Psych Peer Teaching Flashcards
1
Q
Give 2 examples of mood disorders
A
Depression
Bipolar disorders
2
Q
What are the two categories that Mental Illness can be divided into?
A
Organic disorders: Psychiatric disorders secondary to a known physical cause
Functional disorders: no physical abnormality found
3
Q
Give an example of a organic disorder as applied to Mental Illness.
A
- Carcinoma
- Endocrine (Thyroid)
- Delirium
4
Q
What substances might cause an organic mental illness?
A
Psychoactive substances:
- Alcohol
- Illicit drugs
5
Q
What is the definition of ‘psychoses’?
Give 2 examples of functional mental health disorders which can be labelled as ‘psychoses’.
A
Psychoses: the loss of contact with reality
- Schizophrenia
- Mood disorders
6
Q
‘Neuroses’ are classed as functional mental health disorders. Give 2 examples of conditions which can be considered as ‘neuroses’.
A
- OCD
- Phobia
7
Q
Define ‘affect’ as applied to mental health.
A
- Pattern of observable behaviours
- Variable over time
- In response to changing emotional state
8
Q
Define ‘mood’ as applied to mental health.
A
Pervasive sustained emotions.
Colours perception of the world.
9
Q
List 2 screening questions for depression.
A
- During the last month, have you often been bothered by feeling down, depressed, or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
10
Q
Which diagnostic manual is used to diagnose depression?
A
DSM-IV Criteria for depression (9 symptoms).
11
Q
What does the DEAD SWAMP acronym stand for? (Helps you to remember the symptoms of depression).
A
Depressed mood Energy loss or fatigue Anhedonia Death thoughts Sleep disturbances (+/-) Worthlessness / guild Appetite / weight changes Mentation decrease (decreased concentration) Psychomotor agitation / retardation
12
Q
For what duration must symptoms have been present to make a diagnosis of depression?
A
2 weeks
13
Q
What are the 3 core symptoms of depression?
A
Depressed mood
Energy loss / fatigue
Anhedonia
14
Q
A patient presents with fewer than 5 symptoms meeting the depression criteria. How might you describe this clinically?
A
Sub threshold depressive symptoms
15
Q
A patient presents with 5 symptoms of depression plus mild functional impairment. How might you describe this clinically?
A
Mild depression
16
Q
How might a patient with severe depression present?
A
- Most symptoms
- Marked impact on ADL’s +/- psychotic symptoms
17
Q
What are the 2 main methods for assessing a patient with suspected depression?
A
- HAD scale
Hospital Anxiety and Depression Scale (out of 21) - PHQ-9
Patient Health Questionnaire
18
Q
What is the physiological mechanism of depression?
A
Decreased 5-HT -> Decreased Noradrenaline -> Decreased Dopamine
19
Q
What is the 1st line treatment for depression?
A
CBT
20
Q
What is the 1st line drug treatment for depression?
What if the pt has a past Hx of CVD?
A
SSRI: Fluoxetine
If Hx of CVD: Paroxetine, Citalopram, Sertraline are better
21
Q
Give some side effects of SSRIs.
A
- GI disturbance
- Increased risk of suicide if under 30yrs -> regular reviews
22
Q
When might an SSRI be contraindicated in the treatment of depression?
A
- Increased risk of convulsions in epilepsy
- If used with MAO-I, there is a risk of Serotonin Syndrome
23
Q
Give 3 examples of tricyclic antidepressants
A
Amitriptyline
Imipramine
Lofepramine (this is most safe)
24
Q
Give a side effect of Tricyclic antidepressants. When should TCAs be avoided?
A
SE: Arrhythmias
Avoid in heart failure
25
Give an example of a MAO-I. When might an MAO-I be used?
Phenelzine
| Used in resistant depression
26
What are important points to remember when prescribing Phenelzine for depression?
What class of drug is Phenelzine?
- Increased risk of hypertensive crisis
- Avoid tyramine-containing foods (cheese, red wine, broad beans)
Drug class: MAO-I
27
```
What class of drug is Mirtazipine?
Side effects?
```
NaSSA (Noradrenergic and specific serotonergic antidepressants)
SE: Sedative, increased weight
28
Give an example of a SNRI (Serotonin Noradrenaline Reuptake Inhibitors).
Duloxetine
29
What should you be aware of when prescribing an SNRI (eg. Duloxetine)?
- Interact with MAO-I
SE: Increase BP
30
Give 4 causes of Serotonin Syndrome.
MAO-I
SSRIs
Ecstasy
Amphetamines
31
What is the acronym to remember the diagnosis for Serotonin Syndrome?
'CAN'
Cognitive changes: agitation, confusion, euphoria, hallucinations
Autonomic changes: Tachycardia, HTN, Fever, Diaphoresis, Arrythmias, Tachypnoea
Neuromuscular changes: Tremor, Hyperreflexia, Clonus, Ataxia, Incoordination, Seizures
32
What are the 3 fundamental components of Serotonin Syndrome?
- Cognitive state changes
- Autonomic hyperactivity
- Neuromuscular abnormality
33
What is the treatment for Serotonin Syndrome?
- Supportive
| - Cyproheptadine (5-HT antagonist)
34
What is the ICD-10 definition of 'Bipolar'?
Hx of 2 mood disorders
At least 1 = hypomania (<4 days) / mania (>7 days)
35
What is the DSM-IV-TR definition of 'Bipolar'?
1 mania episode +/- depressive episode
36
How might a bipolar patient appear / behave (eg. during a mental state exam)?
A: flamboyantly dressed, self neglect (unkempt / dehydrated)
B: Overactivity, difficult to interview pt. Pt may eat + drink greedily
37
How might a bipolar patient's speech differ from a pt without bipolar?
- Increased pressure of speech
- Increased rate and amount
- Difficult to interrupt.
38
What might a pt with bipolar's mood be like?
- Usually elated
| - Angry
39
Describe a bipolar pt's thoughts (form + content).
Content: Pt has inflated view on own importance, grandiose
Form: chance relationships, verbal associations (alliterations eg. crazy cool cat can catch)
40
Describe a bipolar pt's perceptions.
- May have delusions of persecution or grandiose - mood congruent
- Auditory hallucinations
41
Describe a bipolar pt's cognition and insight.
Cognition is impaired.
| Insight is often absent in mania.
42
Give a differential for bipolar.
- Substance abuse (amphetamines, cocaine)
| - Schizophrenia
43
How is bipolar managed / treated?
- Co-ordinated care
- Rapid access to support in crisis
- ?Hospitalisation (under the Mental Health Act)
- Psychological care - education, promoting social functioning
- Medication
- Annual reviews
44
Explain the medical management of bipolar
Mood stabilisers
1. Lithium
2. Anticonvulsants (Sodium Valproate, Carbamazepine, Lamotrigine)
3. Anti-psychotics (conventional, atypical) -> used in acute mania
45
What are the advantages of using Lithium as a treatment in bipolar disorder?
- Reduces relapse risk by 40%
- Effective against both manic / depressive symptoms
- 18 months = see benefit
46
What is the therapeutic range for Lithium in the treatment of bipolar disorder?
0.4 - 1.0 mmol/l
| This is a narrow therapeutic range
47
What are the 2 most important tests we need to carry out in patients on Lithium (for bipolar)?
1. Renal function (U+E, Creatinine clearance)
- > Li excreted by the kidneys
2. TFTs -> check for hypothyroidism
48
What are the side effects of Lithium?
| * lithium is used as a treatment for bipolar disorder
```
Leukocytosis
Insipidus (diabetic)
Tremors
Hypothyroidism
Increased urine
Mums beware (teratogenic)
```
49
At what level does Lithium become toxic?
> 2.5 mmol/l
50
List some effects of Lithium toxicity
```
Blurred vision
Coarse tremor
Muscle weakness
Ataxia
N&V
Hyper-reflexia
Circulatory failure
Oliguria
Seizures
Coma
```
51
Give the WHO definition for Schizophrenia.
'A severe mental disorder, characterised by profound disruptions in thinking, affecting language, perception, and the sense of self.'
52
Give some risk factors for Schizophrenia.
- FHx
- Intrauterine complications / infection
- Social isolation
- Migrants
- Abnormal family interactions
53
Give some triggers for Schizophrenia.
- Stress
- High emotion
- Drug misuse
54
How long do symptoms have to be present for a diagnosis of schizophrenia to be made?
1 month
55
List some 1st rank symptoms of schizophrenia.
- Delusional perceptions
- Auditory hallucinations (3rd person)
- Somatic passivity
- External control of emotion
- Thought insertion / removal
- Thought broadcasting
- Lack of insight
56
List some negative symptoms of schizophrenia.
'FLAP'
- Flat affect / blunting
- Loss of motivation
- Anhedonia
- Poverty of Speech
57
List some organic disorders that may cause symptoms akin to those seen in Schizophrenia.
Brain disease: head injury, CNS infection
Metabolic: Hypernatraemia, hypocalcaemia
Endocrine: Hyperthyroidism, Cushing's
Drugs: Alcohol, Stimulants, Hallucinogens
58
What investigations might you carry out to rule out an organic cause for schizophrenic symptoms?
Bloods: FBC, U+E, LFT, TFT, Glucose, Calcium, Cortisol. Cultures
Drug + alcohol screen
Urine dipstick / MSU
CT / MRI head
59
Give 3 examples of conventional anti-psychotics.
Haloperidol
Chlorpromazine
Flupentixal
60
Give a side effect of a conventional anti-psychotic.
Decreased occupation of Dopamine at Nigrostriatal pathway.
61
List 4 atypical anti-psychotics.
Risperidone
Olanzepine
Quetiapine
Clozapine
62
List 3 side effects of atypical anti-psychotics.
- Metabolic Syndrome
- T2DM
- Increased stroke risk
63
Give 2 side effects of Olanzepine. What class of antipsychotic is Olanzepine?
- Increased weight
- Sedative
Drug class: Atypical antipsychotic.
64
When might Clozapine be used as an antipsychotic?
Clozapine: Used to treat patients resistant to other drugs. Must have tried 2 drugs for 6 weeks each.
65
Give a side effect of Clozapine.
SE: Agranulocytosis.
66
Describe pseudoparkinsonism.
- Stooped posture
- Shuffling gait
- Rigidity
- Bradykinesia
- Tremors at rest
- Pill-rolling motion of the hand.
67
Describe acute dystonia.
- Facial grimacing
- Involuntary upward eye movement
- Muscle spasms of the tongue, face, neck and back
- > back muscle spasms cause the trunk to arch forward)
- Laryngeal spasms
68
Describe Akathisia.
- Restless
- Trouble standing still
- Paces the floor
- Feet in constant motion, rocking back and forth
69
Describe tardive dyskinesia
- Protrusion and rolling of the tongue.
- Sucking and smacking movements of the lips
- Chewing motion
- Facial dyskinesia
- Involuntary movements of the body and extremities
70
What is 'Neuroleptic Malignant Syndrome' (NMS)?
NMS is a reaction that occurs following starting an antipsychotic / increased dose.
71
What are the signs and symptoms of Neuroleptic Malignant Syndrome?
- Fever
- Autonomic instability
- Stiffness (lead pipe)
- Seizures
- Coma
72
What investigations should you order if you suspect Neuroleptic Malignant Syndrome?
- ABG: Metabolic Acidosis
- Increased Creatinine Kinase
- Leucocytosis
- ECG: Prolonged QT
73
What is the treatment for Neuroleptic Malignant Syndrome?
- Supportive: IV hydration; prevent AKI due to rhabdomyolysis, coolants
- BZDs are 1st line
- Dantrolene (muscle relaxants)
- Dopamine agonist (Bromocriptine)
- If severe: ? Electroconvulsive therapy
74
```
For Serotonin syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils
```
```
Serotonin Syndrome:
Onset: Abrupt
Course: Rapidly resolving
NM findings: Myoclonus & tremor
Reflexes: Increased
Pupils: Mydriasis (dilated pupils)
```
75
```
For Neuroleptic Malignant Syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils
```
```
NMS:
Onset: Gradual
Course: Prolonged
NM findings: Diffuse rigidity
Reflexes: Decreased
Pupils: Normal
```
76
List 5 anxiety disorders.
- Generalised anxiety
- Panic disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Phobias
77
Describe Generalised Anxiety Disorder.
- Feel anxious on most days
- Can't remember last time they felt relaxed - can't calm themselves down
- Worried about many things
- As soon as one anxious thought is resolved, another may appear about a different issue.
78
What is the treatment for Generalised Anxiety Disorder?
CBT + Benzo / SSRIs
79
List the symptoms of a panic attack
- Intense fear + dread
- Palpitations
- SOB + tachypnoea
- Dizziness
- Chills / hot flushes
- Sense of impending doom
80
Describe panic attacks in relation to Panic Disorder.
- Attacks last 5 - 20 mins
- Triggered by stressors or manifest unexpectedly
- Pts show avoidance behaviour / become reclusive
- Can be very debilitating and disruptive to life.
81
What is the treatment for Panic Disorder?
CBT + SSRI
82
Describe 'obsessions' as related to OCD.
Uncontrollable, intrusive, recurrent thoughts of distressing nature.
83
Describe 'compulsions' as related to OCD.
Ritualistic behaviours one has the urge to repeat over and over to relieve anxiety caused by the obsessions.
84
Describe a typical OCD patient.
- Can't control his/her thoughts or behaviours, even when these are recognised as excessive.
- Doesn't get pleasure when performing the behaviours or rituals, but may feel brief relief from the anxiety the thoughts cause
- Experience significant problems in their daily life due to these thoughts / behaviours.
85
What is the treatment for OCD?
CBT + SSRI
86
What is a 'phobia'?
- A strong, irrational fear or something that poses little or no real danger.
- A specific thing
- Avoidance of the thing they are afraid of
- Usually starts in childhood / adolescence
- Can be learned from your parents
87
What is the treatment for a phobia?
CBT
88
What is the lifetime prevalence of PTSD?
10% of women; 4% of men
89
What is the most likely event to cause PTSD?
Sexual assault
90
What are the risk factors for PTSD?
- Previous Mental Health problems
- Past trauma (esp. childhood abuse)
- Lack of support
- Victim-blaming by the environment, reinforcing survivors guilt.
91
List some symptoms of PTSD.
- Intrusive thoughts recalling the traumatic event
- Nightmares / flashbacks
- Feeling detached / unable to connect with loved ones.
- Irritability / angry outbursts
- Hypersensitivity
92
Define 'personality disorder'.
A group of disorders characterised by rigid, maladaptive traits that cause great distress or an inability to get along with others.
93
Which disorders comprise Cluster A of 'Personality Disorders'?
Cluster A: a group of disorders characterised by odd / eccentric behaviours:
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal Personality Disorder
94
Which disorders comprise Cluster B of 'Personality Disorders'?
Cluster B: a group of disorders characterised by dramatic, emotional or erratic behaviours:
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
95
Which disorders comprise Cluster C of 'Personality Disorders'?
Cluster C: a group of disorders characterised by anxious or fearful behaviours:
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-Compulsive personality disorder
96
Describe a person with Schizoid personality disorder.
Which Cluster of personality disorders does it fit in to?
- Detached + cold
- Doesn't feel the need to interact with others (friends, romantic / sexual partners)
- No eye contact
- Has a rich fantasy world
Cluster A.
97
Describe a person who is Schizotypal.
Which Cluster of personality disorders does it fit in to?
- Odd ideas + behaviours
- Difficulties with thinking
- Lack of emotion / inappropriate emotional reactions
- Can have hallucinations and other psychotic symptoms (but not enough to diagnose schizophrenia).
Cluster A.
98
Describe a person who has Paranoid Personality Disorder.
Which Cluster of Personality Disorders does it fit in to?
- Suspicious, untrusting, fear of rejection
- Thinking people hate you, even with evidence to the contrary
- Difficulty forming healthy relationships.
Cluster A.
99
Describe a person with Antisocial Personality Disorder.
Which Cluster of Personality Disorders does it fit into?
- 'Sociopath'
- Incapable of empathy.
- Impulsive, aggressive, easily frustrated, quick temper
- Incapable of guilt
- Manipulative
- Cruel + violent
Cluster B.
100
Describe a person with Histrionic Personality Disorder.
Which Cluster of Personality Disorders does it fit into?
- Self centred
- Craves attention
- V strong emotions that change quickly
- Concerned about appearance
Cluster B.
101
Describe a person with a Narcissistic Personality Disorder.
Which Cluster of Personality Disorders does it fit into?
- Self centred and egoistic
- Doesn't accept criticism and gets aggressive when they do
- Strong sense of your own self-importance
- Crave success, power, attention
- Takes advantages of people
Cluster B.
102
Describe a person with Borderline (emotionally unstable) personality disorder.
Which Cluster of Personality Disorders does it fit into?
- Often the result of insecure attachment / domestic violence / CSE
- Low self esteem, intense feeling of rejection
- Develops very intense feelings for people very quickly
- Find it hard to control emotions they feel very intensely -> emotional rollercoaster
- Often self-harm, engage in risky behaviour
- Associated with depression, alcohol abuse
- Finds it difficult to cope with life stresses
Cluster B.
103
Describe a person with Avoidant personality disorder.
Which Cluster of Personality Disorders does it fit into?
- Feels insecure + inferior
- Worries a lot that they are not good enough
- Craves being liked and accepted but avoids people due to the fear of them not liking them
- Extremely sensitive to criticism
Cluster C.
104
Describe a person with a Dependent personality disorder.
- Easily feels abandoned
- Passive; expects others to make decisions for them
- Finds it hard to do things on their own
- Feels hopeless + incompetent
- Can be abusive in a sneaky way (usually not intentionally, though)
105
What acronym can be used to help remember the components of a suicide risk assessment?
'SAD PERSONS score'
- Sex: Male
- Age: <19, >45
- Depression: present?
- Previous suicide attempt
- Ethanol (or other substance abuse)?
- Rational thinking loss (eg. psychosis, psychotic depression)
- Single or separated
- Organised (attempt wasn't an impulse, but well thought through)
- No social support
- Sickness (eg. Chronic Illness)
If you think they will go home and do it again, you can't let them go home!
106
What is capacity (according to the Mental Capacity Act 2005)?
A person has capacity if they are able to:
- Understand info
- Retain info
- Weigh up info
- Communicate their decision
107
What does Section 2 of the Mental Health Act (1983) state?
- Admission for assessment
- Up to 28 days
- Can't be renewed
- Signed by 2 doctors / 1 doctor and 1 AMHP
- Treatment can be administered, if needed.
108
What does Section 3 of the Mental Health Act (1983) state?
- Admission for treatment
- 6 months; can be renewed
- Signed by 2 doctors / 1 doctor and 1 AMHP
- Can give you treatment + perform investigations etc.
109
What does Section 4 of the Mental Health Act (1983) state?
- Can be signed by 1 AMHP Doctor
- Used in emergency when you're unsafe to go home but only 1 AMPH available
- Can hold you in hospital until another Dr / AMHP arrives, until you can be sectioned under 2 or 3.
- Up to 72 hrs
- Can't treat you, can only keep you in hospital.
110
What does Section 5 of the Mental Health Act (1983) state?
- Detention of a patient already in hospital by a doctor or nurse.
- Can stop you from physically leaving until you can be reviewed and Sectioned under Section 2 or 3.
111
What does Section 135 of the Mental Health Act (1983) state?
- Allows the police to take you from your PRIVATE property and take you to a place of safety (police station / hospital), because a Doctor thinks you need help and are unsafe for yourself or others.
- Up to 72 hrs.
112
What does Section 136 of the Mental Health Act (1983) state?
- Allows police to take you from a PUBLIC place to a place of safety.
- Up to 72 hours.
