psych Flashcards
1
Q
what questionnaire can be used to screen for depression?
A
PHQ-9
HAD
Beck’s
2
Q
what is sub-threshold depression ?
A
fewer than 5 symptoms
3
Q
what are the key symptoms of depression?
A
low mood
anhedonia
fatigue/lack of energy
4
Q
what are some of the symptoms of depression
A
low mood anhedonia fatigue weight change decreased concentration decreased libido agitation disturbed sleep retardation thoughts of death and suicide
5
Q
what are some psychotic symptoms of sever depression?
A
delusions of poverty guilt personal inadequacy responsibility for worlds events hallucinations - usually auditory olfactory hallucinations - bad smells visual hallucinations - tormentors catatonic behaviour
6
Q
what factors increase risk of depression?
A
fam history
chronic illness
adverse life events
7
Q
what are the different types presentations of depression?
A
without somatic symptoms with somatic symptoms with psychotic symptoms atypical seasonal affective
8
Q
what is the initial management for sub-threshold depression?
A
educate on sleep hygiene
active monitoring
low intensity psychosocial interventions (CCBT, provision of written materials, physical activity programmes
9
Q
when should you consider drug treatment for persistent sub-threshold or mild/moderate depression?
A
if the have a past history of moderate or severe depression
if the symptoms of threshold depression have lasted for more than 2 years
if the symptoms of sub-threshold or mild have persisted after other interventions
10
Q
what is the third step of depression management?
A
for persistent sub-threshold symptoms or mild/moderate depression with inadequate response to initial interventions and moderate and severe depression.
The options are an antidepressant or a high intensity psychological intervention (CBT, IPT, couple therapy)
Combination of CBT and medication
11
Q
what is step 4 of depression management?
A
for severe and complex depression - risk to life, refer to specialist mental health team
impatient care and crisis resolution and home treatment crisis team
12
Q
what is the first line drug for depression?
A
SSRI’s (fluoxetine, sertraline, paroxetine, citalopram)
13
Q
what are the second line drug treatments for depression?
A
TCA’s (amitriptyline, clomipramine)
MAOIs (phenelzine, tranylcyromine)
SNRIs (venlafaxine, duloxetine)
SARIs - trazodone
14
Q
What is bipolar?
A
chronic mental health disorder characterised by periods of mania/hypomania alongside periods of depression
15
Q
what is the ICD-10 diagnostic criteria for bipolar?
A
at least 2 episodes, one must be hypomanic, manic or mixed
16
Q
what is the DSM-V criteria for bipolar?
A
occurrence of at least one manic episode. thus by definition any previously well person experiencing their first episode of mania would be classified as bipolar
Type 1 - mania and depression
Type 2 - hypomania and depression
17
Q
what are the symptoms of a manic episode?
A
distinct period of abnormally/persistently elevated moof for at least one week plus at least 3 characteristic symptoms:
- energy - over reactivity, pressure of speech, flight of ideas, racing thoughts, decreased sleep.
- self esteem - over optimistic ideation, grandiosity, decreased social inhibition
- distractibility
- inappropriate behaviour - without considering consequences, reckless with money, inappropriate sexual encounters
- disruption of work, family and social life
- psychotic symptoms - grandiose ideas +/- delusions related to identity or role, persecutory delusions, incomprehensible speech, violent behaviour, catatonic behaviour (manic stupor), lack of insight.
18
Q
what are the symptoms of a hypomanic episode?
A
elevated mood plus at least 3 other symptoms lasting for more than 4 days:
- increased energy, decreased need for sleep, increased sociable and talkative, increased feelings of self esteem, increased sex drive and easily distracted.
Does not interfere with social or occupational function. They have no delusions or hallucinations
19
Q
What is the acute management for bipolar
A
admit if severe - may be due to impaired judgment, high risk of suicide/homicide, severe psychotic, depressive, rapid cycling or catatonic symptoms.
Stop drugs that may be causing mania
give antipsychotic meds for mania and if the are in low mood give anti-depression
20
Q
what is the first, second and third line treatment for someone having an acute manic episode?
A
1st line - antipsychotic - haloperidol, olanzapine quetiapine or risperidone
2nd line - increase dose of AP, or use a mood stabiliser (lithium)
3rd line - valproate
21
Q
what is the first and second line drug treatments for bipolar depression?
A
1st line - fluoxetine combined with olanzapine or quetiapine.
2nd line - if unresponsive to first line consider lamotrigine
22
Q
what is the intermediate management of bipolar?
A
monitor psych status, drug side effects, compliance and therapeutic levels of mood stabilisers
make sure to identify and address significant episodes early.
23
Q
what is the long term management of bipolar?
A
1str line - lithium
2nd line - carbamazepine
24
Q
what are the causes/risks of schizophrenia?
A
genetic - lifetime risk is increased 10% for first degree relatives - associated with DISC1 gene
substance misuse hostile family adverse life events social disadvantage Caribbean have highest rates
25
what are the Schneider's first rank Symtoms
```
TAPP
thought disorder (thought insertion, withdrawal or broadcasting, may interfere with speech
```
Auditory hallucinations - thought echo, running commentary.
passive phenomenon - belief that the body is controlled by an external agency
delusional perceptions - where a real perception is followed by a delusional misinterpretation
26
what is the ICD-10 diagnostic criteria for schizophrenia?
at least one month of either:
at least one of - delusions of control, auditory hallucinations, bizarre persistent delusions
or
at least two of the following
persistent hallucinations
interpolation breaks in train of thought, catatonic behaviour, negative symptoms (apathy, paucity of speech, anhedonia, loss of motivation etc..), significant change in overall behaviour
27
what are the subtypes of schizophrenia?
paranoid - delusions and hallucinations
hebephrenic - disorganised speech behaviour, flat or inappropriate affect.
Catatonic - psychomotor disturbances
undifferentiated - no specific symptoms
post schizophrenic depression - some residual symptoms, depressive picture dominates
residual schizophrenia - less marked previous positive symptoms, prominent negative symptoms.
simple schizophrenia - no delusions or hallucinations
28
when treating acute schizophrenia what factors should you take into consideration?
the risk to self, risk to others and the risk of victimisation
the degree of insight
their social circumstances and support resources.
29
what is the first line pharmacological treatment for schizophrenia?
a second generation antipsychotic - risperidone or olanzapine
30
what would you prescribe when there is a patient with schizophrenia who failed to more than two antipsychotics given for at least 6 weeks?
clozapine
31
what is the schizoaffective disorder?
symptoms of a mood disorder and schizophrenic symptoms within the same episode of illness can be manic or depressive symptoms
the management is the same as for schizophrenia and as for bipolar or depression.
32
what is schizotypal disorder?
a type of personality disorder
they have a lifelong state of eccentricity with abnormal thoughts and affect.
they often appear suspicious, cold, aloof.
there are no definite schizophrenic symptoms
the main treatment is risperidone
33
what are cluster a personality disorders?
paranoid
schizoid
schizotypal
34
what are cluster b personality disorders?
```
(antisocial personality disorder)
histrionic
emotionally unstable
antisocial
narcissistic
```
35
what are cluster c personality disorders?
avoidant/anxious
dependant
anankastic
36
what are the symptoms of paranoid personality disorder?
```
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent
```
37
what are the symptoms of schizoid personality disorder?
```
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family
```
38
what are the symptoms of an anxious/avoidant personality disorder?
Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
Unwillingness to be involved unless certain of being liked
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks doe to fears of embarrassment
Views self as inept and inferior to others
Social isolation accompanied by a craving for social contact
39
what are the symptoms of dependant personality disorder?
Difficulty making everyday decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative
Unrealistic fears of being left to care for themselves
Urgent search for another relationship as a source of care and support when a close relationship ends
Extensive efforts to obtain support from others
Unrealistic feelings that they cannot care for themselves
40
what are the symptoms of anakastic personality disorder?
Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
41
what are the symptoms of histionic personality disorder?
Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
42
what are the types of emotionally unstable personality disorder?
borderline or impulsive
Efforts to avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealization and devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts
43
what are the symptoms of antisocial personality disorder?
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
More common in men;
Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
Impulsiveness or failure to plan ahead;
Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
Reckless disregard for safety of self or others;
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
44
what are the symptoms of narcissistic personality disorder?
```
Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude
```
45
what is delirium?
delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking and altered levels of consciousness
46
what are the causes of delirium?
```
drugs
primary neurological injury (stroke, intracranial bleeding, meningitis)
acute illness(pneumonia, UTI, sepsis), cardiac illness (MI), hypoxia, shock, dehydration, fever, constipation, iatrogenic complications
metabolic abnormalities
pain
prolonged sleep deprivation
drug withdrawal
recent surgery
```
47
what are the four key features of delirium?
a disturbance in attention - reduced ability to focus, sustain or shift attention
a change in cognition - memory deficit, disorientation, language disturbance
the disturbance develops over a short period of time, also tends to fluctuate
there is evidence from the history, physical examination or laboratory findings that the disturbance is caused by
48
what are the three types of delirium?
hyperactive delirium - a condition where a patient might have heightened arousal, with restlessness, agitation, hallucinations and inappropriate behaviour
hypoactive delirium - a condition where a patient might display lethargy, reduced motor activity, incoherent speech and a lack of interest
mixed delirium - a combination of hyperactive and hypoactive signs and symptoms
49
how do you manage delirium?
treat underlying cause
modification of the environment
0.5mg haloperidol as a first line sedative
or olanzapine
50
what can cause a delusional disorder?
neurological lesions: temporal lobe, limbic system, basal ganglia
- cortical - simple, poorly formed and persecutory
- basal ganglia - less cognitive disturbances, more complex content
social - certain situation, decreased self esteem
51
what are the risk factors for delusional disorder?
```
age
sensory impairment
family history
heady injury
substance abuse
social isolation
low SES
recent immigration
```
52
what is a delusional disorder/
the core feature is the development of a delusion or delusional system - often no identifiable organic basis
.
The patient does not suffer from schizophrenia or a mood disorder although depressive symptoms may be present
53
how do delusional disorders present?
acute or insidious but variable course
speech and mood affected by tone of delusional content
their thoughts are generally unimpaired
hallucinations - usually olfactory/tactile although hallucinations are not prominent
often insight is impaired to the degree that delusions influence thought and behaviour
delusions can be persecutory, hypochondrial or grandiose - - they are often concerned with litigation or jealousy
54
what are the different types of delusional disorder?
Erotomania - they believe that someone, usually of higher status, is in love with them
Cotard's syndrome - when the patient believes all of their wealth has gone or that all relatives or friends no longer exist. They may believe that some of their own body parts do not exist.
Capgras syndrome - the patient believes that a person familiar to then has been replaced by a double
Fregoli syndrome - patient believes that a familiar person (often their persecutor) has taken on a different appearance
pathological (delusional ) jealousy - believes partner is being unfaithful, also called the othello syndrome. sometimes associated with organic disorder and psychoactive substance use disorder, cerebral tumours and paranoid schizophrenia
Persecutory delusions (querulant) - most common, the patients believe that they are being persecuted in various ways
delusional perception - true perception to which patient attaches a false meaning
Nihilistic - believing themselves to be dead of the world to no longer exist - psychotic depression
self referential
55
how are delusional disorder managed?
antipsychotics - pimozide
SSRIs benzos - if there is marked anxiety
CBT
minimise risk factors
56
what are the classical three drugs which cause dependance and withdrawal?
alcohol
benzodiazepine
opiates
57
what are the features of dependance syndrome?
Salience - obtaining and using substance takes priority over all other activities and interests
Narrowing of repertoire - loss in variation of substances, setting, route and individuals with whom substances is taken with may become stereotypes
increased tolerance - larger dose required to achieve the same effects, less clinical signs of intox ification
Loss of control of consumption
Continued use despite harm
withdrawal
reinstatement after abstinence
58
what are the initial symptoms and and continued consumption effects of alcohol intoxication? (acute)
initially - elevation of mood, increased socialization and disinhibition
continuing consumption - lability of mood, impaired judgement, aggressive, slurred speech, unsteady gait and ataxia
59
what is the recommendations for units of alcohol per week?
14
60
what is the screening questionnaire for alcohol addiction?
CAGE
C - have you ever felt you should cut back your drinking
A - has anyone ever annoyed you by criticizing your drinking
G - have you ever felt guilty about your drinking
E - have you ever had a drink early in the morning as an eye opener
add questions
what is the most alcohol you have drank in a single day?
what is the most alcohol you have drank in a single week?
61
how can you test alcohol intake?
breath testing
blood alcohol concentration
blood tests: elevated MCV, G-GT and CDT are markers for excess alcohol consumption
urinary tests
62
how is dependance syndrome diagnosed?
three or more of the following present together at some time during the previous year
- strong desire to take the substance
- difficulty controlling substance taking behaviour
- physiological withdrawal state when substance has reduced or ceased
- signs of tolerance
- neglect of other interests or activities due to money or time being spent acquiring substance
- persistence of substance despite the knowledge of harm
63
what are the symptoms of uncomplicated alcohol withdrawal syndrome?
```
symptoms develop 4-12 hours after stopping drinking
shakes
sweats
nausea
vomiting
mood disturbances
sensitivity to sound
sleep disturbances
```
64
what are the symptoms of alcohol withdrawal with perceptual disturbances?
illusions or hallucinations
| typically visual, auditory or tactile
65
what are the symptoms of alcohol withdrawal with withdrawal seizures?
develop 6-48 hours after drinking
generalised tonic-clonic
predisposing factors (previous history of withdrawal fits, concurrent epilepsy, low Na or Mg)
can be fatal
66
what are the symptoms of alcohol withdrawal delirium (delirium tremens)
1-7 days after stopping drinking
altered consciousness and marked cognitive impairment
vivid hallucinations and illusions in any modality
tremor, autonomic arousal, paranoid delusions, moratility 5-15% from CV collapse, infection, hypo/hyper thermia
high mortality rate
67
what drugs are given in alcohol detoxification?
benzodiazepines (initially high doses and reduced gradually) e.g. chlordiazepoxide
thiamine - to prevent wenickes-korsakoffs syndrome
68
how is delirium tremens treated?
emergency hospitalisation
medication - large doses of drug with similar chemical effect (benzos), antipsychotics for hallucinations/delusions - haloperidol
large doses of parenteral (IM or IV)
monitor - temp, fluid electrolytes and glucose
69
what are the psychiatric syndromes associated with alcohol dependence?
- hallucinations
psychotic disorders with delusions - persecutory or grandiose delusions
othello syndrome - pathological delusional jealousy
cognitive impairment
wernicke encephalopathy
korsakoff syndrome
70
what are some complications of long term alcohol use?
liver
GI - gastritis, gastric erosisons, petic ulcers and haematemesis and mallory weiss tears secondary to vomiting, barrett's oesophagus, chronic diarrhoea and pancreatitis
CVS - dilated cardiomyopathy, arrhythmias (AF) , hypetension
Resp - TB, klebsiella and streptococcal pneumonia
Neuro - CNS (CVA, WKS, cerebellar degeneration) PNS (optic atrophy, peripheral neuropathy, myopathy)
ED
gout
psychological - increased depression and anxiety, self harm and suicide risk
amnesia due to intoxication
social problems
abuse
neglect
71
what management can be given after alcohol detoxification?
Psychosocial interventions (individual counselling, motivational interviewing, CBT, group support,)
Disulfiram - causes unpleasant stimulus when alcohol consumed
Acamprosate - reduces craving
Naltrexone - reduces desire to drink
72
what are different types of opioids?
morphine
codeine
heroin
methadone
73
what are features of opioid misuse?
```
rhinorrhoea
needle track marks
pinpoint pupils
drowsiness
watering eyes
yawning
```
74
what are complications of opioid misuse?
viral infections secondary to sharing needles
bacterial infection secondary to sharing needles
venous thromboembolism
overdose may lead to resp depression and death
psychological problems
social problems
75
how is opioid misuse managed?
- naloxone
- rapid detoxification and abstinence
- prescribe a substitute drug - methadone
- naltrexone
76
what is a characteristic feature of opioid overdose?
pinpoint pupils
77
how do you manage opioid overdose?
naloxone
| naltrexone - to prevent relapse
78
how do you treat withdrawal syndrome from stimulants? also what are the symptoms?
symptoms: severe agitated depression, lethargy, suicidal thoughts
treat with benzos and antipsychotics with TCAs
79
what is postnatal depression?
the development of a depressive illness following childbirth, with the onset being within 4 weeks of childbirth.
80
what are normal baby blues?
affects 50-75% of mothers
occurs 2-3 days after birth and lasts for 1-2 days
presentation: weepy, irritated and muddled
labile mood
they may have insomnia
often only requires explanation and reassurance
81
what are the risk factors for postnatal depression
```
personal history of depression
fam history of postnatal depression
severe baby blues
younger , maternal age
unwanted pregnancy
poor relationships and social support
```
82
what are the symptoms of postnatal depression?
```
depressed mood
anhedonia
decreased energy
suicidal ideation
loss of confidence or self-esteem
inappropriate guilt
poor concentration
sleep disturbance
change in appetite
obsessive thoughts
```
83
what can be used to screen for postnatal depression?
The Edinburgh Postnatal Depression Scale may be used to screen for depression:
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a 'depressive illness of varying severity'
sensitivity and specificity > 90%
includes a question about self-harm
84
what is the treatment for postnatal depression?
1st line - facilitated self help if subthreshold, high intensity CBT if moderate - severe
Antidepressants - sertraline or paroxetine
85
what is puerperal psychosis?
psychotic symptoms within 4 weeks of giving birth
86
what is the presentation of puerperal psychosis?
rapid onset, usually with insomnia, restlessness and perplexity
3 common clinical presentations
- prominent affective symptoms (mania/depression with psychotic symptoms
- schizophreniform disorder
- acute organic psychosis
87
how would you manage puerperal psychosis?
usually admission to hospital is required
| consider antipsychotics, mood stabilisers (carbamazepine) antidepressants and ECT in severe cases.
88
what are the ICD-10 guidelines for OCD?
obsessional symptoms +/- compulsive acts present on most days for at least 2 weeks
source of distress or interference with activities
they recognise as individual own thoughts or impulses
at least one act is resisted unsuccessfully
the thought of carrying out the act must not be pleasurable
89
what is the presentation of OCD?
they know their presentation is irrational
recurrent unwanted intrusive thought, images or impulses that enter the patients mind - contamination, aggression (thoughts of harming self or others), infection, morality
compulsions include - checking, washing, counting, insistence on symmetry
90
how is OCD managed?
CBT
SSRI (sertraline or fluoxetine)
2nd line - clomipramine
if no response add antipsychotic
if high risk - consider admitting
91
what is the diagnostic criteria for phobias?
at least two anxiety symptoms restricted to the feared situations
significant distress caused by symptoms/avoidance
recognition that fears are excessive or unreasonable
92
what is agoraphobia and how is it managed?
anxiety and panic symptoms associated with places or situations where escape may be difficult or embarassing, leading to avoidance 8
management:
- antidepressants, BDZs (alprazolam or clonazepam)
- behavioural methods: exposure techniques
- cognitive - education on body reponses
93
what is social phobia and how is it managed?
fear of social situations where they might be exposed to scrutiny by others that might lead to humiliation and embarrassment. e.g. public speaking, fear of vomiting or interacting with opposite sex.
management
CBT
beta blockers, SSRI, MAOIs
94
what is generalised anxiety disorder described as?
Generalised anxiety disorder (GAD) is defined as at least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress, or impairment
95
what are the three key elements of generalised anxiety disorder?
apprehension
motor tension
autonomic overactivity
96
what are the two patterns of anxiety?
generalised anxiety - hours/days/weeks, no associated with specific external threat, excessive worry or apprehension about normal life events
Paroxysmal anxiety - abrupt onset, occurs in episodes, quite severe. Severest from = panic attacks
97
what are some presentations of anxiety?
```
fears
worries
poor concentration
irritability
insomnia
restless
fidgeting
feelin on edge
unable to relax
tremours
headaches
muscle aches
dizzy
palpitations
chest discomfort
difficulty inhaling
dry mouth
N&V
butterflied
increased frequency of urination
```
98
what investigations would you perform for anxiety?
clinical diagnosis
but TFT - to rule out hyperthyroidism
glucose - hypoglycaemia
drug screen
ECG for arrhythmias
99
how is generalised anxiety disorder managed?
```
CBT
applied relaxation
meditation training
sleep hygiene education
SSRI or SNRI
```
beta blockers
100
what is a panic disorder?
Panic disorder is characterised by recurring unexpected panic attacks over a 1-month period and associated worry about their recurrence or implications. Panic attacks involve the sudden onset of intense physical and cognitive symptoms of anxiety that may be triggered by specific cues or occur unexpectedly. Panic disorder may also be characterised by avoidance of situations that may trigger the panic sensations.
101
what are some symptoms of a panic attack?
```
tachycardia
palpitations - chest pain and discomfort
dizziness
perceptual abnormality
resp symptoms
muscle shaking
```
102
how are acute panic attacks managed?
reassurance and benzodiazepines
103
how is ongoing panic disorder managed?
CBT
SSRI or SNRI
benzos can be added
2nd line TCAs
104
what is PTSD?
Post-traumatic stress disorder (PTSD) may develop following exposure to 1 or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters, or military action.
105
what are the features of PTSD?
intrusion symptoms - involuntary re-experiencing aspects of traumatic event (flashbacks, intrusive images, sensory impressions, dreams/nightmares) - these symptoms must impair function for a diagnosis to be made
avoidance symptoms - avoidance of reminders of the trauma
negative alterations in cognitions and mood
alterations in arousal and reactivity (hypervigilance, exaggerated startle response, irritability, angry outbursts.
depression
alcohol or substance misuse
anxiety
106
how is PTSD managed?
trauma-focused cognitive behavioural therapy
eye movement desensitisation and reprocessing (EMDR)
sertraline or fluoxetine or paroxetine
107
what is somatisation disorder?
a disorder in which there is repeated presentation with medically unexplained symptoms, affecting multiple organ systems
108
what are risk factors for somatisation disorders?
childhood illness
history of parental anxiety towards illness
increased risk if you have first degree relative
associated with sexual abuse
109
what is the clinical presentation of somatisation disorder ?
patients have long complex medical histories
multiple, recurrent, frequently changing physical symptoms with the absence of identifiable physiological explanation
GI - nausea, vomiting, diarrhoea, constipation, food intolerance, pain
sexual - loss of libido, ED, regular menses
urinary - dysuria, frequency, retention and incontinence
neurological - paralysis, paraesthesia, sensory loss, seizures, difficulty swallowing, impaired coordination or balance
110
how is a somatisation disorder diagnosed?
more than a 2-year history of multiple symptoms with no physical explanation that disrupts daily life
persistent refusal to be reassured that there is no explanation for symptoms
some degree of impaired social/family functioning due to these symptoms
111
how is somatisation disorder managed?
CBT, mindfulness, interpersonal psychotherapy
antidepressants
explain link between stress and symptoms
offer all necessary investigations and show understanding fo the severity of the symptoms
112
what is hypochondrial disorder?
the persistent belief in the presence of an underlying serious disease e.g. cancer
patient refuses to accept reassurance or negative test results
113
what is conversion disorder?
typically involves loss of motor or sensory function
the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain
patients may be indifferent to their apparent disorder - la belle indifference
114
what is a dissociative disorder?
dissociation is a process of separating off certain memories from normal consciousness
it involves psychiatric symptoms e.g. amnesia, fugue (loss of awareness of ones identity), stupor (near unconsciousness)
115
what is the disorder called when a patient intentionally produces symptoms
Munchausens or factitious disorder
116
what is is called when a patient exaggerates symptoms for financial or other gain?
Malingering
117
what are the factors shown to be associated with increased risk of suicide?
```
male sex
history of deliberate self-harm
alcohol or drug misuse
history of mental illness (depression or schizophrenia)
history of chronic disease
advancing age
unemployment or social isolation/living alone
being unmarried, divorced or widowed
```
118
If a patient has actually attempted suicide, there are a number of factors associated with an increased risk of completed suicide at a future date:
```
efforts to avoid discovery
planning
leaving a written note
final acts such as sorting out finances
violent method
```
119
what are protective factors against suicide?
family support
having children at home
religious belief
120
what is neurosis?
a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, hypochondria) but not a radical loss of touch with reality
121
what are the clinical features of neurosis in the elderly?
non specific anxiety and depressive symptoms predominate and hypochondrial symptoms are often prominent.
122
what can cause neurotic symptoms in the elderly?
multiple factors contribute to new neurotic symptoms in the elderly such as major life events, physical illness, feelings of loneliness, impaired self-care
123
what is the most common form of psychosis in old age?
late paraphrenia - late onset schizophrenia
124
what are the most common symptoms of late paraphrenia?
persecutory delusions are most common
| auditory hallucinations are common
125
what is vascular depression?
```
white matter hyper-intensities on MRI
change to cortical circulation
presentations associated with cognitive impairment and psychomotor retardation
apathy and poor insight
poo response to antidepressants
prodromal dementia
```
126
what is Charles Bonet syndrome?
Charles Bonnet syndrome. Charles Bonnet syndrome (CBS) is a common condition among people who’ve lost their sight. It causes people who have lost a lot of vision to see things that aren’t really there
127
what are risk factors for suicide in the elderly?
```
increasing age
male
physical illness
social isolation
widowed or separated
alcohol abuse
depressive illness, current or past
recent contact with psychiatric services
```
128
what are the general principles when prescribing in elderly patients
start low go slow
maximum efficacy is often achieved at significantly lower doses than in younger adults
beware of dangerous side-effects such as postural hypertension, arrhythmias and sedation
the elderly as particularly sensitive to EPSEs and anticholinergic side effects
beware of drug interactions due to common problems of polypharmacy in the elderly
atypical neuroleptics are generally better tolerated then conventionals
monitor lithium therapy closely as levels can fluctuate easily
129
can you section someone for drugs/alcohol use?
legally you cannot section people for alcohol/durgs alone, need to have a disorder or disability of the mind
130
what is the basic principle of the mental health act?
the basic principle of the act is that there is the least restriction on the patients liberty.
131
who can use the mental health act?
S12 approved doctor
| approved mental health practitioner - mainly social workers or can be nurses
132
what is section 2 of the MHA?
it is an assessment order
detention for 28 days - can not be renewed
used for assessment - although treatment can be given without the patients consent)
133
who needs to be involved in a section 2 MHA?
2 doctors - one must be S12 approved, and one approved mental health practitioner
134
what evidence is required to detain someone under section 2 of the MHA?
patient is suffering from a mental disorder (just need evidence, do not need to know what the disorder is) of a nature or degree that warrants detention in hospital for assessment and the patient needs to be detained for his/her own health or safety or the protection of others.
135
what is section 3 of the MHA?
treatment under the mental health act
can last up to 6 months and can be renewed
it is used to treat patients
136
who is involved in section 2 of the mental health act and what evidence is required?
2 doctors - one S12 approved and 1AMHP
the evidence required is
- patient suffering from a mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital and
the treatment is in the interests of his or her and safety and the protection of others and
appropriate treatment must be available for the patient - thus you must know what the disorder is and why they need to be treated in hospital
137
what is section 4 of the mental health act?
emergency order
it lasts for 72 hours
used in an urgent necessity or emergency when waiting for a second doctor would lead to an undesirable delay
138
who and what is needed for someone to be detained under section 4 of the mental health act?
1 doctor and 1 AMHP
evidence required:
- patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment and -
- the patient ought to be detained for his or her own health or safety or for the protection of others
- there is not enough time for a 2nd doctor to attend (RISK)
139
what is a section 5(2)
it is for patients already admitted (can be psychiatric or general hospital) but wanting to leave
doctors holding power for 72 hours
allows time for section 2 or section 3 assessment
patient cannot be forced to take treatment
140
what is section 5(4)?
for already admitted hospital patients - the same as a 5(2) but for nurses and allows holding power for 6 hours
141
what is section 135?
police section that requires court approval to access patients home and remove them
142
what is a section 136?
police section whereby a person suspected of having a mental disorder in a public space can be removed.
143
how do you assess capacity?
Do they UNDERSTAND the information relevant to decision
Can they RETAIN that information long enough to decide
Can they use of WEIGH UP the information to decide
Can they COMMUNICATE their decision?
of no to any of the questions then they lack capacity
144
when does deprivation of liberty occur?
* They lack capacity to consent to care and treatment arrangements
* They are under continuous supervision and control
* They are not free to leave
* (ALL three elements must be present to be deemed a DOL)
145
what is a best interest assessment?
used to decide what is in the persons best interests when they lack capacity for a particular decision - e.g. finance, non psychiatric treatment and accommodation
*if there are no friends or family or other to support them in thinking about their best interests then they will need an independent mental capacity advocate
146
can you detain people under the mental health act outside of a hospital e.g. in a care home?
no - cannot be in a public place
147
what are the different classes of antidepressants?
SSRIs (sertraline, citalopram, fluoxetine)
SNRIs - Serotonin-noradrenaline reuptake inhibitors (venlafaxine, duloxetine)
Tricyclic antidepressants (TCAs) - (amitriptyline, clomipramine, imipramine)
NaSSA - noradrenergic and specific serotonergic antidepressants (mirtazapine)
monoamine oxidase inhibitors (phenelzine)
148
what is the definition of tolerance?
kuyiu
149
what is the definition of withdrawal?
did
150
what do you give for benzo overdose?
flumazenil
