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3A > Psych - Part 1 > Flashcards

Psych - Part 1 Flashcards

1
Q

Section 2

A

Admit for ASSESSMENT
28 days

  1. Patient is suffering from MHD which requires hospitalisation
  2. Patient poses a risk to themselves or others

Non-renewable
Can appeal after 7 days

Treatment can be given under MCA

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2
Q

Section 3

A

Admit for TREATMENT
6 months

  1. Patient requires hospital treatment
  2. Treatment is in their best interests

May be renewed after 6 months, then annually

Treatment can be given under MHA

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3
Q

Who is required for a section 2

A

Section 2 - 2 doctors

  • Section 12 approved
  • AMHP

Section 3 - 2 doctors
- One is second opinion appointed doctor

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4
Q

Other sections

A

4 - Emergency assessment by doctor, admission required - No time to wait for a second doctor

5 - (2) 72 hours by doctor - (4) 6 hours by a nurse

135 - Home section by the police - 72 hours

136 - Removal from a public place by police - 72 hours

37 - Patient commits a crime - Sent to hospital not prison

41 - Conditional discharge - Live in the community under certain conditions

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5
Q

Treatment sections

A

T2 - Treatment under section 3
- NO capacity
+ Consent

T3 - Treatment under section 3

  • NO capacity
  • NO consent
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6
Q

Depression aetiology

A

Genetic
Childhood trauma

Life circumstances - Financial, relationships, etc.

Mediations

  • BB
  • Isotretinoin

Drugs and alcohol

Hypothyroidism

Chronic disease

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7
Q

Depression core symptoms / diagnostic criteria / severity

A

Low mood
Anhedonia
Fatigue

  1. Symptoms almost every day OR every day for 2 weeks
  2. Change in personality
  3. Interferes with ADLs
Mild = 2 core + 2 other 
Moderate = 2 core + 3 other 
Severe = 3 core + 4 other
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8
Q

Additional symptoms of depression

A

Biological

  • Psychomotor
  • Decreased concentration
  • Change in appetite
  • Decreased libido
  • Change in sleep

Emotional

  • Feelings of worthlessness
  • Decreased confidence
  • Thoughts of self-harm or suicide
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9
Q

Psychotic depression

A

Nihilistic delusions
Hypochondriac delusions
2nd person auditory hallucinations

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10
Q

Depression investigations

A

MSE

HAD - Hospital anxiety and depression

PHQ-9

Bloods

  • TFT
  • Toxicology
  • LFTs - Gamma GT
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11
Q

Mild depression management

A

Self-help
Sleep hygiene
CBT
Interpersonal therapy

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12
Q

Moderate depression management

A
  1. SSRI
  2. Change SSRI

SNRI - Venlafaxine
NaSSA - Mirtazapine
TCA- Amitriptyline
MAOI - Moclobemide

+ ECT?

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13
Q

Severe depression management

A

CBT
ECT
Section?

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14
Q

Illusion

A

The false perception of a detectable stimulus

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15
Q

Hallucination

A

Experience in the absence of an external input

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16
Q

Types of hallucination

A

Hypnoponpic and hypnogogic - Falling in your sleep

Reflex - Stimulus in one sensory field, hallucination in another

Extracampine - Cannot possibly be experienced

Auditory

Pseudo - Patient recognises as unreal - E.g. talking to dead relative

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17
Q

Auditory hallucinations

A

2nd person - Speaking directly to the patient
“YOU are a bad person”

3rd person - Voices discussing the patient
“HE/SHE is a bad person”

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18
Q

Over-valued ideas

A

Non-shakable beliefs held outside social norms

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19
Q

Delusion

A

FIXED BELIEF

  1. Unshakable
  2. Held on illogical grounds
  3. Out of keeping with general culture
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20
Q

Types of delusion

A

Persecutory - They are being mistreated or someone plans to harm them

Grandiose - Over-inflated sense of worth, power, knowledge or identity

Self-referential - Believing innocuous events to have strong personal significance

Nihilistic - Believing themselves to be dead or the world to no longer exist

Misidentification - Somebody has been replaced with an imposter

Delusional perception - True perception to which patient attaches a false meaning

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21
Q

Thought disorders

A 
Thought insertion
Thought withdrawal 
Thought broadcast 
Thought echo 
Thought block
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22
Q

Concrete thinking

A

Taking things very literally

  • Lack of abstract thinking
  • Normal in childhood
  • Schizophrenia or organic brain disease
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23
Q

Loosening of association

A

Sequence of unrelated or only remotely related ideas

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24
Q

Circumstantiality

A

Non-linear thought pattern

- Conversation drifts but returns to the point

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25
Q

Perseveration

A

Repetition of a particular response

- Associated with brain injury or organic disease

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26
Q

Confabulation

A

Filling memory gaps with made up stories
Unintentional
Seen with alcohol abuse

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27
Q

Somatic passivity

A

Sensations imposed upon the body by an outside force

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28
Q

Flight of ideas

A

Rapidly skipping from one thought to distantly related ideas
Relation may be as tentative as rhyming

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29
Q

Pressure of speech

A

Rapid frenzied speech
Difficult to interrupt
May be too erratic to understand

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30
Q

Anhedonia

A

Inability to feel pleasure in normally pleasurable activities

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31
Q

Apathy

A

Lack of interest, enthusiasm or concern

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32
Q

Incongruity of affect

A

Mismatch between emotion and expression

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33
Q

Blunting of affect

A

Loss of expression

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34
Q

Conversion

A

Focal neurological symptoms which cannot be explained by organic disease - Usually follows life stress or trauma

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35
Q

Belle indifference

A

Patient unconcerned with symptoms of conversion disorder

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36
Q

Depersonalisation

A

Feeling unreal, detached and unable to feel emotion

37
Q

Derealisation

A

Watching themselves from the outside

  • In a film
  • Disconnected from body and emotions
38
Q

Dissociation

A

Disconnected from the world or themselves

Usually in response to stress

39
Q

ECT indications

A

Severe depression
Psychotic depression
Catatonia
Prolonged manic episode

40
Q

ECT side effects

A 
Tongue biting 
Headache 
Short-term memory loss 
Confusion
Myalgia

ARRHYTHMIAS

41
Q

Suicide risk

A

SAD PERSONS score

Sex - Male
Age < 19 or > 45
Depression

Previous attempt 
Ethanol / substance misuse 
Rational thinking loss - Schizophrenia? 
Single or unemployed 
Organised 
No social support 
Sickness
42
Q

Paracetamol overdose investigations

A

ABG - Metabolic acidosis
Glucose - Hypoglycaemia

Serum paracetamol levels every 4 hours
Toxicology

LFTs
Clotting profile - Prothrombin time

43
Q

Paracetamol overdose management

A

ABCDE

  • IV fluids
  • Treat acidosis
  • Treat hypoglycaemia

N-acetylcysteine - Dose dependent on paracetamol level @ 4 hours

Arrange psych review

44
Q

Bipolar disorder causes

A

Genetics
Childhood trauma
Sleep deprivation
Post-partum

Drugs

  • Steroids
  • Statins
  • Recreational
  • Antidepressants

Organic

  • Tumour
  • Infection
  • Hyperthyroidism
45
Q

Bipolar disorder investigations

A

MSE

Rule out other causes

  • Toxicology
  • TFTs
  • EEG
  • CT
46
Q

Acute bipolar management

A

Second generation antipsychotic

  • Olanzapine
  • Quetiapine
  • Clozapine

CBT

47
Q

Secondary bipolar management

A

Mood stabiliser

  • Lithium
  • Valproate
  • Antipsychotics
48
Q

Schizophrenia non-organic causes

A

Genetics - FHx
Life circumstances - Migrants?
Illicit drugs

49
Q

Schizophrenia organic causes

A

Neuro

  • Injury
  • Infection
  • Tumour

Recreational drugs and alcohol

Hypernatraemia
Hypocalcaemia

Hyperthyroidism
Cushing’s

50
Q

Schizophrenia diagnostic criteria

A

1 month of symptoms

+ 1 first rank symptom

51
Q

Schizophrenia 1st rank symptoms

A

Delusions

Hallucinations - Auditory 3rd person

Thought disorder - Broadcast, insertion and removal

Passivity phenomena

52
Q

Schizophrenia 2nd rank symptoms

A

Hallucinations
Catatonic behaviour

Negatives

  • Under-activity
  • Low motivation
  • Social withdrawal
  • Self-neglect
  • Anhedonia
  • Flattening of affect
  • Speech poverty
  • Thought poverty
53
Q

Schizophrenia investigations

A

Rule out other causes

  • FBC
  • U/E
  • LFT
  • Toxicology
  • TFT
  • OGTT
  • EEG - Temporal lobe epilepsy??
  • CT
54
Q

Schizophrenia management

A

Second generation antipsychotic

  • Olanzapine
  • Quetiapine
  • Clozapine

CBT

2nd line - Change antipsychotic?

55
Q

Organic causes of visual hallucinations

A

I’M SPACED Out

Infection
Migraine

SOL 
Parkinson's 
Alcohol withdrawal 
Charles Bonnet 
Epilepsy 
Drugs

Optic nerve palsy

56
Q

Serotonin syndrome systems affected

A

CAN you diagnose it

Cognitive
Autonomic
Neuro

57
Q

Serotonin syndrome cognitive features

A 
Agitated 
Confused 
Euphoric 
Manic 
Hallucinating
58
Q

Serotonin syndrome autonomic features

A 
Tachycardia 
Tachypnoea 
Hypertension 
Fever 
Sweating 
Mydriasis 
Arrhythmias
59
Q

Serotonin syndrome neurological features

A 
Tremor 
Ataxia 
Incoordination 
Clonus 
Hyper-reflexive
60
Q

Serotonin syndrome causes

A

SAME OA

SSRI
Amphetamines
MAOIs
Ecstasy

Opioids

Antipsychotics

  • Lithium
  • Olanzapine
  • Risperidone
61
Q

Serotonin syndrome management

A

Supportive
Benzodiazepines
Serotonin antagonist - Cyproheptadine

62
Q

Neuroleptic malignant syndrome presentation

A

After starting or increasing dose of antipsychotic

Hyperthermia 
Sweating 
Tachycardia 
Rigidity 
Seizures 
Hyporeflexia 
Coma
63
Q

Neuroleptic malignant syndrome investigations

A

KALE

^ CK
ABG - Metabolic acidosis
Leukocytosis
ECG - Prolonged QT

64
Q

Neuroleptic malignant syndrome management

A 
Fluids 
Stop cause 
Diazepam 
Dantrolene - Muscle relexant 
Bromocriptine - Dopamine agonist
65
Q

Serotonin syndrome vs neuroleptic malignant syndrome

A

SS

  • Abrupt onset, rapidly peaking
  • Myoclonus and tremor
  • Increased reflexes
  • Mydriasis

NMS

  • Gradual and prolonged
  • Rigidity
  • Decreased reflexes
  • Normal pupils
66
Q

Generalised anxiety disorder diagnostic criteria

A

Anxiety

+ 3 or more symptoms for 6 months

67
Q

GAD symptoms for diagnostic criteria

A

RED SIM

Restlessness
Easily fatigued
Difficulty concentrating

Sleep disturbance
Irritability
Muscle tension

68
Q

Other GAD symptoms

A 
Hyperventilation
Sweating 
Tachycardia 
Goosebumps 
Lump in throat

Needs constant reassurance
Dependent on someone
Avoidance of triggers

69
Q

GAD symptoms in paediatrics

A

Nail biting
Bed wetting
Thumb sucking

70
Q

Causes of GAD

A

Drugs

  • Salbutamol
  • Theophylline
  • Caffeine
  • Antidepressants
  • Corticosteroids

Genetics
Stressors and events
Medical illness

71
Q

GAD non-pharmacological management

A

Education and monitoring
Self-help
CBT
Psych referral

72
Q

GAD pharmacological management

A

SSRI - Sertraline
Pregabalin
Benzodiazepines
Beta-blockers

73
Q

Causes of PTSD

A

Biological - GABA

LIFE TRAUMA

74
Q

PTSD protective factors

A

Male
Caucasian
^ IQ
^ Social class

75
Q

PTSD diagnostic criteria

A

Within 6 months of event
Interferes with ADLs

+ TRIAD

  1. Can’t recall some of the event
  2. Avoids circumstances associated with the event
  3. Constantly relives the experience
76
Q

PTSD symptoms

A

Hyper…

  • Vigilant
  • Arousal
  • Exaggerated startle response

Physical NEGATIVES

  • Decreased concentration
  • Decreased sleep

Mood

  • Guilt
  • Depression
  • Anger
  • Emotional outbursts
77
Q

PTSD management

A

Watchful waiting

< 3 months

  • CBT
  • Medication for sleep disturbance

> 3 months

  • Eye Movement Desensitising and Processing
  • SSRI - Paroxetine
  • NaSSA - Mirtazapine
78
Q

OCD criteria

A
  1. Obsessions or compulsions for 2 weeks
  2. Interferes with ADLs
  3. Originate from the mind
  4. Subject tries to resist them
  5. Repetitive and unpleasant
  6. Action carried out is not pleasurable
79
Q

OCD causes

A

Genetics

Immune - B-haemolytic Strep

80
Q

What are compulsions

A

Repetitive rituals

E.g. washing and checking

81
Q

What are obsessions

A

Recurrent thoughts of a distressing nature

  • Words
  • Ideas
  • Phrases
  • Numbers
82
Q

OCD management

A

CBT
Exposure and response
Psychodynamic therapy

Pharmacology

  • TCA - Cloripramine
  • SSRI - Sertraline
83
Q

What is panic disorder

A

Frequent panic attacks present for 1 month

Period of intense fear…

  • Rapid onset
  • Peaks at 10 minutes
  • Spontaneous or situational
84
Q

Panic disorder physical symptoms

A

Tachycardia
Palpitations
Chest pain

Dizziness
Blurred vision
Paraesthesia

Dry mouth
Abdo pain
Choking sensation

Sweating
Trembling

85
Q

Panic disorder psychological symptoms

A

Feeling of impending doom

Fear of dying
Fear of losing control

Depersonalisation
Derealisation

86
Q

Panic disorder management

A

CBT
SSRI

Review in 12 weeks

TCA - Clomipramine

Refer

87
Q

What is a phobia

A

Strong irrational fear of something which poses little or no danger

88
Q

Phobia management

A

CBT
Benzos
SSRI

3A (31 decks)

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