Psych Flashcards
What is somatization
- multiple recurrent and frequenctly changing physical symptoms with no physiological explanation
- Lasting at least 2 years
- Some sort of functional impairment
What is somatoform pain disorder
severe persistent pain that can’t be explained by illness
What is somatoform autonomic dysfunction
SOB, palpitations, sweating, chest pain, not explained by illness
What is a dissociative disorder
loss of non physical function (memory) with no cause
What is conversion disorder
loss of motor or sensory function with no cause, patient doesnt consciously feign symptoms
What is Munchausens Disorder?
Intentional production of symptoms
What is malingering
exaggerating or creating symptoms for person gain (usually financial)
What is capgras delusion
belief that a close relative or spouse has been replaced by an identical looking imposter
What is a Fregoli delusion
the belief that various person they meet are actually the same person in disguise
How do you manage somatic disorders?
education and reassurance ?CBT
What is a delusion
a fixed belief held outside social normals that is not with normal ideas
What is a hallucination
Experience in abscene of sensory input (except reflex hallucination)
What is depersonalisation?
person loses experience from themself, they are not real but the world is
What is derealisaiton
Person sees themselves as real but the world is not
What is dissociation?
persons persona is detached from whats physically happening, they can see and feel but not control
What is the syndrome where the person believes someone of a higher status is in love with them>
De Clerambault or erotomania
How do you treat somatic disorders?
psychoeducation, reassurance ?CBT
What is othello syndrome?
lover believes against all reasom their partner is being sexually unfaithful
what is the syndrome where a lover believes their partner is being unfaithful?
Othello
Describe effect and MoA of antipsychotics
EPSE - nigrostriatal pathway
Anti -p - mesolimbic/mesocortical
anti emetic - dop block @ CTZ
weight gain - 5-HT antagonism
C,P, shit, spit - anti muscarinic
Post hypo, ejac problems, nasal stuffy - alpha 1 blockage
Describe neuroleptic malignancy syndrome
medical emergency
abnormal blockade of D2 in stritum and hypothalamus
sx: fever, rigidity, HTN, tachy, sweating, delerium
Ix: creatinine kinase very high
Tx: stop drug
EPSE and treatment
1) acute dystonic reaction -> procyclidine
2) Akaithsia -> BB, benzos
3) Parksinsonims -> procyclidine
4) tardive dyskinesia -> tetrabenazine
Typical and atypical anti psychotic examples
typical - haloperidol, chlorpromazine, flupentixol
atypical - risperidone, olanzapine, aripiprazole, quetiapine, clozapine
What are the first rank schizophrenia symptoms?
(1-4)
- thought alienation (insertion, broadcast, withdrawal)
- passive phenomena (under influence of others)
- 3rd person auditory hall
- delusional perception
What are the secondary symptoms of schizophrenia?
(5-8)
- hall in any modality occuring everyday for weeks
- breaks or change of thought leading to incoherent or irrelevant speech
- catatonic behaviour
- -ve symptoms
Negative schizophrenia symptoms
Communication
- poverty of speech and thought
- Poor non-verbal communication
- Blunting of affect
Self
- Amotivation
- Decline in function
- Self neglect
when is schizophrenia diagnosed?
>6 months with marked impairment
1st rank: 1 clear or 2 unclear
2nd rank: 2+
What schizo subtypes does ICD-10 identify?
- paranoid
- prominent hall and/or delusions
- hebephrenic
- fluctuating affect, fragmented delusions and hallucinations
- catatonic
- stupor, waxy flexibilty, negativism
Schizophrenia prodromal syptoms
gradual deterioration in function - ‘altered life tragectory’
- odd thoughts, behaviours and beliefs
- lower intensity, and/or transient psychotic symptoms
- declined interest in daily activity
- social withdrawal
- altered affect
- concentration problems
schizophrenia treatment
ANTIPSYCHOTICS ASAP
- delayed Tx worsens -ve symptoms
psychological
- CBT
- family intervention
- social support (housing, benefits, social skills training)
schizophernia heritability
60-80%
what are the two affective disorders?
- depression
- bipolar
What are the non core symptoms of depression?
Physical
- change in sleep, appetite, libido
- psychomotor retardation or agitation
Psycho
- lack of concentration, confidence
- guilt or worthlessness
- numbess
- suicidal ideation
How do you differentiate between mild, moderate and severe depression?
mild = 2 core, 2-3 other
mod = 2 core, 4 other
severe = 3 core, 4+ other (±psychotic symptoms)
what increases a pt suicide risk?
Sex male
Age<20 44<
Depression
Previous attempts
Ethanol abuse
Rational reasoning loss
Social support
Organised plan
No spouse
Sickness
How do you treat mild depression
low intensity psychological intervention
- sleep hygiene
- anxiety mx (mildfullness)
- problem solving techniques
- computerised CBT
- group based physical activity programmes
no anti-depressants unless
- symptoms persist >8/52
- PMH depression
What is CBT?
Cognitive Behavioural Therapy
- talking treatment
- how your thoughts beliefs and attitudes affect your feelings and behaviours
How do you treat moderate depression?
high intensity psychological intervention
- 8-12 CBT sessions
- OR interpersonal therapy
- IAPT (improving access to psychological therapies)
SSRI
What is interpersonal therapy?
looks at persons abilty to interact with others
focusses on
- conflict with another person
- life changes that affect how you feel about yourself and others
- grief and loss
- difficulty in starting or keeping realtionships going
How do you treat severe depression?
rapid specialist mental health assessment
?inpatient admission
?ECT
Why do people DSH?
- release from psychological pain by replacing with physical pain
- coping strategy
- gain power in an argument
- communicate a message
RF for DSH
Bio: endorphin or serotonin problem
Psycho: low self esteem, identity problems
Social: neglect, abuse, bullying, impulsivity, witnessed
What is an obsession?
Ideas, images or impulses that repetitively enter the patients mind, normally distressing and unsuccessfully resisted. Ego Dystonic: own thoughts but distressing.
What are compulsions?
Repeated acts or rituals, which arent enjoyable or useful. Function is to prevent an objectively unlikely event
increased anxiety if resisted
What area of brain is assoicated with OCD?
orbitofrontal cortex and caudate nucleus
Tx for OCD?
- CBT with exposure and response prevention
- SSRI
- TCA (clomipramine)
What is a phobic disorder?
phobic = anxiety experienced only in certain well defined situations that are not dangerous
disorder = when they cause marked distress and/or signifcantly impair persons ability to function
Give some examples of phobias
- agoraphobia
- crowds, travel, events away from home
- simple
- specific situations
- coulrophobia (clowns)
- social
- fear of scrutiny from others
- sx= blushing, nausea, urgent need to urinate
How are the panic attacks asociated with phobias treated?
- CBT
- ?TCA
- ?SSRI
- ?clonazepam
- ?pregabalin (antiepileptic)
Risk factors for GAD
35-54
divorced or separated
living alone
being a lone parent
GAD mx
- CBT
- SSRI
- SNRI
- ?pregabablin
What factors would lead you to diagnose delirium over dementia?
- altered consciousness
- flucation of symptoms
- abnormal perception (illusions, hallucinations)
- rapid onset
Leading causes of delirium
(not in order)
- infection
- hypoxia
- liver and kidney failure
- alcohol + withdrawal
delirium management
- find cause and treat
- optimize supportive surroundings
- avoid moving wards
- appropriate lighting and 24 hour clock
- talk to pt to reorientate
delirium diff diagnosis
- withdrawal
- mania
- psychosis
- anxiety
- dementia
RF delirium
- post op
- infection
- eldery
- very young
- drugs (benzos, opiates, anticonvulsants)
examples of changes in social behaviour
- lack of co-operation w/ reasonable requests
- change in mood/attitude
- delusions
examples of changes in physical function
- decreased mobility
- agitation
- changes in appetite and sleep
examples of change in cognitive function
- worsened concentration
- disorientation in time
- confusion
what behavioural changes are associated with delirium?
- cognitive function
- perception (hallucinations visual/auditory)
- physical function
- social behaviour
can be hyperactive (agitated and upset) or hypoactive (drowsy and withdrawn)
What is delirium?
ORGANIC fluctuating impaired consciousness with onset over hours or days OR a rapid deterioration in pre-existing cognitive function with assoicated behavioural changes
Difference between manic and hypomanic episode
- manic has psychotic symptoms -hypomanic lasts less than 7-10 days
Manic epsiode symptoms
Physical - decreased sleep, increased energy, appetite change
Social - impaired judgement, disinhibition, grandiosity, eccentric appearance
Elation
pressure of speech
psychotic sx
Bipolar epidemiology
late teen years
types of bipolar
- type I : mania and depression (most common)
- type II: hypomania and depression
- cyclothymia: brief hypomania and brief depression alternating
bipolar mx
- psychological intervention
- lithium 1st line mood stabiliser
- mania mx= stop antidepressant, add antipsychotic
- depression mx= talking therapy, fluoxetine
Which physical health conditions risk increases with bipolar?
-diabetes, CVD, COPD 2-3 times increased risk
What is erotmania
presence of delusion for a famous person being in love with them
how would a patient with schizotypal personality present?
hold odd beliefs and display bizarre behaviours but do not hold their beliefs with delusional conviction
how would a patient with narcissistic personality present?
display long term pattern of inflated self importance, excessive need for admiration and lack of empathy
How would a pt with histrionic personality present
excessively and attention seeking, overly sexual
What are the effects of hyperprolactinaemia?
- breast tenderness
- breast enlargement
- lactation
Which antipsychotic is known to have fewer SE with respect to prolactin elevation?
aripiprazole
common SE of atypicals
weight gain agranulocytosis (clozapine)
Which antidepressant is known for increasing appetite?
mirtazapine
what would you use to treat dyskinesia?
tetrabenazine
what would you use to treat akathisia?
propranolol
what would you use to treat dystonia
procyclidine or benztropine
What is the SSRI of choice in under 18s
fluoxetine
requirements for pt to be detained under section 3
- suffering from mental disorder of a nature or degree which makes it appropriate to receive medical tx in hospital
- necessary for health of pt OR safety of pt OR safety of others
- appropriate tx available
- tx cannot be given under other circumstances
who is involved in a section 3 detainment
- medical professional to prove medically fit
- 2 registered medical practitioners
What is a section 5(2)
doctors holding power
