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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
Perseveration
Repetition of a particular response | - Associated with brain injury or organic disease
26
Confabulation
Filling memory gaps with made up stories Unintentional Seen with alcohol abuse
27
Somatic passivity
Sensations imposed upon the body by an outside force
28
Flight of ideas
Rapidly skipping from one thought to distantly related ideas Relation may be as tentative as rhyming
29
Pressure of speech
Rapid frenzied speech Difficult to interrupt May be too erratic to understand
30
Anhedonia
Inability to feel pleasure in normally pleasurable activities
31
Apathy
Lack of interest, enthusiasm or concern
32
Incongruity of affect
Mismatch between emotion and expression
33
Blunting of affect
Loss of expression
34
Conversion
Focal neurological symptoms which cannot be explained by organic disease - Usually follows life stress or trauma
35
Belle indifference
Patient unconcerned with symptoms of conversion disorder
36
Depersonalisation
Feeling unreal, detached and unable to feel emotion
37
Derealisation
Watching themselves from the outside - In a film - Disconnected from body and emotions
38
Dissociation
Disconnected from the world or themselves | Usually in response to stress
39
ECT indications
Severe depression Psychotic depression Catatonia Prolonged manic episode
40
ECT side effects
``` Tongue biting Headache Short-term memory loss Confusion Myalgia ``` ARRHYTHMIAS
41
Suicide risk
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
Paracetamol overdose investigations
ABG - Metabolic acidosis Glucose - Hypoglycaemia Serum paracetamol levels every 4 hours Toxicology LFTs Clotting profile - Prothrombin time
43
Paracetamol overdose management
ABCDE - IV fluids - Treat acidosis - Treat hypoglycaemia N-acetylcysteine - Dose dependent on paracetamol level @ 4 hours Arrange psych review
44
Bipolar disorder causes
Genetics Childhood trauma Sleep deprivation Post-partum Drugs - Steroids - Statins - Recreational - Antidepressants Organic - Tumour - Infection - Hyperthyroidism
45
Bipolar disorder investigations
MSE Rule out other causes - Toxicology - TFTs - EEG - CT
46
Acute bipolar management
Second generation antipsychotic - Olanzapine - Quetiapine - Clozapine CBT
47
Secondary bipolar management
Mood stabiliser - Lithium - Valproate - Antipsychotics
48
Schizophrenia non-organic causes
Genetics - FHx Life circumstances - Migrants? Illicit drugs
49
Schizophrenia organic causes
Neuro - Injury - Infection - Tumour Recreational drugs and alcohol Hypernatraemia Hypocalcaemia Hyperthyroidism Cushing's
50
Schizophrenia diagnostic criteria
1 month of symptoms | + 1 first rank symptom
51
Schizophrenia 1st rank symptoms
Delusions Hallucinations - Auditory 3rd person Thought disorder - Broadcast, insertion and removal Passivity phenomena
52
Schizophrenia 2nd rank symptoms
Hallucinations Catatonic behaviour Negatives - Under-activity - Low motivation - Social withdrawal - Self-neglect - Anhedonia - Flattening of affect - Speech poverty - Thought poverty
53
Schizophrenia investigations
Rule out other causes - FBC - U/E - LFT - Toxicology - TFT - OGTT - EEG - Temporal lobe epilepsy?? - CT
54
Schizophrenia management
Second generation antipsychotic - Olanzapine - Quetiapine - Clozapine CBT 2nd line - Change antipsychotic?
55
Organic causes of visual hallucinations
I'M SPACED Out Infection Migraine ``` SOL Parkinson's Alcohol withdrawal Charles Bonnet Epilepsy Drugs ``` Optic nerve palsy
56
Serotonin syndrome systems affected
CAN you diagnose it Cognitive Autonomic Neuro
57
Serotonin syndrome cognitive features
``` Agitated Confused Euphoric Manic Hallucinating ```
58
Serotonin syndrome autonomic features
``` Tachycardia Tachypnoea Hypertension Fever Sweating Mydriasis Arrhythmias ```
59
Serotonin syndrome neurological features
``` Tremor Ataxia Incoordination Clonus Hyper-reflexive ```
60
Serotonin syndrome causes
SAME OA SSRI Amphetamines MAOIs Ecstasy Opioids Antipsychotics - Lithium - Olanzapine - Risperidone
61
Serotonin syndrome management
Supportive Benzodiazepines Serotonin antagonist - Cyproheptadine
62
Neuroleptic malignant syndrome presentation
After starting or increasing dose of antipsychotic ``` Hyperthermia Sweating Tachycardia Rigidity Seizures Hyporeflexia Coma ```
63
Neuroleptic malignant syndrome investigations
KALE ^ CK ABG - Metabolic acidosis Leukocytosis ECG - Prolonged QT
64
Neuroleptic malignant syndrome management
``` Fluids Stop cause Diazepam Dantrolene - Muscle relexant Bromocriptine - Dopamine agonist ```
65
Serotonin syndrome vs neuroleptic malignant syndrome
SS - Abrupt onset, rapidly peaking - Myoclonus and tremor - Increased reflexes - Mydriasis NMS - Gradual and prolonged - Rigidity - Decreased reflexes - Normal pupils
66
Generalised anxiety disorder diagnostic criteria
Anxiety | + 3 or more symptoms for 6 months
67
GAD symptoms for diagnostic criteria
RED SIM Restlessness Easily fatigued Difficulty concentrating Sleep disturbance Irritability Muscle tension
68
Other GAD symptoms
``` Hyperventilation Sweating Tachycardia Goosebumps Lump in throat ``` Needs constant reassurance Dependent on someone Avoidance of triggers
69
GAD symptoms in paediatrics
Nail biting Bed wetting Thumb sucking
70
Causes of GAD
Drugs - Salbutamol - Theophylline - Caffeine - Antidepressants - Corticosteroids Genetics Stressors and events Medical illness
71
GAD non-pharmacological management
Education and monitoring Self-help CBT Psych referral
72
GAD pharmacological management
SSRI - Sertraline Pregabalin Benzodiazepines Beta-blockers
73
Causes of PTSD
Biological - GABA LIFE TRAUMA
74
PTSD protective factors
Male Caucasian ^ IQ ^ Social class
75
PTSD diagnostic criteria
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
PTSD symptoms
Hyper... - Vigilant - Arousal - Exaggerated startle response Physical NEGATIVES - Decreased concentration - Decreased sleep Mood - Guilt - Depression - Anger - Emotional outbursts
77
PTSD management
Watchful waiting < 3 months - CBT - Medication for sleep disturbance > 3 months - Eye Movement Desensitising and Processing - SSRI - Paroxetine - NaSSA - Mirtazapine
78
OCD criteria
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
OCD causes
Genetics | Immune - B-haemolytic Strep
80
What are compulsions
Repetitive rituals | E.g. washing and checking
81
What are obsessions
Recurrent thoughts of a distressing nature - Words - Ideas - Phrases - Numbers
82
OCD management
CBT Exposure and response Psychodynamic therapy Pharmacology - TCA - Cloripramine - SSRI - Sertraline
83
What is panic disorder
Frequent panic attacks present for 1 month Period of intense fear... - Rapid onset - Peaks at 10 minutes - Spontaneous or situational
84
Panic disorder physical symptoms
Tachycardia Palpitations Chest pain Dizziness Blurred vision Paraesthesia Dry mouth Abdo pain Choking sensation Sweating Trembling
85
Panic disorder psychological symptoms
Feeling of impending doom Fear of dying Fear of losing control Depersonalisation Derealisation
86
Panic disorder management
CBT SSRI Review in 12 weeks TCA - Clomipramine Refer
87
What is a phobia
Strong irrational fear of something which poses little or no danger
88
Phobia management
CBT Benzos SSRI

3A (31 decks)

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