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phase 3a mine > psych > Flashcards

psych Flashcards

1
Q

mental health act section 2
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • purpose = assessment
  • 28 day detention max
  • cannot be renewed
  • can be treated without consent
  • 2 doctors, 1 AMHP (1 is S12 approved)
  • Patient suffering from mental health disorder of a nature or degree that warrants detention (you don’t need to give a diagnosis- eg psychotic symptoms)
    AND
    Patient is detained for their own safety or protection of others
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2
Q

mental health act section 3
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • purpose = treatment
  • 6 months
  • can be renewed
  • can be treated without consent
  • 2 doctors, 1 AMHP (1 is S12 approved)
  • Patient suffering from mental health disorder of a nature or degree that warrants detention (normally need diagnosis- cos of the treatment aspect)
    AND
    Patient is detained for their own safety or protection of others
    AND
    Appropriate medical treatment must be available

6 months but need another doctor to review at 3 months to see if they agree with the forced medication for this to continue for the final 3 months

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3
Q

mental health act section 4
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • purpose = emergency order “urgent necessity”
  • 72 h max
  • not renewable but wait til second doctor come then convert into section 2
  • cannot be treated without consent
  • 1 doctor, 1 AMHP
  • Patient suffering from mental health disorder of a nature or degree that warrants detention (normally need diagnosis- cos of the treatment aspect)
    AND
    Patient is detained for their own safety or protection of others
    AND
    There is not enough time for 2nd doctor to arrive - the risk is immediate
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4
Q

where does section 2 occur

A

anywhere

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5
Q

where does section 3 occur

A

anywhere

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6
Q

where does section 4 occur

A

anywhere

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7
Q

section 5(4)
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • purpose = nurses holding power, until doctor can attend for further assessment
  • 6h max
  • not renewable but can then give a different section once more professionals arrive
  • can not treat without consent
  • 1 nurse
  • need more time to assess - and think may be danger to self/ others
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8
Q

where does section 5(4) occur

A

hospital only (not a/e)

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9
Q

section 5(2)
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • purpose = doctors holding power
  • 72h max
  • not renewable but can then give a different section once more professionals arrive
  • can not treat without consent
  • 1 doctor
  • need more time to assess - and think may be danger to self/ others
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10
Q

where does section 5 (2) occur

A

hospital only (not a/e)

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11
Q

section 135
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • need to access patients home, then Taken to place of safety (local psychiatric unit / police cell)
  • until further assessment (renewable not really) 36h
  • no treatment
  • police
  • Person suspected of having a mental disorder
    And danger to themselves or others
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12
Q

section 136
- purpose
- length
- renewable
- treat without consent
- who makes this decision
- evidence needed

A
  • Taken from public space, to place of safety (local psychiatric unit / police cell)
  • until further assessment (renewable not really) 24h
  • no treatment
  • police
  • Person suspected of having a mental disorder
    And danger to themselves or others
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13
Q

NICE 1st line therapy for depression, anxiety, OCD, PTSD, eating disorder, psychosis

A

CBT

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14
Q

Psychodynamic (psychoanalytic) therapy
- used for
- what is it

A

depression
uncovering past trauma and more aware of unconcious processes

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15
Q

dialectical behavioural therapy DBT
- used for
- what is it

A
  • bordeline personality disorder / EUPD
  • Balancing acceptance and positive change - relate to self, recognise self and change - manage stress
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16
Q

how long do antidepressants take to work

A

2-4w
longer in older people than young

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17
Q

how long do you need to take antidepressants

A
  • 6-9 months after feel better (if uncomplicated (no psychotic symptoms) and first episode)
  • 2 years (if recurrent depression/ severe episode)
  • To prevent relapse - some people always on
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18
Q

MAOi
- eg
- interactions
- side effect

A
  • Iproniazid
  • Salbumtol, nasal decongestors
  • hypotension
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19
Q

tricylic acids
- eg
- side effect

A

Imipramine
Anticholinergic
- Can’t pee (hesitancy)
- Can’t see (blurred vision)
- Can’t spit (dry mouth)
- Can’t shit (constipation)
Alpha-1 adrenergic antagonism
- Postural hypotension
Antihistaminergic
- Weight gain
Dangerous in overdose
- Lower seizure threshold
- Interferes with cardiac conduction

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20
Q

SSRI
- eg
- side effect

A

Zimeldine Fluoxetine
(Usually transient )
Nausea
Headache
Dizzy
GI upset
Agitation
Anxiety
Sexual dysfunction
Insomnia
Hyponatraemia
Suicidality
- MAYBE - mixed evidence
- But as a result, follow up within 1 week of antidepressants

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21
Q

First line treatment medication for depression, generalised anxiety disorder, post-traumatic stress disorder, eating disorders, obsessive compulsive disorder =

A

SSRI (e.g. citalopram, sertraline, fluoxetine, paroexetnie)

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22
Q

examples of sensory distortion

A

Changes in intensity
Changes in quality
Changes in spatial form
Distorted experiences of time

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23
Q

illusions vs hallucinations

A

Illusions= misinterpretation of stimulus
Hallucinations = Perceptions without an object

both = sensory deceptions

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24
Q

functional hallucination

A

An auditory stimulus causes a hallucination

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25
Q

reflex hallucination

A

stimulus in one sensory modality produces a sensory experience in another

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26
Q

extracampine hallucination

A

hallucination that is outside the limits of the sensory field- e.g. hears voices talking in Paris when they are in Sydney

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27
Q

hypnagogic hallucination

A

hallucinations as person is falling asleep

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28
Q

Hypnopompic

A

hallucinations as person is waking up

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29
Q

Circumstantiality thought disorder

A

Too much unnecessary, convoluted detail before finally reaching the point
can be seen in anxiety

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30
Q

what organic causes for hallucination should be ruled out

A

migraine
epilepsy
delerium
brain tumour

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31
Q

what is thought blocking
where can it be seen

A

sudden interuption of thoughts, mind left blank
schizophrenia

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32
Q

Perservation

A

A certain thought is predominant despite lack of relevance, repeating this.

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33
Q

types of thought alienation

A

Thought insertion
Thought broadcast
Thought withdrawal

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34
Q

primary vs secondary delusions

A

Primary
- A new meaning arises in connection with some other psychological event
- Eg thumbs up meaning distorted to mean a sign from reincarnated wartime friend to find gold
(compared to illusions - thumbs up looks like holding a candle)

Secondary
- Arises from other morbid experiences
- Eg depressed person feeling worthless/ responsible for terrible crime

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35
Q

dissociative amnesia

A

Sudden amnesia that occurs during periods of extreme trauma and can last for hours or even days eg robbed at gunpoint

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36
Q

anhedonia

A

inability to experience joy

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37
Q

conversion and belle indifference

A

CONVERSION
Physical symptoms as a result of psychological distress (without pathology)
- weakened/ stopped body functions
- Blindness
- Mute (aphonia)
- Paralysis
- Headaches
Histrionic personalities (A histrionic personality has a tendency for suggestibility, shallowness, emotional lability, dependency, and selfishness) are more susceptible to conversion disorder

BELLE INDIFFERENCE
Indifference about the disability/ symptoms (conversion)
Emotional disconnect
symptom of conversion disorder

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38
Q

depersonalisation

A

a feeling of some change in the self, associated with a sense of detachment from one’s own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities.

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39
Q

derealisation

A

a sense of one’s surroundings lacking reality, often appearing dull, grey and lifeless

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40
Q

passivity phenomena

A

Somatic passivity
- delusional belief that one is a passive recipient of bodily sensations from an external agency
Made acts, feelings & drives
- actions, feelings and impulses are not their own, but are carried out by the person
- Eg X makes him hit himself when he doesnt want to

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41
Q

made acts, feelings and drives

A

actions, feelings and impulses are not their own, but are carried out by the person
- Eg X makes him hit himself when he doesnt want to

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42
Q

waxy flexibility

A

the patient’s limbs when moved feel like wax or lead pipe, and remain in the position in which they are left.

Found rarely in (catatonic) schizophrenia and structural brain disease.

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43
Q

echolalila

A

automatic repetition of words heard.
(can be present in catatonia)

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44
Q

echopraxia

A

an automatic repetition by the patient of movements made by the examiner
(can be present in catatonia)

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45
Q

logoclonia

A

repetition of the last syllable of a word.
(can be present in catatonia)

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46
Q

negativism

A

motiveless resistance to movement
(can be present in catatonia)

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47
Q

palilalia

A

repetition of a word over and again with increasing frequency.
(can be present in catatonia)

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48
Q

Verbigeration

A

repetition of one or several sentences or strings of fragmented words, often in a rather monotonous tone.
(can be present in catatonia)

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49
Q

delusions of grandiosity associated with what condition

A

mania

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50
Q

nihilistic delusions associated with what condition

A

Believes their body/mind / loved ones don’t exhist
Rare but more common in psychotic depression

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51
Q

capgras delusion =

A

Someone they know has been replaced by a replicate

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52
Q

fregoli delusion =

A

Different people are actually the same person but able to change their appearance

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53
Q

mood stabiliser gold standard =
- therepeutic range =
- S/E =

A

Lithium = gold standard
Narrow therapeutic window - so weekly blood tests – 0.6-1.0mmol/L
S/E = nausea, vomiting, Diarrhea

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54
Q

when is clozapine used

A

2nd line - when 2 other antipsychotics (at least one atypical) has been tried
- then 66% success in these patients!

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55
Q

clozapine side effects and so what needs to be done

A

hypersalivation – potential medication
constipation – potential laxative
neutropenia – weekly bloods
myocardiits – ECG

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56
Q

for each of these state whether 1st/2nd gen:
risperidone
olanzapine
haloperidol

A

2
2
1

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57
Q

for each of these state whether 1st/2nd gen:
Fluphenazine
Zuclopenthixol
clozapine

A

1
1
2

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58
Q

for each of these state whether 1st/2nd gen:
Chlorpromazine
Trifluoperazine
apiprizole
quetiapine

A

1
1
2
2

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59
Q

olanzapine has what side effects particularly

A

weight gain
sedation

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60
Q

why are ECGs done for psychotic patients

A

their medication puts them at risk of increased QT syndrome (and olanzapine has risk of myocarditis)
- seizures, palpitations, blackouts

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61
Q

antipsychotic s/e

A

Sedation
Weight gain
Extrapyramidal symptoms
- Drooling
- Parkinsonism
- Rigidity
- Tremor
- Mask affect
neuroleptic malignant syndrome

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62
Q

NMS
- symptoms
- test
-treatment

A

neuroleptic malignant syndrome

Symptoms
- Temperature drop
- agitated/ restless
- Muscle rigidity
- Sweating
- Tremor
- Incontinence

Test = raised CK

Treatment = stop causing antipsychotic and get fluids

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63
Q

QT syndrome symptoms

A

seizures, palpitations, blackouts

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64
Q

1st vs 2nd generation (generally)
- which acts faster
- which has more S/E
- which is 1st line
- which is better for depots
- which were developed 1st

A

1
2
2
1 (cheaper and able to be in IM form)
1

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65
Q

bipolar 1 vs bipolar 2

A

both require 2 episodes for diagnosis:

Bipolar 1
- 2 episodes including one mania or hypomania episode
- Episodes of mania and depression equally or more mania
- (+/- psychosis, +//- depressive episodes)

Bipolar 2
- 2 episodes : one depressive and one hypomania (not full mania)
- Many more episodes of depression, few of mania
- Therefore easy to miss – so ask about manic symptoms if suspect depression

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66
Q

cyclothymia =

A

Less extreme mania / depression (bipolar)
episodes are shorter in duration (<4d, compared to about a week)
2y+ for diagnosis, no 2month period of stability in this 2y

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67
Q

schizophrenia 1st rank symptoms - where 1 is needed for diagnosis

A

Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception

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68
Q

schizophrenia 2nd rank symptoms - where 2 is needed for diagnosis

A

Delusions
2nd person auditory hallucinations
Hallucinations in any other modality (tactile, gustatory, olfactory)
Thought disorder
Catatonic behaviour
Negative symptoms

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69
Q

generlaised anxiety needs to be going on for how long for diagnosis

A

6months+

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70
Q

early morning waking typical of

A

depression

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71
Q

hard to get to sleep typical of

A

anxiety

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72
Q

what investigations should you carry out following an overdose

A

urine drug screen
bloods - LFTs, U/Es, prothrombin time, paracetemol time, arterial pH, lactate level, salicylate levels
physical examination

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73
Q

counselling vs psychotherapy

A

Counselling = shorter term, psychotherapy = more complex / long-standing
Counselling = for big decision or past/current life event, interpersonal factors often present

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74
Q

core symptoms of depression

A

lethargy
low mood
anhedonia

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75
Q

how long are the core depression symptoms felt for minimum before diagnosis given

A

most of the day, everyday for 2 weeks or more

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76
Q

ECT
- what is it
- when is it indicated

A

Electroconvulsive Therapy - electrical current through brain to cause a seizure

Major depressive disorder (MDD - Severe)
1 it is rapid acting so suitable for those at imminent risk of suicide
2 antidepressant do not treat the psychotic side of psychotic depression so ECT may be appropriate
when multiple classes of antidepressant have failed
3 comorbidities make medication less desirable (elderly, pregnant, physically debilitated )

bipolar (manic OR dep)
schizophrenia

– if these are life threatening / severe / have had previous good response to ECT

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77
Q

what organic disease should be considered as a differential of depression

A

hypothyroidism

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78
Q

somatic passivity=

A

sensation opposed upon their body by an external agent

?same as made feelings (maybe made feelings is made emotions)

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79
Q

delusion vs delusional perception

A

delusional perception is when their is a delusional belief based on a interpretation of a stimus. normal perception and then a delusion is formed around that

eg flatmates moved tv –> they are MI5 and plotting
eg traffic lights go red –> bad thing about to happen
eg thumbs up in street –> sign from god i need to complete a task

80
Q

depression mild/moderate/severe diagnosis

and management

A

Mild = core symptoms +2-3 others / peer teach says <5 symptoms total + minor functional impairment (PHQ:1-9)

Moderate = core +4 others + function affected / peer teach says >5 + variable functional impairment (PHQ:10-14)

Severe = marked loss of function, suicidal
- If any psychosomatic symptoms– Delusions of guilt, Derogatory voices, Nihilistic delusions / peer teach says >5 + marked functional impairment (PHQ:15-27)

mild - low-intensity psychological interventions, group CBT, avoid antidepressants

moderate/severe- antidepressant + high intensity psychological interventions

81
Q

EUPD features

A

childhood trauma/neglect
self harm
subconcious desire for attention
impulsivity
unstable mood, emotional dysregulation - small trigger
intense unstable relationships
onset as young adult/teen
possible : hallucinations, paranoia

82
Q

schizoaffective disorder
- characteristics
- treatment

A

mood alteration (mania normally but can be depression or both)
psychotic symptoms

antipsycotic and mood stabliser

83
Q

sodium valporate
- class of drug
- contraindication and so…
- effect on depression/ mania

A
  • mood stabliser
  • not suitable for any women child-bearing age due to baby birth defects… so highly effective contraception required (implant, coil, depot and NOT pill, condoms as these are temporarily reversible
  • depression +, mania ++
84
Q

how to differentiate schizoaffective disorder from psychotic bipolar disorder

A

schizoaffective disorder has psychotic symptoms before mood symptoms (bipolar other way round)
schizoaffective disorder has less of a depressive drop post manic episodes

85
Q

schizotypal personality disorder

A

discomfort in close relationships - often due to something misinterpretted
odd/eccentric
delusions/hallucinations - but brief and intense

86
Q

schizoid personality disorder

A

difficulty/apathy in forming relationships
no delusions/ halucinations
coherent
reduced pleasure / indifference

87
Q

does paranoid personality disorder have delusions/ hallucinations

A

no

88
Q

personality disorder cluster types

A

Cluster A (‘odd/ eccentric’ - wierd)
- Schizoid (reduced emotions inc libido, no close friends)
- Paranoid (jealous, suspicous, percieve attack, unforgiving)
- Schizotypal

Cluster B (‘dramatic/ erratic’ - wild)
- Emotionally unstable (=EUPD) (unstable relationships, fear of abandonment, suicidal, poor anger control)
- Histrionic (vain, attention seeking, seductive inapprop)
- Narcissistic
- Dissociative (?)
- Dissocial (deceitful, callous, violent, no guilt admission, no safety concern)

Cluster C (‘anxious/fearful’ - worriers)
- Obsessive compulsive
- Dependant (low self confidence, needs reassurance and companionship)
- Avoidant
- Anxious (feels inadequate, social inhibitions, needs to be certain they are liked)
- Anankastic (workaholic, perfectionist, stubborn, inflexible, meticulous)

89
Q

delusonial disorder

A

delusional disorder
no hallucinations
no thought disorder
no mood disorder
no significant flattening of affect

90
Q

mental health and physical health interaction (and how this applies to old people)

A

Both increase the risk of the other (bidirectional relationship)
- And more so than when younger , more delicately balanced
- eg UTI/ hypothyroidism is more likely to result in mental illness
- Eg depressed older person staying in bed will have a greater impact on their physical health - muscle loss, falls, dehydration

Sensory impairment (common in older patients) increases risk of mental illness - depression, anxiety, dementia, visual/auditory hallucinations (in the area of their deficit)

91
Q

vascular depression

A

Higher amount of cerebrovascular disease, the more likely you are to have treatment-resistant depression

92
Q

depression risk affecting alzheimers?

A

increases risk of alzheimers

93
Q

cotard syndrome delusion

A

you or part of you are dead (nihilistic)

94
Q

acohol dependance screening tool

A

CAGE
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

95
Q

alcohol withdrawal treatment

A

Chlordiazepoxide (a benzodiazapine)

96
Q

encephalopathy
- pathophysiology

wernickes’s
- pathophysiology inc cause
- triad presentation
- treatment

A
  • Ammonia not cleared by the liver, builds up in the circulation and passes to the brain
  • Astrocytes try to clear ammonia by converting glutamate → glutamine. Excess glutamine causes imbalance in osmotic pressure so fluid into cells → cerebral oedema
  • Permanent brain damage as ammonia is neurotoxic (halts Krebs cycle, less ATP)

wernicke’s encephalopathy:
- Thiamine reserves exhausted - malnutrition, alcoholism
- Triad (most don’t have all 3)
— Ataxia
— Nystagmus (involuntary eye movements)/ ophthalmoplegia (paralysis / weakness of eye muscles)
— Confusion
- Acute onset
- Reversible : treat with IV thiamine

97
Q

name 3 medicines for alcohol relapse prevention

A

acomprosate - alleviates cravings

disulfiram - makes you v ill (anaphylactic-like) every time you drink alcohol

nalmefene - effect of alc still present but reduced feeling of pleasure/reward

98
Q

opiate overdose treatment

A

ABCDE
Naloxone hydrochloride IV
fluids
oxygen

99
Q

opiate dependancy treatment

A

methadone

100
Q

∙ Describe the features of a dependence syndrome

A

Use of the substance is high priority, higher than other things which were previously higher
Tolerance - increased doses required
Persistence despite harmful consequences
Withdrawal syndrome

101
Q

pos/neg symptoms of schizophrenia

A

POS
delusions (esp persecutory)
hallucinations (esp aud)
formal thought disorder - disorganised thoughts

NEG
apathy
flat affect
self neglect
reduced social interaction
anhedonia
avolition (less empathy)
alogia and catatonia (speaking and moving less)

102
Q

mania vs hypomania

A

Hypomania is a milder version of mania that lasts for a short period (4d+) - less extreme symptoms, smaller effect on function
Mania is a more severe form that lasts for a longer period (7d+).

103
Q

rapid cycling bipolar

A

4 or more depressive, manic, hypomanic episodes in a 12 month period.

104
Q

bipolar with mixed features

A

mania/hypomania and depression at the same time (eg sad and hopeless and restless and overreactive)

105
Q

how long would manic / depressive episodes last if untreated in bipolar

A

manic - 3-6m // >1w? other place
depressive - 6-12m

106
Q

antidepressant effect on mania

A

can trigger / worsen a manic episode

107
Q

acute / chronic mood stablilisers

A

Acute
- Olanzapine
- Haloperidol

Long term
- Lithium- Needs monitoring, is he going to be compliant with services
- Sodium valproate
- lamotrigine, antipsychotics, carbamezapine

108
Q

what is important to remember about paroxetine (antidepressant)

A

needs to be tapered off slowly

109
Q

CBT is 1st line for which diseases

A

depression, anxiety, OCD, PTSD, eating disorder, psychosis

110
Q

eating disorder screening (acronym and questions)

A

SCOFF
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (14 lb or 7.7 kg) in a three month
period?
Do you believe yourself to be Fat when others say you are thin?
Would you say that Food dominates your life?

111
Q

anorexia nervosa

and effects

screening tool

A

restriction of energy intake relative to requirements
restrictive or purge and binge
Underweight (normally cut off around 17.5 BMI) - compared to bulimia

Oral: dental caries
CVS (most common cause of death): hypotension, long QT, arrhythmia, bradycardia, cardiomyopathy
Endocrine: hypokalaemia, hyponatraemia, hypoglycaemia, hypothermia, altered TFTs, increased cortisol, increased growth hormone, amenorrhoea, decreased libido, delayed/arrested puberty, pregnancy poorer prognosis in future, osteoporosis and osteopenia
Kidney issues
MSK eh
Dermatology: dry scaly skin, brittle hair, fine body hair
Haematology: anaemia, leukopenia, thrombocytopenia
Social withdrawal

SCOFF

112
Q

bulimia nervosa

A

recurrent episodes of binge eating (lack of control, large amounts of food) + compensatory behaviour to prevent weight gain (diuretics, vomiting, exercise)
Normal or overweight (normally cut off 17.5BMI )- compared to anorexia nervosa purge and binge type

113
Q

binge eating disorder

A

recurrent episodes of binge eating (episodes of rapid, uncontrolled eating when not hungry until uncomfortably full, eating alone and feeling disgusted after)
no purging/compensatory behaviours

114
Q

purging disorder

A

restrictive behaviours to prevent weight gain + absence of binge eating

115
Q

night eating disorder

A

when asleep
so not aware
eat little in day

116
Q

eating disorder examination / history exploration

A

Eating disorders can affect all systems. However, a normal physical examination does not rule out eating disorders.

Hair thinning/loss
- Lanugo - fine hair all over body
Oedema
Skin dry
Abdominal pain
Sore throat
Cold intolerance
Thyroid
Signs of self-harm
Amenorrhea
Rosvig’s? Sign – indents/calluses from teeth on knuckles from dominant hand down throat
Ulcers
Poor oral hygiene
Enlarged salivary glands
Constipation
Headaches
Fainting, dizzy
Faituge, lethargy
Mood
Appetite
Palpitations
GORD
Polyuria, polydipsia

117
Q

lanugo =

A

fine hair over body typical of long standing eating disorder / underweight people

118
Q

eating disorder investigations

A

Bloods - Electrolytes, TFTs, LFTs, CRP, vit D, glucose, CK, vit B12, folate, phosphate, calcium, iron, mg, copper, zinc, PTH, sex hormones
ECG
CT head
Glucose (DM)
Congestive heart failure
DEXA (OA)
SUSS test - sit up, squat and stand - assessing muscle wasting
Psychological assessment after stabilised
Urinalysis
Salivary gland enlargement
Cardiomegaly
Dental enamel erosion

119
Q

eating disorder comorbidities

A

Cardiac
- Arrhythmia
- Low BP, HTN
- Low HR
- HF
T2DM
OA/ osteoporosis
Sleep apnea
Dyslipidaemia
Anaemia
Thyroid problems
Low K
Low WBC
Suicide risk
Seizures
Kidney failure
Cognitive impairment
Muscle weakness
Vitamin deficiencies (eg wernickes)
Infection
hypothermia

120
Q

eating disorder immediate and long term management

A

Short term = Marsipan guidance ((management really sick patients with anorexia nervosa) - national protocol for acute eating disorder presentation)
refeed
- Fine line between refeeding and underfeeding syndrome
- Re feeding (dont go too fast)
— Low electrolytes (monitor!)
— Arrythmias (ECG monitored too)
— HF
— Seizure
— -Diarrhea/ GI upset
— Confusion, delerium
— Paralysis
— Respiratory depression, SOB
— Fluid excess
— Rapid weight gain
— Increased BP and HR
— Hyperglycaemia
- May be NG tube, fortisip etc
- Electrolyte replacement (inc thiamine) IV
- Possible bathroom supervision

Long term -
Referral to eating disorder psychiatry service
online self help
CBT
family therapy - explore underlying issue
Focal Psychodynamic Therapy (FPT)

121
Q

key features of explaining MUS (medically unexplained symptoms) / functional / somatic diagnosis

A

Explain early on the option that this is psychological
Explain that this is common
- 20% to ⅓ of GP
- Around half of new referrals to secondary care
Explain that this does not mean that what they are experiencing is not real. It is genuine. It is not imagined
Explain that this is not their fault, they did not choose this
Explain that there is hope - the good news is that these symptoms are potentially reversible. However, they need to collaborate and put in work in order to achieve this.

122
Q

MUS (medically unexplained symptoms) / functional / somatic diagnosis Treatment

A

Physio
Pain relief
CBT
Psychodynamic therapy
Regular check-ups
inc physical examination
Take patient seriously, open minded, happy to reassess
Increases patient satisfaction
signs taken over symptoms
Health beliefs - ICE about diagnosis
Antidepressants
Reassurance
Behavioural advice
Tracking symptoms - who with, doing what, feeling what,
Ways to reduce stress, relaxation, manage concerns
Medication review

123
Q

alcohol withdrawal symtpoms

A

delerium tremens - visual hallucinations of small animals, no insight
sleep distrubance - circadian distruption - disorientation
seizures
naus/vom
shakes
wernickes
delerium
can fluctate - worse at night
Change in HR, BP, temperature
anxiety
irritability
sweaty

124
Q

OCD screening questions

A

Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you would like to get rid of, but cannot?
Do your daily activities take a long time to finish?
Are you concerned about putting things in a special order, or are you upset by mess?
Do these problems trouble you?

know its unreasonable and active (not passive) (DD schiz),

125
Q

Antidepressant medication ladder

A

SSRI
different SSRI
Metazapine
Venlafaxine
Combination (either venlafaxine and metazapjne or SSRI and metazapine )

126
Q

Metazapine
- class
- side effect

A

Noradrenergic and specific serotonergic antidepressant (NaSSA)

Increase in appetite
Drowsiness
(So good of patient also complains of difficulty sleeping or poor appetite!)

127
Q

Venlafaxine

A

Stronger antidepressant
Try after having tried 2 x SSRI
Venlafaxine is an SNRI

128
Q

What are pseudohallucinations

A

Voice sounds inside your head
Illusion rather than hallucination eg mirage
Recognised as unreal by the patient
Historically indicates not psychosis (but lines are blurring)

129
Q

First line deletion treatment

What to avoid

A

Haloperidol

Lorazepam can aggregate

130
Q

Quetiapine different uses

A

Antidepressant/mood stabiliser - 300-350mg per day

Antipsychotic- 600-800mg per day

131
Q

Acomprosate

A

Anti craving alcohol dependence drug used post detox

132
Q

Disulfuride

A

Feel sick and get strong withdrawal type symptoms whenever you drink alcohol

133
Q

OCD severity scale

A

Yale–Brown Obsessive-Compulsive Scale (Y-BOCS)

134
Q

OCD medications yes’s and no’s

A

SSRI 1st line
- Escitalopram
- Fluoxetine
- Fluvoxamine
- Paroxetine
- Sertraline
- Citalopram (unlicensed)

TCA - Clomipramine 2nd line (TCA) if SSRI contraindicated or previous good response to clomipramine
Monitor for emergence of suicidal / psychotic symptoms

No benzodiazapines (Addiction/dependance) or antipsychotics

treat physcial injuries eg cream for excessive hand washing

135
Q

PTSD medication

A

the first line drug treatments are venlafaxine (a SNRI) or a SSRI

Antidepressants
Sertaline (licensed)
Paroxetine (licensed)
Amitriptyline
Phenelzine

136
Q

EMDR

A

eye movement desensitization and reprocessing

Reprocess the memory so that is is dealt with and stored in the brain better

Eye movements → Triggers the difficult memories to come to the surface and learning techniques to deal with the effects - breathing, mindfulness, learning to process this in the right way

for PTSD (joint first line with CBT?)

137
Q

anxiety medication

A

Citrolapram (SSRI) or
SertraLine (SSRI)

Beta blockers for heart symptoms
Not benzodiazepines (dependence and addiction)

138
Q

pressure of speech =

A

difficult to interrupt, annoyed when interrupt

139
Q

flight of thought vs looseing associations

A

flight of thought is more extreme on the scale than looseing associations

140
Q

circumstantiality vs tangentiality

A

circumstantiality- long answer but will answer it, but tangential - will go off topic and not answer original q)

141
Q

clang associations

A

rhyming links (name, game), punning (soul, sole

142
Q

mania core 3 symptoms + others

A
  1. increase in activity
  2. elevated mood , euphoria
  3. irritable - heightened sensitivity

risk taking /reckless
disinhibition
anger, irritability
sociable
appetite and sleep change
increased libido
pressured speech
flight of thought

143
Q

ADHD triad

minimum diagnosis age

A

poor concentraion
overactivity
inattention

6

144
Q

ASC ( autism spectrium condition) triad

A

difficulties in social understanding
preoccupations
language difference

145
Q

ocd vs ocpd (6)

A

ocd is ego dystonic (person knows its not right) whereas ocpd lacks insight

ocd has more variation over time

ocd’s actions result from preventing catastrophe, whereas ocpd’s action result from attempt to be perfection

ocpd may have other personality disorder symtpoms eg intense unstable relationships etc

ocpd experiences intrusive thoughts (obsessions) less often and their compulsions are less to do with relieving the anxiety from their intrustive thoughts and more to do with controlling the desired outcome.

ocpd may have resulted from overstrict/ overprotective parents and so this behaviour is an attempt to avoid punishment

both have rigidity

146
Q

how might depression present in young children

A

tantrums, irritability, refusion to go to school, clingy to parents, unable to express emotions

147
Q

4 attatchment types

A
  1. Secure – ‘I’m ok, you’re there for me’
  2. (Insecure) avoidant – ‘It’s not ok to be emotional’
  3. (Insecure) ambivalent – ‘I want comfort but it doesn’t help me’
  4. (Insecure) disorganized – ‘I’m frightened’
148
Q

which antipsychotics (in general) are worse for:
- extrapyramidal
- weight gain
- sexual problems
- sedation

A
  • typical
  • both
  • typical
  • both
149
Q

apiprizole side effects and speed of action

A

fewer side effects so good for starting off with but takes longer to have an effect so less appropriate for acute presentation

150
Q

capacity assessment

A

To have capacity a person must be able to:
•UNDERSTAND the information that is relevant to the decision they want to make
•RETAIN the information long enough to be able to make the decision
•WEIGH UP the information available to make the decision
•COMMUNICATE their decision by any possible means, (including talking, using sign language, or through simple muscle movements such as blinking an eye
or squeezing a hand.)

151
Q

amnestic confabulation is seen in what disease

A

korsakoff (vit b1 thiamine deficinecy - commonly alcoholism)

152
Q

acomprosate

A

anti craving for alcohol dependance

153
Q

disulfiride

A

makes feel v sick (like withdrawal) when alcohol is drank

154
Q

2 anti alcohol addiction drugs

A

acomprosate (ac = anti-cravind)
disulfiride (sulf= toxic, makes very sick when you drink alcohol)

155
Q

quitiapine different levels of dose

A

300-350 = antidep/ mood stabiliser
600-800 = antipsychotic

156
Q

antidepressant order given

A
  • SSRI
  • different SSRI
  • metazapine (NaSSA) - increase appetite and drowsiness so good if these are problem areas
  • venlafaxine (SNRI) - stronger
  • combination- metazapine and SSRI or metazapine and venlafaxine
  • citrolapram and sertraline good if anxiety element
157
Q

learning disability tx

A
  • teach life skills eg toilet, social skills, problem solving
  • alter behaviour eg sexual disinhibition
  • treat comorbidity - psychosis, depression, OCD, anxiety, epilepsy, bipolar
  • CBT if mild
  • psychodynamic therapies for emotional development, relationships, bereavement..
158
Q

what drugs may cause cognitive impairment

A

Anticholinergic
- Amitriptyline
- Oxybutin
- promethazine, chlorpheniramine
Opiates affect cognitive function
alcohol withdrawal acute

159
Q

learning difficulty vs learning disability

A

Learning difficulty
- -Psychological term to describe impairment in usually one domain
- Disorders of speech/ language, motor function,
- Eg dyslexia

Learning disability
- Global impairment affecting functioning and intelligence
- Less than 70 IQ

160
Q

learning disability causes

A

Prenatal
- Genetic (Downs syndrome, Fragile X syndrome )
- Infection (HIV, herpes, measles, rubella, chlamydia, syphilis, CMV, toxoplasmosis )
- Toxic (Smoking, alcohol, drugs, Lithium, sodium valproate, phenytoin , Lead)
- Metabolic (HTN, Hypothyroidism , Anemia , Rh incompatibility , Folic acid deficiency)

Perinatal
- Infections (Encephalitis, Meningitis )
- Trauma (Forceps , Bleeding , Hypoxia , Premature, Low birth weight)
- Malnutrition

Post natal
- Trauma (Head injury , Hypoxia , Physical abuse )

161
Q

fragile x syndrome

A

Physical
- Low muscle tone
- Long narrow flat face
- Large ears
- High forehead
Poor feeding
Autism
Cognitive disability
Learning disability - maths and abstract concepts
Anxiety - social, avoidance of eye gaze, withdrawal from social interaction
Attention issues, distractible, hyperactive, impulsive
Can be a carrier - milder symptoms

162
Q

what assessment is used to measure intelligence

A

weschler

163
Q

learning disability assessments

A
  • intellecutal impairment (weschler)
  • functioning assessments
  • assess handicaps - quality of life
  • determine cause
164
Q

lithium
- effect on depression/mania
- when is this used
- therapeutic range / monitoring
- what may affect levels
- toxicity symptoms
- toxicity treatment

A

mania +++
depression ++

lithium is 1st line for bipolar /mania

Narrow therapeutic window - so weekly blood tests – 0.6-1.0mmol/L

dehydration (diuretics, diar/vom, water/salt intake, heat wave), reduced renal function, NSAIDs may cause toxicity
- Naus /vomit/ diarrhea
- Confusion
- Excessive sleeping
- Seizures
- Coarse tremor
- Myoclonic jerks

tx:
Stop lithium
Rehydrate
Consider haemodialysis if v high level
Consider restarting lithium once stabilised - was this due to poor education, non compliance or is this due to renal function change and they should not be on this anymore

165
Q

lamotrigine effect on depression/mania

A

mania -
depression ++

(opposite to antipsychotics!– except olanzapine can be used a bit in depression)

166
Q

carbamezapine

A

mood stabilser
not NICE recommended
lihtium, then other one, then carbamezapine (3rd line)

167
Q

depakote =?

A

form of sodium valporate

168
Q

discontinuation syndrome
- acute/chronic
- symptoms
- which drugs are worst for this
- prevention

A
  • acute, self limiting, few weeks
  • GI disturbance
    Parasthesia - Electric shock
    Headache
    Anxiety
    Dizzy
    Fatigue
    Sleep disturbance
    Sweating
    Tinnitus
    Flu-like symptoms
  • Paroxetine and venlafaxine are especially difficult for this due to short half lifes!
  • slow tapering off of antidepressants
169
Q

antidepressants classes and examples

A

SSRI - sertraline, citalopram, fluoxetine, paroxetine, zimeldine

SNRI - venlafaxine, duloxetine, mitrazapine

MAOi - phenelzine, isocarboxazid, iproniazid (MAOi used not so much due to foreign importing costs)

TCA - amitryptiline, clompipramine, nortriptyline, dosulepin, lofepramine, imipramine

other - mirtazapine

170
Q

SSRI side effects

A

Often short term
- GI side effects - nausea/ vomit/ diarrhea, weight loss/ anorexia (give PPI to elderly maybe)
- Increase in anxiety /suicidality
- Sexual dysfunction (not short term)
- insomnia

takes 2-4w to work

171
Q

TCA side effects

A
  • Less appropriate for older adult
    —- Postural hypotension, blurred vision, constipation, drowsy, confused
  • Less appropriate for overdose risk
  • weight gain
  • cardiac s/e
    -agitation
172
Q

MAOi side effects

A

Cheese reactions → dietary restrictions
- foods High in tyrosine (cheese, bovril, red wine, beer, banana …) causing big throbbing headache at bottom of head + tachycardia, arrythmias, nausea …. ‘hypertensive crisis’
Antidote = prazosin, phentolamine

postural hypotension, constipation

173
Q

SNRI side effects

A

sexual dysfunction, nausea, headache, anxiety, insomnia, sweating, increased BP

174
Q

depresssion/ antidepressants pathophysiology

A

depression = lack of neurotransmitters in brain (serotonin/ noradrenaline)

antidepressants keep neurotransmitters in cleft for longer / prevent breakdown …

175
Q

serotonin syndrome
- cause
- symptoms
- treatment

A
  • overdose
  • dual antidepressant usage
  • drugs such as tramadol effects serotonin levels
  • neuromuscular hyperactivity - rigid, tremor, myoclonus, hyperreflexia
  • autonomic dysfunction - tachycardia, BP changes, hyperthermia, sweating, shivering, diarrhea
  • altered mental state - confusion, mania, agitation
  • Supportive
  • Cyproheptadine (5-HT2 antagonist)
176
Q

SSRI possible complications to watch out for

A

hyponatraemia – may be contributed to by PPI usage

GI bleed

177
Q

anticholinergic side effects

A

eg for tca ??

cant see
cant pee
cant sit
cant shit

178
Q

schizophrenia and antipsychotics pathophysiology

A

Psychosis is caused by excess dopamine

Schizophrenia patients have relative underactivity in meso-cortical pathway, and relative overactivity in mesolimbic pathway

Antipsychotics are dopamine D2 antagonists

However this causes extra pyramidal side effects (EPSE) (parkinsonism symptoms)

Atypicals: occupy 5HT2a — less extra pyramidal side effects

179
Q

anxiety symptoms
- emotional
- physical
- behavioural

A

Emotional symptoms – fear, worry, nervous

Physical Symptoms – sweating, tremor, palpitations, nausea, breathless, tired, light-headed/dizzy, tingly, chest pain, sleep worse, trembling, GI upset (lots..)

Behavioural - avoidance of feared object, irritable ‘mood swings’, poor conc

180
Q

delerium tremens
- when does this occur
- what is typical
- treatment

A
  • alcohol withdrawal. 48h on (but hallucincations from 12h on)
  • visual hallucinations - small animals
  • no insight
  • admit. Chlordiazepoxide or diazepam (long-acting benzos). carbamezapine
  • and thiamine/ vit B / pabrinex (all same thing)
  • if psychotic :haloperidol
181
Q

BDI-II

A

Becks Depression Inventory 2

(a bit like PHQ9)

21 depression symptoms- ranked 1-3/4(?)
over 2w

182
Q

SSRI time frame

A

takes 2-4 w to work, wait at least this long before switch
can have s/e in first few weeks
take min 6m after recovered (prevent relapse)

183
Q

post natal depression
- when
-managment

baby blues

A
  • most 3-4w post-birth but in 1y
  • CBT, SSRI (if breastfeeding–> sertraline or paroextenie , not citalopram)

few days after birth, resolves within several weeks

184
Q

dysthymia
= ?
- defined as what
- managment

A

persistent depressive disorder
2+y, subthreshold ? (minor not major depression)
CBT and SSRI

185
Q

bipolar mx

A

pyschotherapy - CBT, interpersonal therapy
support

mood stabiliser - lithium, sodium valp, carbamez
SSRI
antipsychotics - olanzapine, risperidone

NB: lithium needs monitoring!
- before start, get U/E, ECG, TFT, FBC, BMI (and measure these every 6m)
- serum lithium levels recorded 1 w after dose change until stable within 0.6-0.8 (and every 3m for first year)

186
Q

bipolar tx in emergency (Acute mania)

A

Quetiapine + Lithium +- benzodiazepines

187
Q

anxiety RF

A

female, 35-64y, Hx of trauma, Hx of anxiety disorders, FHx of anxiety, physical/ emotional stress, chronic conditions, substance abuse, single parents, divorced/widowed, live alone

188
Q

GAD7

A

anxiety diagnosis (7 symptoms, frequency over 2w (even though diagnosis needs 6m))

mild = 5-9
moderate = 10-14
severe = 15+

189
Q

PTSD symptoms

onset when

duration

A

HEAR
Hyperarousal
Emotional Numbing
Avoidance
Reliving the Situation

1-6m after event (acute distress disorder presents within 1m, give them short-term CBT and SSRI rather than EDMR)

4w+ (acute distress disorder lasts <4w)

190
Q

ERP =?

A

exposure and response therapy

for OCD (+phobias/anxiety?)

do activity and don’t do compulsion

191
Q

negative symptoms of schiz

positive

A

Anhedonia
Affect blunted
Asocial
Alogia
Attention deficit
Avolition
Catatonia

Delusions
Hallucinations
Formal Thought disorder
Thought interference
Passivity

192
Q

metabolic DD of schiz

A

Hypercalcaemia
B12 def
Folate deficiency

–> psychosis

193
Q

types of schiz

A

“Paranoid Psychotic Humans Can’t Supply Understandable Reasoning”

Paranoid: just +ve sx

Post-schizophrenic Depression: depression with schiz hx in last 12months + some schiz sx still present

Hebephrenic: thought disorganisation (mainly young onset, poor prognosis)

Catatonic: 1 or more -ve sx

Simple: no psychotic sx, with -ve sx

Undifferentiated: meet Dx criteria but doesnt fit other types

Residual: -ve sx lasting one year following a psychotic episode

194
Q

addiction criteria

A

3 or more

Acute intoxication
Harmful use
Dependence
Withdrawal sx
Psychotic disorder
Amnesia
Residual disorder

195
Q

what do these mean:

preservation
echolalia
neologism
word salad
expressive dysphagia
clanging
alogia
palolagia

A

Perseveration - repeating the same words/answers.

Echolalia - repeating exactly what someone has said.

Neologism - making up new words.

Word salad - disorganised speech, sentences that do not make sense.

Expressive dysphasia - difficulty putting together words. Often develops following a stroke.

clanging - words strung together by sound/ rhyme rather than by meaning

alogia: little information conveyed by speech

palolagia : compulsive repetitions of utterances (saying same word lots in a paragraph)

phase 3a mine (16 decks)

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