Psych Flashcards
What is the term given to someone with a fear of outdoor spaces
Agoraphobia
What sleep disturbance do you classically see in depression
EMW
Give 4 types of bipolar
Type 1
Type 2
Rapid cycling
Cyclothemia
How many cycles would someone with rapid cycling bipolar have in a year
4+
First line tx for self harm
DBT
What are the 3 key features of mania
IHE
Irritability
Hyperactivity
Elated out of context
Definition of delusion
A fixed unshakeable belief, out of context of religious and cultural norms, that is held in the face of evidence
Name the two MHA police orders and when they are applied
S13– need a house warrant
S136-in community/ a&e, hold for 24hrs (+12)
What sleep disturbances do you see in GAD
Insomnia, struggle to get to sleep + wake lots in the night
How long do you ha e to have had depressive symptoms for to get a diagnosis
2weeks
How long do you have to have had manic symptoms for to get a diagnosis of mania
1week
How long do you have to have hypomanic symptoms for to get a diagnosis of hypomania?
4days+
What are the causes of lithium toxicity
Dehydration- any cause for this
Excessive intake
Decline in renal function
Drug interactions
Complications of lithium toxicity
Induction of Serotonin syndrome
Nephrogenic diabetes insipidus
Coma
Death
Before starting lithium what tests do you need to do:
Preg test
Renal function test
Thyroid function test
What advice would you give to someone starting lithium
Stay hydrated
Don’t restrict salt intake
Carry lithium card
Lithium toxicity symptoms
Tremors hyperreflexia Ataxia Nystagmus Inability to concentrate urine
Sign - hypothyroidism
Core features of PTSD
Reliving experiences
Hyper vigilance
Avoidance
Due to traumatic event - occurs w/in 6 months
Symptoms of anxiety
Sweating
Palms/tachyC
HyperV
May go on to vomit/ pass out
Sign- wringing hands
(Enhanced startle response, difficulty concentrating)
Treatment for anxiety
Propanalol / benzos for tachyC
SSRIs- paroxetine/ fluoxetine
SSNRI- venlaflaxine
Mirtazapine - more sedating antiD
Psychological- CBT exposure techniques (graded or flooding) In PTSD - trauma focussed CBT Breathing techniques Mm relaxation techniques
What are the characteristics of OCD
Obsessional thoughts and compulsive acts
They have insight but feel compelled
What is meant by blunted affect
Reduced emotional responsiveness
What is meant by flat affect
No emotional responsiveness
What is psychoanalysis
Opening the pt up to ideas about themself
What is the difference between OCD and OCPD?
OCPD- perfectionism, not aware their habits are detrimental, think others should function the same. Harsh super ego. Ego-syntonic
OCD - aware their actions are irrational and are distressed by it , ego dystonic
Define ego
Ones self that bridges between conscious and unconscious though
Define dystonic (such as ego-dystonic)
Responses and behaviours are against a persons beliefs and will
Inconsistent with ones self concept
What is meant by egosyntonic
Responses and behaviours are in keeping with the needs and goals of the ego, consistent with ones ideal self image
Treatment of lithium toxicity
Hydration.
Stop lithium
Hemodialysis
Symptoms of serotonin syndrome
Altered mental state - irritable, confused,manic
Autonomic dysfunction- bp, tachyC, hypothermia,diarrhoea
NM hyperactivity- tremor, hyperreflexia, (myo)clonus
What class of antidepressants give rise to anticholinergic SEs - name two
TCAs - amitriptylin, imipramide
What life threatening SEs does clozapine have. How are they monitored
Agranulocytosis- blood tests
Myocarditis - annual ecg
What is clozapine used to treat
Treatment resistant schizophrenia ( have to have tried 2APs at a reasonable dose prior)
SEs of olanzapine
Metabolic SEs
Increase cholesterol and glucose - diabetic risk
What syndrome are you at risk of when you take lamotragine ?
Steven Johnson’s syndrome
Which APs require hepatic monitoring
Carbamazepine
Na valproate
MH illness+ fever + APs is a combination for what syndrome
Neuroepileptic syndrome
MH illness + fever + ssris are a combination for what syndrome
Serotonin syndrome
How to pharmacologically treat an acute depressive crisis
SSRI-citalopram
AP- olanzapine
Benzo- lorazepam
What is the classic picture of vascular dementia
Vasculopath
Stepwise decline
Executive function is first to go
What dementia is it likely to be in a younger person who has personality changes
Frontotemporal
How would you investigate FT dementia
SPECT - see reduce bf to frontal and temporal areas
Give the classic symptoms of Alzheimer’s
Short term memory problems Losing things Forgetting names / appts/ convos Getting lost Pacing Word finding difficulties
What area of the brain is damaged in Alzheimer’s
Hippocampus
Name 3 ACEi drugs used to tx mild to mod Alzheimer’s
Rivistigmine
Galantamine
Donepezil
Name a NMDA R antagonist used to tx severe Alzheimer’s
Memantine
SE of ACEi Alzheimer’s meds’
N&V
Classic symptoms of Lewy body Alzheimer’s
Visual hallucinations (M symps come after)- stuffing gait (don’t confuse w/ Parkinson’s dementia
Classic symptom of Parkinson’s dementia
Emotional liability
(1/3 of PD pts )
(Have to have had motor symps for a year before)
What illness is pseudo-dementia commonly seen in
Severe depressive disorder
Two key features of pseudo dementia
Are aware their memory is rubbish (insight)
Respond to ADs
What medication must you not give in Alzheimer’s w/ Lewy bodies ?
APs - as can precipitate movement disorders
How many points is the ACE out of and what is the cut off?
/100
Cut off 85
How many points is the mini ACE out of and what’s the cut off score?
/30
Cut off 21
How many points is the mmse out of and what are the cut offs?
/30
Severe dementia = <12
Moderate = 13-20
Severe = 21-24
What is Capgras syndrome
That someone they know is being replaced by an imposter
Fregoli syndrome
That a stranger is someone they know in disguise
What is De clerabaults syndrome
That someone at a higher role in society is I love with them
Cotards syndrome
A person believes they are dying/ dead/ putrefying I.e. have lost all their blood
Charles bonnet syndrome
Complex visual hallucinations in pts with visual impairments - pt has insight
3 differences between EUPD and BAD
High and low moods occur within a day in EUPD.
Impulsivity is in high and low moods in EUPD but only in high moods in BAD
EUPD doesn’t have manic episodes
Tx EUPD w/ DBT tx BAD w/ CBT
What are the features of EUPD
Devo quick and strong attachments/ strong sense of abandonment
Self harm
Impulsivity
Mood swings
Inner subjective space voices
Two types of EUPD
Boarderline
Impulsive
What psychological interventions would be appropriate for someone with EUPD
DBT to teach coping mechanisms
Mentalisation based therapy (MBT)
Cognitive analytic therapy
What psychological therapy would be appropriate for someone with dementia
CST
Cognitive stimulation therapy
How does MBT work?
encourages pt to think what other people feel and think so they feel less persecuted by others
How does cognitive analytic therapy work in EUPD
It teaches pt about helpful and unhelpful relationships
What is attachment theory
It is a psychological theory regarding relationships between humans. Young children need to develop a relationship with at least one primary care giver for normal social and emotional devo
What are the three types of attachment someone can develop
Secure
Insecure
Disorganised
Name two chemicals in the brain that are altered during trauma
Cortisol
Adrenaline
How does repeated trauma cause illness
High cortisol levels lower the immune system
Why is memory altered in repeated trauma
Stress can inhibit neurogenasis
What areas of the brain are affected by repeated trauma
Hippocampus, medial prefrontal cortex, HPA axis, amygdala
Differentials for bipolar
Cyclothemia
Schizoaffective disorder
EUPD
What is the DSM-IV criteria for T1 bipolar
Hx of 1+ manic episodes, 4+ symps of mania lasting over 1 week giving marked functional impairment/ hospitalisation
What is the DSM-IV criteria for T2 bipolar
1+ depressive episode (lasts for 2w and occurs most days) 1+ hypomanic episode
Symptoms are not attributed to a physical illness or induced by a drug
How does CBT work
Helps identify harmful thought patterns and behaviours
What is the term for when a person places too much importance on a normal stimulus
Delusions of reference
Mr X has heard his neighbours talking about him inside their house between themselves
3rd person auditory hallucinations
What is a delusional perception
A two stage process where you first perceive a stimulus then a delusion develops around it
What is passivity phenomena and what illness is it commonly seen in
Where a persons thoughts or actions are influenced or controlled by an external agent
Schizophrenia
What are the schneiderian first rank symptoms of schizophrenia
3rd person auditory hallucinations
Thought alienation - I, W, B
Delusion of control-Passivity phenomena (inc somatic passivity)
Thought disordered
Why do an ECG when someone is on APs
APs can cause long QT syndrome
Psychiatric Differentials for schizophrenia
Acute/transient psychotic episode
BPD+ psychotic symps
Delirium
Dementia
Mood disorders :
BAD+ psychotic symps
Depression + psychotic symps
Schizoaffective disorder
How long do schizo fist rank symptoms have to be present for for ICD10 diagnosis
1month
Organic differentials for schizo
V I- Steroids, l-dopa, anticholinergics T- trauma A- SLE M-b12 deficiency, heavy metal poisoning, thyrotoxic storm I- encephalitis, HIV, neuro syphilis N- Brain tumour/ mets C
+ drugs (cannabis) and alcohol
Treatment for first acute manic episode
Antipsychotic
Core symptoms of mania
Elated
Irritability
Hyperactivity
How long do you have to have symps of depression for a diagnosis
2w
How long do you have had to have had manic symptoms for for a diagnosis of mania
1w
What comorbidities might you have with depression
Anxiety
Bipolar
Addictive disorder
What are the most common causes of lithium toxicity
Dehydration
Decline in renal function
Drug interactions
What should you check before starting someone on lithium
Thyroid function
Pregnancy
Renal function
What is the cause of wernickes encephalopathy
Thiamine / B12 deficiency
What is the triad of wernickes encephalopathy
Ataxia
Confusion
Opthalamoplegia
What could be an organic cause for mania
Hyperthyroidism
