Psych Flashcards
1
Q
what disease has frequently smell hallucinations
A
Typical neurodegeneretive disorders like Parkinson, Alzheimers, epilepsy?
2
Q
Bulimia vs Anorexia, similarities? (7)
A
- Both are eating disorders
- Both can include the binge-purge
- Both suffer from low self-esteem
- Bad self-image
- Both affected by genetic and enviornmental factors
- Hypotension (bulimia = tach, anorexia = brady)
- Malnutrition and low electrolytes
3
Q
Bulimia vs Anorexia, main difference?
A
Bulimia = norm/overweight, Anorexia = underweight (BMI <18.5)
(Bulimia patients are more characterized by Binge-purge than anorexia patients=
4
Q
DSM-V criteria for bulimia nervosa?
A
Binge-purge at least once/week over 3 months
5
Q
Other signs that someone has bulimia? (6)
A
- Russel’s sign
- Mallory-Weiss syndrome
- Halatosis
- Eroded teeth
- Parotid gland swelling
- Loss of electrolytes and metabolic alkalosis (due to puking)
6
Q
Treatment for bulimia? (2)
A
- Psychotherapy and CBT (try to eat small amounts of desired food, see that it has not consequenses)
- Medical: Fluoxetine
7
Q
Typical signs of anorexia?
A
- BMI < 18,5
- Fear of Gaining Weight
- Bad self-image
- Binge-purge, overexercise
- Food rituals
- Refuse to eat in front of others
8
Q
Physical changes with anorexia? (12)
A
- Muscle loss
- Hypotension with bradycardia (cardiac muscle loss)
- Orthostatic hypotnsion
- Edema (CHF and low protein)
- Electrolyte loss (decreased intake)
- B1 def
- Amenorrhea
- Bloating and constipation
- Pancytopenia
- Lanugo
- Osteoprorosis
- Refeeding syndrome!!
9
Q
Treatment for anorexia? (2)
A
- CBT (individual and with family, improve self esteem etc…)
- Medical: Fluoxetine (if they take antipsychotics for something else, consider quetiapin or mirtazipin as they increase apetite)
10
Q
Difference in ICD vs DSM? (9)
A
- ICD does not list characteristics/requirements to confirm diagnosis like DSM does
- ICD is more about clinical discression (guidelines rather than criteria)
- Especially different in the ways of classifying personality disorders (DSM classifies types, ICD clissify by severity and trait)
- DSM is better to diagnose people, as it doesn’t only list a bunch of symptoms where all need to be met, instead it tells you how many of the listed symptoms need to be met to determine a diagnosis
- DSM also allows clinical discression (remember, the DSM is just a manual, doesn’t need to diagnose even if criteria are met)
- ICD has less specified grouping on some disorders (example instead of choosing between bipolar or depressive disorder, you have a common goup in ICD called mood disorders)
- Different typing of schizophrenia
- Some disorders in ICD have their own chapter instead of being a part of “mental disorder” chapter (e.g sleep-wake disorders, as they often are due to neurological problems as well, not only psychiatric)
- DSM has exclusion criteria, while ICD puts these other possible disorders as their own part called “boundries with other disorders”
11
Q
Diagnostic criteria for Schizophrenia? (5)
A
2 of the following symptoms with at least one being a major symptom lasting for at least 6 months were at least 1 month of that time is spent in active phase, and other causes must be ruled out:
- Delusions
- Hallucinations
- Disorganized speech (word-salad)
- Disorganized behaviour /catatonic behaviour (weard movements)
- Negative symptom
12
Q
What are the 3 phases that Shizophrenia patients cycle through?
A
- Prodromal phase - withdrawn, anxiety
- Active phase - severe symptoms/positive symptoms
- Residual phase - cognitive symptoms (concentration problems)
13
Q
Shizophrenia: Positive symptoms? (5)
A
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behaviour
- Catatonia
14
Q
Shizophrenia, Negative symptoms? (3)
A
- Flat affect
- Alogia (poverty of speech)
- Avolition (decreased motivation)
15
Q
Main treatment for Schizophrenia?
A
Atypical Antipsychotics!!! (Olanzapine, Quetiapine etc…)
*Supportive psychotherapy and training in social skills may also help
16
Q
According to the old classification, what are the 5 subtypes of schitzophrenia?
A
- Paranoid: Where someone feels he is being persecuted or spied on.
- Disorganized: Where people appear confused and incoherent.
- Catatonic: Where people can be physically immobile or unable to speak.
- Undifferentiated schizophrenia: A subtype in which no paranoid, disorganized or catatonic features are prominent .
- Residual Schizophrenia: In which psychotic symptoms are markedly diminished or no longer present .
17
Q
Which type of Schitzophrenia is treated with ECT?
A
Catatonic (though this is an old classification, these days ECT is reserved for treatment-resistant schizophrenia)
18
Q
Another name for Disorganized Schizophrenia?
A
Hebephrenic Schizophrenia
19
Q
Treatment depending on the subtype of Schizophrenia:
A
- Paranoid: AA
- Catatonic: ECT, AA + benzodiazepines (relax muscles –> easier movements, lorazepam can be used for both diagnosis and treatment)
- Undifferentiated: AA (respond slower, they are alert, but thinking takes time to recover if it does at all)
- Schizoaffective: AA + antidepressants/mood stabilisers
20
Q
Etiology of Schizophrenia? (5)
A
Combination of physical, genetic, psychological and environmental factors:
- Identical twin of someone with the disease have a 50% chance of getting it themselves
- Shcizophrenia patients have small difference in brain structure
- Dopamine and Seretonin imbalance may be a cause
- Problems in birth may increase chance of developng it
- Stress and drug abuse may be a trigger of developing it in high-risk patients
21
Q
Examples of type of delusions and hallucinations Schizophrenia patients might have?
A
- Delusions: of control (someone/something controls their actions) and reference (think insignificant remarks are directed at them “tv speaks to me”)
- Hallucinations: mainly auditory (hearing voices), but also some have visual hallucinations
22
Q
What do we mean by “pillow sign” when discussing Schizophrenia?
A
Remember, these patients have abnormal movements! What we often see is that when these patients are lying down, their head might still stay elevated even though there’s no pillow under it (pillow sign).
23
Q
Long term management of Schizophrenia?
A
Important that they get early medical treatment. Further on, psychotherapy for teaching them social skills and health managment so they can take care of themselves (remember to shower, get out of bed, be with others etc…)
24
Q
Epidemiology of Schizophrenia?
A
- Prevelance: 1%
- Men = Women
- Earlier in Men (early 20’s, than in women (late 20’s)
- More in people with first-degree relatives
- Half of them attempt suicide
25
What do we mean by calling it "Autism Spectrum"
That it's a spectrum of disorders differing in severity
26
2 major areas of consideration when evaluating Autism spectrum?
1. Social communication and interaction
2. Restricted or repetitive behaviour
These areas are again divided into sub-categories
27
4 subdivisons of Social communication and interactions in Autism?
1. **Social reciprocity** - how child responds in social inteactions, autistic children often want to be alone
2. **Joint attention** - ability to share interest with someone else
3. **Nonverbal communication** - using or interpreting nonverbal communication (e.g child doesn't put its arms up when it wants to be picked up, or can't tell when parents are upset from their body language)
4. **Social relationships** - making and maintaining friends (behaviour problems)
28
Restricted or repetitive behaviour in autism? (6)
1. Lining up toys
2. flapping hands
3. imitating words or phrases
4. fixated routines
5. restrictive thinking (fixated on knowing about one major subject like vacuum cleaners)
6. Hypo- or hyperactivity to sensory input
29
Other important signs commonly seen in autism? (2)
1. reacts badly to sounds
2. problems maintaining eye contact
30
Important cooperative partner in diagnosing autism?
Parents or teachers, as many of the symptoms can be observed at home or in school, parents can be given a list of things to look for or a severity chart
31
How does a severity chart in autism organised?
As a spectrum from level 1 (high-functioning) to level 3 (severe autism)
32
Give an example of how autism lvl 1 can manifest?
* Patient can maybe speak full sentences, but have problem with having a conversation with others (back and forth exchange of info)
* May show some difficulty with exchanging between activities
33
Give an example of a lvl 3 autism
* only speak a few words or rarely interacts
* extremely resistant to change
* problems are considered to severely interfere with daily life
34
In addition to the signs, what other criteria has to be met before an autism diagnosis can be set? (3)
1. Has to interfere with daily life (social, academic etc...)
2. Has to manifest itself from an early age (\< 3 years old)
3. Exclude disorders with similar symptoms
35
Asperger syndrome, where does it fall on the autism spectrum?
level 1
36
Exclusion disorders similar to autism? (4)
1. Rett syndrome (genetic disorder, slow development in early age)
2. Hearing impairment (rule out with audiometry)
3. Selective mutism (refusal to speak)
4. Intellectual disability
37
Diagnostic criteria for autism?
* Patient must experience all communicating problems, and at least 2 restricted/repetitive behaviour symptoms
* Must be \< 3 years old
* Must be considered an issue to daily life
* Other causes are excluded
38
Etiology of autism?
Mainly thought to be due to genetic causing changes in brain development (though no genes have been specified yet)
39
Treatment for autism?
1. Special education
2. Lifelong behavioural management
3. Symptom-targeted medication
* Neuroleptics for aggression
* SSRI for repetitive behaviour
40
Symptoms of mania? (DIG FAST)
* **D**istractability
* **I**nsomnia
* **G**randiosity (high self-esteem)
* **F**light of ideas
* **A**ctivities (psychomotor Activation)
* **S**exual indiscretions (or other pleasurable activities)
* **T**alkativeness/pressured speech
41
Difference between mania and hypomania? (4)
1. Mania is more severe
2. Mania \> week || Hypomania \>4 days
3. Mania causes significant problems in social/occupational function, while Hypomania doesn't
4. Mania may be have psychotic features, Hypomania doesn't
42
Shortly explained, what is Bipolar disorder?
A disorder where a patient shifts between periods of extreme lows (depression similar to Major depressive disorder) and extreme highs (mania)
43
3 types of Bipolar Disorder?
1. Bipolar 1
2. Bipolar 2
3. Cyclothemia
44
Manic-depressive interval of bipolar disorder 1?
* Depressive episodes lasting \> 2 weeks
* Manic episodes lasting \> 1 week (though can last for months)
45
Manic-depressive interval of bipolar disorder 2?
* Depressive episodes lasting \> 2 weeks (like in bipolar 1)
* HYPOmanic episodes lasting \> 4 days
46
Manic-depressive interval of Cyclothymia?
* Less severe depressive episodes
* Less severe manic episodes
Depressive and manic episodes are similar in duration here
47
2 variations that may occur within the cycle of bipolar disorder?
1. Mixed episodes - where depression and mania may occur at the same time
2. Rapid cycling - 4 or more episodes of depression or mania within 1 year
48
Etiology of Bipolar disorder?
Genetic and enviromental
* 10x risk if family member has it
* High risk if you have other psych-disorder
49
General treatment for Bipolar disorder?
* Lifelong moodstabilizers (first line, and can be used alone i monotherapy)
* Consider including or replacing with antipsychotics if mood stabilizers can't control mania
* Consider including SSRI if mood stabilizers can't control depression
* ECT if mania is refractory
50
Which mood stabilizers may be used in bipolar disorder?
1. Lithium (first line)
2. Lamotrigine (second line)
3. Carbamezipine
4. Valproic Acid
51
Which mood stabilizer is NOT teratogenic?
Lamotrigine
52
Lithium side effects? (9)
1. GI symptoms (nausea/diourrhea...)
2. Milde tremors
3. Polyuria/Nefrogenic Diabetes Insipidus (blocks ADH-rec)
4. Acute kidney failure
5. Hypothyroidism (blocks TSH-receptors) and Goiter
6. Leukocytosis
7. Teratogenic (Epstein's anomaly in fetus)
8. Neurologic symptoms (ataksia, dysarrthria, confusion, coma)
9. Skin (psoriasis, dermatitis, acne)
53
Therapeutic index of lithium?
0.6 - 1.5 mmol/L
54
Why do most bipolar patients need Lithium + SSRI treatment?
Cause mood stabilizers like lithium are best at controlling manic episodes than they are at controlling depressive episodes
55
Treatment for acute mania (severe) in bipolar patients? example?
* Mood stabilizer + Antipsychotic
* Lithium + Haloperidol is a common combo, but atypical antipsychotics like Olanzapine and Quetiapine may also be used
56
Typical or atypical antipsychotics for mild/moderate mania?
Atypical er usually used (although typical are also effective)
57
Treatment for bipolar pregnant patient
CAVE: Mood stabilizers (Lithium and Valproic acid are bad for fetus)
* Give typical antipsychotics like Haloperidol for mania
* Give SSRI like escitalopram for depression
58
Treatment option if you want to switch mood-stabilizer monotherapy with something else when treating bipolar patients?
* Atypical antipsychotic (Aripiprazole, Olanzapine, Quetiapine...) for mania
* SSRI for depression
59
Why do you have to be careful when treating bipolar patient with SSRI?
Cause it might increase the mania!
60
Other possible medications that may be used in bipolar disorder? (2)
1. Anticonvulsants (Lamotrigine, Valpric Acid, Carbamezipine)
2. Benzodiazepines
61
What's a delusion and how can it manifest itself as? (8)
Delusion is a break from reality, with fixed false beliefs that can't be changed with reasonable arguments
1. Paranoia
2. Ideas of reference
3. Thought broadcasting
4. Delusions of grandur
5. Delusions of guilt
6. Persecutory delusions
7. Erotomanic delusions
8. Somatic delusions
62
What's paranoia?
feeling being followed, tracked or targeted
63
What do we mean by "Ideas of reference"?
Believe some event is especially related to them ("the guy on tv is talking to me")
64
What's Thought broadcasting?
To believe others can hear their thoughts
65
What are Delusions of Grandur?
Believe they have special powers or are sent on a special misson that only they can do
66
What are Delusions of guilt?
To believe unrelated events are somehow their fault ("WW2 is my fault")
67
What are Persucatory delusions?
Believing they are being harassed by others, even though they're not
68
What are Erotomanic delusions?
Feeling someone that doesn't know them are in love with them (being in love with an movie star)
69
What are Somatic delusions?
Thinking you have a somatic ilness even though you don't
70
What types of hallucinations are there? (5)
1. Visual hallucination (seeing)
2. Olfactory (phantosmia).
3. Gustatory hallucinations (tatse)
4. Auditory hallucinations (hearing)
5. Tactile hallucinations /feeling)
71
Most common cause of visual hallucinations?
Lewy body dementia or drug intoxication
72
Most common cause of olfactory hallucinations?
Neurodegenerative disorders like parkinson and alzeihmers, but also Epilepsy with aura (affecting temporal region)
73
Most common cause of tactile hallucinations?
Drug or alcohol abuse
74
What's the difference between obsessions and compulsions?
* Obsessions: recurrent, intrusive thoughts that may cause anxiety
* Compulsions: actions that OCD patients do to reduce the anxiety that comes from the obsessions (impact daily life)
75
Give examples of obsessions and their compulsions
1. Germs --\> Cleaning
2. Unsafe --\> Checking
3. "Something bad wil happen" --\> Repeating
4. Anxiety --\> Arranging
5. Bad thoughts --\> come up with words or phrases to replace the bad thoughts and turn them into good thoughts (mental rituals)
76
DSM criteria for OCD? (4)
Following criteria has to be met:
1. Having obsessions, compulsions or both
2. Time consuming (distress in daily life)
3. Not due to substance abuse or somatic illness
4. Rule out other mental disorder (OCPD etc...)
77
Causes for OCD?
1. Genetics (higher risk if you have an identical twin with OCD)
2. Environment and upbringing
3. Seretonin abnormalities
78
Treatment for OCD? (5)
1. CBT (Exposure and response therapy), where patient is exposed for trigger of obsession, but learns to handle anxiety without doing compulsion
2. Medication: SSRI (sertraline or escitalopram), Antipsychotics (Risperidone), TCA (clomipramine)
3. Deep brain stimulation (brain pacemaker) for refractory OCD
4. Neuromodulory surgeries as last resort for severe refractory OCD
79
First line and second line treatment regimen for OCD?
* First-line: CBT + SSRI (sertarlin)
* SNRI (venlafaxine) + TCA (Clomipramine)
80
1st-line treatment for trichotillomania?
TCA (Clomipramine)
81
SSRI dosage when treating OCD?
* Sertraline, start 25mg, increase to 50mg afte 1 week (if you need to increase further, you can increase by 50mg at a time each week, up to a max dosage 200mg/day
* Escitalopram, start 10mg, can increase dosage up to 20mg
82
How does SSRI treatment of OCD differ from SSRI treatment in depression?
OCD may require higher SSRI dosage and longer time for treatment to have effect
83
Explain the Psychodynamic theory on OCD?
Psychodynamic theories of OCD state that obsessions and compulsions are signs of unconscious conflict that you might be trying to suppress, resolve, or cope with.11 These conflicts arise when an unconscious wish (usually related to a sexual or aggressive urge) is at odds with socially acceptable behavior.
84
What is Agoraphobia?
A fear of leaving the house
85
How to treat Agoraphobia?
* 1st line: CBT + SSRI (sertralin)
* Benzodiazepines or pregabalin may also be of help as they have a relaxing effect
86
Common rule to remember when giving a personality disorder diagnosis?
Make sure the patient is over 18 years old!! (because it's normal for teenager to behave oddly cause they're premature and hormonal, and it usually goes over for them)
87
Subdivisions of Cluster A personality disorders? (3)
"Weird"
1. Paranoid personality disorder (accusatory)
2. Schizoid personality disorder (alone)
3. Schizotypal personality disorder (awkward)
88
How does Paranoid personality disorder manifest itself? (7)
1. Accusatory
2. Distrustful and suspicious of others
3. Assume that others will dissapoint, manipulate or talk shit about them (have superficial relationships, often live in isolation)
4. They try to ensure loyalty of friends and family
5. Act severely if they feel like they've been lied to or backstabbed
6. Hold grudges for long of time
7. In return their behaviour often leads to people starting to dislike them or talk badly about them
89
How does Schizoid personality disorder manifest itself? (4)
"Alone"
1. Avoid social interaction
2. Not interested in being with others (not due to anxiety or paranoia, just due to them being not interested)
3. Finds all types of physical contact to be unpleasurable
4. Flat affect
90
How does Schizotypal personality disorder manifest itself? (4)
"Awkward"
1. Magical thinking ("got up on left side, so today it's gonna rain")
2. Ideas of reference (think everything that happens in the world relate to their destiny)
3. They think they're in tune with everything around them --\> overconfidence and self-centered way of speech (socially innapropriate)
4. Alone, but they don't like being alone, they're just alone because people generally find them weird
91
Which disorder are people with Cluster A at higher risk of developing?
Schizophrenia
92
Main difference between Paranoid Personality Disorder and Paranoid Schizophrenia?
1. Paranoid schizophrenia has more intense paranoia
2. Paranoid schizophrenia often accompanies delusions (PPD don't)
3. No positive symptoms in PPD
93
What do Schizoid personality disorder and Schizophrenia have in common?
Flat affect
94
Treatment for Cluster A personality disorder?
**Psychotherapy**, although general therapy tend to be ineffective since asking these patient confront their own actions and beliefs might cause them more strain, and people with PPD might even become more distrustful. It's better to just try to support the individual instead of challenging them, for example by helping them improve their understanding of social activities.
95
Subdivisions of Cluster B Personality Disorder? (4)
"Wild"
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
96
Which disorders do Cluster B personality disorders often relate with? (2)
1. Mood disorders: Depression and Bipolar
2. Substance abuse disorders
97
How does Antisocial Personality Disorder manifest itself? (6)
1. Manipulate for personal gain (often by charming others)
2. Disregard for moral values and social norms
3. Little empathy
4. Willing to hurt others to help themselves
5. Prone to aggressive and unlawful behaviour (sociopath/psychopath)
6. Feel no remorse or guilt for their actions
98
Other than the signs, what else is important to remember when considering to diagnose someone with Antisocial Personality Disorder? (2)
1. Must be over 18 years old
2. Have a history of conduct disorder
99
How does Borderline Personality Disorder manifest itself? (4)
1. Unstable moods (go from intense joy to rage)
2. Good relationships often get dramatic and sour
3. Use splitting as defence mechanism (shift between seeing things as completely good or completely bad)
4. Terrified of abandonement (do extreme things to keep people from leaving)
100
How does Histrionic Personality Disorder manifest itself? (4)
1. Attention seeking
2. Very emotional
3. Manipulate situations to get more attention (leads to superficial relationships)
4. Viewed as shallow, flighty and egocentric
101
How does Narcissistic Personality Disorder manifest itself? (5)
1. Grandiose self-image (think they're better than they are and deserve the best)
2. Think their ideas are the best and others must agree
3. Secretly have bad self-esteem
4. Lash out if they get criticized
5. Exploit others for own personal agenda
102
Treatment for Borderline personality disorder?
* Mainly: Dialectical Behaviour Therapy
* in norway we mostly use Mentalization-Based Therapy
* You can additionally also give antidepressants or anti-anxiety meds for symptomatic relief
103
What's Dialectical Behaviour Therapy?
* Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy.
* Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.
* Has some similarities with mindfullness.
104
What's Mentalization-Based Therapy?
* Mentalization based therapy (MBT) is a specific type of psychodynamically-oriented psychotherapy designed to help people with borderline personality disorder (BPD).
* Its focus is helping people to differentiate and separate out their own thoughts and feelings from those around them.
105
Subdivisions of Cluster C personality disorders? (3)
Worried
1. Avoidant
2. Obsessive-Compulsive
3. Dependent
106
Which disorder do Cluster C personality disorders have strongest relationship with?
Anxiety disorders
107
How does Avoidant Personality Disorder manifest itself? (5)
1. Shy
2. Socially inhibited
3. Want social relationship with others, but rarely take social risks and usually avoid social situations
4. Low self-esteem
5. Respond badly to rejection and negative feedback (become more withdrawn whan that happens)
108
Main difference between Avoidant personality disorder and social phobia?
In Social phobias, the anxiety is due to a specific situation (like public speaking)
109
How does Obsessive-Compulsive Personality Disorder manifest itself? (5)
1. Obsessed with orderliness, control, rules, details, perfectionism
2. Is often inflexible
3. Easily stressed
4. Ineficient (spend more time worrying about tasks, than doing them)
5. Rigid to beliefs and moral issues (stubborn)
110
There are a few differences between OCD and OCPD, but what's the main one?
* OCD is ego-dystonic (they realise that their behaviour is a problem and want to stup but can't)
* OCPD is ego-syntonic (they don't see their behaviour as a problem)
111
How does Dependent Personality Disorder manifest itself? (3)
1. Intense fear of seperation and rejection (overly cling to their relationships)
2. Lack self-confidence (inability to make decisions)
3. Hold on to someone that can take care of them (often get trapped in abusive relationships)
112
Type of treatment for Cluster C Personality Disorders? (2)
1. Social skills training (group therapy is good)
2. Anxiety management (either by psychotherapy or medication)
113
10 types of immature defense mechanisms?
1. Acting out
2. Denial
3. Displacement - redirecting feelings to a less threatening object
4. Intellectualization - facts and logic to avoid stressful thoughts/emotions
5. Passive aggression -
6. Projection - attributing their impulses onto others (often in PPD)
7. Rationalization
8. Reaction formation - behaving opposite to what they feel
9. Regression - revert to earlier developmental stage (often in DPD)
10. Splitting - believing people are either just good or just bad (BPD)
114
4 mature defense mechanisms?
1. Sublimation - transform unacceptable thoughts into acceptable actions
2. Altruism - coping with stressor by helping others
3. Suppression - avoiding bad thoughts/feelings
4. Humor - joking about their bad situation
115
Clinical Indications for ECT? (4)
* MDD:
* If it's severe and suicidal risk is very high
* If there are Psychotic features and antipsychotics don't help
* Drug-resistant MDD or in patient's that don't handle the drugs well
* Bipolar disorder:
* If mood stabilizers and other drugs doesn't help (ECT treats both mania and depression)
* If it has severe or drug-resistant depression episodes
* Refractory or severe mania
* Schizophrenia
* If it's drug resistant or if drugs have caused severe side-effects (e.g NMS)
* In catatonic Schizophrenia
* Dementia (if there's severe aggression)
116
In which circumstances do we consider ECT to be of less risk than typical medication? (2)
If we are treatinng:
1. Elderly patients
2. Pregnant patients
117
What's Othello syndrome?
Pathological jealousy, a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having any real proof.
118
What's a mood-congruent delusion?
Any delusion that may occurr during depression and mania
119
What's important to remember when you give elderly patients psych-medicines?
Be careful with giving elderly patients drugs that decrease neurocognitive function (e.g benzo's, pregabalin etc...) as many of them often already have decreased cognitive function
120
When giving elderly patients medicine, what's important to remember about dosage?
Give minimal effective dose (remember they have decreased metabolism, so low doses in elderly people have good effect)
121
Most common psychiatric illnesses in geriatric patients?
Depression
122
After depression, what are other common psychiatric illnesses in geriatric patients? (3)
1. Dementia
2. Delirium and delusions
3. cognitive Decline
123
Cuses for depression in elderly patients?
1. Psychosocial (retired, death of loved ones etc...)
2. Biological like medical and psychiatric illness (3D's)
124
How does psychiatric illnesses progress with age (esp. schizo and mood disorders)?
* Generally worsens
* Cognitive impairment
* Decreased functionality (because of recurrence and relapses over time
125
How does Bipolar disorders progress with age?
Increased depression with age
126
Definition of a delusion? Example?
A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. (example: believing someone is spying on them even though they're proved otherwise)
127
Main difference between obsession and delusion?
* Obsession speaks to quality of thought
* Delusion speaks to quality of belief
128
Treatment of delirium vs treatment of psychosis?
Both can be treated with antipsychotics, but in delirium you have to additionally treat the underlying issue and there are many (e.g infection = antibiotics, electrolyte imbalance = give fluids and electrolytes, alcohol withdrawl =give benzo etc...)
129
What's a Pseudohallucination?
AN involuntary sensory experience vivid enough to be regarded as a hallucination, but considered by the person as subjective and unreal
130
Most common cause of dementia?
**Alzheimer disease (65%)**, after that you have vascular dementia (20%)
131
Other causes for dementia?
Causes for dementia:
* **D**egenerative disease (alzheimer, parkinson etc...)
* **E**ndocrine (parathyroid, thyoid, pituitary, adrenal ec...)
* **M**etabolic (alcohol, electrolytes, B12 def, hepatic, renal glucose)
* **E**xogenous (heavy metals, CO, drugs)
* **N**eoplasia
* **T**rauma
* **I**nfection
* **A**ffective disorder (pseudodementia)
* **S**troke/**S**tructure (vascular dementia, hydrocephalus etc...)
132
Another name for dementia is?
Major Neurocognitive Disorder
133
What are the 4 parts the within our conciousness that are usually affected by a neurocognitive disorder?
1. Memory
2. Judgement
3. Attention
4. Orientation
134
Define dementia and how does it manifest itself?
A decline in cognitive function with global deficits and stable loss of consciousness.
1. Progressive memory loss worsening over time
2. Personality changes
3. Mood and behaviour changes (e.g wandering around, aggression etc...)
It's progression can be classified into one of 4 levels, depending on severity
135
4 stages of severity of Dementia?
1. Preclinical - slight forgetfulness, fully oriented and capable of self-care
2. Mild - moderate memory loss, impaired executive function, impaired function at home, but can still do most chores
3. Moderate - severe memory loss, agnosia, impaired social judgement, needs help with several chores like dressing and hygiene
4. Severe - severe memory loss, oriented only to one person, needs help with all chores in daily life, might develop aphasia
136
How is Dementia diagnosed?
* Mainly clinical
* Mini-Mental State Exam (MMSE) or Montreal Cognitive Assessment (MoCA)
* Normal diagnostic tests like blood tests, culture, virology etc... to find out if there's a somatic cause for it
* Brain MRI might show atrophy and other changes
* Definitive answer requires brain autopsy (histopathology)
137
Treament for dementia?
* Mainly Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
* If it's Alzheimer dementia, add Memantine (NMDA antagonist)
* If they have strong psychosis, add low-dose antipsychotic (avoid benzo)
* Provide environmental cues, structure in daily life, and education for them, their family and their caregivers
138
Dementia types? (6)
1. Alzheimer's disease.
2. Vascular dementia.
3. Lewy Body Disease.
4. Frontotemporal dementia.
5. Alcohol related dementia.
6. Down syndrome and Alzheimer's disease.
139
2 Main signs of frontotemporal dementia?
* Personality and behavior changes (frontal part)
* Progressive aphasia and other speaking disorders (temporal)
140
2 main causes of Frontotemporal dementia?
1. Alzheimer disease (neurofibrillary tangles)
2. Pick disease (tau bodies)
141
What's delirum?
An acute disturbance with altered cognition that develops over a short period of time (hours to days).
142
Causes for delirium?
I WATCH DEATH
* **I**nfection
* * **W**ithdrawl
* **A**cute metabolic/substance **A**buse
* **T**rauma
* **C**NS pathology
* **H**ypoxia
* * **D**eficiencies
* **E**ndocrine
* **A**cute vascular (MI)
* **T**oxins
* **H**eavy metals
143
How does delirum manifest itself? (6)
1. Acute onset within hours-days (often after a somatic illness)
2. Shift between intervals of Hyperactive and and Hypoactive symptoms
3. Hallucinations, illusions or delusions
4. Combative, anxious, paranoid or stuporous behaviour
5. Decreased memory and attention
6. Sundowning (more symptoms at night)
144
Hyperactive symptoms of delirum?
1. Agitation
2. Incoherent speech
3. Disorganized thoughts
4. Delusions
5. Hallucinations and illusions
6. Disorientation
145
Hypoactive symptoms of delirum?
1. Lethargy
2. Drowsiness
3. Less reactive
4. Withdrawn
146
Diagnosis of delirium?
Check for an underlying cause and do according tests for that
1. Neurological exam
2. Vital signs and blood tests
3. Consider if the medications they take may be a cause
4. Consider if substance abuse is a reason and test for it
5. Renal and hepatic status
147
Treatment of delirium? (4)
Remember, deirium is often reversible!
1. Treat underlying cause (e.g infection = antibiotics etc...)
2. Normalize fluids and electolytes if they're abnormal
3. Optimize sensory environment (e.g hearing aid for hearing problems)
4. Low-dose antipsychotics (haloperidol) for agitation and psychosis
148
Delirium vs Dementia? (5)
1. Delirium is acute onset, while dementia is slowly-progressive
2. Early phase of delirium presents with severe cognitive symptoms, while early dementia presents with little to no symptoms (cause it hasn't progressed enough)
3. Hallucination is mainly seen in delirium, only possible in dementia if it's dementia with delirium
4. Delirium is usually reversible, dementia is not
5. Delirium might quickly fluctuate in symptoms and severity within a short time-period, dementia doesn't
149
Delirium tremens vs normal delirium? (4)
1. Delirium Tremens is mainly a withdrawl symptoms in alcohol-withdrawl
2. DT symptoms can occur anytime of day in any severity (no sundowning)
3. Normal delirum is mainly due to an underlying disease not necessarly associated with alcohol withdrawl
4. DT is treated with benzos, normal delirium is not
150
Definition of Generalized Anxiety Disorder?
It's an anxiety disorder characterized by excessive, persistent and often irrational worry about events or activities in daily life. This excessive worry often interferes with daily functioning, and sufferers are overly concerned about everyday matters.
151
Symptoms of GAD? (5)
1. Worries and Anxiety
2. Restlessness
3. Concentration problems
4. Muscle tension
5. Insomnia --\> fatigue
152
DSM diagnostic criteria for GAD? (5)
Following criteria has to be met:
1. Excessive anxiety more days than not for \>6 months (e.g \>90 days out of 180 days)
2. Patient finds it hard to control (can't calm down)
3. Adult: 3 or more GAD symptoms, Child: 1 or more GAD symptoms
4. Impairs daily life
5. Not due to medication, drug abuse or other illness
153
Treatment for GAD? (3)
1. CBT is first line
2. SSRI's are helpful
3. if nothing else helps, try benzo's
154
Define Social Anxiety Disorder? (4)
1. Fear and anxiety in social situations due to a fear of being judged by others
2. Egodystonic
3. Interfere with daily life and relationships
4. Lasts for \> 6 months
155
Physical symptoms seen in people with Social Anxiety? (5)
1. Trembling
2. Derealization (in severe anxiety)
3. Blushing
4. Spacing out
5. Use of drugs/alcohol to deal with anxiety
156
Treatment of Social Anxiety Disorder? (4)
1. CBT is 1st line
2. SSRI may often help
3. Benzo may also help
4. B-blocker may help some of the physical symptoms
157
What's a panic attack?
* An intense fear that something bad is going to happen
* Symptoms may last minutes to hours
* Can happen evereywhere, even in familiar places where one is usually calm
* women \> men
158
DSM criteria for diagnosing panic attacks?
At least 4 of the following symptoms /can last minutes to hours):
1. Dizziness
2. Nausea
3. Sweating
4. Shortness of breath
5. Trembling
6. Numbness
7. Palpitations
8. Angina
9. Chills
10. Feeling chocked
11. Feeling detached
12. Fear of losing control
13. Fear of death
159
Which mental disorders are often prone to panick attacks?
1. Panic Disorder
2. Anxiety disorders
3. PTSD
4. Depressive disorder
5. Substance abuse disorder
160
Criteria for diagnosing someone with Panic _Disorder_? (4)
1. Recurrent and unexpected panic attacks
2. Persitant worry or behavioral change due to panic attack
3. Not due to medication or substance abuse
4. Not due to other illness
161
Behavioural changes that people with panic disorder might develop after a while? (3)
1. Avoidance - avoiding places where they previously hade panic attacks
2. Anticipatory anxiety - being anxious of developing a panic attack
3. Agoraphobia - choose to stay isolated so no-one can se them panicking
162
Treatment of panic disorder? (4)
1. CBT (learn, monitor, breathing and relaxation techniques, change beliefs, exposure)
2. SSRI
3. Benzodiazepines
4. Antiseizure medications like pregabalin may also be used sometimes
163
Types of psychotherapy? (6)
1. **Psychodynamic therapy** – a psychoanalytic therapist will encourage you to say whatever is going through your mind. This will help you become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems.
2. **Cognitive Behavioural Therapy (CBT)** – a form of psychotherapy that examines how beliefs and thoughts are linked to behaviour and feelings. It teaches skills that retrain your behaviour and style of thinking to help you deal with stressful situations.
3. **Cognitive Analytical Therapy (CAT)** – uses methods from both psychodynamic psychotherapy and CBT to work out how your behaviour causes problems, and how to improve it through self-help and experimentation.
4. **Interpersonal Psychotherapy (IPT)** – looks at the way an illness can be triggered by events involving relationships with others, such as bereavements, disputes or relocation. It helps you cope with the feelings involved, as well as work out coping strategies.
5. **Humanistic Therapy** – encourage you to think about yourself more positively and aim to improve your self-awareness.
6. **Family and Couple (systemic) therapy** – therapy with other members of your family that aims to help you work out problems together.
164
Name all 6 SSRI's
1. Sertralin
2. Citalopram
3. Escitalopram
4. Fluoxetin
5. Fluvoxamin
6. Paroxetin
165
Indication for SSRI's? (7)
1. Depression
2. OCD
3. Panic Disorder
4. PTSD
5. GAD
6. Social disorder and social fobia
7. Fluoxetin: Bulimia
166
Side effects of SSRI's? (6)
1. Nausea/Vomiting
2. Diarrhea
3. Insomnia
4. Decreased libido, orgasm and ejaculation
5. SIADH
6. Seretonergic Syndrom
167
Medication-spesific side-effects of SSRI's? (3)
1. Paroxetin = Category D pregnancy (heart problems in fetus)
2. Citalopram/Escitalopram = Long QT-interval
3. Fluoxetin, Fluoxamin, Paroxetin = Inhibit Cyt p450
168
Name all 5 SNRI's
1. Duloxetin
2. Venlafaxin
3. Desvenlafaxin
4. Milnacipran
5. Levomilnacipran
169
3 conditions that any of the SNRI's can treat?
1. Depression
2. Anxiety
3. Neuropathic pain
170
2 additional indications for Duloxetine?
1. Urinary incontinence
2. Fibromyalgia
171
5 additional indications for Venlafaxine?
1. Social anxiety
2. Panic disorder
3. OCD
4. PTSD
5. Postmenopausal hot-flashes
172
Side-effects of SNRI's?
1. Insomnia
2. Nausea/vomiting
3. Increased BT (and other adrenergic symptoms)
4. Decreased libido, orgasm and ejaculation
5. Seretonin syndrome
6. Duloxetin: hepatotoxic
7. Venlafaxine: inhibit cyt p450
173
What is seretonin syndrome?
A complex of severe seretonin activity, usually an antidepressant side-effect
174
Symptoms of Seretonin Syndrome? (7)
1. Hyperthermia
2. Rubor
3. Rigidity
4. Aggitation
5. Psychogenic Non-Epileptic Seizure (PNES)
6. Coma
7. Suicidal thoughts
175
Antitoxin to seretonin syndrome?
Cyproheptadine
176
Pharmacokinetiks of Tricyclic Antidepressants?
Inhibit reuptake of Seretonin and Norepinephrine, incrising their level
177
178
What are the 2 types of TCA's?
1. Tertiary (non-selective)
2. Secondary (only increase Norepinephrine)
179
Name the 3 Tetriary TCA's and 2 Secondary TCA's
Tertiary (non-selective):
1. Amitriptylin
2. Klomipramin
3. Imipramine
Secondary (selective, norepinephrine):
1. Desipramine
2. Nortriptyline
180
Indications for TCA's? (4 + 2)
1. Severe depression
2. Neuropathic pain
3. Migraine
4. Phobias
5. Clomipramine: OCD, anxiety, narcolepsy
6. Amitriptyline: chronic pain, nocturnal eneuresis
181
Side-effects of TCA's? (7)
1. Sedation (H1 inhibitor)
2. Anticholinergic effect (inhibit M-receptors)
3. Ortthostatic hypotension (a1-inhibitor)
4. Serotonin syndrome
5. 3C's = Convulsjoner, Coma, Cardiotoksisk (arytmi og QT-forlengelse)
6. Cyt p450 inhibitors
7. Weight increase
182
Pharmacokinetics of Typical Antipsychotics, and the pathways the affect? (6)
Inhibit D2 receptors, affecting the following pathways
1. **Mesolimbic system** - motivation, wishes, beliefs,
2. **Mesocortical system** - feelings
3. Nigrostriatal pathway - unconcious movements
4. Tuberofundibular pathway - prolactin release
5. Chemoreceptor trigger zone (Area Postrema) - nausea
6. Medullar periventricular zone - apetite
183
Name the typical antipsychotics (3 +4)
High-dose (weak):
1. Chlorpromazin
2. Chlorprothixene
3. Levomepromazin
Low-dose (strong):
1. **Haloperidol**
2. **Fluphenazine**
3. Flupentixol
4. Pimozid
184
Indication for Typical Antipsychotics (5)
1. Psychotic episodes
2. Strong manic episodes
3. Strong delusions
4. Huntington's syndrome
5. Tourette's syndrome
185
Side-effects of Typical Antipsychotics? (10)
1. Orthostatic hypotensionn og long QT-interval (inhibit a1)
2. Sedative (H1 inhibitor)
3. Anticholinergic (M-receptor inhibitor)
4. Metabolic syndrome: dyslipidemia and hyperglycemia
5. Dystonia
6. Oculogyric crisis
7. Akathisia
8. Pseudoparkinosnism
9. Tardive dyskinesia
10. NMS - neuroleptic malignant syndrome
186
What's Dystonia?
Muscular spasms of facial muscles, tongue and back-muscles ocurring within hours - days
187
What's an Oculogyric crysis?
Spasms of the ocular muscles causing them to look up and to the side
188
What's Akathisia?
Restlessness and uncontrollable movements lasting days - months
189
What's pseudoparkinsonism?
Syndrome of parkinson-like symptoms: rigidity, bradykinesia and tremors
190
What's tardive dyskinesia?
Continous, rythmical movements of oral muscles.
191
What's Neuroleptic Malignant Syndrome?
* Side-effect of antipsychotics.
* Same symptoms as seretonin syndrome, but only difference is that in NMS has HYPOreflexia and normal pupils, while in seretonin syndrome it's the opposite.
192
Treatment of NMS? (2)
1. Dantrolene (muscle relaxor)
2. Bromocriptine (D2 agonist)
193
Causes for MDD? (4)
1. Genetics (increased when family members have it)
2. Environment
3. Monoamine deficiency theory - decreased/changed seretonin, norepinephrine or dopamine
4. Tryptophan deficiency - less tryptophan means less seretonin made in the body
194
Symptoms of MDD?
* **S**leep changes (more or less)
* **I**nterest loss (less interest of previous pleasurable activities)
* **G**uilt (worthlessness)
* * **E**nergy decrease (lack of energy)
* * **C**oncentration decrease (decreased concentration/cognition)
* **A**ppetite loss/gain
* **P**sychomotir increase or decrease (anxiety or lethargy)
* **S**uicidality (thoughts or attempts)
195
DSM criteria for diagnosis of MDD? (4)
1. **5 of 9 SIG E CAPS symptoms**
2. NO MANIA!!
3. Affects daily life
4. Not due to drugs, substances or other illness
196
Non-pharmacologic treatment of MDD? (2)
Pharmacologic treatment of MDD? (4)
* Non-Pharm:
1. Physical activity and healthy diet
2. Psychotherapy (CBT and interpersonal therapy)
* Pharmacologic:
1. SSRI
2. SNRI
3. TCA
4. Antipsychotics (if there's psychotic depression)
197
What's atypical depression?
depression, but certain things can still make you happy (less loss of interest)
198
What's dysthymia?
Milder depression symptoms for longer time (\>2 years)
199
What's Post-partum depression?
* Depression starting during or within first month after childbirth
* Can occurr in men as well
* Hormonal changes and sudden lifestyle change may be a cuse
200
Most common phobias? (4)
1. acrophobia, fear of heights.
2. arachnophobia, fear of spiders
3. autophobia, fear of being alone
4. claustrophobia, fear of tight spaces
201
Risk Factors for Suicide?
SAD PERSONS
* **S**ex (male)
* **A**ge (\<19 or \>45)
* **D**epression
* * **P**revious attempt
* **E**xcess alcohol or subtance abuse
* **R**ational thinking loss
* **S**ingle
* **O**rganizing an attempt
* **N**o social support
* **S**ickness (somatic)
202
Name the Atypical Antipsychotics (7)
1. Aripiprazol
2. Clozapin
3. Quetiapine
4. Olanzapine
5. Paliperidone
6. Risperidone
7. Ziprasidone
203
Indications for Atypical Antipsychotics? (6)
1. **Acute manic episodes**
2. OCD
3. Bipolar disorder
4. Anxiety
5. Depression
6. Tourette's syndrome
204
Side-effects of Atypical Antipsychotics? (7)
Like the typical antipsychotics, but less severe
1. Orthostatic hypotension (a1-inhibitor)
2. Sedation (H1-inhibitor)
3. Anticholinergic effects (M-inhibitor)
4. Hyperprolactinemia (Risperidon)
5. Prolonged QT-interval (Ziprasidone)
6. Metabolic Syndrome (Clozapin og Olanzapine)
7. Seizure og Agranulocytosis (Clozapin)
205
Injectable (IM) antipsychotics? (2 +4)
Typical:
1. Fluphenazin
2. Haloperidol
Atypical:
1. Aripiprazole
2. Risperidone
3. Paliperidone
4. Olanzapine
206
What's Psychoanalysis treatment and which disorders is it used for?
* Psychoanalysis is a method of treating emotional difficulties that involves communication between a psychoanalyst and an individual, with the goal of gaining insight into the individual's inner world and how it affects his or her emotions, behavior, and relationships.
* Used for anxiety and depression
207
Causes for aggression? (3)
1. Psychiatric (psychosis, delirium and others)
2. Substance abuse
3. Somatic (dementia, tumor , pain)
208
In which neurodegenerative disease is depression most common?
Parkinson's disease
209
What's Acute Stress Disorder?
An intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than a month. (if it lasts more, it's PTSD)
210
What's PTSD?
An intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting over a month.
211
Symptoms of PTSD? (4) What about children?
1. Re-experiencing the trauma (nightmares, flashbacks)
2. Avoids certain situations and environments that may cause stress
3. Hypervigilant (always on-guard)
4. Hyperarousal (startled by even small triggers)
\*Children don't show these symptoms, but may show symptoms later in life
212
Treatment of PTSD? (3)
1. Exposure therapy (expose to triggers and show them that they are safe)
2. Group therapy (can re-live trauma in a supportive environment)
3. Medication: Antidepressants (esp. SSRI's), antianxiety medications and sleep medication
213
Criteria/signs for substance-use disorder? (11)
1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance
214
Background of CBT?
* CBT is based on the combination of the basic principles from behavioral and cognitive psychology.
* It is different from historical approaches to psychotherapy, such as the psychoanalytic approach where the therapist looks for the unconscious meaning behind the behaviors and then formulates a diagnosis. Instead, CBT is a "problem-focused" and "action-oriented" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. The therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and decrease symptoms of the disorder.
* CBT is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of psychological disorders,and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms.
* The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two.
215
Criteria/signs for diagnosing someone with catatonia? (8)
Having 3 or more of the following:
1. Not responding to other people or their environment
2. Not speaking
3. Holding their body in an unusual position
4. Resisting people who try to adjust their body
5. Agitation
6. Repetitive, seemingly meaningless movement
7. Mimicking someone else’s speech
8. Mimicking someone else’s movements
216
The 3 types of catatonia?
1. Akinetic catatonia
2. Excited catatonia
3. Malignant catatonia
217
Signs of Akinetic catatonia? (4)
1. Most common
2. Stares blankly and won’t respond when spoken to
3. May repeat words/phrases they hear
4. Sometimes sit or lie in an unusual position and won’t move
218
Signs of Excited catatonia? (3)
1. Patient may move, but movement seem pointless or impulsive
2. They may seem agitated, combative or delirious
3. May mimic movement of others around them
219
What's Malignant catatonia?
* When the catatonia affects somatic health like dangerous changes in BP, temperature, breathing or heart rate
* These patient may be dehydrated, have blood clots, or kidney failure due to their catatonia
220
Psych symptoms of Hypo- and Hyperthyroidism? (2+4)
Hypothyroidism:
1. Mild to severe fatigue
2. Depression
Hyperthyroidism:
1. Anxiety
2. Nervousness
3. Restlessness
4. Irritability
221
First time depressed patient that started on ssri, feeling better after two months, what to do?
6 months medication, 6 weeks tamper down
222
Main symptoms of Delirium Tremens? (3)
1. Fever
2. Agitation
3. Hallucinations
