PSYCH TABLE Flashcards
What does MSE stand for in psychiatry?
Mental State Examination
The MSE is a structured assessment of a patient’s mental state.
What are the components assessed in the appearance and behaviour section of the MSE?
Appearance and behaviour include:
* Appearance
* Behaviour
* Psychomotor retardation
* Posture
* Eye contact
* Hand movements
What aspects are evaluated in the speech section of the MSE?
The aspects of speech include:
* Quantity
* Rate
* Tone
* Volume
What is the difference between subjective and objective mood?
Subjective mood is reported by the patient, while objective mood is observed by the clinician.
Define affect as assessed in the MSE.
Affect refers to the observable expression of emotion, such as being blunted, depressed, or flat.
What does thought content include in the MSE?
Thought content includes:
* Delusions
* Obsessions
* Compulsions
* Overvalued ideas
* Suicidality
What does cognition assess in the MSE?
Cognition assesses if the patient is oriented to space and time.
What is the purpose of the Mental Capacity Act (MCA) 2005?
The MCA establishes principles and procedures for assessing mental capacity and ensuring decisions are made in the best interests of individuals lacking capacity.
List the 5 key principles of the Mental Capacity Act.
The key principles are:
* Presumption of capacity
* Support for decision-making
* Unwise decisions do not imply lack of capacity
* Best interests decisions
* Least restrictive options
What are the two steps in assessing capacity under the MCA?
The two steps are:
1) Assess for impairment or disturbance in mind or brain
2) Determine inability to:
* Understand relevant information
* Retain relevant information
* Weigh up relevant information
* Communicate a decision
What are the criteria for a patient to be treated under the Mental Health Act (MHA)?
The criteria are:
* Must have a mental disorder
* Risk to health/safety of self or others
* Treatment must be available
What is the assessment process under the MHA?
The assessment requires two doctors (one must be section 12(2) approved) and an Approved Mental Health Professional (AMHP).
What are core symptoms of depression?
Core symptoms include:
* Low mood
* Anhedonia
* Low energy
What is the duration for symptoms to be classified as depression?
Symptoms must last for at least two weeks.
What are associated physical symptoms of depression?
Physical symptoms include:
* Irregular sleeping pattern
* Slow movements
* Weight changes
What defines mild depression according to symptom criteria?
Mild depression is defined as 2 core symptoms plus 2 associated symptoms.
What is the PHQ-9 used for?
The PHQ-9 is a questionnaire used to assess the severity of depressive symptoms over the past two weeks.
What is serotonin syndrome?
Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the CNS.
List symptoms of serotonin syndrome.
Symptoms include:
* Altered mental status
* Autonomic hyperactivity
* Neuromuscular abnormalities
What are common risk factors for self-harm in patients?
Risk factors include:
* Previous attempts
* Mental health conditions
* Male sex
* Poor social support
Define psychosis.
Psychosis involves delusions, hallucinations, and thought disorders.
What are common antipsychotic medications?
Common antipsychotic medications include:
* Olanzapine
* Quetiapine
What characterizes brief psychotic disorder?
Brief psychotic disorder is characterized by sudden, short-term psychotic behavior lasting at least one day but less than one month.
What are baby blues?
Baby blues are mild mood swings, irritability, anxiety, and tearfulness occurring in the first two weeks after childbirth.
What is postnatal depression?
Postnatal depression is a severe form of depression that can develop up to one year after childbirth and affects daily functioning.
What is postpartum (puerperal) psychosis?
Postpartum psychosis is a severe mental health condition starting a few weeks after birth, characterized by delusions, hallucinations, and mood swings.
What are the symptoms of mania?
Symptoms of mania include:
* Abnormally elevated mood
* Increased energy
* Decreased sleep
* Grandiosity
* Risk-taking behavior
Differentiate between mania and hypomania.
Mania involves significant impairment of function, while hypomania has milder symptoms without significant impairment.
What is the definition of bipolar disorder?
Bipolar disorder involves recurrent episodes of depression and mania/hypomania.
What is cyclothymia?
Cyclothymia is characterized by mild symptoms of hypomania and low mood that do not significantly impair function.
What is generalized anxiety disorder?
Generalized anxiety disorder is characterized by excessive and uncontrollable worry across various life domains lasting at least six months.
List physical symptoms caused by generalized anxiety disorder.
Physical symptoms include:
* Restlessness
* Muscle tension
* Fatigue
What is cyclothymia?
Milder symptoms of low mood and hypomania
Not severe enough to significantly impair function
What characterizes Generalised Anxiety Disorder?
Excessive and uncontrollable worry across various life domains, persistent symptoms for 6 months
Symptoms include excessive worrying, irritability, insomnia, and physical symptoms.
What are common physical symptoms of Generalised Anxiety Disorder?
- Restlessness
- Muscle tension
- Fatigue
- Palpitations
- Sweating
- Tremor
- Gastrointestinal symptoms
- Headaches
- Sleep disturbance
These symptoms are caused by overactivity of the sympathetic nervous system.
List some risk factors for Generalised Anxiety Disorder.
- Females
- Comorbid conditions (depression, substance misuse, personality disorder)
- Lower economic status
- Life changes
- Lack of education
- Urban living
These factors can increase susceptibility to anxiety disorders.
What is the ICD-11 criteria for Generalised Anxiety Disorder?
- Excessive worry and apprehension
- Difficulty controlling worry
- Restlessness, muscle tension, fatigue
- Duration of 6 months
It is important to rule out secondary causes such as substance use or hyperthyroidism.
What is the first-line treatment for Generalised Anxiety Disorder?
Cognitive Behavioral Therapy (CBT)
SSRIs are also commonly prescribed.
True or False: Panic attacks always indicate a panic disorder.
False
Panic attacks can occur without a diagnosis of panic disorder.
What are the symptoms of a panic attack?
- Tension
- Palpitations
- Tremors
- Sweating
- Dry mouth
- Chest pain
- Shortness of breath
- Dizziness
- Nausea
Symptoms can manifest suddenly and last for a short time.
What is the GAD-7 questionnaire used for?
To assess the severity of Generalised Anxiety Disorder
Scores range from mild (5-9) to severe (15-21) anxiety.
What treatment options are available for moderate to severe anxiety?
- Cognitive Behavioral Therapy
- Medication (SSRIs, SNRIs)
- Propranolol for physical symptoms
SSRIs like sertraline are often the first-line medication.
What is Propranolol used for in anxiety treatment?
To treat physical symptoms of anxiety, such as palpitations and tremors
It does not address underlying anxiety and is short-term.
What characterizes Social Anxiety Disorder?
Fear of social scrutiny that impedes daily functioning
It is the most common anxiety disorder.
Define Agoraphobia.
Fear of places or situations that may cause feelings of helplessness or embarrassment
Often involves avoidance behaviors.
What are the first-line treatments for phobias?
Cognitive Behavioral Therapy and exposure techniques
Flooding and systematic desensitization are also common methods.
What are obsessions in OCD?
Intrusive, unwanted thoughts or images causing distress
They lead to compulsions aimed at reducing anxiety.
What is an acute stress reaction (ASR)?
Immediate and intense psychological response following a traumatic event
Symptoms can include intrusive memories and heightened arousal.
What differentiates PTSD from ASR?
PTSD symptoms persist for more than six months
ASR symptoms occur within four weeks after the traumatic event.
What are the symptoms of PTSD?
- Re-experiencing (flashbacks, nightmares)
- Avoidance of reminders
- Hyperarousal (sleep problems, irritability)
- Emotional numbing
Symptoms develop after exposure to a traumatic event.
What is an Adjustment Disorder?
Maladaptive responses to stressors leading to mood disturbances
Symptoms last for up to six months after the stressor.
What are the characteristics of Class A personality disorders?
- Paranoid
- Schizoid
- Schizotypal
These disorders involve enduring patterns of abnormal behavior.
What characterizes Antisocial Personality Disorder?
Disregard for the rights of others and lack of empathy
Often involves manipulative and impulsive behavior.
What is the main treatment for Borderline Personality Disorder?
Dialectical Behavioral Therapy (DBT)
It focuses on managing emotions and interpersonal relationships.
What are the traits of Avoidant Personality Disorder?
Feelings of social inadequacy and hypersensitivity to negative evaluation
Individuals often isolate themselves to avoid criticism.
What are the key characteristics of Narcissistic Personality Disorder?
Grandiosity, need for admiration, lack of empathy, entitlement, exploit others, arrogant, preoccupied with personal fantasies and desires
What are the Class C personality disorders?
Anxious or fearful disorders
What are common features of Avoidant Personality Disorder?
Feelings of social inadequacy, hypersensitivity to negative evaluation, self-imposed isolation to avoid potential criticism
What characterizes Dependent Personality Disorder?
Psychological need to be cared for by others, submissive and clinging behaviour, lack confidence and initiative, seek new relationships as source of care and support
How does Obsessive-Compulsive Personality Disorder differ from OCD?
Distinct from OCD, it involves preoccupation with orderliness, perfectionism, and control, impairs flexibility and efficiency
What is a Somatoform Disorder?
Presence of physical symptoms that cannot be explained by a medical condition, drug, or other mental health disorder; it is an unconscious process
What is Conversion Disorder?
A psychiatric condition that results in neurological symptoms without any underlying neurological cause, linked to emotional stress
What is Hypochondriasis?
Excessive concern about developing a serious illness despite lack of evidence; often leads to unnecessary tests and investigations
What is Munchausen Syndrome?
A fictitious disorder where patients intentionally fake signs and symptoms to gain attention and play ‘the patient role’
What is Malingering?
Intentional faking or inducing illness for secondary gain, such as financial benefits
What are the first rank symptoms of Schizophrenia?
Auditory hallucinations, thought disorders, passivity phenomena, delusional perceptions
What are examples of positive symptoms in Schizophrenia?
Auditory hallucinations, delusions, thought disorders, passivity phenomena, delusional perceptions
What are some negative symptoms of Schizophrenia?
Affective blunting, anhedonia, alogia, avolition, social withdrawal
What factors are associated with a poor prognosis in Schizophrenia?
Strong family history, gradual onset, low IQ, prodromal phase of social withdrawal, lack of obvious precipitant
What is Neuroleptic Malignant Syndrome?
A rare but life-threatening reaction to antipsychotics, characterized by hyperthermia, altered mental state, autonomic dysregulation, and rigidity
What is Anorexia Nervosa characterized by?
Self-imposed starvation, relentless pursuit of extreme thinness, intense fear of gaining weight, distorted body image
What are the two subtypes of Anorexia Nervosa?
*Restrictive subtype
*Bulimic subtype
What are the physical signs of Anorexia Nervosa?
*Hypotension
*Bradycardia
*Enlarged salivary glands
*Lanugo hair
*Amenorrhea
What is Bulimia Nervosa?
Recurrent binge eating episodes followed by compensatory behaviours such as self-induced vomiting, laxative abuse, or excessive exercise
What is Body Dysmorphic Disorder (BDD)?
Preoccupation with an imagined defect in physical appearance or excessive concern about a slight physical anomaly, leading to significant functional impairment
What are the symptoms of a Paracetamol overdose?
Nausea, vomiting, abdominal pain, jaundice, altered mental state
What is the treatment for Paracetamol overdose?
N-acetylcysteine (NAC) administration
What are the signs of Alcohol Withdrawal?
*Tremor
*Sweating
*Nausea and vomiting
*Tachycardia
*Anxiety
*Insomnia
What is Delirium Tremens?
Severe form of alcohol withdrawal characterized by acute confusion, hallucinations, and autonomic hyperactivity
What are the classic signs of Wernicke’s Encephalopathy?
*Ataxia
*Ophthalmoplegia
*Confusion
What is the treatment for Wernicke’s Encephalopathy?
High dose thiamine
What is Wernicke’s encephalopathy?
A neurological condition characterized by confusion, ataxia, ophthalmoplegia, and nystagmus due to thiamine (B1) deficiency.
It is often associated with chronic alcoholism.
What are the classic signs of Wernicke’s encephalopathy?
- Ataxia
- Ophthalmoplegia
- Nystagmus
All three signs do not need to coexist in a single patient.
Is Wernicke’s encephalopathy reversible?
Yes, it is reversible with appropriate treatment.
High-dose thiamine supplementation is crucial.
What is the treatment for Wernicke’s encephalopathy?
High-dose thiamine supplementation, such as Pabrinex.
Important in settings where patients have a history of excessive alcohol use.
What is Korsakoff’s syndrome?
A chronic memory disorder often seen in alcoholics resulting from untreated Wernicke’s encephalopathy or long-standing thiamine deficiency.
It includes symptoms like confabulation and amnesia.
What are the characteristics of Korsakoff’s syndrome?
- Anterograde amnesia
- Retrograde amnesia
- Confabulation
- Impaired memory
- Irreversible condition
Resulting from untreated Wernicke’s encephalopathy.
What are symptoms of stimulant intoxication?
- Euphoria
- Hypertensive crisis
- Increased HR
- Dilated pupils
- Seizures
- Excessive thirst
Particularly associated with MDMA.
What is delirium?
An acute confusional state characterized by disorientation, hallucinations, and memory problems.
Symptoms can be hyperactive, hypoactive, or mixed.
What are the components of the 4AT assessment for delirium?
- Drugs and Alcohol
- Eyes, ears, and emotional disturbances
- Low output state
- Infection
- Retention
- Ictal
- Under-hydration/Under-nutrition
- Metabolic disorders
- Subdural hematoma, sleep deprivation
Used to identify delirium causes.
What is dementia?
Chronic impairment of multiple higher cortical functions, including memory, thinking, cognition, comprehension, and language.
Affects daily functioning significantly.
What screening tool suggests dementia with a score of 24 or less out of 30?
Mini-Mental State Examination (MMSE).
Scores indicate severity: 20-24 mild, 13-20 moderate, <12 severe.
What are common risk factors for Alzheimer’s disease?
- Advanced age > 65
- Genetics (APOE gene)
- Downs syndrome
- Family history
- CV risk factors
- Traumatic brain injury
Additional factors include smoking and low education.
What are the core features of Alzheimer’s disease?
- Amnesia
- Aphasia
- Agnosia
- Apraxia
Cognitive decline is progressive.
What is the hallmark of vascular dementia?
Progressive, stepwise deterioration in cognition due to impaired blood flow to the brain.
Often associated with a history of cerebrovascular events.
What are the diagnostic criteria for Lewy body dementia?
- Fluctuating cognition
- Parkinsonism
- Visual hallucinations
Diagnosis is primarily clinical.
What is frontotemporal dementia characterized by?
Profound behavioral and personality changes, often presenting at a younger age.
It may include disinhibited behavior and repetitive checking.
What is autoimmune encephalitis?
Non-infectious neuroinflammation leading to acute or sub-acute mental status changes.
Symptoms fluctuate and can include confusion and seizures.
What is a common cause of autoimmune encephalitis?
Anti-NMDA receptor subtype.
Most common in young adults and children, particularly females.
What does T2 signal in the frontal lobe indicate?
Autoimmune encephalitis
Indicates possible non-infectious neuroinflammation
What are common symptoms of autoimmune encephalitis?
- Confusion
- Seizures
- Movement disorders
- Behaviour changes
- Emotional lability
- Psychosis
Symptoms can fluctuate and progress over days to weeks
Who is most commonly affected by anti-NMDA receptor subtype autoimmune encephalitis?
Young adults and children, with a higher prevalence in females
Fast onset typically occurs in young people
What laboratory findings are associated with autoimmune encephalitis?
- Low sodium in LG1
- Antibodies: LG1, NMDA receptor
Diagnostic tests should include blood work and imaging
What does lumbar puncture reveal in cases of autoimmune encephalitis?
Increased lymphocytes in CSF (lymphocytic pleocytosis)
This finding is indicative of neuroinflammation
What treatments are commonly used for autoimmune encephalitis?
- Steroids
- IV immunoglobulins
- Plasma exchange
- Rituximab
Plasma exchange can cause infection and electrolyte imbalances
What neurotransmitter do GABA-A receptors primarily respond to?
GABA
GABA-A receptors are ligand-gated ion channels that allow chloride ions to flow through
Which class of antidepressants selectively inhibit the reuptake of serotonin?
SSRIs (Selective Serotonin Reuptake Inhibitors)
Examples include Fluoxetine, Sertraline, and Citalopram
What are common indications for SSRIs?
- Depression
- Generalized anxiety (GAD)
- Panic disorder
- OCD
- PTSD
- Phobic states
SSRIs should not be used in mania or with warfarin
What is a significant side effect of Citalopram?
Dose-dependent QT interval prolongation
Caution is advised due to risk of cardiac issues
What can occur if SSRIs are suddenly discontinued?
Discontinuation syndrome
Symptoms include increased mood changes, restlessness, and GI disturbances
What is the mechanism of action of monoamine oxidase inhibitors (MAOIs)?
Inhibit the enzyme monoamine oxidase
This leads to increased levels of serotonin and norepinephrine in the brain
What are common side effects of MAOIs?
- Hypertensive crisis
- Weight gain
- Sedation
- Sexual dysfunction
Patients must avoid tyramine-containing foods to prevent hypertensive reactions
What is the role of lithium in psychiatry?
Mood stabilizer for bipolar disorder and recurrent depression
Serum lithium levels should be monitored regularly
What are the common side effects of lithium?
- Fine tremor
- Dry mouth
- GI disturbance
- Increased thirst and urination
- Drowsiness
Toxicity can lead to coarse tremor and CNS disturbances
What type of antidepressant is mirtazapine?
NaSSAs (Noradrenergic and Specific Serotonergic Antidepressants)
It is a second-line choice especially if there is weight loss
What are common side effects of SNRIs?
- Nausea
- Insomnia
- Increased heart rate
- Agitation
SNRIs are contraindicated in patients with high blood pressure or heart disease
What are the main indications for using antipsychotics?
- Schizophrenia
- Psychosis
- Mania
- Agitation
Atypical antipsychotics are often first-line treatments
What are common side effects of typical antipsychotics?
- Extrapyramidal symptoms
- Hyperprolactinemia
- Weight gain
- Sedation
These side effects are more common in first-generation antipsychotics
What is a key monitoring requirement for patients on clozapine?
Weekly FBC (full blood count)
Monitoring for agranulocytosis is critical due to its risk
What should be avoided in patients taking SSRIs?
- Warfarin
- Aspirin
- NSAIDs
These can increase the risk of bleeding
What is a common side effect of lithium?
Increased weight
Lithium can lead to weight gain as a side effect.
What should women of childbearing age take when commenced on lithium?
Contraception
Lithium is generally avoided in pregnancy due to the high risk of cardiac malformations.
What conditions are contraindicated for lithium use?
Addison’s disease, rhythm disorder, Brugada syndrome, low sodium diets, untreated hypothyroidism
These conditions can exacerbate lithium’s side effects.
What type of medication is lamotrigine?
Anti-convulsant
Lamotrigine is used primarily for seizure control.
What is sodium valproate classified as?
Anti-convulsant
Sodium valproate is also known for its teratogenic effects.
What are the teratogenic risks associated with sodium valproate?
Neural defects and developmental delay
Strict rules apply for females of childbearing age.
Which class of drugs enhances the effect of GABA?
Benzodiazepines
Benzodiazepines increase the frequency of chloride channel opening.
Name three benzodiazepines.
- Diazepam
- Clonazepam
- Lorazepam
Benzodiazepines are used for sedation, anxiety relief, and muscle relaxation.
What is the recommended duration for prescribing benzodiazepines?
2-4 weeks
Long-term use can lead to tolerance and dependence.
What type of receptor does midazolam enhance?
GABA receptor
Midazolam acts on the inhibitory GABA receptor.
What is the effect of GABA binding to its receptor?
Influx of chloride ions
This influx reduces membrane potential, causing sedative effects.
What class of drugs is classified as GABA-A drugs?
Barbiturates
Barbiturates increase the duration of chloride channel opening.
Name the three groups of Z-drugs.
- Imidazopyridines (e.g., zolpidem)
- Cyclopyrrolones (e.g., zopiclone)
- Pyrazolopyrimidines (e.g., zaleplon)
Z-drugs act on the α2-subunit of the GABA receptor.
What are the adverse effects of Z-drugs similar to?
Benzodiazepines
Both classes increase the risk of falls in the elderly.
What does ECT stand for?
Electroconvulsive Therapy
ECT is used for severe depression and other mental health disorders.
What does CBT stand for?
Cognitive Behavioral Therapy
CBT is a common talking therapy used to treat various mental health issues.
Define ‘Denial’ as a defense mechanism.
Refusal to accept reality
Denial is considered a pathological defense mechanism.
What is ‘Projection’ in the context of defense mechanisms?
Attributing uncomfortable thoughts or feelings to others
Projection is classified as an immature defense mechanism.
What does ‘Displacement’ refer to in neurotic defenses?
Redirection of impulses onto a different target
Displacement can lead to short-term advantages but may cause long-term issues.
What is a characteristic of mature defenses?
Considered the most advanced form of defense mechanisms
Examples include altruism and sublimation.
Define ‘Sublimation’ as a defense mechanism.
Redirecting negative thoughts or feelings into a more positive form
This is an example of a mature defense mechanism.
What is the purpose of ‘Rationalization’ as a defense mechanism?
Creation of false but credible justifications
Rationalization helps individuals cope with uncomfortable feelings.
