Psych Flashcards

Question

What are the longer term treatments used for bipolar disorder?

Answer 1

mood stabilisers - lithium, valproate, carbamazepine during pregnancy use antipsychotics

Answer 2

Quetiapine olanzapine (+/- fluoxetine) lamotrigine

Answer 3

``` L- leucocytosis I - insipidus diabetes (nephrogenic) T - tremors (if coarse, think toxicity) H - hydration I - increased GI motility U - underactive thyroid M - metallic taste, mums beware - teratogenic ``` Lithium + diuretics = beware dehydration Lithium + NSAIDs = beware kidney damage

Answer 4

``` weigth gain nephrotoxicity tremor diabetes insipidus hypothyroidism ```

Answer 5

``` dry mouth/extreme thirst strange movements very sleepy nausea and vomiting diarrhoea confusion ``` basically act like a drunk person

Answer 6

chronic, mildly depressed mood and diminished enjoyment not severe enough to be depression at least 2 years tx with SSRIs and CBT

Answer 7

``` Past psychiatric hx conflicting feelings about the pregnancy hx of abuse as a child USS showing foetal abnormalities low socioeconomic status lack of supportive relationships ```

Answer 8

psycholoigcal therapy | because if breastfeeding - antidepressants can have adverse effect on the baby

Answer 9

``` family hx/genetic link insult to brain development in early life smoking cannabis in adolescence severe childhood bullying socioeconomic depreivation adverse life events ```

Answer 10

dopamine excess - overactivity in mesolimbic and corticolimbic dopaminergic pathways

Answer 11

at least 1 first-rank symptom or at least 2 second rank symptoms for a duration of at least 1 month

Answer 12

3rd person auditory hallucinations (running comentary, hears people talking ABOUT them) thought disorder/alienation - broadcast, withdrawal, insertion, deletion passivity phenomenon - made to do or feel things against their will - as if someone is controlling their thoughts, feelings and actions

Answer 13

``` delusions 2nd person auditory hallucinations any other modality of hallucination formal thought disorder (words come out wrong becasue thoughts are muddled) catatonic behaviour negative symptoms ```

Answer 14

delusions hallucinations formal thought disorder

Answer 15

``` poverty of speech flat affect poor motivation social withdrawal lack of concerns for social conventions ```

Answer 16

poor attention and memory

Answer 17

``` schizophrenia schizoaffective disorder delusional disorder brief/acute psychotic episodes (if they last < 1 month, then not schizophrenia) drug induced psychosis SOL - brain tumour or abscess ```

Answer 18

diabetes/insulin resistance and dyslipidaemia QT segment changes on ECG agranulocytosis - clozapine extra-pyramidal side effects due to dopamine blockade urinary retention blurred vision weight gain hyperprolactinaemia (dopamine bloackade --> dopamine downregulates prolactin)

Answer 19

acute dystonia (hours) - muscle spasm, acute torticollis, eyes rolling back parkinsonism (days) - tremor, bradykinesia Akathisia (days to weeks) - inner restlessness, pacing and intolerable agitation tradive dyskinesia (months t years) - grimacing, tongue protrusion, lipsmacking

Answer 20

Procyclidine (anticholinergic)

Answer 21

general persistent, excessive worry about a number of different events individual finds the worry difficult to control for at least 3 weeks (ICD) or 6 months (DSM) no particular stimulus often comorbid with depression, substance misuse etc

Answer 22

``` alcohol use benzo use stimulants - esp if withdrawing co-existing depression family hx childhood abuse, neglect excessively pushy parents life stresses/events physical health problems ```

Answer 23

``` hyperthyroidism phaeochromocytoma lung disease - excessive use of salbutamol congestive heart failure - heart meds hypoglycaemia ```

Answer 24

``` unpleasant/fearful emotional state bodily discomfort physical symptoms - palpitations, tachycardia, sweating, tremor, chest pain, nausea, chills/hot flushes apprehension increased vigilance sleeping difficulties ```

Answer 25

conservative - individual self-help/self-help groups, CBT, applied relaxation therapy Medical - SSRIs or SNRIs, pregabalin, benzos, beta-blockers like propranolol for physical symptoms

Answer 26

physical - tachycardia, palpitations, sweating, dizziness, choking psychological - feel like they're going to die, impending doom, depersonalisation, derealisation, fear of losing control

Answer 27

genetics - FHx of OCD or tic disorder parental over-protection may occur after strep infection - PANDAS subtype - paediatric neuropsychiatric disorders associated with streptococci

Answer 28

``` time consuming (>1hr/day) bsessions and/or compulsions present most days for at least 2 weeks distressing and interfering with ADLs avoidance of the stimuli that trigger the symptoms ```

Answer 29

psychoeducation CBT - exposure followed by response prevention meds - SSRIs

Answer 30

Physical symptoms without physical explanation persistent for at least 2 yrs more common in women usually GI and skin complaints massive impact on daily functioning often results in multiple needless operations as they refuse to believe that there is no organic cause tx - excluding all organic illness

Answer 31

presents with neurological SIGNS (rather than symptoms) e.g. paralysis, weakness, amnesia btu the examination is inconsistent pt is not faking it consciously no evidence of underlying pathology

Answer 32

10 ml or 8g

Answer 33

CAN'T STOP ``` Compulsion to drink alcohol Aware of harms but persists Neglect of other activities Tolerance to alcohol Stopping causes withdrawal Time preoccupied with alcohol Out of control use Persistence, futile wish to cut down ```

Answer 34

1. acute detoxification 2. motivational interviewing 3. psychological therapies 4. self-help groups 5. medication 6. relapse prevention measures

Answer 35

Disulfram - blocks alcohol metabolism resulting in flushing, headaches, anxiety and nausea Acamprosate - acts on GABA to reduce cravings and risk of relapse Naltrexone - opioid receptor antagonist

Answer 36

1. pre-contemplation 2. contemplation 3. planning/preparation 4. action 5. maintenance 6. sustained maintenance or potential for relapse

Answer 37

An acute confusional state secondary to alcohol withdrawal - medical emergency requiring inpatient care

Answer 38

1-7 days | peak incidence at 48-72 hours

Answer 39

``` clouding of consciousness disorientation amnesia for recent events psychomotor agitation tremors visual, auditory and tactile hallucinations (characteristically of small people or animals) fluctuations in severity risk of cardiovascular collapse, paranoid delusions/fear, confabulation and heavy sweating ```

Answer 40

thiamine (pabrinex) lorazepam antipsychotics - haloperidol, olanzapine

Answer 41

short term memory loss and confabulation occurs in heavy drinkers due to thiamine deficiency thiamine deficiency causes damage and haemorrhage to the mamillary bodies of the hypothalamus and the medial thalamus

Answer 42

``` head injury post-anaesthesia basal/temporal lobe encephalitis carbon monoxide poisoning other causes of B1 deficiency - anorexia, starvation, hyperemesis ```

Answer 43

Triad of: 1. confusion/intellectual impairment 2. ataxia 3. ophthalmoplegia (eye muscle paralysis) and nystagmus due to thiamine deficiency

Answer 44

IV pabrinex (high potency thiamine replacement)

Answer 45

``` hypothyroid primary hypoparathyroidism hypercortisolaemia (iatrogenic - steroids) hypocortisolaemia - Addison's hypopituitarism ```

Answer 46

``` Preoccupation with food self-conscious about eating in public vigorous exercise constipation cold intolerance depressive and compulsive symptoms binging/purging or extreme restriction subtypes ```

Answer 47

BMI <17.5 emaciation dry and yellow skin peach fuzz hair on face and trunk (lanugo hair) bradycardia and hypotension anaemia consequences of repeated vomiting - hypokalaemia, alkalosis, pitted teeth, parotid swelling, sarring of the dorsum of the hand (Russel's sign)

Answer 48

Z drugs - zopiclone, zolpidem, zapeplon (first-line) sedating antidepressants - mirtazapine sedating antipsychotics - quetiapine melatonin

Answer 49

late-onset schizophrenia, after age 45 | less emotional blunting and personality decline compared to younger onset

Answer 50

delusions and hallucinations - esp about neighbours paranoid - often about neighbours partition delusion - patient believes that people or objects can go trough walls less negative symptoms (blunting/apathy) and formal thought disorder compared to early onset

Answer 51

social isolation sensory deficits - poor eyesight/hearing reclusive and suspicious pre-morbid personality more common in women

Answer 52

a belief that everything inside them is rotting/they're already dead inside seen in spychotic depression

Answer 53

complex visual hallucinations in a person with partial or severe blindness - macular degeneration, diabetic retinopathy patients understand that the hallucinations are not real and often have insight

Answer 54

Already diagnosed with personality disorder usually physical symptomology multiple A&E presentations to several different hospitals frequent admissions often multiple surgical procedures multiple aliases, no fixed address of regular GP when discovered - discharge themselves against medical advice

Answer 55

``` Down's syndrome Autism specturm disorder and Asperger's syndrome Williams syndrome Fragile X syndrome Global developmental delay cerebral palsy ```

Answer 56

1. impaired social interaction 2. speech and language disorder 3. imposition of routines - ritualistic and repeptitive behaviour

Answer 57

inattention hyperactivity impulsiveness restlessness poor concentration

Answer 58

methylphenidate (Ritalin) - monitor growth psychotherapy

Answer 59

paranoid schizoid schizotypal

Answer 60

Emotionally unstable Histrionic Narcissistic Antisocial

Answer 61

avoidant anxious dependent obsessive compulsive/anankastic

Answer 62

Definition = pervasive and unwarranted tendency to interpret the actions of others as demeaning or threatening - think the world is a conspiracy - thinks people are devious - acts as if always on guard, suspicious - commonest behaviour - watchfulness - least likely to be trusting - emotional hot-spot - being discirminated against THINK MAD-EYE MOODY

Answer 63

Definition = pervasive pattern of indifference to social relationships and a restricted range of emotional expereince and expression - thinks the world is uncaring - thinks poeple are pointless, replaceable - thinks they are the only person they can depend on - commonest behaviour - withdrawal - least likely to be emotionally available and close - emotional hotspot - being over-cared for and smothered by others THINK SEVERUS SNAPE

Answer 64

pervasive pattern of deficits in interpersonal relatedness and pecularities of ideation, experience, appearance and behaviour. THINK LUNA LOVEGOOD

Answer 65

Definition = pervasive pattern of instability of mood, interpersonal relationships and self-image. - thinks the world is contradictory - thinks people are untrustworthy - ashamed of themselves commonest behaviour - self-harm - least likely to be able to show self-compassion - emotional hotspot - abandonnment

Answer 66

Definition = pervasive pattern of excessive emotionality and attention seeking. - thinks the world is their audience - thinks people are in competition for attention - thinks they are vivacious (attractively lively and animated) - commonest behaviour - exhibitionism - least likely to be able to listen to others - emotional hotspot - being actively or passively side-lined

Answer 67

Definition = pervasive pattern of grandiosity, lack of empathy and hypersensitivity to the evaluation of others - thinks the world is a competition - thinks people are inferior - thinks they are special - commonest behaviour - competitveness - least likely to be humble - emotional hotspot - loss of face/social rank/social status/being embarrassed

Answer 68

psychopath - when they get into trouble with the law. Sociopath - same features without problems with the law Definition = childhood conduct disorder before the age of 15 and a pattern of irresponsible and antisocial behaviour post 15 years - thinks the wolr dis predatory - thinks people are weak - thinks of themselves as autonomous and alone - commonest behavioural approach - crushing - least likely to be gentle and sensitive - emotional hotspot - perceiving exploitation

Answer 69

Definition = pervasive pattern of social discomfort, fear of negative evaluation and timidity - thinks the world is evaluative - thinks people are judgemental - thinks they are inept - commonest behaviour - inhibition - least likely to be assertive - emotional hotspot - exposed ridicule or rejection

Answer 70

Definition = pervasive pattern of dependent and submissive behaviour - thinks the world is overwhelming - thinks people are stronger and more competent than themselves - they are needy - commonest behaviour - clinging - least likely to be self-sufficient emotional hotspot - making a decision

Answer 71

Definition = pervasive pattern of perfectionism and inflexibility - thinks the world is sloppy - thinsk people are irresponsible - thinks they are responsible - commonest behaviour - control - least likely to be flexible - emotional hotspot - making a mistake

Answer 72

An abnormal and excessive reaction to an identifiable life stressor.

Answer 73

1. re-experiencing - flashbacks, nightmares 2. avoidance - avoiding people, situations or circumstances resembling the traumatic event 3. hyperarousal - hypervigilance for threat, startles easily, struggles to sleep 4. emotional numbing

Answer 74

``` euphoria pinpoint pupils drowsiness constipation respiratory depression ```

Answer 75

``` goose flesh (piloerection) pupil dilation yawning sweating abdo cramps insomnia ```

Answer 76

compulsory admission to hospital for assessment

Answer 77

compulsory admission to hospital for treatment

Answer 78

emergency order | when waiting for a second doctor would lead to undesirable delay

Answer 79

for a patient ALREADY admitted but wanting to leave

Answer 80

nurses this is their holding power until a doctor can attend

Answer 81

For a patient ALREADY admitted to hospital but wanting to leave

Answer 82

Doctors 72 hours doctor's holding power - gives time for section 2 or 3 to be put in place. Has to be a doctor on that specific ward, cannot be done in A&E

Answer 83

Section 135 and 136 136 - suspicion of having a mental disorder in a public place 135 - needs court order to acccess patient's home and remove them

Answer 84

Psychiatric emergency caused by excess of enuroleptic medicaion or acute wthdrawal from Parkinson's medication. ``` onset over hours or days hyperpyrexia hyporeflexia sweating normal pupils tachycardia rigidity rasied CK ```

Answer 85

``` stop the offending agent or give L-dopa in dopamine withdrawal IV fluids Benzos bromocriptine dantrolene ``` dantrolene is also used to prevent and treat malignant hyperthermia

Answer 86

Caused by SSRIs, MAOIs, Ecstacy, Amphetamines (cocaine, mcat), antiemetics (metoclopramide), St John's Wort

Answer 87

``` onset over minutes/hours hyperthermia/hyperpyrexia sweating hyperreflexia clonus rigidity altered mental state dilated pupils ```

Answer 88

IV fluids Benzos stop the offending agent

Answer 89

positive symptoms are caused by dopamine overactivity in the mesolimbic system. negative symptoms are cuased by dopamine underactivity in the mesocortical system.

Answer 90

erotomania young woman believes man of higher status is secretly in love with her and is sending her secret messages

Answer 91

pthological jealousy - high risk of abuse and violence