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Y5 - Psychiatry > Psych - Background & General > Flashcards

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
Q

What psychological therapies would you use in schizophrenia?

A

CBT
Family therapy
Concordance therapy

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26
Q

What are the considerations in a psychiatric risk assessment?

A

Risk to self
Risk to others
Risk from others

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27
Q

What are the risks to self you would consider in a psychiatric risk assessment?

A 
Neglect
Social Withdrawal
Self harm
Suicide
Financial / sexual impropriety
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28
Q

What are the subtypes of schizoprenia (5)?

A 
Paranoid
Catatonic
Hebephrenic - disorganised mood / behaviour speech, shallow affect
Simple
Residual
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29
Q

What are the symptoms of catatonic schizophrenia (7)?

A

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

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30
Q

What is Beck’s triad of depression?

A

Worthlessness (self), hopelessness (the future) and helplessness (the world)

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31
Q

What are the theories of affective disorders?

A

Behavioural, psychoanalytical, neurochemical, and endocrine disturbance

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32
Q

What is depression?

A

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

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33
Q

Epidemiology - how common is depression? What is the prevalence? F:M? Peaks?

A

3rd most common reason for primary care consultation
Lifetime prevalence 15%
F:M 2:1
Peak F 40s, M60-70

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34
Q

What are the aetiological theories of depression?

A 
Genetics - short serotonin transporter
Personality 
Environment - early adverse events
Adverse events
Physical causes
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35
Q

What are the physical causes of depression?

A 
Cushings
Hypothyroidism
Stroke
Parkinsons
MS
Hyperparathyroidism
Drugs
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36
Q

Which drugs may cause depression?

A

Beta blockers
Antihypertensives
Stimulants e.g. cocaine

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37
Q

What are the core symptoms of depression (3)?

A

Low mood
Low energy
Anhedonia

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38
Q

What are the cognitive symptoms of depression?

A 
Worthlessness
Uselessness
Feeling unloveable
Dwelling on past misdeeds
Pessimistic view of the future
Lost confidence
Suicidal outlook
Memory impairment
Psychomotor retardation
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39
Q

What are the biological symptoms of depression?

A 
Altered sleep
Altered appetite
Lack of sex drive
Constipation
Aches and pains
Dysmenorrhoea (often due to medication)
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40
Q

What are the typical sleep patterns of a depressed patient

A

Early morning waking (>2hrs earlier than normal)
Initial insomnia
Less commonly - hypersomnia

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41
Q

What are the typical appetite changes in depression?

A

Lack of appetite
Lack of interest in food
Weight loss
Less commonly - Hyperphagia and weight gain

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42
Q

What are the psychological symptoms of depression?

A

Decreased concentration

Mood fluctuations during one day

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43
Q

What psychotic symptoms present in depression?

A

Auditory hallucinations - mainly 2nd person negative
Rarely visual hallucinations
Delusions (nihilistic, poverty, persecutory)
Guilt

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44
Q

What are the diagnostic criteria for depression?

A

2wk Hx of 2 core symptoms

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45
Q

What are the subtypes of depression (4)?

A

SAD
Atypical depression - reversed bioogical symptoms and retained mood reactivity
Agitated depression - depression with psychomotor agitation
Depressive stupor - profound psychomotor retardation

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46
Q

What are the physical differentials for depression (4)?

A

Hypothyroidism
Head injury
Cancer
Quiet delirium

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47
Q

What is adjustment disorder?

A

Unpleasant, mild, affective symptoms following a life event. Less severe than depression.

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48
Q

What are the differentials for depression (8)?

A 
Physical
Adjustment disorder
Sadness
Bereavement
BPAD / schizoaffective / schizophrenia
Substance misuse
Postnatal depression
Dementia
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49
Q

What investigations would you do in a ?depressive?

A

Bloods - TFTs, FBC, HBA1c
Depression rating scales (e.g. Beck’s depression inventory)
If ?cerebral - CT/MRI

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50
Q

Management options in depression?

A

1) Psychological
2) Pharmoacological
3) ECT

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51
Q

What are the pharmacological therapies for depression?

A

SSRI
Tricyclics - inhibit NA and 5HT3 reuptake
MAO inhibitors

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52
Q

What to do if withdrawing anti-depressants?

A

Tail off to avoid discontinuation Sx (flu, electric shock sensations, headaches, vertigo, irritability)

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53
Q

What psychological management is used in depression?

A 
Watch and wait
CBT
Sleep hygiene
Exercise
Self help
Psychodynamic psychotherapy
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54
Q

What would you observe in an MSE for a depressed PT?

A

Speech - slow, monosyllabic, little spontaneous speech, monotonous
Thoughts - negative content
Mood - low, agitated
Eye contact - decreased / reluctant

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55
Q

What are the stages of bereavement?

A

Numbness, pining, depression, recovery

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56
Q

What is the typical cycle pattern in BPAD?

A

cycle once or twice per year, but sometimes more rapid.

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57
Q

What are the core symptoms of BPAD (4)?

A

Elevated / cheerful / elated / uncontrollably excited, but sometimes irritable
Labile / fluctuant emotions
Increased energy / highly motivated
Lots of new interests / friends

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58
Q

What are the cognitive symptoms of BPAD (7)?

A 
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
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59
Q

What are the biological symptoms of BPAD (4)?

A

Reduced need for sleep
Voracious appetite for food and sex
Increased libido causing promiscuity
Poor judgement causing risk taking

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60
Q

What are the psychotic symptoms of BPAD (3)?

A

Grandiose delusions
Persecutory delusions
Auditory hallucinations

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61
Q

What are the diagnostic criteria for BPAD?

A

PT who has suffered from a manic episode and any other affective dpisode.
Need 1/52 mania for diagnosis

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62
Q

What are the differentials for BPAD?

A

Organic
Schizophrenia / schizoaffective
Cyclothymia
Puerperal disorders

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63
Q

What organic disorders may be differentials for BPAD?

A 
Drugs
Dementia
Frontla lobe disease
Delirium
Cerebral HIV
Myxoedema madness
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64
Q

What investigations would you do in a ?BPAD?

A

Physical exam
Bloods - FBC, TFT, CRP (infection)
Urine drug screen
If ?organic - CT / MRI

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65
Q

What are the management options in BPAD?

A

Pharmacological - mood stabilisers

Psychological

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66
Q

What non-mood stabiliser drugs can be used in BPAD?

A

Antipsychotics - olanzapine

Anticonvulsants - lamotragine

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67
Q

How do you manage acute mania?

A

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

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68
Q

How do you manage mania longer term?

A

Prophylaxis is important - episodes get more frequent and worse
First line Tx = mood stabilisers
Beware anti-depressants in BPAD PTs - may trigger mania

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69
Q

What are the psychological management options for BPAD?

A

CBT to identify relapse indicators and avoidance tactics

Psychodynamic therapy when stable

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70
Q

What is somatisation?

A

Physical symptoms without an identifiable physical cause.

Expression of psychological distress through physical means

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71
Q

How common is somatisation?

A

20-60% of primary care PTs are somatising

80% of first presentation mood disorders are described in somatic terms alone

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72
Q

What is conversion disorder?

A

Loss of neurological function as a result of extreme psychological distress - memory, power, sensory function or speech

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73
Q

What is anxiety disorder?

A

Impending sense of doom, persistent fear, anxiety or apprehension.
Becomes a disorder when it interferes with normal life

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74
Q

What are the pharmacological treatments for anxiety disorders?

A 
Anxiolytics
SSRIs
Benzodiazepines
Tricyclics
for 8-12 months
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75
Q

What are the psychological treatment options for anxiety?

A

CBT
Relaxation techniques
Distraction techniques
Respiratory training

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76
Q

How do you treat a phobia?

A

CBT - change the way they behave

Systematic desensitisation / gradual exposure / flooding

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77
Q

What pharm can help phobias?

A

SSRIs

Benzodiazepines

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78
Q

What is a panic attack?

A

Intense fear or discomfort with at least 4 symptoms developed abruptly and peaking within 10 minutes

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79
Q

What are the symptoms of a panic attack?

A 
Breathing difficulties / choking feeling
Chest discomfort / tightness
Palpitations
Tingling / numbness in hands / feet / mouth
Depersonalisation / derealisation
Shaking
Dizziness / faints
Sweating
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80
Q

What is panic disorder?

A

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

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81
Q

What is an obsession?

A

Ruminating, circular thoughts recognised as your own thoughts and recognised as absurd
Thoughts make the PT feel uncomfortable

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82
Q

What is a compulsion?

A

Ritual that PT believes will avert disaster

Means of dealing with obsessive thoughts

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83
Q

What are the pharmacological therapies for OCD?

A

SSRI

Tricyclic

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84
Q

What is PTSD?

A

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

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85
Q

What is an acute stress reaction?

A

An earlier, PTSD like, reaction to traumatic events. Within 4 weeks and remits within 2/7-4/52

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86
Q

Treatment options for PTSD?

A

Pharm - SSRI, Anxiolytics
Psychotherapy
Eye movement desensitisation and reprocessing

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87
Q

Generalised anxiety disorder treatment?

A

CBT

Pharm - SSRI, Benzodiazepines

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88
Q

Differentials for generalised anxiety disorder?

A 
Hyperthyroidism
Substances
Excess caffeine
Depression
Avoidant PD
Dementia
Schizophrenia
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89
Q

What is personality?

A

The dynamic organisation inside the person of psychophysical systems to create a person’s characteristic patterns of behaviour, thoughts and feelings.

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90
Q

What are the type A personality disorders?

A

Schizotypal
Schizoid
Paranoid

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91
Q

What are the type B personality disorders?

A

Borderline
Histrionic
Narcissistic
Antisocial

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92
Q

What are the type C personality disorders?

A

Anankastic
Dependent
Avoidant

93
Q

What is paranoid personality disorder?

A

Don’t trust anyone and hold grudges

94
Q

What is Schizoid PD?

A

Just want to be alone in your fantasy world

95
Q

What is schizotypal PD?

A

Odd relationships, thoughts and ideas. Others view you as eccentric. Visual / auditory hallucinations.

96
Q

What is antisocial / dissocial PD?

A

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
Q

What is borderline / emotionally unstable PD?

A

Chronic feelings of emptiness, unstable emotions, impulsivity. Can quickly make and break relationships.

98
Q

What is narcissistic PD?

A

You crave power, success and status; you seek attention and exploit others for your own gain.

99
Q

What is histrionic PD?

A

Self centred and overly dramatic. Emotions are strong and change quickly. You worry a lot about your appearance and crave excitement.

100
Q

What is anakastic PD / OCD?

A

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
Q

What is dependent PD?

A

Unable to make decisions - need lots of support

102
Q

What is avoidant PD?

A

You worry a lot, are anxious, tense, inferiority complex and sensitive to criticism.

103
Q

What are the complications of PD?

A 
Secondary mental illness
Suicidal behaviour
Self harm
Violence / criminal behaviour
Risky behaviour
104
Q

What illnesses are secondary to PD?

A 
Depression
Addictions
Eating disorders
Impulse control disorders
Anxiety disorders
Psychosis
105
Q

How do you treat PDs?

A

Pharm - SSRIs, mood stabilisers in borderline PD

Psychological - psychoanalysis, CBT, dialectical behaviour therapy

106
Q

What is Dementia?

A

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
Q

What is the most common dementia?

A

Alzheimers

108
Q

What is the incidence of dementia?

A

6% over 65, 20% over 80

109
Q

What are the differentials for dementia?

A 
Minimal cognitive impairment
Depression
Delirium
Dysphasia
LD
110
Q

What are the symptom groups for dementia (4)?

A 
Four A's:
Amnesia
Aphasia
Agnosia
Apraxia
111
Q

How do you diagnose dementia?

A

2/4 of four A’s: amnesia, aphasia, agnosia, apraxia

112
Q

What dementia would you worry about in a PT with parkinsonian symptoms?

A

Lewy body dementia

113
Q

What risks would you wory about in a dementia PT?

A 
Suicide
Agitation
Wandering
Gas cookers
Leaving taps on
Driving
114
Q

What investigations would you do in a ?dementia PT?

A

Bloods - FBC, U&E, TFT, LFT, B12, Folate, syphilis serology
Cognitive test - MMSE / MOCA, ACE3
CT scan
Psychology review

115
Q

What pharmacological therapies are available for dementia?

A

Cholinesterase inhibitors:
Donepezil (aricept)
Rivastigmine
Glantamine

116
Q

How do you monitor pharm treatment in dementia?

A

MMSE - if it stays stable, they’re working. If it drops to <10, discontinue.

117
Q

What is alzheimers disease?

A

Indious onset of progressive cognitive decline in the absence of vascular or other risk factors. Memory loss and personality change.

118
Q

What is the aetiology of alzheimers disease?

A

Genetic - beta amyloid plaques, neurofibrillary tangles (silver stain)

119
Q

What are the risks for alzheimers?

A

Age, sex, dialysis, downs, head injury, premorbid intelligence

120
Q

What is the prognosis for alzheimers?

A

Life expentancy 8 years

121
Q

What is lewy body dementia?

A

Dementia first, parkinsonian symptoms second

122
Q

What is the aetiology of lewy body dementia?

A

Abnormal phosphorylation in microfilaments.

123
Q

What are the diagnositc criteria for lewy body dementia?

A

2/3 of:
Fluctuating consciousness / alertness
Recurrent visual hallucinations
Parkinsonian features

124
Q

What are the non-core features of lewy body dementia?

A 
Repeated falls / syncope
Nocturnal confusion
Transient LoC
Neuroleptic sensitivity
Tactile / olfactory hallucinations
125
Q

What is the prognosis for lewy body dementia?

A

Life expectancy 6 years.

126
Q

What is vascular dementia?

A

Abrupt onset stepwise deterioration with a fluctuating course and vascular risk factors.
Focal neurological signs and patchy deficits.

127
Q

What are the risk factors for vascular dementia?

A

Male, age, cardiovascular disease, cerebrovascular disease, DM, HTM, hypercholesterolaemia, smoking, ETOH

128
Q

What are the clinical signs of vascular dementia?

A

Mood, personality and behaviour changes. Late loss of insight.

129
Q

What is fronto-remporal dementia?

A

Early onset dementia with behavioural problems, affective symptoms, speech disorders and motor involvement.

130
Q

What are the typical signs of fronto-temporal dementia?

A

Disinhibition
Impulsivity
Rigidity of behaviour
Utilisation behaviour

131
Q

What is Picks dementia?

A

Fronto-temporal dementia with tau protein inclusions (pick bodies)

132
Q

What are the behavioural and psychological symptoms of dementia (BPSD) (8)?

A 
Apathy
Depression
Irritability
Anxiety
Agitation
Delusions
Disinhibition
Wandering
133
Q

What are the differentials for BPSD?

A 
UTI
Constipation
Medication
Chest infection
Stroke
Hypoxia
134
Q

What is the risk of using anti-psychotics in dementia?

A

They increase stroke risk.

135
Q

What is delirium?

A

Disturbance of consciousness and a change in cognition that develops over a short period of time.

136
Q

What are the symptoms of delirium (6)?

A 
Fluctuating consciousness
Disorientation
Change in cognition (memory deficit, language disturbance)
Difficulty attending to tasks
Mood changes
Psychotic symptoms
137
Q

When are symptoms of delirium worst?

A

Often at night

138
Q

How do you treat delirium?

A

Prevention!
Environmental management
Tranquilisation only if necessary for safety

139
Q

What can cause delirium?

A 
Substance withdrawal
Trauma
Hypoxia
Infection
Inflammation
Metabolic
Endocrine
Intracerebral causes
Nutrition
Medications
140
Q

What is huntingdon’s disease?

A

Autosomal dominant disease causing dementia and chorea

141
Q

What is the mutation in huntingdon’s disease?

A

Trinucleotide repeat in huntingtin gene on Chr 4.

Shows anticipation - repeats lengthen and disease worsens over generations

142
Q

What is the pathological sign of huntingdon’s disease?

A

Deposition of huntingtin protein in basal ganglia and thalamus causing atrophy.

143
Q

What are the clinical signs of huntingdon’s disease?

A

Personality and behavioural changes
Later subcortical dementia
Chorea affecting limbs, trunk, face and speech
Wide based lurching gait.

144
Q

What is the prognosis for huntingdon’s?

A

Survival 15y

145
Q

What effect does HIV have on the brain?

A

HIV dementia

146
Q

What are the symptoms of HIV dementia?

A

Early apathy and withdrawal progressing to subcortical dementia with ataxia, tremor, seizures and myoclonus

147
Q

What is normal pressure hydrocephalus?

A

Rare, potentially reversible, cause of dementia in older adults. Caused by meningitis or head injuries.

148
Q

What is the pathology in normal pressure hydrocephalus?

A

Impaired CSF absorption with normal ventricular communication.

149
Q

What are the main prion diseases?

A

CJD, vCJD, iatrogenic CJD, Kuru

150
Q

What is the pathology of prion disease?

A

Abnormally folded proteins deposit and form spongiform / amyloid changes in the cerebrum, basal ganglia and cerebellum.

151
Q

What is amnesic syndrome?

A

Anterograde memory loss +- retrograde loss with other functions intact.

152
Q

What causes amnesic syndrome?

A

Damage to the lumbic structures dealing with memory (by hypoxia, encephalitis, CO poisoning)

153
Q

What is the most common amnesic syndrome?

A

Korsakoff’s syndrome.

154
Q

What causes korsakoff’s syndrome?

A

B1 deficiency

155
Q

What precedes korsakoff’s syndrome?

A

Wernicke’s encephalopathy

156
Q

What memory is affected by antergrade amnesia?

A

Long term memory. Working memory is intact, but information is discarded once not immediately required.

157
Q

What is paraphrenia?

A

Late onset schizophrenia, often categorised with paranoid schizophrenia or persistent delusional disorder

158
Q

What are the symptoms of paraphrenia?

A

Paranoid ideation
Auditory hallucinations
Other hallucinations
Rarely negative symptoms

159
Q

What are the risk factors for paraphrenia?

A 
Sensory impairment (hearing / visual)
Social isolation.
160
Q

What is self harm?

A

An act that intentionally causes physical injury to ones own body that doesn’t result in death.

161
Q

Who is most affected by suicide?

A

Male 45, known to psychiatric services, substance abuser, command hallucinations, poor social support, chronic illness

162
Q

What are worrying signs when discussing a suicide attempt / self harm?

A 
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
Q

What are the four stages of substance misuse?

A

Intoxication
Harmful use
Dependency
Withdrawal

164
Q

What is the ICD-10 definition of dependency?

A

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
Q

What is the neurobiological theory of dependence?

A

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
Q

What are the symptoms of alcohol withdrawal?

A

Headache, nausea, retching, vomiting, tremor, sweating; insomnia, anxiety, agitation, tachycardia, hypotension; DT

167
Q

What are the CAGE questions?

A

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
Q

What investigations would you do in an alcoholic?

A

Physical exam

Bloods - FBC, U&E, LFT, TFT, ECG

169
Q

What is dependence syndrome?

A

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
Q

What are the symptoms of delirium tremens?

A

Confusion
Hallucinations (esp visual)
Coarse tremor, especially hands
Affective changes - extreme fear and hilarity
Autonomic disturbance - sweating tachycardia, HTN, dilated pupils, fever

171
Q

What is the treatment for DT?

A

Pabrinex
Benzodiazepines
Manage dehydration and electrolyte abnormalities

172
Q

What is wernicke’s encephalopathy?

A

Rapid onset delirium due to thiamine deficiency

173
Q

What are the symptoms of wernicke’s encephalopathy?

A 
Acute confusion
Horizontal nystagmus
Lateral rectus palsy
Peripheral neuropathy
Ataxia
Also:
N&V
Lethargy
Hypotension
Emotional lability
Anxiety
Insomnia
Malnutrition
174
Q

How would you investigate a ?Wernicke’s?

A

EEG - diffuse slowing
CSF - mild protein elevation
Increased serum pyruvate

175
Q

What are the symptoms of Korsakoff’s syndrome?

A 
Anterograde amnesia
Patchy retrograde amnesia
Confabulation
Peripheral neuropathy
Poor insight
Jolly affect
176
Q

What are the possible aetiologies of Korsakoff’s syndrome?

A 
Thiamine deficiency
Hypothalamic tumour
SAH
Infection
CO poisoning
177
Q

How do you treat korsakoff’s syndrome?

A

Give pabrinex

178
Q

How do you treat acute alcohol detoxification?

A

Benzodiazepines to reduce withdrawal
Vitamin replacement (pabrinex) against wernicke’s
Prophylactic anticonvulsant

179
Q

How do you maintain alcohol abstinence?

A 
CBT
Group therapy
Disulfiram
Acamprosate
Naltrexone
Fluoxetine
180
Q

What are the signs of alcohol withdrawal and when do they occur?

A

Tremulousness 6-36h
Hallucinations 12-24h
Seizures 6-48h
DTs 3-5d

181
Q

What are the physical complications of IV drug use?

A 
Abscesses
Septicaemia
Endocarditis
HIV
Hep B and C
182
Q

What are they signs of opiate use (7)?

A 
Euphoria
Feeling warm and well
Sedation
Analgesia
Bradycardia
Respiratory depression
Pinpoint pupils
183
Q

What are the signs of opiate withdrawal (10)?

A 
Dysphoria
Dilated pupils
Goose flesh
Shivering
Sneezing
Yawning
Feeling very sick / feverish
Restless / urge to score
Everything runs
Nausea
184
Q

How do you treat opiate addiction?

A

Focus on harm reduction, not abstinence

Detox - gradual using methadone, support with lofexidine for physical symptoms and benzo’s for anxiety

185
Q

What substitutes can be prescribed in opiate addiction?

A

Methadone
Buprenorphine (subutex)
Buprenorphine + naloxone (subuxone)

186
Q

How do stimulants work?

A

Potentiate neurotransmitter effects (DA, NA, 5HT)

187
Q

What are the side effects of stimulant use?

A 
Arrythmias
HTN
Stroke
Anxiety / panic
Drug induced psychosis
"Crash" after substance wears off
188
Q

What are the signs of marijuana use (4)?

A

Injected conjunctivae
Tachycardia
Dry mouth
Restlessness / irritability

189
Q

What is classical conditioning?

A

Conditioned response to a stimulus

190
Q

What is operant conditioning?

A

Reinforcement of conditioned responses by positive / negative reinforcement

191
Q

What aspects of life does the mental capacity act cover?

A

Property, affairs, accomodation, healthcare and personal care

192
Q

What does a patient have to do to have capacity?

A

Understand
Retain for long enough to decide
Weigh up pros and cons
Communicate the decision

193
Q

What is a section 2 order? How long does it last?

A

Admission for assessment, 28 days

194
Q

What is a section 3 order? How long does it last?

A

Admission for treatment, 3 months

195
Q

What is section 5.2?

A

Healthcare professionals holding power - risk to self or others

196
Q

What is CBT first line treatment for?

A 
Depression
Social anxiety
PTSD
Generalised anxiety disorder
OCD
Bulimia
Panic disorder and specific phobias
197
Q

What is section 1(36)?

A

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.

198
Q

What are the criteria for a section 1(36)?

A

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

199
Q

How long can you detain someone on section 1(36)?

A

72 hours

200
Q

What is the key difference between bulimia and anorexia?

A

Bulimics are normal weight

201
Q

What are the key features of bulimia?

A 
Binge eating
Compensatory behaviours
Overvaluation of the thin ideal
Normal weight (BMI>17.5)
Low self esteem
202
Q

What is the BMI threshold for bulimia?

A

> 17.5

203
Q

What problems commonly associate with bulimia nervosa?

A

Depression
Alcohol and substance misuse
PTSD
PD

204
Q

What are the physical complications of bulimia nervosa?

A 
Salt imbalance
Kidney damage
Arrythmias
GI damage
Nutritional deficiency
205
Q

What is the F:M ratio for bulimia?

A

9:1

206
Q

What is the peak age of onset of bulimia?

A

20-29

207
Q

What are the key risk indicators in bulimia?

A

Rate of weight loss
Methods of weight loss
Response to past treatment
Co-morbid mental status

208
Q

What are the risks associated with purging?

A

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

209
Q

How do you treat bulimia nervosa?

A

Evidence based self-help
Specialist CBT
Fluoxetine - 30% reduction in cycles
OutPT / day care if high risk

210
Q

What is the key sign of anorexia nervosa?

A

Severely underweight!

211
Q

What is the mortality of anorexia?

A

5.6% per decade

212
Q

How long does anorexia usually last?

A

6y

213
Q

What are the main features of anorexia?

A 
Severely underweight
Deliberate weight loss
Body image distortion & fear of fat
Endocrine dysfunction
Amenorrhoea
214
Q

What problems are associated with anorexia?

A

PD!
Impulsive, chaotic or emotionally unstable
Rigid, obsessional, anxious, avoidant
Associated depression, anxiety

215
Q

What are the neurological symptoms of anorexia nervosa?

A

Large cerebral ventricles

Proximal myopathy

216
Q

What are the endocrine symptoms of anorexia nervosa?

A

Hirsutism

217
Q

What are the cardiovascular symptoms of anorexia nervosa?

A 
Mitral valve prolapse
Bradycardia
Hypotension
Arrythmias
Cardiac failure
218
Q

What are the GI symptoms of anorexia nervosa?

A

Constipation
Abdo pain
Ulcers
Liver abnormalities

219
Q

What are the MSK symptoms of anorexia nervosa?

A

Osteoporosis

Collapsed vertebrae

220
Q

What are the reproductive symptoms of anorexia nervosa?

A

Amenorrhoea
Shrunken uterus
Small, multifolicullar ovaries

221
Q

What are the general physical symptoms of anorexia nervosa?

A

Pancytopaenia
Lethargy
Cold intolerance

222
Q

What is the F:M ratio for anorexia?

A

9:1

223
Q

What is different about the distribution of anorexia and bulimia?

A

Anorexia is worldwide, bulimia is only western

224
Q

What is the main belief of anorexic PTs?

A

GI disturbances - not weight and shape issues (cf. bulimia). E.g. vomiting, fullness, bloating, lack of appetite.

225
Q

Is anorexia heritable?

A

Yes

226
Q

How would you investigate ?anorexia?

A 
BMI
Squat test
ESR, TFTs
FBC, U&E, Phosphate, albumin, LFT, CK, glucose
ECG
227
Q

How do you treat anorexia nervosa?

A

Early intervention with integrated care!

228
Q

What is tardive dyskinesia?

A

Abnormal facial and extremity movement after long term anti-psychotic use.

229
Q

What is akathisia?

A

Inability to sit still, feeling of restlessness and uncomfortableness. S/E of antipsychotics, SSRIs, SNRIs.

Y5 - Psychiatry (4 decks)

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