Psych Flashcards
What are the domains of a mental state assessment?
- Appearance and behaviour- physical health, hygiene, clothes, posture, motor abnormalities
- Speech- tone, volume, speed, rhythm
- Thoughts
- Mood- underlying emotion (e.g. mild climate, dysthymic)
- Affect- how you present (e.g. presents as warm but cloudy, tearful or angry)
- Perception- any hallucinations, illusions
- Cognition- consciousness, memory, orientation, attention
- Insight- ability to understand one’s condition
What is a delusion of reference?
When you believe actions of other people/media/events are directly related and communication to you
What is a delusion of grandeur?
Believing you are incredibly famous, rich, intelligent etc.
What is a persecutory delusion?
Believing that someone/something has malicious intent against you
What is thought insertion?
Believing thoughts have been inserted into your mind
What is thought broadcast?
Believing your thoughts are being broadcasted to others
What is thought withdrawal?
Believing your thoughts are being taken out of your mind
What are the most common types of delusion in schizophrenia?
Persecutory or delusions of reference
What are examples of positive symptoms in schizophrenia?
Delusions
Hallucinations
Illusions
Formal thought disorders: disorganised speech, neologisms (making up words)
Abnormal physical behaviours- uncomfortable and strange postures/ positions, inability to move, random movements etc.
What are examples of negative symptoms in schizophrenia?
Reduced social function :
Physical signs- weight change, poor hygiene, not taking care of oneself, withdrawn from interactions
Speech- poverty of speech (not speaking much, unable to explain answers)
Blunting of affect
Difficult to distinguish from depression
Avolition- lack of interest in life
Bradykinesia
What are the types of hallucinations?
Auditory
Visual
Olfactory
Tactile
What are lilliputian hallucinations?
Common in Charles Bonnet Syndrome
- hallucinations of little people
What are the first rank symptoms in schizophrenia?
Symptoms that are very indicative of schizophrenia;
- All thought alienation- insertion, withdrawal, broadcast
- 3rd person auditory hallucination (voices outside the head talking about you)
- Somatic/ tactile hallucinations (something touching you, insects crawling out of your skin)
- Delusional perception
- Passivity- being controlled
What is delusional perception?
When seemingly normal things are perceived to have an other meaning to you (e.g. traffic lights showing amber means the world is going to end)
What are the second rank symptoms in schizophrenia?
Symptoms that are common in schizophrenia and other psychiatric conditions
- Delusions of reference
- Paranoid delusions
- Persecutory delusions
- 2nd person auditory hallucinations (more often in mania)
What is the diagnostic criteria for schizophrenia?
ICD-10: 1 first rank symptom for at least 1 month
DSM-5: 2 of the following symptoms for 6 months (inc 1 postive)
- delusions
- hallucinations
- disorganised speech
- disorganised or catatonic behaviour
- negative symptoms
IN THE ABSENCE OF DRUG INTOXICATION, BRAIN DISEASE OR PRIMARY AFFECTIVE DISORDERS
What are common differential diagnoses for schizophrenia?
- Delusional disorder (one primary delusion)
- Brief psychotic disorder (symptoms for less than a month)
- Manic depression (distinguished with periods of elation)
- Organic psychosis (caused by neurological disease or drugs)
- Drug intoxication (illegal and steroids)
- Epilepsy
- Dementia
- B12 deficiency
- Hypoglycaemia
- Trauma/ head injury
What is the pathology of schizophrenia?
- excess dopaminergic activity
- abnormal glutamate activity
What investigations would you do in ?schizophrenia?
- drug screening
- EEG
- blood glucose
- neuro exams
- CT/MRI (SOL, enlarged ventricles)
What is the aetiology/ risk factors of schizophrenia?
Genetics (family history) Poor neurodevelopment (abuse, school problems) Low socioeconomic status Over-involved families Adverse life events Drug abuse (cannabis)
What is a personality disorder?
An abnormal behavioural pattern formed in childhood/adolescence that causes issues in forming relationships or functioning in society.
What is the aetiology of personality disorders?
Genes + environment
- abnormal perinatal/postnatal development
- abuse
- poor attachments
- poorly formed behaviour patterns in childhood
What are the 3 clusters of personality disorders?
A: Odd/ eccentric
- Schizoid PD (Social withdrawal, restricted emotion or
pleasure, aloof)
- Paranoid PD (Mistrust, cold, hypersenstive, poor
relationships)
- Schizotypal PD (delusions, ideas of reference, magical
thinking)
B: Dramatic
- Borderline PD (unstable/intense relationships,
impulsive, transiently suicidal)
- Histrionic PD (immature, shallow, suggestible)
- Narcissistic PD
- Antisocial PD
C: Anxious
- Avoidant/ Anxious PD (persistent feelings of
inadequacy, reluctancy to engage due to fear)
- Obsessive compulsive PD (excessive doubt, stubborn,
rigidity, perfectionist)
- Dependent PD
What is the management for BPD/EUPD?
DBT!! Dialectical Behavioural Therapy (CBT + acceptance)
Group therapies
What is the management for cluster C (anxious) personality disorders?
- Anxious PD
- OCPD
- Dependant PD
CBT + Psychodynamic
Group therapies
What are the principles of CBT?
Links between:
- Thoughts
- Feelings
- Behaviour
Challenge thinking patterns to overcome associations
What is required to deem that someone has capacity?
- Understanding information
- Retain information
- weigh and use this information to make a decision
- Communicate that decision
Which law governs issues on mental capacity?
The Mental Capacity Act (2006)
What is a lasting power of attorney?
Someone with capacity gives someone else (usually friend or relative) the right to make decisions on their behalf should they lose capacity
What is an advance decision?
Making decisions for the future in advance in case they are unable to do so in the future
Can be regarding;
- healthcare
- DNACPR
What is a DoLS?
Deprivation of Liberty Safeguards
- Deprived of liberty (ability to come and go as they please)
- In a carehome or hospital
Must:
- be over 18
- Have a mental disorder
- Lack capacity
- be in the patient’s best interest
- Not sectioned under Mental Health Act
- DoL must not contradict any advanced decisions or LPA
What is the difference between a DoL and sectioning?
DoL: not being treated for mental health disorder
What is sectioning?
Compulsory admission due to a mental disorder severe enough that the person is at risk to themselves or others
What is Section 2?
- Who can do it
- What for
- How long for
2 doctors (1 who is section 12 approved)
+ 1 AMHP
For assessment
28 days
What is Section 3?
- Who can do it
- What for
- How long for
2 doctors (1 who is section 12 approved)
+ 1 AMHP
For treatment
6 months
What is Section 4?
- Who can do it
- What for
- How long for
1 doctor
When situation is too urgent to arrange a section 2
72 hours
What is Section 5(2)?
- Who can do it
- What for
- How long for
1 doctor
Urgent detention of an inpatient (anywhere except A+E)
72 hours
What is Section 5(4)?
- Who can do it
- What for
- How long for
1 Mental health nurse
Urgent detention of a psychiatric inpatient in the absence of a doctor
6 hours
What is Section 135?
- Who can do it
- What for
- How long for
Police Officer
Removal from home to a safe place
72 hours
What is Section 136?
- Who can do it
- What for
- How long for
Police Officer
Removal from public to a safe place
72 hours
What are the risk factors for suicide?
Male Age 35-49 Mental illness Physical disability Chronic illness or pain Drug and alcohol abuse Loss of job Social isolation Relationship breakdown Debt Bereavement Imprisonment
What are indicators of an upcoming successful suicide attempt?
- Plans
- Written notes
- Final acts (arranging finances, wills etc.)
- Efforts to avoid discovery
- Previously violent attempts
What is conversion disorder?
Patients experience loss of physical function without a cause
What is Munchausen’s syndrome?
Patients cause their own disability to seek attention or care
What is somatisation?
Patients simply complain of symptoms
What is malingering?
Faking disability or disease for personal gain (e.g. financial or drug)
What is the SSRI of choice in adolescents?
Fluoxetine
What is Othello syndrome?
Patient believes partner is being unfaithful
Delusional jealousy
What is ECT licensed for?
Rapid and short term management of:
Severe and treatment-resistant depression
Catatonia
Prolonged episode of mania
What are the signs of dependence?
Compulsions to engage with addicted substance/action Aware of harms but persist **Neglect of other activities** Tolerance Stopping causes withdrawal Time is preoccupied with substance/action Out of control use Persistent
What pathway causes substance abuse?
Mesolimbic dopaminergic reward pathway
What is the management for substance abuse?
Residential rehabilitation
CBT
Group therapy
Contingency management programmes (e.g. rewards given for negative drug tests)
Management of any infections (e.g. HIV or Hepatitis with IVDU)
What is the aetiology of substance abuse?
Peer pressure
Addiction to prescribed opioids
Desire for pleasurable effect
Psychiatric illness: depression, impulsivity/anxiety, BPD, Antisocial PD,
What is delerium tremens?
+ presentation
Severe alcohol withdrawal:
- tremors
- seizures
- auditory and visual hallucinations
- headache
- vomiting/ nausea
- agitation
- sweating
- palpitations
- depression
- craving
- insomnia
In delerium tremens, when do symptoms start?
6-12 hours: sweating, agitation, craving, anxiety, tremor
36 hours: seizures
48-72 hours: COARSE tremors, hallucinations, confusions, delusions, tachycardia
What is the management of delerium tremens?
Reducing doses of chlordiazepoxide
CBT, community support groups
contingency management programmes
What is the management for schizophrenia?
Antipsychotics: Atypical: Olanzapine or Risperidone
Typical: Haloperidol
What are the side effects of ECT?
+ who is at risk?
Immediate:
- Status epilepticus
- Involuntary muscle spasm
- SE of GA
- arrhythmias
- Headache
Long term:
- Retrograde and anterograde amnesia
At increased risk:
- Elderly
- Pregnant
What is mania?
Period >7 days Euphoria/ elevated mood Irritability Inappropriate elation Increased energy Increased pressure and speed of speech Increased speed of thoughts- flight of ideas ±grandiose delusions Loss of inhibition Poor attention Insomnia Increased appetite
Symtoms cause functional impairment
May require hospitalisation due to risk to self/ others
What is hypomania?
Period <7 days Increased mood and energy Increased pressure/ speed of speech Flight of ideas Poor attention Insomnia Increased appetite
NO psychotic symptoms
What is bipolar disorder?
Condition with 2 or more episodes of significant mood disturbance inc. at least one episode of mania/hypomania/ mixed
What is the Type 1 and Type 2 Bipolar Disorder?
Type 1 (most common): Mania+ Depression Type 2: Hypomania + Depression
What is the management for bipolar disorder?
Acute:
- Depression: SSRI or lithium or atypical antipsychotic
- Mania: Lithium or atypical antipsychotic
Long term (prophylaxis):
- Lithium
- Sodium Valproate
- Lamotrigine
- Carbamazepine
What are the risks of Lithium?
Thyrotoxic Teratogenic Nephrotoxic Can cause arrhythmias - hypercalcaemia
What is depression?
> 2 weeks of low mood
What are the symptoms of depression?
Low mood Anhedonia Feelings of guilt Feelings of worthlessness Change in appetite/ libido/ weight Disturbed sleep Psychomotor agitation or retardation Fatigue Deliberate self harm Thoughts of suicide/ death
Psychotic symptoms:
- delusions or poverty, guilt, inadequacy, nihilism
- hallucinations (auditory, visual, olfactory)
- Catatonia
What investigations would you want to do in ?depression?
Bloods: FBC, blood glucose, TFTs, LFTs, U+Es, calcium levels
Imaging: Head CT/MRI if atypical presentation
What is the management for depression?
CBT, CAT, Individual guided self help, structured group activity
SSRIs- Fluoxetine, Citalopram, Escitalopram, Sertraline
SNRIs- Venlafaxine, Duloxetine
TCA
Other: mirtazapine
ECT
What are the side effects of SSRIs?
Nausea, vomiting, diarrhoea
Insomnia, irritability
Erectile dysfunction
Increased suicidal ideology
What are the side effects of SNRIs?
Raised BP and HR
Nausea, vomiting, diarrhoea
Insomnia, irritability
Erectile dysfunction
Increased suicidal ideology
What is the management of generalised anxiety disorder?
First and second line: individual guided self help, then CBT
Drugs: propanolol, SSRIs or venlafaxine
Acute: Benzodiazepines, zopiclone
What is OCD?
Marked anxiety associated with compulsions and obsessions
Cause distress
Has good insight
What is the management of OCD?
CBT (exposure and response therapy)
Behavioural therapy
Family psychotherapy
SSRIs; escitalopram, fluoxetine, sertraline
Antipsychotics (risperidone, olanzapine)
ECT
How do you detox and maintain detoxification from heroin?
Buprenorphine
and
Methadone
What is the presentation of PTSD?
- Re-experiencing;
flashbacks, nightmares, visions, distress - Avoidance or rumination;
avoiding stimuli or obsessing over it - Hyper-arousal or Emotional numbing;
hyper-vigilance, easily startled, irritable,
social withdrawal, difficulty
concentrating, sleep disturbances,
feelings of detachment, amnesia
What is the management for PTSD?
Therapy: Eye movement desensitisation and reprocessing (EMDR) or Trauma-Focussed CBT (TF-CBT)
Drugs: Paroxetine, mirtazipine, zopiclone short-term
What is the presentation of OCD?
Carrying out a compulsion is not a pleasurable act
Obsessions/thoughts are distressing
Must have at least one compulsion that is unsuccessfully resisted
Obsessions are known to be the individuals own thoughts
Symptoms for >2 weeks
Commonly; cleaning, checking, counting
What is the presentation of panic disorder?
> 4 panic attacks a week for >4 weeks
Unanticipated and not affected by surroundings
What is the management of panic disorders?
CBT and SSRIs
What is agoraphobia?
Fear of unfamiliar spaces with no way to escape or hide
What is a phobia?
Anxiety disorder with a strong, irrational fear towards something that poses no actual threat
What is the management of phobias?
CBT and SSRIs
What is anorexia nervosa?
Inc DSM criteria
An eating disorder based on food restriction
DSM Criteria:
- Persistent restriction of energy intake
- Irrational fear of gaining weight or getting fat
- Undue influence of body weight and image on self-evaluation, or lack of recognition of seriousness of condition, or disturbance in perception of body weight or image
What investigations would you want to do in ?anorexia?
ESR + TFTs- weight loss
U+Es to check for electrolyte balance in malnutrition and?vomiting
DEXA
ECG
What is a healthy BMI?
18.5-24.9
What is the management for anorexia nervosa?
CBT-ED
MANTRA
Multivitamin and mineral supplementation
Oral supplementation of nutrition
What is bulimia nervosa?
+ DSM criteria
Repeated episodes of uncontrolled eating followed by compensatory weight loss behaviours
DSM:
- recurrent episodes of binge eating (eating a lot without control)
- Recurrent compensatory weight loss behaviours e.g. vomiting, laxatives, excessive exercise etc.
- At least once a week for 3 months
- Body image/ weight unduly effects self-esteem and valuation
- Does not occur in anorexia nervosa
What are the investigations and management of bulimia nervosa?
Investigations: U+Es (hypokalaemia with vomiting)
Management: Bulimia focused guided self help
CBT-ED
What is the management for gambling addiction?
Group therapies; 12 step recovery: Gamblers Anonymous
CBT
What mental health teams are available for community?
Early intervention team- for first episode psychosis
Community mental health team
Crisis team
Assertive outreach team- long term illness
