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B TO REVISE - PHASE 3A > PSYCH EXTRA CONDITIONS > Flashcards

PSYCH EXTRA CONDITIONS Flashcards

1
Q

ACUTE STRESS REACTION
What is acute stress reaction?

A
  • Transient disorder that can occur as an immediate response to exceptional stressor with threat to security or physical integrity (rape, natural catastrophe) but typically resolves once stressor removed/after few days
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1
Q

ACUTE STRESS REACTION
How does acute stress reaction present?

A
  • Anger, depression/anxiety, excessive grief, social withdrawal, narrow attention
  • Basically presents as PTSD but <1m so not called PTSD (only if no resolution >1m)
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2
Q

GRIEF REACTION
What is the normal grief reaction?
How does it present?

A
  • Normal reaction after a sad event e.g. sad after death of loved one
  • Usually occurs <6m from event (delayed grief = >2w until grieving, prolonged grief = hard to define but >12m)
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3
Q

GRIEF REACTION
What are the stages of a normal grief reaction?

A
  • Denial incl. numbness, pseudohallucinations of deceased (auditory, visual), may focus on physical objects that remind them
  • Anger usually to family or HCPs
  • Bargaining, depression + acceptance (may not go through all 5 stages)
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4
Q

TIC DISORDERS
What is the epidemiology of tics?

A
  • Transient simple tics affect 10% of children
  • May be associated with OCD, ADHD + ASD
  • M>F, usually present around or after 5y
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5
Q

TIC DISORDERS
What are the two types of tics?
How may they manifest?

A
  • Simple
  • Complex
  • May be invisible to observer (abdo tensing, toe crunching)
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6
Q

TIC DISORDERS
Give some examples of simple tics

A
  • Throat-clearing
  • Blinking
  • Sniffing
  • Head jerking
  • Eye rolling
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7
Q

TIC DISORDERS
Give some examples of complex tics

A
  • Physical movements (twirling on spot, touching objects)
  • Copropraxia (obscene gestures)
  • Coprolalia (obscene words)
  • Echolalia
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8
Q

TIC DISORDERS
What improves or worsens tics?
What sensations are felt before tics?

A
  • Stress + stimulant meds worsen, distraction improves
  • Premonitory = pts feel urge to perform tic, often several times to get relief from that urge (can be suppressed but internal tension builds)
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9
Q

TIC DISORDERS
What is the management of mild tics?

A
  • Watch + wait (usually improve over time
  • Education + reassurance
  • Avoid caffeine + stress
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10
Q

TIC DISORDERS
What is the management of severe tics?

A
  • Habit reversal training
  • ERP
  • Antipsychotics considered in VERY severe cases
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11
Q

CONDUCT DISORDER
What is conduct disorder?
What are the 2 types?

A
  • Persistently, marked antisocial behaviours
  • Socialised = child has peer group, often share antisocial behaviour
  • Unsocialised = rejected by others so more isolated + hostile
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12
Q

CONDUCT DISORDER
What is the epidemiology of conduct disorder?
What are some risk factors?

A
  • M>F, more common in adolescents
  • Urban upbringing, deprivation, parental criminality, harsh or inconsistent parenting (behaviours often learned from parents)
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13
Q

CONDUCT DISORDER
What is the clinical presentation of conduct disorder?

A
  • Aggression/violence towards people or animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
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14
Q

CONDUCT DISORDER
How is conduct disorder managed?

A
  • 3–11y = group parent training programme (focus on parenting skills to improve child’s behaviour)
  • 9–14y = child-focused programmes (focus on child’s behaviours)
  • Older = multimodal interventions with many services
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15
Q

CONDUCT DISORDER
What can be used as a last resort in conduct disorder?

A
  • Antipsychotic like risperidone to reduce aggressive tendencies
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16
Q

ODD
What is oppositional defiant disorder (ODD)?
What may be linked to ODD?

A
  • Negative, hostile + defiant behaviour particularly directed towards authority figures like parents + teachers
  • Common in children with ADHD, may be linked to parenting styles
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17
Q

ODD
How can ODD and conduct disorder be differentiated?

A
  • Less severe + more common
  • Children are NOT aggressive and do NOT destroy property or steal etc.
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18
Q

ODD
What is the clinical presentation of ODD?

A
  • Loses temper + argumentative
  • Actively defies or refuses to comply with adult’s requests or rules
  • Blames others for their mistakes or misbehaviour
19
Q

ODD
What is the management of ODD?

A
  • Child-focussed programmes + group parent training programmes
20
Q

CONVERSION DISORDERS
What is a conversion disorder?

A
  • Actual loss or disturbance of normal motor/sensory function which initially appears to have neuro or physical cause but is later credited to psychological
21
Q

CONVERSION DISORDERS
What is the most severe form of dissociative/conversion disorders?

A
  • Dissociative identity disorder (multiple personality disorder) = inability to recall personal information, may have loss of identity.
22
Q

CONVERSION DISORDERS
What are the features of conversion disorders?

A
  • Paralysis (any pattern)
  • Aphonia (complete loss or whispered speech)
  • Sensory loss (area may cover patient’s beliefs about anatomy)
  • Seizure (NEAD)
  • Amnesia (short-term memory loss usually too severe for forgetfulness)
23
Q

CONVERSION DISORDERS
When would you suspect conversion disorder?

A
  • Clinically inconsistent nature (or absence) of signs
  • Excluded underlying organic disease
  • Convincing psychological explanation for deficit (can be induced by stressful event)
24
Q

CONVERSION DISORDERS
What is the management of conversion disorder?

A
  • Present Dx of positive (emphasise likelihood of recovery)
  • May need physio
  • CBT, interpersonal therapy, supportive psychotherapy or family therapy may help
25
Q

HYPOCHONDRIASIS
What is hypochondriacal disorder?

A
  • Preoccupation with fear of having a serious disease (C = condition) which persists despite -ve Ix + appropriate reassurance
26
Q

HYPOCHONDRIASIS
What is the clinical presentation of hypochondriasis?

A
  • Over-valued idea of having serious medical condition, often fatal
  • Ruminates on possibility, misinterprets insignificant bodily abnormalities as signs of serious disease needing investigation
  • Unable to be reassured by negative investigations
27
Q

HYPOCHONDRIASIS
What is the management of hypochondriasis?

A
  • Clarify Sx real but emphasise absence of organic cause
  • SSRIs may help
  • ERP to illness cues, CBT to identify + challenge misinterpretations + substitute realistic interpretations
28
Q

SOMATOFORM PAIN
What is somatoform pain disorder?

A
  • Complaint of persistent + distressing pain which is not adequately explained by organic pathology
29
Q

SOMATOFORM PAIN
What is the management of somatoform pain disorder?

A
  • Atheoretical “see what works” approach
  • Pain clinics (anaesthetics led, antidepressants, transcutaneous electrical nerve stimulation/TENS, local + regional nerve blocks)
  • Relaxation training, CBT, hypnotherapy
30
Q

MUNCHAUSEN’S
What is Munchausen’s (factitious disorder)?

A
  • Pt intentionally falsifies their Sx, past Hx + fabricate signs of physical or mental disorder with primary aim of obtaining medical attention + Tx
  • May flee when story questioned
31
Q

MUNCHAUSEN’S
What are the 3 subtypes of Munchausen’s?

A
  • Wandering
  • Non-wandering
  • By proxy
32
Q

MUNCHAUSEN’S
What is wandering Munchausen’s?

A
  • M>F
  • Move hospital-hospital, job-job, place-place, makes elaborate stories, changes name
33
Q

MUNCHAUSEN’S
What is non-wandering Munchausen’s?

A
  • F>M
  • More stable lifestyles, less dramatic presentations
  • Often paramedical professionals
  • Associated with EUPD
34
Q

MUNCHAUSEN’S
What is Munchausen’s by proxy?

A
  • F>M
  • Mothers, carers, paramedic staff who simulate or prolong illness in their dependents
  • Clinical focus to prevent further harm on the dependent
35
Q

MUNCHAUSEN’S
What is the management of Munchausen’s?

A
  • Reduce iatrogenic harm from inappropriate tests + treatment
  • Challenge pt in non-punitive manner
  • Healthcare systems change to prevent harm (blacklisting)
36
Q

MALINGERING
What is malingering?
Give some examples

A
  • Fraudulent simulation or exaggeration of Sx for personal gain
  • Drug-seeking behaviours, avoid army service, compensation
37
Q

SLEEP DISORDERS
What is insomnia?

A
  • Issues with – falling to, maintaining or poor quality of sleep (≥3d/week for 1m)
38
Q

SLEEP DISORDERS
What are the 2 types of insomnia?

A
  • Primary = intrinsic + Extrinsic factors (fear of falling asleep, poor sleep hygiene, change of environment)
  • Secondary = to illness or substance misuse (sleep apneoa, circadian rhythm disorder, shift work)
39
Q

SLEEP DISORDERS
What is the management of insomnia?

A
  • Rx with zopiclone if good sleep hygiene unsuccessful
  • Mirtazapine
40
Q

SLEEP DISORDERS
What is narcolepsy?
What is cataplexy?

A
  • Hypersomnolence, sleep paralysis, hypnogogic + hypnopompic hallucinations
  • Cataplexy = sudden loss of muscle tone often triggered by emotion
41
Q

SLEEP DISORDERS
What is the management of narcolepsy?

A
  • Multiple sleep latency EEG, early onset REM sleep
  • Rx with daytime stimulants (modafinil) + night-time sodium oxybate
42
Q

SLEEP DISORDERS
What is circadian rhythm disorder?

A
  • Mismatch between sleep-wake cycle + circadian rhythms (jet lag, shift work)
43
Q

SLEEP DISORDERS
What is parasomnia?

A
  • Restless leg syndrome
  • Nightmares + night tremors
  • Sleep walking + talking
44
Q

SLEEP DISORDERS
What are some sleep hygiene advice?

A
  • Limit caffeine, alcohol + cigarettes
  • Reduce noise, lights + phone use, wind down before bed
  • Reduce sleep during day + try establish regular pattern

B TO REVISE - PHASE 3A (9 decks)

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