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EOY4 > Psych > Flashcards

Psych Flashcards

1
Q

What is the aim of the mental state exam?

A

To give a description that is so accurate that someone else is able to walk onto the ward and pick the patient you’ve described out.

This is a snapshot of a persons mental state at the TIME OF ASSESSMENT

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2
Q

What are the components of the mental state exam?

A

Appearance and Behaviour

Speech

Mood and Affect - subjective, objective, affect

Thoughts - Form, Content, Possession

Perceptions - illusions vs hallucinations

Cognition
Insight
Risk

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3
Q

Define mood

A

The sustained, subjective, experienced emotion over a period of time.

(the climate)

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4
Q

Define affect

A

Immediate expressions of emotions e.g. smiling at a joke

the weather

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5
Q

Define formal thought disorder

A

An impairment in the ability to form thoughts from logically connected ideas

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6
Q

What is thought form?

A

Are they able to form thoughts in a logical and linear pattern

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7
Q

What are some examples of thought form pathology?

A

Loosening of associations (derailment, tangentiality, word salad)

Circumstantiality

Flight of ideas

Neologism

Perseveration

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8
Q

What is loosening of associations?

A

A lack of connection between ideas

Examples -

Derailment

Tangential = conversation drifts without focus and never comes back to the point

Word salad = just saying random words (quite rare)

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9
Q

What is circumstantiality?

A

Conversation drifts and eventually comes back to the point

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10
Q

What is perseveration?

A

Repetition of a particular response in the absence/cessation of the stimulus

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11
Q

What is neologism?

A

Creation of new words

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12
Q

What are the components that make up thought stream?

A

Acceleration

Retardation

Blocking

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13
Q

What are examples of thought acceleration?

A

Pressure of speech = speak rapidly and with an unapparent urgency

Flight of Ideas = Abrupt leaps from one topic to another. Might have connections, might be puns or rhymes etc.

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14
Q

Define a delusion

A

A fixed, false belief which is firmly held despite evidence suggesting otherwise. The delusion goes against the normal social and cultural belief system of the individual.

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15
Q

How do primary and secondary delusions differ?

A

Primary = unconnected to previous events or ideas

Secondary = arise from and are understandable in the context of previous events or ideas

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16
Q

Describe a grandiose delusion

A

Feel they are ‘special’ / the best at something / really important/ a religious figure

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17
Q

Describe a persecutory delusion

A

Feel that others are conspiring against them to cause harm/ steal money/ destroy their reputation

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18
Q

Describe a delusion of reference

A

Feel that random events, objects or behaviours of other people have a special significance to themselves

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19
Q

Describe a delusion of guilt

A

Feel they have done something sinful or shameful

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20
Q

Describe a nihilistic delusion

A

Feel they are worthless/dying/decaying

Common in depression+ psychosis

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21
Q

What is Cotard’s syndrome?

A

Severe case of nihilism

Believe that everything is non-existent incl. themselves

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22
Q

Define thought interference

A

A person can experience thoughts that they don’t perceive to be their own and have been put there by an external element

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23
Q

Define thought withdrawal

A

A person can experience what they perceive to be the removal of their own thoughts

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24
Q

Define thought broadcast

A

A person can experience what they perceive to be their thoughts out loud

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25
Q

Define the passivity phenomenon

A

The perception that they (mood or actions) are being controlled by someone else

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26
Q

Define an illusion

A

A misinterpretation of an existing external stimulus

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27
Q

Define a hallucination

A

A perception in the absence of an external stimulus

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28
Q

Define depersonalisation

A

Feeling detached from normal sense of self

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29
Q

Define derealisation

A

Feeling of unreality in which the environment/people in it are experienced as unreal

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30
Q

Define psychosis

A

A mental state in which reality is greatly distorted

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31
Q

How does psychosis commonly present? (in very simple terms)

A

Hallucinations

Formal Thought Disorder

Delusions

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32
Q

Give 6 non-organic causes of psychosis

A

Schizophrenia

Acute Psychotic Episode

Mood Disorder + Psychosis

Drug-induced psychosis

Schizoaffective disorder

Delusional disorder

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33
Q

Give 6 organic causes of psychosis

A

Drug induced/iatrogenic medication

Delirium

Dementia

Endocrine disturbances - Cushing’s, Hyperthyroidism,

Metabolic disturbances - B12 deficiency

Neurosyphyllis

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34
Q

Which drugs can cause psychosis? (recreational and iatrogenic please)

A

Recreational - Cannabis, cocaine, alcohol [withdrawal], LSD

Iatrogenic - Steroids, dopamine agonists e.g. Methyldopa, anti-malarial

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35
Q

How could you differentiate non-organic causes of psychosis?

A

Look for other symptoms e.g….

Schizoaffective – presence of a mood disorder too. This psychosis is mood congruent!

Mood disorders + Psychosis – depression or mania symptoms also present

Puerperal – there will be a baby about (usually happens within first 2 weeks of birth)

Delusional disorder – single/set of delusions for >3 months. Usually persecutory, grandiose, hypochondriacal. No hallucinations or thought disorder

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36
Q

What are Schneider’s first rank symptoms of Schizophrenia? (5)

A
  • Persecutory delusions
  • 3rd Person Auditory Hallucinations
  • Formal thought Disorder
  • Passivity phenomenon
  • Thought interference
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37
Q

What are the negative symptoms of schizophrenia? (6As)

A

Alogia

Apathy (blunted affect)

Anhedonia

Asocial behaviour

Avolition
(reduced motivation)

Attention
deficits

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38
Q

What are the hypothesised biological causes of Schizophrenia?

A

Dopamine hypothesis (overactivity of mesolimbic pathway - D2 receptors

Genetics (risk increases with FHx)

Obstetric complications, low birth weight

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39
Q

What are the environmental risk factors for the development of Schizophrenia?

A

Psychological stressors

Migrant status

Urban living

Substance misuse (esp cannabis)

Low socioeconomic status

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40
Q

What are 4 poor prognostic factors for Schizophrenia?

A

Strong FHx
Gradual onset/long prodromal phase

Lower IQ

No obvious precipitating factor

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41
Q

What are the bedside investigations when a patient presents with Psychosis and why?

A

Causative Factors = Urine drug test (rule out psychosis)

Factors affecting management = ECG (Antipsychotics can cause prolonged QT)

Weight/BMI - APs cause metabolic syndrome

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42
Q

What are the blood tests to investigate causative factors for psychosis?

A

TFTs (hyperthyroidism)

Serum Calcium (Hypocalcaemia)

B12 and Folate (deficiency can cause neuropsychiatric symptoms)

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43
Q

What are the blood tests that will aid management options in a patient presenting with psychosis?

A

FBC - baseline for anaemia or infection

HbA1c and Cholesterol = Atypical APs cause metabolic syndrome

U&E and LFT – check function before starting

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44
Q

What is the biological management of Schizophrenia/psychosis?

A

Atypical Antipsychotics e.g. Risperidone or Olanzapine. Clozapine for treatment resistant.

Adjuvant Benzodiazepines (agitation)

ECT – catatonia is an indication

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45
Q

What is the psychological management of Schizophrenia/psychosis?

A

CBT can reduce residual symptoms

Family intervention + psychoeducation

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46
Q

What is the social management of Schizophrenia/psychosis?

A

Support groups - Referral to Early Psychosis Team if first presentation

Support worker

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47
Q

What is the definition of an affective disorder?

A

Any condition characterized by distorted, excessive or inappropriate moods/emotions for a sustained amount of time

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48
Q

What is the definition of a depressive disorder?

A

An affective disorder characterized by persistent low mood, loss of pleasure and/or lack of energy ALONG WITH emotional, cognitive and biological symptoms

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49
Q

What are the 3 core symptoms of depression?

A

Anhedonia

Low energy

Low mood (for at least 2 weeks)

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50
Q

What are 5 biological symptoms of depression?

A

Diurnal Variation of Mood (mood worse in morning)

Early morning wakening (2 hours before normal and can’t get back to sleep)

Loss of libido

Loss of appetite +/- weight

Psychomotor retardation

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51
Q

What are 3 cognitive symptoms of depression?

A

Poor concentration/memory

Suicidal ideation

Negative thoughts (beck’s cognitive triad)

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52
Q

What is the criteria for a mild depression (ICD-10)?

A

2 core symptoms + 2 other symptoms

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53
Q

What is the criteria for a moderate depression (ICD-10)?

A

2 core symptoms + 3-4 other symptoms

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54
Q

What is the criteria for a severe depression (ICD-10)?

A

3 core symptoms + >4 other symptoms

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55
Q

What is the criteria for a severe depression + psychosis (ICD-10)?

A

3 core symptoms + >4 other symptoms + psychosis

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56
Q

What are the modifiable risk factors for depression? (5)

A

Poor coping

Stress

Low socioeconomic status

Unemployment

Substance misuse

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57
Q

What are the non-modifiable risk factors for depression? (4)

A

Female

Fix

Personality Type

Neurotransmitter imbalance

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58
Q

What are the bedside tests to do when investigating depression and why?

A

ECG - Sertraline can prolong QT

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59
Q

What are the blood tests to do when investigating depression and why?

A

TFTs (rule out hypothyroid)

Calcium (rule out hypocalcaemia)

FBC (rule out anaemia)

U&E, LFT (baseline)

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60
Q

What are 2 diagnostic questionnaires for depression?

A

PHQ-9

Hospital Anxiety and Depression Scale (HADS)

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61
Q

What is the biopsychosocial management of MILD depression?

A

Bio - antidepressant not routinely offered

Psycho - Low intensity psychosocial intervention e.g. CBT. (Let’s talk Leicester)

Social - Support groups, physical exercise programme

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62
Q

What is the biopsychosocial management of MODERATE depression?

A

Bio - Antidepressant

Psycho - High intensity psychosocial intervention (see therapies)

Social - Support groups

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63
Q

What is the biopsychosocial management of SEVERE depression?

A

Bio - Try other ADs or an adjuvant e.g. Lithium. ECT (treatment resistant depression/ with psychosis)

Psycho – Assess risk
Psych referral if risk is high, depression is severe or recurrent or no response to treatment

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64
Q

What is the definition of Bipolar Affective Disorder?

A

A chronic, episodic mood disorder characterized by at least one period of elevated mood (mania) and a further episode of mania or depression (can also be hypomania).

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65
Q

What are the biological symptoms of mania?

A

Increased appetite

Reduced sleep (*)

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66
Q

What are the cognitive symptoms of mania?

A

Increased irritability

Delusions (grandiose usually)*

Flight of ideas*

Easily distracted*

Impaired insight

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67
Q

What are the behavioural symptoms of mania?

A

Disinhibition (*) - sexually, socially, spending

Elevated mood*

TALKATIVE/Pressure of speech*

Restless*

‘marked’ sexual energy

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68
Q

What are the non-modifiable risk factors for BPAD?

A

Fix

Age (~19)

BAME Ethnicity

Neurochemical imbalances (Monoamine hypothesis)

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69
Q

What are the modifiable risk factors for BPAD?

A

Substance misuse

Stressful live events

Postpartum

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70
Q

What is the diagnostic criteria for BPAD?

A

At least TWO episodes of significantly disturbed mood

One has to be MANIA or HYPOMANIA

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71
Q

What is the definition of hypomania?

A

Mildly elevated mood/irritable for more than 4 days

Symptoms are present but to a lesser extent

Interferes with NDAs but not severely

Might still have insight

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72
Q

How long do symptoms have to be present for to diagnose mania?

A

Over 1 week

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73
Q

What is bipolar 1?

A

Periods of SEVERE mood episodes

Can be mania or depression

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74
Q

What is bipolar 2?

A

Milder form so get hypomania that alternates with periods of severe depression

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75
Q

What is rapid cycling?

A

More than 4 mood swings in a 12 month period

No asymptomatic periods in between

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76
Q

What investigations should be done for a patient presenting with mania/depression/bpad?

A

Bed - Urine drug test – illicit drugs can mimic mania

Bloods:
Baselines: U&Es (for starting Lithium), LFTs (for starting mood stabilisers), FBC

Rule out other differentials: TFTs, Calcium, Glucose

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77
Q

What is the short term biological management of BPAD?

A

An antipsychotic.

Benzos can be used for sleep/agitation

ECT can be used if severe and unresponsive

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78
Q

What is the long term biological management of BPAD?

A

Lithium 4 weeks after resolution of an acute episode

Can consider Valproate or Olanzapine if no response

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79
Q

What is the psychological management of BPAD?

A

High intensity CBT (only depression)

Psychoeducation

Self-help – recognizing symptoms of relapse

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80
Q

What are 3 really important things to remember when managing BPAD?

A

Inform DVLA as cannot drive within 3 months of an acute manic episode

Don’t use antidepressants by themselves if presenting with severe depression as can make them swing the other way

Valproate absolutely contraindicated in women of child bearing age. Lithium can be monitored during pregnancy but contraindicated in breastfeeding

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81
Q

What is the CALMER mnemonic for managing BPAD?

A

C onsider hospitalisation (section)

A typical antipsychotic

L orazepam

M ood Stabiliser (Teratogenic)

E CT

R isk

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82
Q

What are SSRIs? What is their indication and method of action?

A

Selective Serotonin Reuptake Inhibitor

Block 5HT3 reuptake into pre-synaptic neurone = increasing amount of serotonin in synaptic cleft

Depression, panic disorder, social phobia,, OCD, PTSD

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83
Q

What are the side effects of SSRIs?

A

GI

STRESSS:
Sweating
Tremor
Rashes
Extrapyramidal SE
Sexual dysfunction
Suicidal Ideation
Somnolence (drowsy)
84
Q

Give 4 cautions when using SSRIs? And 1 absolute contraindication

A

Cautions: Cardiac disease, Acute angle closure glaucoma, breast feeding, using with other drugs that cause GI bleeds

Absolute CI: MANIA/Hx OF MANIA

85
Q

What is serotonin syndrome?

A

Rare but life threatening condition due to increased serotonin activity

Happens within minutes

Usually SSRIs but also TCAs or Lithium

86
Q

What are the clinical features of serotonin syndrome?

A

Cognitive - agitation, confusion, hallucinations

Autonomic - sweating, tachycardia, hyperthermia, hypertension

Somatic - Myoclonus, hyperrelfexia, tremor

87
Q

What is the management of serotonin syndrome?

A

Stop the drug

Supportive

88
Q

Which SSRI should be prescribed if the patient has a history of cardiac disease/post MI?

A

Sertraline

89
Q

Which SSRIs should NOT be prescribed in a person with a history of cardiac disease/QT prolongation?

A

Citalopram

Escitalopram

90
Q

Which drugs should not be prescribed alongside SSRIs?

Think bleeding

A

NSAIDs (give a PPI as well if you have to)

Warfarin
Heparins

91
Q

What is an SNRI? Give 2 examples

A

Selective Noradrenaline Reuptake Inhibitor

Venlafaxine
Duloxetine

More rapid onset + more effective

92
Q

What is the mechanism of action of SNRIs?

A

Prevents noradrenaline and serotonin reuptake but do not prevent acetylcholine reuptake

93
Q

In which group of patients should SNRIs be avoided?

A

Cardiac disease
Uncontrolled hypertension

Have to do BP before starting

94
Q

What is a NASSA? Give an example

A

Noradrenaline Serotonin Specific Antidepressant

Mirtazapine

95
Q

What is the MOA of a NASSA?

A

Weak inhibition of noradrenaline reuptake

Anti-histaminergic (sedating and increases appetite)

A1 and A1 blocker

96
Q

In which group of people is Mirtazapine a good option for?

A

Those who need to gain weight or need help with sleeping

97
Q

What are the side effects of Mirtazapine?

A

Increased appetite/weight gain

Drowsy

Postural hypotension

Abnormal dreams

98
Q

What is a TCA? Give some examples

A

Tri-cyclic antidepressant

Amitriptyline, Nortriptyline

99
Q

What is the MOA of TCAs?

A

Inhibit adrenaline, serotonin reuptake

Also have cholinergic and 5HT2 affinity

100
Q

What are the side effects of TCAs?

A

Anticholinergic - can’t see, can’t wee, can’t shit, can’t spit

CVS - arrhythmias, postural hypotension

Weight gain

Dyskinesia?

101
Q

What are contraindications to TCA use?

A

Cardiac disease - recent MI, arrhythmia

Liver disease

Agranulocytosis

102
Q

Which foods should be avoided if taking an MOAI? What are the signs if someone has been eating these?

A

Tyramine rich foods e.g. cheese, marmite, red wine

Can cause a hypertensive crisis - headache, fever, convulsions

103
Q

What is the difference between a typical and atypical antipsychotic?

A

Mainly the extent to which they cause EPSE (typical are more likely)

104
Q

What are some examples of typical antipsychotics?

A

Haloperidol

Zuclopenthixol

Chlorpromazine

105
Q

What are some examples of atypical antipsychotics?

A

Risperidone

Olanzapine

Quetiapine

Aripriprazole

Clozapine

106
Q

When should clozapine be prescribed?

A

If there has been no response to two other antipsychotics

107
Q

What is the MOA of antipsychotics?

A

Antagonise D2 receptors = reducing dopamine transmission (typical)

Atypical also acts on other receptors e.g. serotonergic receptors

108
Q

What are 2 side effects that are specific to clozapine?

A

Agranulocytosis

Hypersalivation

109
Q

What are the extrapyramidal side effects?

A

PAD-T

Within weeks:
Parkinsonism
Akathisia (restlessness)
Dystonia (acute, painful muscle spasms)

Tardive dyskinesia (lip smacking/chewing - longer term use)

110
Q

What are 3 contraindications to antipsychotic use?

A

CNS depression, phaeochromocytoma, comatose state

111
Q

What is neuroleptic malignant syndrome?

A

Rare but life threatening condition seen in patients taking an antipsychotic/ dopaminergic drugs e.g. levodopa

more common in young males and typical AP use

112
Q

What are the clinical features of NMS?

A

within 10 days of starting

Pyrexia, muscle rigidity, autonomic instability

Bloods: Raised CK, Leucocytosis (maybe), Deranged LFTs

113
Q

What is the management of NMS?

A

Stop drug and supportive - fluids, cooling

Can give dantrolene or bromocriptine

114
Q

What are 3 complications of NMS?

A

PE

Renal failure

Shocl

115
Q

What are 4 cautions when using antipsychotics?

A

Parkinsons

Cardiovascular disease

Epilepsy

Myasthenia graves

116
Q

Which blood tests should be done prior to starting an Antipsychotic?

A

FBC, U&E, LFT (baseline)

Fasting blood glucose , cholesterol (atypicals cause metabolic syndrome)

?prolactin

Baseline CK

117
Q

Which bedside tests should be done prior to starting an Antipsychotic?

A

ECG - looking for QT prolongation

Blood pressure

BMI/weight (metabolic syndrome)

118
Q

What is a depot and what are the advantages?

A

Long acting, slow release antipsychotics given IM every 1-4 weeks

Improve adherence e.g. if not complying
Bypass first pass metabolism

flupenthixol, zuclopenthixol, risperidone, olanzapine, aripriprazole = examples

119
Q

What are 3 side effects of atypical antipsychotics?

A

Weight gain

T2DM

More likely to cause stroke in elderly

120
Q

What are the indications for the use of Lithium?

A

Long term management of Bipolar/ prophylaxis of Mania

Can also be used for prophylaxis of recurrent depression

Start 4 weeks after an acute episode

121
Q

What are the NORMAL side effects of Lithium? (6)

A

Fine tremor

Polydipsia, Polyuria, Oedema (Lithium is a SALT)

Weight gain

Teratogenic (in 1st Trimester)

Impaired Renal Function

Hypothyroidism

122
Q

What are the signs of lithium toxicity?

A

Coarse tremor

N&V

Ataxia

Muscle weakness

123
Q

What are the signs of severe lithium toxicity?

A

Nystagmus

Dysarthria

Hyperreflexia

Oligura

Hypotension

124
Q

How should mood stabilisers be managed during pregnancy?

A

Seek expert advice

Reduce Valproate gradually over 4 weeks

Monitor Lithium levels during pregnancy? BUT contraindicated in breastfeeding

125
Q

Which investigations should be done before starting lithium? What is important to remember?

A 
Pregnancy Test
Baseline ECG (QT Elongation)

Bloods
U&E
LFT
TFTs

Lithium has a really narrow therapeutic window so needs close monitoring!

126
Q

What is ECT?

A

The passage of a small electrical current through the brain with a view to inducing a modified epileptic seizure which is therapeutic.

Used under general anaesthetic and with a muscle relaxant

127
Q

What are the indications for ECT?

A

ECT

Euphoria – prolonged or severe mania

Catatonia

Tearfulness – treatment resistant depression, serious risk to self or others, life threatening depression e.g. refusing to drink

128
Q

What are the contraindications to ECT?

A

MARS

MI (<3 months) or major unstable fracture

Aneurysm (cerebral)

Raised ICP (absolute CI)

Stroke (<1 month), Severe anaesthetic risk, Hx of Status Epilepticus

129
Q

What are the short term effects of ECT?

A

PC DAMS

Peripheral nerve palsies
Confusion
Dental trauma
Anaethetic risk
Muscle/headaches
Short term memory loss
130
Q

What are the long term effects of ECT>

A

Anterograde and retrograde amnesia

131
Q

What is the Mental Health Act?

A

The Mental Health Act is a law that allows people with a mental disorder** (Important) to be admitted to hospital, detained and treated without their consent (sectioned) either because they are a risk to themselves or a risk to others.

Excluded if under the influence

132
Q

What is a mental disorder defined as?

A

Any disorder or disability of the mind

DOES NOT include dependence on drugs/alcohol

133
Q

When should the MHA be used?

A

REVISE OUR MHA

Refusal of voluntary treatment
Other options not appropriate
Mental disorder
Harm (risk)
Appropriate treatment available
134
Q

Describe section 2 of the MHA

A

Admission, assessment, and response to treatment

Lasts for 28 days

Can appeal to a tribunal within the first 14 days

135
Q

Describe section 3 of the MHA

A

Already known to MH services/have a diagnosis/following admission under S2

Lasts 6 months

Can appeal to a tribunal only once within the 6 month period can be done again if the section is renewed

Can be treated without consent for 3 months (get a 2nd opinion after)

136
Q

Who can put a section 2 or 3 in place?

A

An Approved Mental Health Practitioner (AHMP) or nearest relative (rarely)

On the recommendation of 2 approved clinicians (at least 1 has to be a section 12 approved doctor)

137
Q

Where can a section 2 or 3 be put in place?

A

Place of safety or hospital

138
Q

Describe a section 5(2)

A

Urgent detention of an inpatient on any ward (BUT NOT A&E!!)

Assessed for an S2 or S3 or discharge + admittance as an informal pt

Can’t appeal

139
Q

Who can put a section 5(2) in place?

A

An ‘approved clinician’

Usually a doctor but can be other things

140
Q

Where can a section 5(2) be put in place?

A

Any ward

BUT NOT A&E REMEMBER THIS BECAUSE YOU GOT IT WRONG IN EOY3

141
Q

Describe a section 5(4)

A

Urgent detention of an inpatient for up to 6 hours

Inpatient is already being treated for a mental disorder in hospital

142
Q

Who can put a section 5(4) in place

A

An ‘approved clinician’

A registered mental health nurse can put in place if a doctor can’t attend immediately

143
Q

Where can a section 5(4) be put in place?

A

Hospital

144
Q

Describe a section 135

A

Allows a police officer to enter a person’s property if they are suspected to be suffering from a mental disorder, in order to take them to a place of safety

145
Q

Describe a section 136

A

Allows a police officer to remove someone from a public place if they are suspected to be suffering from a mental disorder, in order to take them to a place of safety

146
Q

Describe a section 117

A

Free aftercare given following a section 3

147
Q

What is a Community Treatment Order?

A

Allows pts on Section 3 to leave an inpatient facility if they are well enough to do so.

Can be recalled if they do not comply upon which they can be detained for up to 72 hours

Can’t enforce treatment on them within the community

148
Q

What are the features of Parkinsonism?

A

Tremor

Bradykinesia

Rigidity

Shuffling gait

149
Q

What is akathisia?

A

Restlessness

150
Q

What is dystonia?

A

Painful muscle spasms in face, neck, jaw and eyes*

Eyes = oculogyric crisis

151
Q

What is tardive dyskinesia?

A

Abnormal, involuntary movements e.g. chewing/pouting

152
Q

Why may antipsychotic use cause lactation/hyperprolactinaemia?

A

Dopamine inhibits Prolactin

SO giving a dopamine antagonist removes the inhibition on prolactin

= ↑ prolactin
(hyperprolactinaemia) which causes lactation

153
Q

What is the definition of a personality disorder?

A

A deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture.

It is pervasive and inflexible, has an onset in early adulthood and is stable over time, leading to distress or impairment.

Pervasive, persistent, problematic

154
Q

What are the non-modifiable risk factors for PD?

A

family history

155
Q

What are the modifiable risk factors for PD?

A

Environment - malattachement, abuse/neglect

Social - low socioeconomic status

156
Q

What are the cluster A PDs?

A

Weird

Paranoias, schizoid, schizotypal

157
Q

What are the cluster B PDs?

A

Wild

EUPD

Antisocial

Histrionic

158
Q

What are the cluster C PDs?

A

Worried

Dependent

Avoidant

Anankastic/obsessional

159
Q

What is the biopsychosocial management of PDs?

A

Bio - symptom management. not really much you can do otherwise.

Psycho - Dialectial Behavioural Therapy (DBT), CBT, IPT, Psychodynamic Psychotherapy

Social - manage comorbidities, risk asses + crisis plan. Find them something that makes them feel good about themselves

160
Q

Describe the paranoid PD

A

Irrational suspicion and mistrust of others

Interpret motivations as malevolent.

161
Q

Describe the schizoid PD

A

Lack of interest and detachment from social relationships

apathy

restricted emotional expression

162
Q

Describe EUPD

A

More common in women

Self harm V common, as are several suicide attempts

Impulsive behaviours V common e.g. substance abuse, “indiscriminate sex”, reckless spending

Chronic emptiness

Fear abandonment

Intense and unstable relationships

163
Q

Describe antisocial PD?

A

More common in men than women

Callous, blame others, remorseless, impulsive, violent tendencies

Often co-morbid with other things like:
Substance abuse
Poor reading
Really common amongst people in prison!

164
Q

Define anxiety

A

An unpleasant emotional state involving SUBJECTIVE fear and somatic symptoms

165
Q

How can the types of anxiety be categorised?

A

Paroxysmal > situation dependent > phobic (specific, agoraphobia, social phobia)

Paroxysmal > situation independent > panic

Continuous > Generalised anxiety disorder

166
Q

Describe generalised anxiety

A

Symptoms present most of the time and aren’t situation/stimulus specific

Excessive worry about normal things

Long duration

167
Q

Describe the common features of paroxysmal anxiety disorders

A

Abrupt onset of discrete episodes

Episodes are severe and have strong autonomic symptoms

Short duration usually with a stimulus/trigger

168
Q

What is the definition of GAD?

A

A syndrome of ongoing, uncontrollable and widespread worry about events/thoughts that pt recognises as excessive/inappropriate

Symptoms present on most days for at least 6 months

More common in females

169
Q

What are 3 predisposing factors for GAD?

A

Genetics/FHx

Living alone

High achieving personality

170
Q

What are 3 precipitating factors for GAD?

A

Stressful life events

Unemployment

Relationship problems

171
Q

What are 3 maintaining factors for GAD?

A

Living alone

Stress

Ways of thinking

172
Q

Give 5 common features of GAD

A

Excessive worry

Autonomic hyperactivity

Restlessness

Sleep disturbance

Muscle tension

173
Q

What is the biopsychosocial management of GAD?

A

BIO = SSRI (sertraline as is also anxiolytic)

Psycho = CBT, mindfulness

Social = Support, self help, exercise!

174
Q

Define a phobia

A

An intense, irrational fear of an object/situation/place that is recognised as disproportionate or unreasonable

175
Q

What is agoraphobia?

A

Fear of public spaces/entering public spaces from when immediate escape would be hard

176
Q

What is social phobia?

A

Fear of social situations which may lead to humiliation, criticism or embarrassment e.g. speaking to a crowd

177
Q

What do social phobia, specific phobia and agoraphobia all have in common?

A

Avoidance is a very common feature

178
Q

What are some clinical features of phobic anxiety disorders?

A

Autonomic response - tachycardia, vasovagal +/- syncope

Tight chest, breathing fast, feeling of impending doom

Psycho = anticipatory anxiety, can’t relax, avoidance, fear of dying

179
Q

What is the general management of phobic anxiety disorders?

A

Bio - SSRI (escitalopram or sertraline). Benzo (not long term)

Psycho - CBT +/- exposure, psychodynamic

Screen for substance misuse

180
Q

What is panic disorder?

A

Recurrent, episodic and severe panic attacks

These attacks are unpredictable and do not have a trigger

181
Q

What are the symptoms of a panic attack?

A

PANICS D

Palpitations
Abdo symptoms
Numb/nausea
Intense fear of death
Choking feeling
Sweating/short of break
Depersonalisation/derealisation

Crescendo within a few minutes then reaches peak

182
Q

What is the general management of panic disorder?

A

Bio - SSRI (no improvement after 12 weeks = stop). Not Benzos.

Psycho - CBT (focus on triggers). Psychoeducation. Mindfulness.

Social - self help. exercise. support groups

183
Q

Define PTSD

A

An intense, prolonged, delayed reaction following exposure to a particularly traumatic event

184
Q

Define an acute stress reaction

A

An abnormal reaction to sudden stressful events. Symptoms same as PTSD but have an immediate onset and diminish after ~48 hours

185
Q

Define adjustment disorder

A

Significant distress and impaired social functioning when adapting to new circumstances

symptoms within one month of event

have to be present for 6 months

186
Q

What are the 4 main features of PTSD?

A

Reliving - flashbacks, nightmares, distress in similar situations

Avoidance - rumination, can’t recall specific details

Hyperarousal - irritability, jumping at loud noises, hyper vigilance, can’t concentrate

Emotional numbing - detached, anhedonia, negative thoughts about oneself

187
Q

What are the stages of grief?

A 
Denial
Anger
Bargaining
Depression
Acceptance
188
Q

How should PTSD be managed within 3 months of the trauma?

A

Watchful waiting + risk assessment

Manage sleep (zopiclone)

189
Q

How should PTSD be managed after 3 months since the trauma?

A

Trauma focussed psychological intervention e.g. CBT, eye movement desensitisation and reprocessing (EMDR)

Paroxetine, mirtazapine, amitryptiline

190
Q

What characterises OCD?

A

Recurrent obsessional thoughts and compulsive acts

191
Q

Define an obsession

A

Unwanted, intrusive thoughts/images/urges that repeatedly enter the individual’s mind

They are distressing for the individual who also recognises them as egodystonic (absurd) and a product of their own mind

Then tries to resist them

192
Q

Define a compulsion

A

Repetitive, stereotyped behaviours/mental acts that a person feels driven into performing

Do not bring pleasure, more relief

Covert or overt

193
Q

Roughly, what is the ICD-10 criteria for OCD?

A

Obsessions and/or compulsions present on most days for at least 2 weeks

Obsessions/compulsions share a number of features (see features card) ALL have to be present

Cause distress/interfere with ADLs

194
Q

Which features must obsessions and compulsions show?

A

FORD CAR

Failure to resist
Originate from patient’s mind
Repetitive
Distressing (but acknowledged as unreasonable)

CARrying out the obsessive thought is not pleasurable but reduces anxiety

195
Q

What is the management of mild OCD?

A

Low intensity psychological intervention (exposure with response prevention)

196
Q

What is the management of moderate OCD?

A

SSRI (fluoxetine, paroxetine, sertraline, citalopram)

or High intensity psychological intervention (ERP)

197
Q

What is the management of severe OCD?

A

SSRI + CBT+ERT

198
Q

Define anorexia nervosa

A

An eating disorder characterised by (FEEDD):

Fear of weight gain
Endocrine disturbances e.g. amenorrhoea
Emaciated appearance
Deliberate weight loss
Distorted body image
199
Q

What are the physical effects of anorexia nervosa?

A

Fatigue

Hypothermia

Electrolyte imbalances - hypokalaemia, hyponatraemia

peripheral oedema due to hypoalbuminaemia

200
Q

What is refeeding syndrome?

A

A life-threatening syndrome that results from food intake following a period of prolonged starvation/malnourishment

Caused by a spike in insulin = protein and glycogen synthesis = increased electrolyte uptake

Leads to Hypokalaemia, hypophosphataemia, hypomagnesiumaemia, thiamine deficiency

201
Q

What are the features of Bulimia Nervosa?

A

BULIMIA

Binge eating
Use of drugs to prevent weight gain/purging 
Low K
Irregular periods
Mood disturbance
Irrational fear of being fat
Alternating periods of starvation
202
Q

Define substance abuse

A

Frequent/excessive use of a substance for a non-medical reason

Consumption of the substance to a harmful level without the compulsion to repeatedly to do so

Impairs daily functioning e.g. relationships

203
Q

Define addiction

A

Inability to consistently abstain from consuming a substance (or an activity e.g. gambling)

Impairs behavioural control

Have cravings

Loss of insight

Dysfunctional emotional response

204
Q

What are the signs of alcohol withdrawal within 6-12 hours?

A

Tremor, sweating, tachycardia, anxiety

205
Q

What are the signs of alcohol withdrawal at around 36 hours?

A

Seizures

206
Q

What are the signs of alcohol withdrawal at around 72 hours?

A

Delirium Tremens (coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)

EOY4 (22 decks)

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