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Phase 3a > Psych > Flashcards

Psych Flashcards

1
Q

What are some risk factors for mild cognitive impairment (MCI)?

A
  • Age - 65+
  • diabetes
  • smoking
  • HTN
  • elevated cholestrol
  • obesity
  • depression
  • lack of physical exercise
  • low education level
  • lack of mental or social stimulation
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2
Q

What are some differential diagnoses of someone presenting with increased forgetfulness and a lower than average score on MMSE?

A
  • mild cognitive impairment
  • delirium
  • depression
  • pseudo dementia
  • vitamin B12 deficiency
  • drug side effects/interactions
  • hypothyroidism
  • infections (think UTI in women)
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3
Q

How would you investigate someone with MCI?

A
  • Bloods - FBC, vit B12, random + fasting blood glucose
  • full physical examination
  • full Hx
  • CT/MRIb/SPECT
  • cognitive assessment - MMSE, addenbrookes & MOCA
  • MMSE <10 = severe, <23 mild.
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4
Q

How would you manage someone with MCI?

A
  • no meds indicated for MCI, however Tx of underlying causative medical condition if there is one
  • employ routine early, regular exercise, healthy diet, reduce alcohol, avoid stress, keep social active
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5
Q

What 4 things are necessary for Capacity? Can it change?

A
  • understand the decision to be made
  • retain the information
  • weigh up the pros and cons
  • communicate the decision

capacity is DECISION & TIME specific

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6
Q

Define Phenomenology.

A

Description of signs and symptoms through an empathetic assessment of subjective experience.

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7
Q

Define an illusion.

A

illusions are misperceptions of real external stimuli

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8
Q

Define a hallucination.

A

Hallucinations are perceptions occurring in the absence of an external physical stimulus. Auditory, visual, olfactory, gustatory, tactile, somatic.

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9
Q

What’s the difference between 2nd and 3rd person auditory hallucinations?

A
  • 2nd = YOU are a bad person, YOU are the next messiah, YOU are going to die
  • 3rd = Running commentary (suggestive of schizophrenia)& voices discussing/commenting
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10
Q

What is a reflex hallucination?

A

A stimulus in one sensory field causes a hallucination in another sensory modality.

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11
Q

What’s the difference between an over-valued idea and a delusion?

A

Over-valued idea is a false/exaggerated belief that is sustained by logic but is NOT as rigid as a delusion

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12
Q

Define Delusion.

A

A false unshakeable idea or belief which is out of keeping with the patients educational, cultural and social background. Something that is outside of normal experience.

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13
Q

Briefly describe some common delusions.

A

persecutory - everything bad is your fault - depression
grandiose - believe you’re jesus, superman, cured cancer. - schizo
paranoid - FBI are after you - schizo
self-referential - newspaper/TV talking to you,
Nihilistic - already dead, bowels rotted - depression

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14
Q

What are some examples of thought disorders?

A 
Alienation - catch all term for the below
Insertion 
Withdrawal 
Broadcast 
Echo 
Block
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15
Q

What are examples of disorders of expression?

A 
Concrete thinking 
Loosening of association 
circumstantiality 
perseveration 
confabulation
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16
Q

Define perseveration.

A

repetition of a word, theme or action that is more than deemed relevant or appropriate.

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17
Q

Define confabulation.

A

Telling a false account of events in order to fill a gap in memory.

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18
Q

What are some passive phenomenology?

A

Somatic passivity - passive recipient of thoughts, feelings, sensations, LIFE
catatonia
psychomotor retardation

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19
Q

describe some features of catatonia

A

it’s a state of excited or inhibited motor activity in the absence of a mood or neuro disorder.

  • waxy flexibility - patients limbs moved into a position and they stay there
  • echolalia - repetition of words heard by the patient
  • echopraxia - automatic repetition of movements that the examiner made the patient do
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20
Q

Define psychomotor retardation

A
  • slowing of thoughts & movements, to a variable degree.

- Occurs in depression but may be drug induced (antipsychotics) or structural (Parkinson’s)

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21
Q

What is pressure of speech?

A

very rapid delivery of speech with a wealth of associations which may be unusual and often wanders off point. (suggestive of mania)

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22
Q

What is flight of ideas?

A

Rapid skipping from one thought to another that is distantly related. Can be very tenuously related.

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23
Q

Define Anhedonia.

A

The inability to take pleasure from something one would usually find enjoyable.

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24
Q

Define incongruity of affect.

A

emotional responses which seem grossly out of tune with the situation or subject being discussed.

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25
Q

Define depersonalisation.

A

A feeling of some change in self, associated with a sense of detachment from one’s own body.

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26
Q

define derealisation.

A

A sense of one’s surroundings lacking reality, often appearing dull, grey and lifeless.

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27
Q

What is the difference between obsession and compulsion?

A 
Obsession = a recurrent persistent thought, image or impulse that happens without voliation that is seen as being ones own  &amp; remains despite efforts to resist
Compulsion = repetitive, apparently purposeful behaviour performed in a stereotyped way accompanied by a subjective sense that it must be carried out despite acknowledgement of it's purposelessness.
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28
Q

Define Akathisia.

A

A condition marked by motor restlessness, ranging from anxiety to an inability to lie or sit quietly or to sleep

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29
Q

What are the 3 core symptoms of depression?

A
  • low mood
  • loss of energy (anergia)
  • loss of pleasure (anhedonia)
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30
Q

What are some other common symptoms associated with depression?

A
  • changes in sleep (typically early morning waking)
  • changes in libido
  • changes in appetite
  • diurnal mood variation
  • agitation
  • loss of confidence
  • loss of concentration
  • guilt
  • hopelessness
  • suicidal ideation
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31
Q

How do you tell between mild & moderate depression?

A 
mild = core + 2-3 symptoms 
moderate = core + 4 other symptoms + functioning affected
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32
Q

How do tell between moderate and severe depression?

A 
moderate = core + 4 Sx + functioning affected 
Severe = several symptoms + suicidal + marked loss of functioning
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33
Q

What are the 2 types of severe depression?

A
  • With or Without psychotic symptoms

- typically mood congruent (nihilistic & guilty delusions, derogatory voices)

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34
Q

What are some possible presentations of depression?

A
  • Post natal - 13% of women
  • recurrent depression
  • part of bipolar illness
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35
Q

What’s the difference between bipolar I and II?

A 
I = both mania + depression (sometimes only mania)
II = more episodes of depression, only mild hypomania EASY TO MISS
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36
Q

What’s the duration & symptoms of hypomania?

A
  • between 4-7 days
  • elevated mood (euphoric/dysphoric/angry)
  • increased energy
  • poor concentration
  • increased talkativeness
  • mild reckless behaviour
  • sociability/overfamiliarity
  • increased libido/sexual disinhibition
  • increased confidence
  • decreased sleep need
  • change in appetite
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37
Q

What’s the duration & symptoms of Mania?

A
  • Greater than 1 week of Sx
  • extreme uncontrollable elation
  • over activity
  • pressure of speech
  • impaired judgment
  • Extreme risk taking behaviour
  • social disinhibition
  • inflated self-esteem
  • with psychotic Sx
  • mood congruent/incongruent
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38
Q

What are some psychotic disorders?

A
  • Schizophrenia - MAIN ONE
  • delusional disorder
  • Schizotypal disorder
  • depressive psychosis
  • manic psychosis

-organic psychosis

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39
Q

Describe the epidemiology of Schizophrenia?

A
  • 1% lifetime risk
  • stable incidence across the world
  • 1:1 F:M
  • onset typically 2nd-3rd decade second small peak in late middle age
  • increase suicide risk
  • increased risk of death from CVD, Resp disease and infection (x2, 3, 4)
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40
Q

What are the first rank Sx of Schizophrenia?

A

need greater than 1 Sx

  • thought alienation
  • passivity phenomena
  • 3rd person auditory hallucination
  • delusional perceptions
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41
Q

What are the second rank symptoms of Schizophrenia?

A

Need 2 or more

  • delusions
  • 2nd person auditory hallucinations
  • hallucinations in other modalities
  • thought disorder
  • catatonic behaviour
  • negative Sx
42
Q

What are the negative Sx associated with schizophrenia?

A
  • blunting affect
  • amotivation
  • poverty of speech
  • poverty of thought
  • poor non-verbal communication
  • clear deterioration in functioning
  • self neglect
  • lack of insight
43
Q

What are some features of generalised anxiety disorder?

A
  • excessive anxiety across different situations
  • > 6 months
  • tiredness
  • poor concentration
  • irritability
  • muscle tension
  • sleep changes (initially insomnia)
44
Q

What are some physical Sx of panic disorder?

A
  • palpations
  • chest pain
  • choking
  • tachypnoea
  • Dry mouth
  • Urgency of micturition
  • Dizziness
  • blurred vision
  • Parathesiae
45
Q

What are some psychological Sx of panic disorder?

A
  • feeling of impending doom
  • fear of dying
  • fear of losing control
  • depersonalisation
  • derealisation
46
Q

Define OCD.

A

Obsessive thoughts with compulsive acts

47
Q

What are some examples of obsessions?

A

Obsessive thoughts or images

  • often unpleasant - death/sexual/blasphemous
  • repetitive
  • intrusive
  • irrational
  • recognised as patient’s own thoughts
48
Q

What are compulsion actions?

A
  • Checking
  • washing
  • counting
  • symmetry
  • repeating certain words or phrases
49
Q

A patient believes that a close relative has been replaced by an identical looking impostor. Which is this known as?

A

Capgras delusion.

50
Q

A patient describes meeting the same person but they are in lots of different disguises. What is this phenomena known as?

A

Fregoli delusion

51
Q

What are the physiological abnormalities seen in Anorexia nervosa?

A
  • hypokalaemia
  • low FSH, LH, oestrogens & testosterone
  • raisied cortisol & growth hormone
  • impaired glucose tolerance
  • hypercholestrolaemia
  • hypercarotinaemia
  • low T3
52
Q

What are some clinical features of Anorexia Nervosa?

A
  • reduced BMI
  • bradycardia
  • hypotension
  • enlarged salivary glands
53
Q

What questionnaire would you use to determine the likelihood of Anorexia?

A

SCOFF
-do you ever make yourself SICK because you feel too full?
-do you every worry you’ve lost CONTROL over your eating?
-have you recently lost more than ONE stone in 3 months?
-do you ever believe you’re FAT when people say you’re thin?
-does FOOD dominate your life?
<2 yes = likely diagnosis of anorexia

54
Q

What’s the difference between bulimia and anorexia?

A
  • bulimia = 5x more common and can present with a normal weight - eating pattern binge then purge (laxative abuse, vomiting, starving)
  • anorexia = calorie restriction and significantly low BMI, intense fear of fatness, delayed puberty if below pubertal age.
55
Q

What are some impacts of low body weight?

A
  • thinking slowed/inflexible, find it difficult to switch topics or make decisions
  • concentration poor - partly due to lack of nutrition and partly because of thoughts about food
  • mood - somewhat low and get very irritated
  • lose interest in things that aren’t to do with food
  • behaviour - heightened obsessiveness, eating becomes ceremonial, hoarding of objects/food. no explanation for actions.
56
Q

What happens during refeeding syndrome?

A
  • reinstitution of nutrition at too quick of a rate
  • Person no longer needs to utilise fat and protein stores
  • causes a spike in insulin secretion and massive cellular uptake of electrolytes
  • causes a drop in serum phosphate (and other electrolytes) which produces the clinical Sx of refeeding syndrome
57
Q

when treating anorexia how do you avoid refeeding syndrome?

A
  • Thiamine and vitamin B complexes given when feeding resumes
  • biochemistry should be closely monitored
  • abnormalities in K+, Po4- and MG2+ should be corrected.
58
Q

When and how does refeeding syndrome present?

A
  • 3-4 days from commencement of nutrition
  • muscle weakness
  • confusion
  • coma
  • seizures
  • death
59
Q

What are key features of a dependence syndrome?

A
  • Tolerance - do you need more a of a substance ot make you feel how you want to.
  • Primacy - Does your substance habit come before anything else?
  • Physical and mental withdrawal - craving and shaking
  • Loss of control - do you feel in control anymore?
  • Continued use after harmful consequences.
60
Q

What are the symptoms of a alcohol withdrawal?

A
  • starts 1-7 days after the last drink
  • anxiety
  • sweating
  • insomnia
  • hallucinations (Lilliputian)
  • seizures
  • Delirium Tremens (5%)
61
Q

Describe what happens during Delirium Tremens.

A
  • other Sx of withdrawal
  • vivid hallucinations
  • delusional beliefs
62
Q

What is the treatment regime for someone withdrawing from alcohol?

A
  • IVI
  • thiamine given stat then daily
  • Benzos - increase GABA effect serving to replace alcohol - ween
  • Treat psychologically first to assess motivation - prep for detox
63
Q

What are the long term complications of alcohol dependence?

A
  • Wernicke-Korsakoff Syndrome
  • Wernicke triad = Ataxia, ophalmoplegia and acute confusion
  • Korsakoff - anterograde amnesia (can’t make new memories) and confabulate to fill in the gaps
64
Q

What is the pathophysiology of Wernicke-Korsakoff’s syndrome?

A
  • Happen due to thiamine deficiency
  • Most calories come from alcohol so less B12 intake
  • alcohol disrupts the absorption of B12 in the stomach
  • alcohol disrupts liver enzymes that converts B12 into active form
65
Q

Define tolerance.

A

A state which an organism no longer responds to a drug - requires higher dose to achieve same effect

66
Q

Define Dependence.

A

A state which an organism functions normally only in the presence of a drug

67
Q

Define withdrawal.

A

physical and psychological disturbance when drug is removed.

68
Q

How would you treat alcohol related hepatitis? or pancreatitis?

A
  • corticosteroids
  • nutritional support
  • pancreatic enzyme supplements
69
Q

Pinpoint pupils + track marks + passed out. immediate Tx?

A
  • IV/IM naloxone

- bloods for tox screen

70
Q

What treatments are available for anxiety disorders?

A
  • first line Tx - self taught CBT
  • second line - CBT guided
  • Third line - high-intensity CBT or Drugs: SSRI = sertraline or SNRI - Venlafaxine
  • fourth line - specialist centre referral and maybe offer pregabalin
71
Q

What are the A-H criteria of PTSD?

A 
A = exposure to trauma 
B = persistent re-experiencing of trauma 
C = avoidance of trauma related stimuli 
D = negative thoughts that began or worsened after trauma 
E = arousal or reactivity tht began or worsened after trauma 
F = symptoms lasting longer than 1 month 
G = creating stress or functional impairment
H = not due to medication, substance abuse or organic illness
72
Q

Define Generalised anxiety disorder.

A

Persistent or excessive worry about a number of different things. Happening for most of the day lasting for longer than 6 months.

73
Q

Define Panic Disorder.

A

Panic attacks with no specific stimulus.

74
Q

How do you treat panic disorder?

A
  • Beta-blocker - propranolol
  • benzos acutely (addictive)
  • mindfulness based therapies
  • psychoed
  • CBT
75
Q

Define a phobic disorder.

A

Anxiety triggered by exposure to a stimulus.

76
Q

How do you treat a phobic disorder?

A

-Graded exposure therapy

77
Q

Define social phobia.

A

Debilitating fear of humiliation in social interaction.

78
Q

Define agoraphobia.

A

Extreme fear of public places.

79
Q

What are some differences between dementia and delirium?

A

Delirium vs Dementia

  • acute onset vs insidious
  • fluctuating & usually reversible vs slow progressive
  • days to weeks vs years
  • condition/medication vs neurological/cerebrovascular disease
  • attention greatly impaired vs only impaired in severe disease
  • varied memory loss vs memory loss evident (particularly recent events)
  • immediate medical attention vs nonemergency
  • visual and tactile hallucination vs delusions in 40%
80
Q

What are the 3 main criteria of a delusional belief?

A
  • Certainty - patient believes delusion absolutely
  • incorrigibility - belief cannot be shake with explanation
  • impossibility - belief is untrue without doubt
81
Q

What investigations may be useful in query schizophrenia?

A
  • LFTs + FBC could indicate alcohol abuse
  • serological test of syphilis
  • screening for AIDS (HAND)
  • Urine analysis - substance abuse
  • CT head for SOL if focal Sx present
82
Q

What is recommended as first line Tx for schizophrenia?

A
  • olanzapine or quetiapine

- atypical anti-psychotics

83
Q

what is the MOA of atypical (2nd gen) anti-psychotics?

A
  • D2 receptor blockers in mesolimbic/mesocortical pathways

- lower extrapyramidal Sx

84
Q

Define treatment resistant schizophrenia. What treatment would you use in this case?

A
  • no relief of Sx after a trial of 2 antipsychotic drugs

- clozapine

85
Q

What precautions must be taken when starting a patient on clozapine? Why?

A
  • weekly blood tests for 18 weeks then every 2 weeks for a year
  • causes agranulocytosis
86
Q

What are some common side effects of antipsychotics?

A
  • weight gai causing secondary diabetes
  • hyperprolactinaemia
  • gynaecomastia
  • sedation
  • headaches
  • dizziness
  • parkinsonisms
  • dystonia
  • Akathisia -restlessness
  • tardive dyskinesia
  • acute dystonia
87
Q

What are some risk factors for schizophrenia?

A
  • medication non-adherence
  • past psychiatric history
  • alcohol and drug use
  • Family Hx
  • young black male
88
Q

What are the risks of starting an elderly person on an antipsychotic?

A
  • increased risk of Stroke

- increased risk of VTE

89
Q

What is a delusional perception?

A

-a true perception which the patient attributes a false meaning.
FIRST RANK SCHIZOPHRENIA SX

90
Q

How do you treat acute dystonia reactions in antipsychotic usage?

A

-IM procyclidine

91
Q

What are the features of fragile X syndrome?

A
  • development delay - learning diabilities and cognitive impairment
  • usually affects males
  • delayed speech and language development
  • 1/3rd have ASD
92
Q

What are some causes of learning disabilities?

A
  • genetics - down’s (most common), Edwards, turners
  • perinatal - infection (EBV), bacterial (meningitis), parasites, delivery (hypoxic brain injury), maternal alcohol or drug use
  • Trauma - RTA
  • CNS tumour
93
Q

Define learning disability.

A

Significant life long condition that starts before adulthood that affects development and leads to help being required to understand information, learn skills and cope independently.
-NHS says IQ <70

94
Q

Define learning difficulty.

A

any learning or emotional problem that affects a persons ability to learn, get along with others and follow convention. Can be overcome with adjustments.

95
Q

When factors should be considered when a person with a learning disability is going to be going through a bereavement?

A
  • prepare the person and involve them if this is possible
  • they might display challenging behaviour as routine/mood of environment changes
  • explain clearly what is happening to the person with terminal illness
  • explain death without using euphemisms
96
Q

What’s the criteria for diagnosing Anorexia?

A
  • <85% expected body weight
  • fear of weight gain
  • disproportionate idea of body
  • amenorrhoea or decreased libido
97
Q

What questions do you ask when trying to assess suicide risk?

A
  • Did you attempt?
  • Did you think it was going to work?
  • Did you plan/write a note?
  • Have you tried to take your life before?
98
Q

Briefly describe attachment theory.

A

-The idea that babies for an attachment in early life with 1 care giver and this forms the basis of all social interactions in the future.
-lack of secure attachment causes developmental consequences:
~decline in IQ
~depression
~aggression
~delinqunincy
~affectionless psychopathy

99
Q

What impact does early life trauma have on a person?

A

-impairs development of brain function
-impairs thinking, relationships, memory and health
-Problematic development of effect executive function:
~controlling impulses
~organisation
~planning
~initiation
~motivation

100
Q

What are the A,B & C categories of personality disorders?

A

A - Odd or eccentric
B - dramatic or emotional
C - Anxious or avoidant

101
Q

How would you treat mania?

A

ACUTE
mild/moderate - lithium monotherapy OR atypical antipsychotic
Severe - mood stabilizer (lithium or valporate) PLUS antipsychotic

CHRONIC
lithium, valporate, carbamazepine, lamotrigine.

Phase 3a (15 decks)

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