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Psych - Background & General Flashcards

1
Q

Bio-Psycho-Social Model

Three Ps?

A

Predisposing
Preipitating
Perpetuating

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2
Q

Name the two psychiatric classification systems

A

ICD-10, DSM-IV

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3
Q

Psychiatric hiarchy of diagnosis

A

1) Organic
2) Psychosis
3) Affective
4) Neurosis
5) Personality
6) No mental illness

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4
Q

Definition of Psychosis

A

“loss of connection with reality”

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5
Q

Two main symptoms of psychosis

A

Hallucinations and delusions

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6
Q

What is a hallucination?

A

Perception without stimulus

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7
Q

What is an illusion?

A

Distorted perception of real stimulus

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8
Q

What are visual hallucinations typical of?

2 Classifications and examples

A

Organic brain disease (e.g. Lewy body dementia)

Drugs (LSD, Delirium Tremens)

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9
Q

What are olfactory hallucinations typical of?

A

Temporal lobe epilepsy

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10
Q

What is a delusion?

A

A false unshakeable belief held in the face of evidence to the contrary outside the cultural norms for that individual

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11
Q

What is an overvalued idea?

A

An isolated preoccupying belief accompanied by a strong affective response. Like a delusion that can be doubted.

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12
Q

What are the typical delusions?

A 
Persecutory / paranoid
Grandiose
Delusions of reference
Guilt
Nihilistic delusions
Jealousy
Control
Possession of thought
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13
Q

What is schizophrenia?

A

Disorder of thinking, perceiving and motivation.

It has positive and negative symptoms

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14
Q

What is the prevalence and age of onset of Schizophrenia?

A 
Lifetime prevalence - 1%
Male = female
Male late 20s
Female early 30s
Urban > rural, immigrants > nationals
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15
Q

What are the main aetiological theories of schizophrenia?

A 
Genetic
Neuro-chemical
Neurological abnormalities
Substance abuse
Obstetric complications
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16
Q

What are the three phasse seen in Schizophrenia?

A

Prodrome - social withdrawal and loss of interest in life
Acute phase - positive symptoms
Chronic phase - negative symptoms

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17
Q

What are schneiders first rank symptoms of schizophrenia?

A 
Auditory hallucinations
Thought withdrawal, insertion and interruption
Thought broadcasting
Thought echo
Somatic hallucinations
Delusional hallucinations
Delusional perception
Feelings / actions "influenced" be external agents
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18
Q

What are the typical auditory hallucinations in schizophrenia?

A

Voices spoken aloud (outside their head)
Third person voices referring to them
Running commentary

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19
Q

List the positive symptoms of schizophrenia.

A

Delusions
Hallucinations
Thought disorders (insertion / withdrawal / broadcast)
Passivity (sense of being controlled)

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20
Q

List the negative symptoms of schizophrenia.

A 
Loss of motivation
Blunting (loss of affect variation)
Paucity of thought
Loosening of association
Anhedonia
Social withdrawal
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21
Q

What are the diagnostic criteria for schizophrenia?

A

First rank symptoms present for one month

Organic causes / mania / delirium excluded

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22
Q

What are the differentials for schizophrenia?

A 
Organic cause
Acute transient psychotic episode
Mood disorder
Schizoaffective disorder
Persistent delusional disorder
Schizotypal disorder
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23
Q

What investigations would you do in a ?schizophrenic?

A 
Bloods - FBC, U&E, LFT, TFT, CRP, fasting glucose, HIV, Syphylis
Urine drug screen
CT if ?organic cause
EEG if ?epilepsy
OT assessment of ADLs
Social work assessment
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24
Q

What are the management options for Schizophrenia?

A

Anti-psychotics
Psychological therapies
Social interventions

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25
What psychological therapies would you use in schizophrenia?
CBT Family therapy Concordance therapy
26
What are the considerations in a psychiatric risk assessment?
Risk to self Risk to others Risk from others
27
What are the risks to self you would consider in a psychiatric risk assessment?
``` Neglect Social Withdrawal Self harm Suicide Financial / sexual impropriety ```
28
What are the subtypes of schizoprenia (5)?
``` Paranoid Catatonic Hebephrenic - disorganised mood / behaviour speech, shallow affect Simple Residual ```
29
What are the symptoms of catatonic schizophrenia (7)?
Stupor - immobile, mute, unresponsive but conscious Excitement - extreme, purposeless motor hyperactivity Posturing - assuming and maintaining bizarre positions Rigidity - holding a rigid posture against efforts to be moved Waxy flexibility - minimal resistance to being moved and maintenance of postures for long period Automatic obedience Perseveration - inappropriate repetition of words / movements
30
What is Beck's triad of depression?
Worthlessness (self), hopelessness (the future) and helplessness (the world)
31
What are the theories of affective disorders?
Behavioural, psychoanalytical, neurochemical, and endocrine disturbance
32
What is depression?
Marked and persistently low mood with physical, psychological and associated symptoms which distort thinking and reduce motivation. A pervasive lack of interest in usual activities; irritability, anxiety or tearfulness
33
Epidemiology - how common is depression? What is the prevalence? F:M? Peaks?
3rd most common reason for primary care consultation Lifetime prevalence 15% F:M 2:1 Peak F 40s, M60-70
34
What are the aetiological theories of depression?
``` Genetics - short serotonin transporter Personality Environment - early adverse events Adverse events Physical causes ```
35
What are the physical causes of depression?
``` Cushings Hypothyroidism Stroke Parkinsons MS Hyperparathyroidism Drugs ```
36
Which drugs may cause depression?
Beta blockers Antihypertensives Stimulants e.g. cocaine
37
What are the core symptoms of depression (3)?
Low mood Low energy Anhedonia
38
What are the cognitive symptoms of depression?
``` Worthlessness Uselessness Feeling unloveable Dwelling on past misdeeds Pessimistic view of the future Lost confidence Suicidal outlook Memory impairment Psychomotor retardation ```
39
What are the biological symptoms of depression?
``` Altered sleep Altered appetite Lack of sex drive Constipation Aches and pains Dysmenorrhoea (often due to medication) ```
40
What are the typical sleep patterns of a depressed patient
Early morning waking (>2hrs earlier than normal) Initial insomnia Less commonly - hypersomnia
41
What are the typical appetite changes in depression?
Lack of appetite Lack of interest in food Weight loss Less commonly - Hyperphagia and weight gain
42
What are the psychological symptoms of depression?
Decreased concentration | Mood fluctuations during one day
43
What psychotic symptoms present in depression?
Auditory hallucinations - mainly 2nd person negative Rarely visual hallucinations Delusions (nihilistic, poverty, persecutory) Guilt
44
What are the diagnostic criteria for depression?
2wk Hx of 2 core symptoms
45
What are the subtypes of depression (4)?
SAD Atypical depression - reversed bioogical symptoms and retained mood reactivity Agitated depression - depression with psychomotor agitation Depressive stupor - profound psychomotor retardation
46
What are the physical differentials for depression (4)?
Hypothyroidism Head injury Cancer Quiet delirium
47
What is adjustment disorder?
Unpleasant, mild, affective symptoms following a life event. Less severe than depression.
48
What are the differentials for depression (8)?
``` Physical Adjustment disorder Sadness Bereavement BPAD / schizoaffective / schizophrenia Substance misuse Postnatal depression Dementia ```
49
What investigations would you do in a ?depressive?
Bloods - TFTs, FBC, HBA1c Depression rating scales (e.g. Beck's depression inventory) If ?cerebral - CT/MRI
50
Management options in depression?
1) Psychological 2) Pharmoacological 3) ECT
51
What are the pharmacological therapies for depression?
SSRI Tricyclics - inhibit NA and 5HT3 reuptake MAO inhibitors
52
What to do if withdrawing anti-depressants?
Tail off to avoid discontinuation Sx (flu, electric shock sensations, headaches, vertigo, irritability)
53
What psychological management is used in depression?
``` Watch and wait CBT Sleep hygiene Exercise Self help Psychodynamic psychotherapy ```
54
What would you observe in an MSE for a depressed PT?
Speech - slow, monosyllabic, little spontaneous speech, monotonous Thoughts - negative content Mood - low, agitated Eye contact - decreased / reluctant
55
What are the stages of bereavement?
Numbness, pining, depression, recovery
56
What is the typical cycle pattern in BPAD?
cycle once or twice per year, but sometimes more rapid.
57
What are the core symptoms of BPAD (4)?
Elevated / cheerful / elated / uncontrollably excited, but sometimes irritable Labile / fluctuant emotions Increased energy / highly motivated Lots of new interests / friends
58
What are the cognitive symptoms of BPAD (7)?
``` Inflated self esteem / confidence Optimism Poor concentration Pressure of speech Flight of ideas May be dysphoric - "sad because they have too much to give" Racing thoughts ```
59
What are the biological symptoms of BPAD (4)?
Reduced need for sleep Voracious appetite for food and sex Increased libido causing promiscuity Poor judgement causing risk taking
60
What are the psychotic symptoms of BPAD (3)?
Grandiose delusions Persecutory delusions Auditory hallucinations
61
What are the diagnostic criteria for BPAD?
PT who has suffered from a manic episode and any other affective dpisode. Need 1/52 mania for diagnosis
62
What are the differentials for BPAD?
Organic Schizophrenia / schizoaffective Cyclothymia Puerperal disorders
63
What organic disorders may be differentials for BPAD?
``` Drugs Dementia Frontla lobe disease Delirium Cerebral HIV Myxoedema madness ```
64
What investigations would you do in a ?BPAD?
Physical exam Bloods - FBC, TFT, CRP (infection) Urine drug screen If ?organic - CT / MRI
65
What are the management options in BPAD?
Pharmacological - mood stabilisers | Psychological
66
What non-mood stabiliser drugs can be used in BPAD?
Antipsychotics - olanzapine | Anticonvulsants - lamotragine
67
How do you manage acute mania?
Stop all medication that may contribute Monitor food and water - exhaustion! If not treated, give mood stabiliser or anti-psychotic If response poor, give both Optimise treatment if already treated ECT is an option if medication doesn't work and PT is at risk from over-activity
68
How do you manage mania longer term?
Prophylaxis is important - episodes get more frequent and worse First line Tx = mood stabilisers Beware anti-depressants in BPAD PTs - may trigger mania
69
What are the psychological management options for BPAD?
CBT to identify relapse indicators and avoidance tactics | Psychodynamic therapy when stable
70
What is somatisation?
Physical symptoms without an identifiable physical cause. | Expression of psychological distress through physical means
71
How common is somatisation?
20-60% of primary care PTs are somatising | 80% of first presentation mood disorders are described in somatic terms alone
72
What is conversion disorder?
Loss of neurological function as a result of extreme psychological distress - memory, power, sensory function or speech
73
What is anxiety disorder?
Impending sense of doom, persistent fear, anxiety or apprehension. Becomes a disorder when it interferes with normal life
74
What are the pharmacological treatments for anxiety disorders?
``` Anxiolytics SSRIs Benzodiazepines Tricyclics for 8-12 months ```
75
What are the psychological treatment options for anxiety?
CBT Relaxation techniques Distraction techniques Respiratory training
76
How do you treat a phobia?
CBT - change the way they behave | Systematic desensitisation / gradual exposure / flooding
77
What pharm can help phobias?
SSRIs | Benzodiazepines
78
What is a panic attack?
Intense fear or discomfort with at least 4 symptoms developed abruptly and peaking within 10 minutes
79
What are the symptoms of a panic attack?
``` Breathing difficulties / choking feeling Chest discomfort / tightness Palpitations Tingling / numbness in hands / feet / mouth Depersonalisation / derealisation Shaking Dizziness / faints Sweating ```
80
What is panic disorder?
Spontaneous unexpected occurrence of panic attacks conisting of discrete period of intense fear. May be many a day / a few a year Not accounted for by another mental disorder
81
What is an obsession?
Ruminating, circular thoughts recognised as your own thoughts and recognised as absurd Thoughts make the PT feel uncomfortable
82
What is a compulsion?
Ritual that PT believes will avert disaster | Means of dealing with obsessive thoughts
83
What are the pharmacological therapies for OCD?
SSRI | Tricyclic
84
What is PTSD?
Experience of fear, helplessness, persistent reliving of events, hyper arousal and avoidance of being reminded of the event Symptoms must last 1/12 and significantly affect the PTs life
85
What is an acute stress reaction?
An earlier, PTSD like, reaction to traumatic events. Within 4 weeks and remits within 2/7-4/52
86
Treatment options for PTSD?
Pharm - SSRI, Anxiolytics Psychotherapy Eye movement desensitisation and reprocessing
87
Generalised anxiety disorder treatment?
CBT | Pharm - SSRI, Benzodiazepines
88
Differentials for generalised anxiety disorder?
``` Hyperthyroidism Substances Excess caffeine Depression Avoidant PD Dementia Schizophrenia ```
89
What is personality?
The dynamic organisation inside the person of psychophysical systems to create a person's characteristic patterns of behaviour, thoughts and feelings.
90
What are the type A personality disorders?
Schizotypal Schizoid Paranoid
91
What are the type B personality disorders?
Borderline Histrionic Narcissistic Antisocial
92
What are the type C personality disorders?
Anankastic Dependent Avoidant
93
What is paranoid personality disorder?
Don't trust anyone and hold grudges
94
What is Schizoid PD?
Just want to be alone in your fantasy world
95
What is schizotypal PD?
Odd relationships, thoughts and ideas. Others view you as eccentric. Visual / auditory hallucinations.
96
What is antisocial / dissocial PD?
Don't care about others feelings, are easily frustrated and aggressive, don't develop close relationships and are unable to learn from pleasant experiences
97
What is borderline / emotionally unstable PD?
Chronic feelings of emptiness, unstable emotions, impulsivity. Can quickly make and break relationships.
98
What is narcissistic PD?
You crave power, success and status; you seek attention and exploit others for your own gain.
99
What is histrionic PD?
Self centred and overly dramatic. Emotions are strong and change quickly. You worry a lot about your appearance and crave excitement.
100
What is anakastic PD / OCD?
Perfectionist, cautious and find it hard to make decisions. You have high moral standards and worry about doing the wrong thing and judging people. You are sensitive to criticism and may have obsessional thoughts / behaviours.
101
What is dependent PD?
Unable to make decisions - need lots of support
102
What is avoidant PD?
You worry a lot, are anxious, tense, inferiority complex and sensitive to criticism.
103
What are the complications of PD?
``` Secondary mental illness Suicidal behaviour Self harm Violence / criminal behaviour Risky behaviour ```
104
What illnesses are secondary to PD?
``` Depression Addictions Eating disorders Impulse control disorders Anxiety disorders Psychosis ```
105
How do you treat PDs?
Pharm - SSRIs, mood stabilisers in borderline PD | Psychological - psychoanalysis, CBT, dialectical behaviour therapy
106
What is Dementia?
Chronic, progressive cognitive impairment with disturbance of higher cortical functions (planning, organising, problems solving), memory, emotion, personality and behaviour with no clouding of consciousness
107
What is the most common dementia?
Alzheimers
108
What is the incidence of dementia?
6% over 65, 20% over 80
109
What are the differentials for dementia?
``` Minimal cognitive impairment Depression Delirium Dysphasia LD ```
110
What are the symptom groups for dementia (4)?
``` Four A's: Amnesia Aphasia Agnosia Apraxia ```
111
How do you diagnose dementia?
2/4 of four A's: amnesia, aphasia, agnosia, apraxia
112
What dementia would you worry about in a PT with parkinsonian symptoms?
Lewy body dementia
113
What risks would you wory about in a dementia PT?
``` Suicide Agitation Wandering Gas cookers Leaving taps on Driving ```
114
What investigations would you do in a ?dementia PT?
Bloods - FBC, U&E, TFT, LFT, B12, Folate, syphilis serology Cognitive test - MMSE / MOCA, ACE3 CT scan Psychology review
115
What pharmacological therapies are available for dementia?
Cholinesterase inhibitors: Donepezil (aricept) Rivastigmine Glantamine
116
How do you monitor pharm treatment in dementia?
MMSE - if it stays stable, they're working. If it drops to <10, discontinue.
117
What is alzheimers disease?
Indious onset of progressive cognitive decline in the absence of vascular or other risk factors. Memory loss and personality change.
118
What is the aetiology of alzheimers disease?
Genetic - beta amyloid plaques, neurofibrillary tangles (silver stain)
119
What are the risks for alzheimers?
Age, sex, dialysis, downs, head injury, premorbid intelligence
120
What is the prognosis for alzheimers?
Life expentancy 8 years
121
What is lewy body dementia?
Dementia first, parkinsonian symptoms second
122
What is the aetiology of lewy body dementia?
Abnormal phosphorylation in microfilaments.
123
What are the diagnositc criteria for lewy body dementia?
2/3 of: Fluctuating consciousness / alertness Recurrent visual hallucinations Parkinsonian features
124
What are the non-core features of lewy body dementia?
``` Repeated falls / syncope Nocturnal confusion Transient LoC Neuroleptic sensitivity Tactile / olfactory hallucinations ```
125
What is the prognosis for lewy body dementia?
Life expectancy 6 years.
126
What is vascular dementia?
Abrupt onset stepwise deterioration with a fluctuating course and vascular risk factors. Focal neurological signs and patchy deficits.
127
What are the risk factors for vascular dementia?
Male, age, cardiovascular disease, cerebrovascular disease, DM, HTM, hypercholesterolaemia, smoking, ETOH
128
What are the clinical signs of vascular dementia?
Mood, personality and behaviour changes. Late loss of insight.
129
What is fronto-remporal dementia?
Early onset dementia with behavioural problems, affective symptoms, speech disorders and motor involvement.
130
What are the typical signs of fronto-temporal dementia?
Disinhibition Impulsivity Rigidity of behaviour Utilisation behaviour
131
What is Picks dementia?
Fronto-temporal dementia with tau protein inclusions (pick bodies)
132
What are the behavioural and psychological symptoms of dementia (BPSD) (8)?
``` Apathy Depression Irritability Anxiety Agitation Delusions Disinhibition Wandering ```
133
What are the differentials for BPSD?
``` UTI Constipation Medication Chest infection Stroke Hypoxia ```
134
What is the risk of using anti-psychotics in dementia?
They increase stroke risk.
135
What is delirium?
Disturbance of consciousness and a change in cognition that develops over a short period of time.
136
What are the symptoms of delirium (6)?
``` Fluctuating consciousness Disorientation Change in cognition (memory deficit, language disturbance) Difficulty attending to tasks Mood changes Psychotic symptoms ```
137
When are symptoms of delirium worst?
Often at night
138
How do you treat delirium?
Prevention! Environmental management Tranquilisation only if necessary for safety
139
What can cause delirium?
``` Substance withdrawal Trauma Hypoxia Infection Inflammation Metabolic Endocrine Intracerebral causes Nutrition Medications ```
140
What is huntingdon's disease?
Autosomal dominant disease causing dementia and chorea
141
What is the mutation in huntingdon's disease?
Trinucleotide repeat in huntingtin gene on Chr 4. | Shows anticipation - repeats lengthen and disease worsens over generations
142
What is the pathological sign of huntingdon's disease?
Deposition of huntingtin protein in basal ganglia and thalamus causing atrophy.
143
What are the clinical signs of huntingdon's disease?
Personality and behavioural changes Later subcortical dementia Chorea affecting limbs, trunk, face and speech Wide based lurching gait.
144
What is the prognosis for huntingdon's?
Survival 15y
145
What effect does HIV have on the brain?
HIV dementia
146
What are the symptoms of HIV dementia?
Early apathy and withdrawal progressing to subcortical dementia with ataxia, tremor, seizures and myoclonus
147
What is normal pressure hydrocephalus?
Rare, potentially reversible, cause of dementia in older adults. Caused by meningitis or head injuries.
148
What is the pathology in normal pressure hydrocephalus?
Impaired CSF absorption with normal ventricular communication.
149
What are the main prion diseases?
CJD, vCJD, iatrogenic CJD, Kuru
150
What is the pathology of prion disease?
Abnormally folded proteins deposit and form spongiform / amyloid changes in the cerebrum, basal ganglia and cerebellum.
151
What is amnesic syndrome?
Anterograde memory loss +- retrograde loss with other functions intact.
152
What causes amnesic syndrome?
Damage to the lumbic structures dealing with memory (by hypoxia, encephalitis, CO poisoning)
153
What is the most common amnesic syndrome?
Korsakoff's syndrome.
154
What causes korsakoff's syndrome?
B1 deficiency
155
What precedes korsakoff's syndrome?
Wernicke's encephalopathy
156
What memory is affected by antergrade amnesia?
Long term memory. Working memory is intact, but information is discarded once not immediately required.
157
What is paraphrenia?
Late onset schizophrenia, often categorised with paranoid schizophrenia or persistent delusional disorder
158
What are the symptoms of paraphrenia?
Paranoid ideation Auditory hallucinations Other hallucinations Rarely negative symptoms
159
What are the risk factors for paraphrenia?
``` Sensory impairment (hearing / visual) Social isolation. ```
160
What is self harm?
An act that intentionally causes physical injury to ones own body that doesn't result in death.
161
Who is most affected by suicide?
Male 45, known to psychiatric services, substance abuser, command hallucinations, poor social support, chronic illness
162
What are worrying signs when discussing a suicide attempt / self harm?
``` Careful planning Final acts in anticipation of death Isolation at the time of the act Precautions taken to prevent discovery Writing a suicide note Definite intent to die Belief in lethality of method Violence of method Ongoing wish to die / regret that attempts failed ```
163
What are the four stages of substance misuse?
Intoxication Harmful use Dependency Withdrawal
164
What is the ICD-10 definition of dependency?
Cluster of physiological, behavioural and cognitive symptoms in which the use of a substance takes on higher priority than other behaviours that once had greater value.
165
What is the neurobiological theory of dependence?
Drugs cause DA release in the ventral tegmental area. This projects to the prefrontal cortex and the nucleus accumbens is central to sensation of pleasure.
166
What are the symptoms of alcohol withdrawal?
Headache, nausea, retching, vomiting, tremor, sweating; insomnia, anxiety, agitation, tachycardia, hypotension; DT
167
What are the CAGE questions?
Ever felt need to Cut down? Ever fely Annoyed by criticism of drinking? Ever felt Guilty about your drinking? Ever felt like you need an Eye opener?
168
What investigations would you do in an alcoholic?
Physical exam | Bloods - FBC, U&E, LFT, TFT, ECG
169
What is dependence syndrome?
3 or more of: Compusion to drink Difficulty controlling drinking Phsyiological withdrawal and use of substances to avoid withdrawal Tolerance Progressive neglect of other activities Persistent use despite evidence of harmful consequence
170
What are the symptoms of delirium tremens?
Confusion Hallucinations (esp visual) Coarse tremor, especially hands Affective changes - extreme fear and hilarity Autonomic disturbance - sweating tachycardia, HTN, dilated pupils, fever
171
What is the treatment for DT?
Pabrinex Benzodiazepines Manage dehydration and electrolyte abnormalities
172
What is wernicke's encephalopathy?
Rapid onset delirium due to thiamine deficiency
173
What are the symptoms of wernicke's encephalopathy?
``` Acute confusion Horizontal nystagmus Lateral rectus palsy Peripheral neuropathy Ataxia Also: N&V Lethargy Hypotension Emotional lability Anxiety Insomnia Malnutrition ```
174
How would you investigate a ?Wernicke's?
EEG - diffuse slowing CSF - mild protein elevation Increased serum pyruvate
175
What are the symptoms of Korsakoff's syndrome?
``` Anterograde amnesia Patchy retrograde amnesia Confabulation Peripheral neuropathy Poor insight Jolly affect ```
176
What are the possible aetiologies of Korsakoff's syndrome?
``` Thiamine deficiency Hypothalamic tumour SAH Infection CO poisoning ```
177
How do you treat korsakoff's syndrome?
Give pabrinex
178
How do you treat acute alcohol detoxification?
Benzodiazepines to reduce withdrawal Vitamin replacement (pabrinex) against wernicke's Prophylactic anticonvulsant
179
How do you maintain alcohol abstinence?
``` CBT Group therapy Disulfiram Acamprosate Naltrexone Fluoxetine ```
180
What are the signs of alcohol withdrawal and when do they occur?
Tremulousness 6-36h Hallucinations 12-24h Seizures 6-48h DTs 3-5d
181
What are the physical complications of IV drug use?
``` Abscesses Septicaemia Endocarditis HIV Hep B and C ```
182
What are they signs of opiate use (7)?
``` Euphoria Feeling warm and well Sedation Analgesia Bradycardia Respiratory depression Pinpoint pupils ```
183
What are the signs of opiate withdrawal (10)?
``` Dysphoria Dilated pupils Goose flesh Shivering Sneezing Yawning Feeling very sick / feverish Restless / urge to score Everything runs Nausea ```
184
How do you treat opiate addiction?
Focus on harm reduction, not abstinence | Detox - gradual using methadone, support with lofexidine for physical symptoms and benzo's for anxiety
185
What substitutes can be prescribed in opiate addiction?
Methadone Buprenorphine (subutex) Buprenorphine + naloxone (subuxone)
186
How do stimulants work?
Potentiate neurotransmitter effects (DA, NA, 5HT)
187
What are the side effects of stimulant use?
``` Arrythmias HTN Stroke Anxiety / panic Drug induced psychosis "Crash" after substance wears off ```
188
What are the signs of marijuana use (4)?
Injected conjunctivae Tachycardia Dry mouth Restlessness / irritability
189
What is classical conditioning?
Conditioned response to a stimulus
190
What is operant conditioning?
Reinforcement of conditioned responses by positive / negative reinforcement
191
What aspects of life does the mental capacity act cover?
Property, affairs, accomodation, healthcare and personal care
192
What does a patient have to do to have capacity?
Understand Retain for long enough to decide Weigh up pros and cons Communicate the decision
193
What is a section 2 order? How long does it last?
Admission for assessment, 28 days
194
What is a section 3 order? How long does it last?
Admission for treatment, 3 months
195
What is section 5.2?
Healthcare professionals holding power - risk to self or others
196
What is CBT first line treatment for?
``` Depression Social anxiety PTSD Generalised anxiety disorder OCD Bulimia Panic disorder and specific phobias ```
197
What is section 1(36)?
Police power to contain a person having a mental health crisis in a public place to somewhere they can be examined and assessed by a doctor.
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What are the criteria for a section 1(36)?
Person appears to be suffering from a mental disorder Person appears in immediate need of care Need to remove the person to a place of safety to protect themselves / the interests of others
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How long can you detain someone on section 1(36)?
72 hours
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What is the key difference between bulimia and anorexia?
Bulimics are normal weight
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What are the key features of bulimia?
``` Binge eating Compensatory behaviours Overvaluation of the thin ideal Normal weight (BMI>17.5) Low self esteem ```
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What is the BMI threshold for bulimia?
>17.5
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What problems commonly associate with bulimia nervosa?
Depression Alcohol and substance misuse PTSD PD
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What are the physical complications of bulimia nervosa?
``` Salt imbalance Kidney damage Arrythmias GI damage Nutritional deficiency ```
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What is the F:M ratio for bulimia?
9:1
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What is the peak age of onset of bulimia?
20-29
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What are the key risk indicators in bulimia?
Rate of weight loss Methods of weight loss Response to past treatment Co-morbid mental status
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What are the risks associated with purging?
Electrolyte disturbance - higher in IDDM, advice dioralyte Dental damage - advice to not brush too long, don't use acidic mouth wash Laxatives - don't reduce calorie consumption, do lose electrolytes
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How do you treat bulimia nervosa?
Evidence based self-help Specialist CBT Fluoxetine - 30% reduction in cycles OutPT / day care if high risk
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What is the key sign of anorexia nervosa?
Severely underweight!
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What is the mortality of anorexia?
5.6% per decade
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How long does anorexia usually last?
6y
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What are the main features of anorexia?
``` Severely underweight Deliberate weight loss Body image distortion & fear of fat Endocrine dysfunction Amenorrhoea ```
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What problems are associated with anorexia?
PD! Impulsive, chaotic or emotionally unstable Rigid, obsessional, anxious, avoidant Associated depression, anxiety
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What are the neurological symptoms of anorexia nervosa?
Large cerebral ventricles | Proximal myopathy
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What are the endocrine symptoms of anorexia nervosa?
Hirsutism
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What are the cardiovascular symptoms of anorexia nervosa?
``` Mitral valve prolapse Bradycardia Hypotension Arrythmias Cardiac failure ```
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What are the GI symptoms of anorexia nervosa?
Constipation Abdo pain Ulcers Liver abnormalities
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What are the MSK symptoms of anorexia nervosa?
Osteoporosis | Collapsed vertebrae
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What are the reproductive symptoms of anorexia nervosa?
Amenorrhoea Shrunken uterus Small, multifolicullar ovaries
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What are the general physical symptoms of anorexia nervosa?
Pancytopaenia Lethargy Cold intolerance
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What is the F:M ratio for anorexia?
9:1
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What is different about the distribution of anorexia and bulimia?
Anorexia is worldwide, bulimia is only western
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What is the main belief of anorexic PTs?
GI disturbances - not weight and shape issues (cf. bulimia). E.g. vomiting, fullness, bloating, lack of appetite.
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Is anorexia heritable?
Yes
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How would you investigate ?anorexia?
``` BMI Squat test ESR, TFTs FBC, U&E, Phosphate, albumin, LFT, CK, glucose ECG ```
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How do you treat anorexia nervosa?
Early intervention with integrated care!
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What is tardive dyskinesia?
Abnormal facial and extremity movement after long term anti-psychotic use.
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What is akathisia?
Inability to sit still, feeling of restlessness and uncomfortableness. S/E of antipsychotics, SSRIs, SNRIs.

Y5 - Psychiatry (4 decks)

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