Psych Flashcards
thyroid abnormality in anorexia
low T3 (all else norm)
schizotypal personality disorder
lack close friends other than family
have odd & eccentric beliefs
schizoid personality disorder
lack close friends
no interest in sexual relationships
indifferent to praise
NO odd behaviours or beliefs
paranoid PD
cant confide in others
question loyalty of friends
see hidden meanings in benign things
histrionic PD
crave centre of attention
sexually inappropriate or suggestible
relationships presumed more intimate than they are
antisocial PD
break the law deceptive - always lying impulsive - cant plan ahead disregard for safety of others lack of remorse
avoidant PD
avoids social situations for fear of being disliked
fears of embarrassment etc in relationships
views self as inept or inferior to others
borderline PD
unstable relationships
always making attempts to avoid abandonment
recurrent suidical behavior
chronic emptiness
unstable self image
narcissitic PD
\++ self importance sense of entitlement lack of empathy need for admiration chronic envy
role of frontal lobe
executive functioning
personality
voluntary movement
expressive language (brocas)
role of parietal lobe
2 point discrimination
reading
writing
knowing right from left
role of temporal lobe
memory
hearing
receptive language (wernickes)
role of occipital lobe
primary visual cortex
passivity phenomenen
the feeling of being the Mx or control of other people
delusion definition
a fixed false belief
persecutory delusion
false belief of being malevolently treated in some way
somatic delusion
false belief of having a physical defect or medical condition
loosening of associations
muddled talk that is illogical.
talks freely but no info given.
knight’s move thinking
pt jumps from subject to subject with no apparent link
flight of ideas
pt jumps from subject to subject but words are associated with rhyme / can see slight connection
tangential thinking
pt moves from point to point and never comes back to the question being asked
circumstantiality
pt gives excessive detail when answering q, but does eventually come back to answer it
how long should a depressive ep last for it to be called depression
2w
core symptoms of depression
low mood
loss of pleasure/interest in activities
low energy
additional features of depression
disturbed sleep unreasonable guilt feelings of worthlessness reduced concentration change in appetite loss of confidence suicidal behaviour
Mx mild depression
no anti-depressants
behavioural changes e.g. sleep hygiene
criteria for moderate depression
at least 2 core symptoms + additional symptoms
total at least 6
criteria for severe depression
all 3 core symptoms + additional symptoms
total at least 8
somatic depression
increased appetite
changes in sleep
lack of energy
aches and pains
cotards syndrome
delusion belief that they are dead or non-existent
seen in severe depression
psychotic depression
usually 2nd person derogatory delusions (worthlessness)
Mx depression
SSRI or SNRI
ECT indications
catatonia
severe depression refractory to meds
psychotic symptoms
how long should someone take anti-depressant for
at least 6m
neurotransmitter causes sedation
reduced histamine
woman hearing things, but knew it was inside her head
pseudo-hallucination
neurotransmitter reduced in depression
serotonin
man who says he is losing memory and doesnt like going out because of this. low mood and wife died. MMSE 28/3- - DDx?
depression
how long must GAD symptoms be present for diagnosis
6m
Mx GAD
- CBT +/- SSRI (sertraline)
Drugs also 1st line are:
- SNRI
- atypical antidepressants
- pregabalin
how long must stay on meds for in GAD
18m if responding to Tx
Mx panic disorder
CBT or drug treatment
1. SSRI
if not responding after 12w, give TCA (clomipramine, imipramine)
Mx social phobia
SSRI + CBT with emphasis on exposure
Mx specific phobia
exposure therapy
features of PTSD
- flashbacks
- nightmares
- emotional numbing
- dissociation
- re-enactment
- increased arousal
- avoidance
timeline of PTSD
<48h = acute stress reaction <4w = acute stress disorder <3m = acute PTSD >3m = chronic PTSD
Mx PTSD
NOT debriefing
<4w = watchful waiting
- Trauma focussed CBT or Eye movement Desensitisation + Reprogramming
how long do OCD symptoms need to be present for Dx
2w
Mx OCD
CBT - Exposure and Response Prevention
Drugs - SSRI, TCA (clomipramine)
Neurotransmitter changes in GAD
decreased GABA
decreased serotonin
increased noradrenaline
Persistent sexual thoughts about woman at his church, more he thinks about it, worse it gets, keeps telling you he is in a happy marriage - Dx?
OCD
Boy doesn’t like doing presentations, drinking more and more on nights out - Dx?
social phobia
Woman anxious, phoning her parents all the time - Dx?
GAD
Totally random panic attacks, tingling in fingers, sweating, palpitations - Dx?
panic disorder
Mind racing with worries and drinks alcohol to calm -Dx?
GAD
pathology of SCZ
increased mesolimbic dopamine
heritability of SCZ
80%
-ve symptoms of SCZ
apathy incongruity catatonia anhedonia (inability to derive pleasure) avolition (poor motivation)
How many 2nd gen anti-psychotics should be tried before putting pt on Clozapine
2
delusional perception
normal object is perceived with delusional insight
how long must symptoms of SCZ be present for diagnosis
1m
who can help with explaining diagnosis to schizophrenic’s parents?
community psychiatric nurse
paraphrenia
late onset SCZ (>65)
Woman with prominent negative symptoms of schizophrenia, social withdrawal etc - who should she see
OT
Dismantling electrical equipment because of fear of recording - Dx?
SCZ
symptoms of hypomania
increased talkativeness
decreased need for sleepy
increased sexual energy
mild spending sprees
how long do hypomania symptoms need to last for diagnosis
4 d
symptoms of mania
flight of ideas grandiose delusions pressure of speech reduced need for sleep loss of normal social inhibitions distractability marked sexual indiscretions
how long do mania symptoms need to last for diagnosis
1w
Mx acute mania
- aripiprazole or olanzapine
2. haloperidol or lorazepam
long term Mx bipolar
mood stabiliser:
- Lithium carbonate
- sodium valproate
- carbamazepine
Mx depression in bipolar
fluoxetine
Dx of anorexia nervosa
wt loss at least 15% below expected weight for age and height
self-perception of being too fat
self-induced wt loss
widespread endocrine disorder
subtypes of anorexia nervosa
restrictive
binging/purging
BMI categories for anorexia nervosa
low risk: 17.5-16
mod risk: 16-15
high risk: 15-13
v high risk: <13
effect of anorexia on K levels
low
effect of anorexia on FSH and LH
low
effect of anorexia on oestrogen and testosterone
low
effect of anorexia on cortisol
increased
effect of anorexia on GH
increased
effect of anorexia on cholesterol
increased
Dx of bulimia nervosa
recurrent episodes of overeating
preoccupation with eating and strong desire or compulsion to eat
counter-acts episodes of eating with self-induced vomiting or purging
refeeding syndrome
the metabolic abnormalities that occur when feeding a person following a period of starvation
metabolic abnormalities in refeeding syndrome
hypokalaemia
hypophosphataemia
hypomagnesaemia
prevention of refeeding syndrome
if person hasnt eaten for >5 days, for first 2 days re-feed them at less than 50% of their daily requirements
complication of hypomagnesaemia
torsades de pointes
binge drinker, self-harm repeatedly, overly sexual/lots of brief relationships - PD?
borderline PD
irritable, callous, no responsibility, expects family to do everything - PD?
dissocial PD
biggest risk factor for borderline PD
sexual abuse
man who works really hard, doesn’t spend any money on his wife - PD?
Obsessive Compulsive PD
neurotransmitter affected in anorexia
reduced serotonin
ECG abnormality in anorexia
prolonged QT
criteria of dependence
strong desire to take substance difficulty controlling use physiological withdrawal state tolerance neglect of other pleasures persistence despite evidence of harm
role of the pre-frontal cortex
sets goals and focusses attention (last to develop), thats why young people are more impulsive
what causes symptoms of alcohol withdrawal (neurotransmitters)
++ glutamate
and
– GABA
high risk alcohol drinking (units)
> 35 units/wk
how many hrs after stopping alcohol do symptoms of withdrawal start
6-12h
how many hrs after stopping alcohol do symptoms of withdrawal peak
24-48h
what complication happens 36h after stopping alcohol
generalised seizures
what complication happens 72h after stopping alcohol
delirium tremens
delirium tremens presentation
agitation fever confusion disorientation paranoia hallucinations
cause of wernickes encephalopathy
thiamine deficiency (B1)
presentation wernickes encephalopathy
- confusion
- ataxia
- opthalmoplegia
complication of wernicke’s encephalopathy
korsakoff’s syndrome
dexotification definition
the process of becoming alcohol/substance free
medicines given for alcohol detox
Chlordiazepoxide or Diazepam \+ Pabrinex (IV thiamine) \+ hydration
medication given for alcohol relapse prevention
- Naltrexone
- Acamprostate
- Disulfiram
signs of opiate intoxification
pinpoint pupils
resp depression
euphoria
opioid replacement therapy
Methadone or Buprenorphine (no decrease in dose)
opioid detoxification therapy
Methadone or Buprenorphine (decrease dose gradually to get them drug free)
Mx BZD overdose
Flumazenil (ONLY iatrogenic overdose)
BZD detoxification
Chlordiazepoxide or Diazepam
- reduce dose every 2-3w in steps
BZD detoxification
Chlordiazepoxide or Diazepam
- reduce dose every 2-3w in steps
side effects of diazepam and chlordiazepoxide
eye irritation
tremor
urinary retention
borderline LD - IQ and mental age
IQ 70-84
Mental age 12-15y
mild LD - IQ and mental age
IQ 50-69
Mental age 9-12y
moderate LD - IQ and mental age
IQ 35-49
Mental age 6-9y
severe LD - IQ and mental age
IQ 20-34
Mental age 3-6y
profound LD - IQ and mental age
IQ <20
Mental age <3y
triad of ADHD
inattention
hyperactivity
impulsivity
- has to be developmentally inappropriate, impairing, pervasive and long-standing
test for ADHD
no test! clinical Dx
Mx ADHD
psychological
- classroom training and parent training
- social skills training
pharmacological
- methylphenidate (ritalin)
- lisdexamfetamine
- dexamfetamine
What Ix needs to be done prior to starting ADHD meds and why
ECG - all ADHD drugs can be cardiotoxic
Triad of ASD
language impairment
abnormal thought and behaviour
qualitative impairment in social interaction
Asperger’s syndrome
autistic features without aloneness or linguistic difficulty
person w learning difficulties, doesn’t understand what psych pills are for - whos best to see?
community mental health nurse or community psychiatric nurse
person w learning difficulties and cant communicate, who is best to see
SALT
boy running out in front of cars, learning difficulties, trouble with the police, inattention - Dx?
ADHD
criteria to detain under MHA
- mental disorder (mental illness, LD, PD)
- pt has impaired decision making with regards to Tx of mental disorder
- pt at risk to self or others
- less restrictive measures not appropriate
- necessary
power of attorney
under the AWI act
can only be granted when a person has capacity
- looks after financial/welfare things
welfare guardian
under the AWI act
can only be granted when the person has already lost capacity
- looks after financial/welfare things
who can use place of safety order
police
can police go into someones house for place of safety order
no -need a warrant
place of safety only applies if person is in a public place
how long can someone de detained in place of safety
24h
how long does nurse’s holding power last
2h
who can order emergency detention
FY2 or above
MHO approval needed for emergency detention ?
no
how long does emergency detention last for
72h
does pt have right of appeal in emergency detention
no
who can order short term detention
Approved Medical Practitioner (need MHO approval)
how long does short term detention last for
28d
does pt have right of appeal in short term detention
yes (only before 14d)
does short term detention authorise Tx
yes
does emergency detention authorise Tx
no
who can order CTO
need either 2 AMPs or 1 AMP and 1 GP
what does a CTO require first before it is placed
tribunal
what happens in proposed CTO if pt too unwell to find their own solicitor
curator adalatum is used
how long does CTO last for
up to 6m
what is a T2 form
used when the patient can give consent to Tx under CTO
what is a T3 form
used when the patient cannot give consent to Tx under CTO
examples of SNRI
venlafaxine
duloxetine
1st line SSRI post-MI
sertraline
1st line SSRI in children/adolescents
fluoxetine
s/e of SSRI
GI upset
increased risk of GI bleed
hyponatraemia
ECG complication on citalopram
QT prolongation
s/e of TCAs
anticholinergic effects
QT prolongation
examples of MAOI
phenlezine
isocarboxazid
s/e of MAOIs
anticholinergic effects
hypertensive reaction with tyramine containing foods e.g. cheese, broad beans
EPSEs and timings of presentation from typical antipsychotics
acute dystonic reaction (hours-days) - muscle spams
parkinsonism (days-mths) - bradykinesia, tremor, rigidity
akathisia (months) - restlessness
tardive dyskinesia (yrs) - purposeless repetitive movements
examples of typical antipsychotics
haloperiodl
chlorpromazine
medication always co-prescribed with typical antipsychotics
prochlorperazine
s/e of antipsychotics
anti-cholinergic effects sedation prolonged QT reduced seizure threshold increased risk of VTE and stroke
examples of atypical antipsychotics
risperidone quetiapine aripiprazole olanzapine clozapine
atypical antipsychotic causing wt gain
olanzapine
s/e of atypical antipsychotics
wt gain
metabolic syndrome
antipsychotic causing prolonged QT (torsade de pointes)
haloperidol
antipsychotic that causes photosensitivity
chlorpromazine
s/e of clozapine
agranulocytosis reduced seizure threshold constipation myocarditis hypersalivation
monitoring of clozapine
weekly for 1st 6m
fornightly for 2nd 6m
monthly therafter
one mth after cessation
what must pt not do whilst on clozapine
stop or start smoking
person on olanzapinedevelops dry mouth, what transmitter is responsible
ACh
diaebtic pt has psychosis, what Tx do they get
typical antipsychotic - not atypical bcos they cause metabolic syndrome and pt already has diabetes.
therapeutic range of lithium
- 4-1.0 mmol/Li
i. e. NARROW
monitoring lithium levels
check levels weekly and after each dose change until conc stable
once established check evry 3m - 12h post dose
what blood tests are checked when pt on lithium, and how often
every 6m - renal and thyroid function
s/e of lithium
n+v metallic taste in mouth worsening of psoriasis nephrotoxicity hypothyroidism wt gain idiopathic intracranial HTN fine tremor hair loss
ECG abnormality on lithium
T wave flattening
psychaitrists role
diagnosis, prescription, Use of MHA and AWI, advocacy
who can help old man who wants to move into a care home
Social worker
taxi driver getting lost, giving the wrong change - Dx
alzheimers
Which disease has a degenerated nucleus basalis of Meynert (NBM)
Alzheimers and Parkinsons
man who wants to kill himself - what part of MSE does this come under
thought content
man has flight of ideas - what part of MSE does this come under
thought form
man picked up phone during interview - what part of MSE does this come under
behaviour
man cant complete the MMSE - what part of MSE does this come under
cognition
man happy when talking about his cats - what part of MSE does this come under
affect
