Psych Flashcards
PTSD
Trauma Re-experiencing Avoidance Unable to function Month Arousal
Psychotherapy - CBT SSRI's Prazosin for nightmares Benzos for anxiety Trauma therapy Eye movement desensitisation and reprocessing - EDR
Acute stress disorder
3 days to a month
Trauma
Impairment of function
>/= 9 Intrusive symptoms, negative mood, dissociative symptoms, arousal symptoms
CBT for treatment
Usually no pharmacotherapy
Adjustment disorder
Stress within 3 months - emotional/behaviour
Distress out of proportion / impairment
Not another disorder
Not normal bereavement
Stress for not more than 6 months after stressor terminated
Mood, anxiety, conduct disturbance, or mixed
Persistent if lasts over 6 months
Treat with psychotherapy, crisis intervention, benzodiazepines
OCD
Obsessions (recurrent and persistent thoughts, urges or images - unwanted –> anxiety) / Compulsions (behaviours or mental acts compelled to perform in response to obsession –> usually to reduce anxiety or distress but usually excessive or not realistic)
>1 hour a day or significant functional impairment
Not due to substances
Not another mental disorder
CBT
SSRI
Clomipramine - TCA or risperidone
Panic Disorder
STUDENTS fear the 3 C’s
1 month or more anxiousness - persistent concern or worry about additional panic attacks or their consequences / maladaptive change in behaviour
Not due to substance or medical condition
Not another mental disorder
CBT - exposure, cognitive restructuring, relaxation techniques
Pharmaco -
- SSRI/SNRI –> other antidepressants
- Avoid bupropion or TCA”s due to stimulating effects
- Benzodiazepines only for short term use
STUDENTS fear the three C’s
Sweating Trembling Unsteadiness Depersonalisation/derealisation Excessive heart rate / palpitations Nausea Tingling SOB Fear of dying / going crazy Choking Chills Chest pain
GAD
FIRST C Fatigue Irritability Restlessness Sleep disturbance Tension Concentration issues
Functional impairment
Not attributable to substance or medical condition
Not another mental disorder
Decrease caffeine, alcohol Good sleep hygiene FBC, TFT, UEC, urinalysis and urine drug CBT and mindfulness SSRI and SNRI's PRN benzos
ALWAYS RULE OUT:
caffeine, stimulant use, alcohol/drugs!!!!
Separation Anxiety Disorder
Excessive distress when anticipating or expericeing separation
Persistent and excessive worry about losing attachment
Persistent and excessive worry about untoward event
Persistent reluctance to separate due to fear
Excessive fear or persistent reluctance about being alone
Refusal to sleep
Nightmares involving separation
Complaints of physical symptoms
> 4 weeks
Distress
Not another mental disorder
Selective mutism
Failure to speak in specific social situations
Education/occupation affected
At least 1 month
Not due to lack of knowledge with spoken language
Not explained better by another communication disorder or not during course of another disorder like schizo
Social anxiety disorder
Fear or anxiety about social situations
Individual fears that they will act in a way or show anxiety that will be negatively evaluated
Social situations almost always provoke fear or anxiety
Fear is out of proportion to actual threat posed by social situation
Persistent - 6 months or more
Distress
Not due to substance or medical condition
Not explained by another mental disorder
Agoraphobia
COOPE
Closed areas Open areas Outside the home Public transport Enclosed places
Avoids situations
Actively avoided or endured with intense fear
Out of proportion
Persistent - >6 months
Significant distress
Excessive despite presence of another medical condition
Not another mental health disorder
Substance induced anxiety
Panic attacks / anxiety
Symptoms soon or during after substance
Substance capable of producing the symptoms
Not other anxiety disorder
Not during delirium
Clinically significant distress - improves following stopping substance
Body Dysmorphic Disorder
Preoccupation with 1 or more perceived flaws in physical appearance
Repetitive behaviours in response to appearance concerns
Clinically significant distress in functioning
Not another disorder
Anorexia Nervosa
Energy restriction
Intense fear of gaining weight or becoming fat
Disturbance in self-perceived weight or shape
Bulimia nervosa
Recurrent episodes of binge-eating
Recurrent inappropriate compensatory behaviour in order to prevent weight gain
Binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months
Self evaluation is unduly influenced by body shape and weight
Disturbance does not occur exclusively during episodes of AN
Medication induced psychotic disorder
Delusions/Hallucinations Evidence of above soon after substance intoxication or withdrawal or after exposure Not better explained by another disorder Not during delirium Significant clinical distress
Psychosis due to another medical condition
Hallucinations/Delusions Evidence not due to another medical condition Not another mental disorder Not during delirium Clinically significant distress
Schizophreniform
A - same as schizophrenia
B - rule out schizoaffective, psychotic features of bipolar or depression
—- If mood episodes have occurred during active-phase symptoms, present for minority of total duration
C - other causes
D - Less than 6 months
Schizophrenia
Delusions, Hallucinations, Disorganised speech, disorganised behaviour, negative symptoms
Loss of function to work
Continuous for over 6 months
Schizoaffective, depressive or bipolar with psychotic features have been ruled out
Not due to substance or medical condition
If history of Autism of childhood communication —> can only be diagnosed if prominent delusions or hallucinations occur with other symptoms of schizophrenia for at least 1 month
Schizoaffective disorder
Same as A for schiozphrenia
Delusions or hallucinations for 2 or more weeks in absence of major mood episode during lifetime duration of illness
Major mood episode symptoms are present for the majority of total duration of active and residual periods of the illness
Not due to substance or medical condition
Bipolar type in young, depressive type in older
Brief psychotic disorder
2 or more of - Delusions - Hallucinations - Disorganised speech - Grossly disorganised or catatonic behaviour Rule out schizoaffective etc. - No depressive or manic concurrently with active-phase symptoms Rule out other causes
Delusional Disorder
Delusions for over a month
Criteria A for schizophrenia NEVER been met - if hallucinations are present, not prominent and related to the delusional theme.
Functioning not markedly impaired
Manic or depressive episodes - brief if occurred
Not due to substance or another medical condition
Major depressive episode
5/9 of
- Appetite
- Sleep disturbance
- Anhedonia
- Depressed mood
- Fatigue
- Agitation - psychomotor
- Concentration
- Esteem - Excessive feelings of guilt or worthlessness
- Suicidal
Functional impairment
Not substance induced, not secondary to medical condition, not another psychiatric diagnosis
Major depressive disorder
Major depressive episode criteria present
Not schizoaffective and not superimposed on schizophrenia or other psychotic disorder
There has never been a manic or hypomanic episode
Exercise, mindfulness, zinc supplementation
Antidepressants
Change class or add augmenting agent if no response
Need to allow at least 4 weeks to see if antidepressant is working
ECT
TMS
Phototherapy
ECT - particularly for melancholic and psychotic symptoms, postnatal depression and psychosis, previous good response to ECT, strong suicidal ideation, catatonia
Psychotherapy
Social skills training
Experimental - magnetic seizure therapy, deep brain stimulation, vagal nerve, ketamine
Manic episode
> 1 week
GIFTS DP At least 3 or 4 if mood is only irritable
- Goal directed activity or psychomotor agitation
- Inflated self esteem or grandiosity
- Flight of ideas
- Talkative or pressure
- Sleep - decreased need for
- Distractibility
- Pleasurable activities
Significant impairment
Not due to substance or medical condition
Hypomanic episode
At least 4 days
Greater than or equal to 3 of GIFTS DP
Different to character when not symptomatic
Disturbance in mood and change in functioning
Not severe enough to cause marked impairment
Not due to substance or medical condition
Cyclothymia
2 years hypomanic symptoms that don’t meet criteria for hypomanic episode and numerous periods with depressive symptoms that don’t meet criteria for a major depressive episode
During 2 years hypomanic and depressive present half the time and not without for more than 2 months
No MDE, manic or hypomanic episode
A not better explained by psychotic disorder
Not due to substance or medical condition
Significant distress
Persistent depressive disorder
More days than not for 2 years IHELLPP - Insomnia or hyper - Feelings of hopelessness - Low energy or fatigue - Low esteem - Poor appetite or overeating - Poor concentration or difficulty making decisions Not without for more than 2 months Criteria for MDD may be present for 2 years No manic or hypomanic, not cyclothymic Not psychotic Not due to medical condition or substance Significant distress
Paranoid personality disorder
SUSPECT
Suspicious that others are exploiting or deceiving them
Unforgiving
Spousal infidelity without justification
Perceive attacks on character, counterattacks quickly
Enemies or friends - preoccupied with acquaintance trustworthiness
Confiding in others is feared
Threats interpreted in benign remarks
Schizoid
DISTANT
Detached affect and emotionally cold
Indifferent to praise or criticism
Sexual experiences of little interest
Takes done alone
Absence of close friends that are not 1st degree relatives
Neither desires nor enjoys close relationships
Takes pleasure in few if any activities
Schizotypal
ME PECULIAR
Magical thinking Experiences unusual perception Paranoid ideation Eccentric behaviour Constricted or in appropriate affect Unusual thinking or speech Lacks close friends Ideas of reference Anxiety in social situations
Borderline
IMPULSIVE
Impulsivity Mood instability Paranoia / dissociation under stress Unstable self image Labile intense relationships Suicidal Inappropriate anger Vulnerability to abandonment Emptiness
Antisocial personality
CORRUPT
Cannot conform to law Obligations ignored Reckless disregard for safety Remorseless Underhanded (deceitful) Planning insufficient (impulsive) Temper (irritable and aggressive)
Narcissistic Personality Disorder
GRANDIOSE
Grandiose Requires excessive admiration Arrogant Needs to be special Dreams of success, power, beauty and love Interpersonally exploitative Others: Lacks empathy, unable to recognise feelings and needs of others Sense of entitlement Envious or believes others are envious
Histrionic personality disorders
ACTRESSS
Appearance used to attract attention Centre of attention Theatrical Relationships are believed to be more intimate than they are Easily influenced Seductive behaviour Shallow expression of emotions which rapidly shift Speech is impressionistic and vague
Avoidant Personality Disorder
CRINGES
Criticism or rejection reoccupies thoughts in social situations
Restraint in relationships due to fear of being shamed
Inhibited in new relationships due to fear of inadequacy
Needs to be sure of being liked before engaging socially
Gets around occupational activities required interpersonal contact
Embarrassment prevents new activity taking or risks
Self-viewed as unappealing or inferior
Dependent personality
RELIANCE
Reassurance required for everyday decisions
Expressing disagreement difficult
Life responsibilities assumed by others
Initiating projects as they have no confidence
Alone makes them feel helpless or uncomfortable
Nurturance - goes to excessive lengths to obtain
Companionship sought urgently
Exaggerated fears of beings left to care for themselves
OCPD
SCRIMPER
Stubborn Cannot discard worthless objects Rule/detail obsessed to the point of loss of activity Miserly Perfectionistic Excludes leisure due to devotion of work Reluctant to delegate to others
Gambling
> 4
- Increasing amounts to achieve excitement
- Restless or irritable when attempting to cut down or stop gambling
- Has made repeated unsuccessful efforts to control, cut back or stop gambling
- Preoccupied with gambling
- Gambles when distressed
- After losing money, returns another day to get even
- Lies to conceal gambling
- Lost significant relationship, job, educational or career opportunity because of gambling
Not manic episode
Nicotine
> 2 in 12 months
Tobacco in larger amounts over longer period than was intended
Persistent desire or failed attempts to cut down
Time spent in activities for obtaining or using tobacco
Craving to use tobacco
Recurrent use –>? failure to fulfil roles
Continued tobacco use despite social or interpersonal problems caused by tobacco
Recurrent where it is hazardous
Used despite knowledge of having persistent physical or psychological problem that has been caused or exacerbated by tobacco
Tolerance - need for increased amounts, diminished effect
Withdrawal - need tobacco/nicotine to avoid withdrawal symptoms
Tobacco withdrawal Daily use for at least several weeks Abrupt cessation/reduction --> >4 - Irritability, anger, frustration - Anxiety - Difficulty concentrating - Increased appetite - Restlessness - Depressed mood - Insomnia Significant distress Not attributed to another medical condition or another mental disorder or due to another substance
Opioid use disorder
Larger amounts over longer period than was intended
Persistent disre or failed attempts to cut down
Time spent in activities for obtaining, using or recovering from
Craving use
Recurrent use –> failure to fulfil roles at work
Continued use despite social or interpersonal problems
Activities given up due to use
Continued despite knowledge of harms
Tolerance
Withdrawal
Intoxication Recent use Problematic or psychological changes --> euphoria --> apathy, dysphoria, psychomotor agitation or retardation Pupillary constriction + 1 of - Drowsiness or coma - Slurred speech - Impairment in attention or memory
Withdrawal: Cessation of reduction in ovoid use that has been heavy and prolonged OR administration of opioid antagonist after a period of use >3 of Dysphoria Nausea and vomiting Muscle aches Lacrimation or rhinorrhoea Pupillary dilation, piloerection or sweating Diarrhoea Yawning Fever Insomnia Significant distress Not attributable to another medication condition or another disorder
Sedative, hypnotic or anxiolytic intoxication
INTOXICATION
Recent use
Maladaptive behavioural or psychological changes (inappropriate sexual or aggressive behaviour, mood lability)
>1 of
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus
- Impaired cognition (attention, memory)
- Stupor or coma
Not due to another medical condition and not by another mental disorder
WITHDRAWAL Cessation or reduction in prolonged use >2 of - Autonomic hyperactivity - Hand tremor - Insomnia - N and V - Transient visual, tactile or auditory hallucinations or illusions - Psychomotor agitation - Anxiety - Grand mal seizures Significant distress Not attributable to another medical condition or another mental disorder
RA and TA
Mental Act Prevents Real Niggas Consenting
Mental illness present Assessment required Properly made at MHS Risk No less restrictive way Consent - lack capacity
TA - add on regular review, and tribunal to review
Delirium
DELIRIUM - Symptoms
Disordered thinking Euphoric - labile mood Language impaired Illusions/delusions.hallucinations (usually visual) Reversal of sleep wake cycle Inattention Unaware/disoriented Memory deficits
ABCDE - DSM
Attention and awareness Brevity - Acute and fluctuating Cognitive changes Direct physiological cause Explanation not due to alternative
Aetiology
Infectious Withdrawal Acute metabolic disorder Trauma CNS Hypoxia Deficiencies Endicronipathies Acute vascular Toxins Heavy metals
Dementia
DEMENTIAS
Delirium/Drugs Emotional/Endocrine Memory Elective Neurological Toxic Intellect Amnesic Schizophrenia
Evidence of significant cognitive decline from previous level
Cognitive deficits interfere with independence in everyday activities
Do not occur exclusively in the context of a delirium - not better explained by another disorder
Altered mental state
AEIOUTIPS
Alcohol withdrawal syndrome Epilepsy, electrolytes, hepatic/uraemic encephalopathy Insulin Opiates Uraemia Temperature Infections PE SOL, stroke, shock, seizure
De-escalation
DEESCALATION
Don’t withdraw privileges, seclude or medicate
Ensure safety of others
Escape
Stance - protective and read
Calm, non-threatening
Allow for ventilation of anger and feelings
Leave the area if secure and safe to do so
Assistance and enough skill staff available
Time out - offer time out
Invite to sit and verbalise concerns
Options/choices - exercise, music, coffee
Never turn your back
CBT
Cognitive restructuring Behavioural activation Specific problem solving Goal-oriented Coping skills Multiple strategies - role [playing etc. Makes patients pay attention to their mood following automatic thoughts to learn about the relationship between these thoughts and their emotions
Cultural
Optimise accuracy
Setting
Confidentiality
Respect
Language
Establish rapport and maintain cultural safety
Consider access, adherence, support, understanding
Enhancing knowledge Utilise resources Assess existing knowledge Understand the context Partake in health service orientation Take the time to engage Be culturally aware Create connections
Social displacement syndrome
Necessity to leave Barbed wire phase Liberation phase Early after-effects phase Delayed after-effects phase Recovery phase
Problems Family and community disconnection Geographical dislocation Lifestyle change Loss of spirituality Cultural despair
Barriers: Lack of knowledge lack of trust reluctance to seek help Costs of care Tranport Employment commitments Cultural differences Language Housing, etc. support Schooling for children
Anti-convulsants side effects
VALPROATE
Appetite Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity Encephalopathy
Lithium
Hypocalcemia Hypothyroidism Nephrogenic diabetes insipidus Convulsions, coma QtC prolongation Metallic taste in mouth Tremor, choreathetoid movements Hyperreflexia Ataxia, Nystagmus, Blurred vision due to nystagmus, dysarthria, dysdiedochokinesis NV, abdominal pain Arrhthymias
NMS
FALTER
Fever Autonomic instability Leucocytosis Tremor Enzymes Rigidity
NALEEM
Name Age/ethnicity Living Education Extras MHAct
Moods and affect
Euthymic Apethetic Angry Dysphoric Europhobic Apprehensive
ACE-R
Attention, Fluency, Memory, Language, Visuospatial abilityies
FAB
Abstraction, Fluency, impulsivity, reflexes
DSM VS ICD
ICD is heierachriacal, descriptive, international
DSM is hiereachiral, encourages more diagnoses, uses operationalised criteria, american, avoids theoretical explanations when no ethology
Attachment and development
Birth - 6 months - forming bond
6-2 years - More than 1 person attachment, need mother for secure base,
2-5 - Tolerate separation, fears and phobias intense - need to have guidance
School - Have capacity to monitor own thinking, memory and action, and recognise privacy of thought
Adolesence - can feel alone, need support, friends become attachment –> OBSERVER SELF
Adulthood - couple, numerous, secure is protective in psychological health
SECURE BASE –> SELF ESTEEM –> SELF IMAGE –> PERSONALITY
Clozapine Monitoring
WBC and neurotrphils weekly for 18 weeks –> MOnthly
Cardiac parameters every 2 days for 1st month, weekly for first 18 weeks –> monthly
Troponin and CRP 6 monthyly
ECG - 1,2,3,4 weeks, then 6 monthly
Echo - starting and 6 monthly
Metabolic monitoring - 6monthly
IF WBC 3.0 HAVE TO STOP or NEUTRO <1.5
Agranulocytosis Cardiomyopathy Myocarditis hypersaliviation Constipation Nocturnarl enuresis
SAME AS OTHER antipsychotics other than this
Rare - hepatitis, cholestatic jaundice, pancreatitis, thrombocytopenia, NMS, Diabetes, Paralytic ileum, collapse
Factors contributing to adherence
Knoweldge Side effets Cultural beliefs Regimen complexity Finances Social support and access Lack of patient involvement Disatisfication heatht literacy Forgetfulness
Lithium
Nausea Vomiting Diarrhoea Nephrogenic diabetes insipudus Renal function Thyroid - hypothrryoidia Weight gain hair loss Neurological - motor impairment, confusions, convulsions Metallic taste Disoreintation, Ataxia, dysarthria Muscle twitches, tremor Hypercalcemia ESPES sometimes Cognitive impariment
Atypical antipsychotics
Antihistamine - sedation, weight gain
Alpha - hypotension, dizziness, drowsiness
Weight gain, diabetes
Muscuarinic - blurring of vision, increased intraocular pressure, dry mouth and eyes, urinary retention, constpiation
D2 - prolactinaemia, breast swelling, pain
ESPES - acute dystonia, akathisia, tardive dyskinesia, parkinsonism
QTC
NMS
Phenothiazines - obstructive jaundice
DA –> GABA –> GLUT ++++++
Blocking DA normalises inhibitory function of GABA
3 monthly for first year then 6 monthly
Psychosis positive and negative
POSITIVE IS IN MESOLIMBIC
DA –> GABA –> GLUT (double inhibitory) –> increased DA = increased glut
NEGATIVE IS MEESOCORTICAL
DA –> GLUT (excitatory) (decreased DA = negative symptoms)
