - delusion, loosening of association, thought acceleration
I - non existent insight
C - orientated to TPP, poor attention
List positive and negative symptoms of schizophrenia
Positive (Delusions Held Firmly Think Psychosis) - delusions, hallucinations, formal thought disorder, thought interference, passivity phenomena
Negative (As) - avolition, asocial behaviour, anhedonia, alogia (poverty of speech), affect blunted, attention deficits