PSYCH TO DO Flashcards
1
Q
ECT
What are some adverse effects of ECT?
A
- Short-term retrograde amnesia
- Headache
- Confusion + clumsiness
2
Q
DEPRESSION
What are 2 theories speculating the causes of depression?
A
- Stress vulnerability = someone with high vulnerability will withstand less stress before becoming mentally unwell
- Monoamine hypothesis = depression caused by deficiency in monoamines (serotonin, noradrenaline) hence why Tx works
3
Q
DEPRESSION
What are the biological causes of depression?
A
- Personal/FHx + genetics
- Personality traits (dependent, anxious, avoidant)
- Physical illness (hypothyroid, anaemia, childbirth)
- Iatrogenic (beta-blockers, steroids, substance misuse)
4
Q
DEPRESSION
What are the three core symptoms of depression?
A
- Low mood
- Anhedonia
- Anergia
5
Q
DEPRESSION
What are some psychological symptoms of depression?
A
- Guilt, worthlessness, hopelessness
- Self-harm/suicidality
- Low self-esteem
6
Q
DEPRESSION
What are some cognitive symptoms of depression?
A
- Beck’s triad = negative views about oneself, the world + the future
- Poor concentration + impaired memory
- Avoiding social contact + performing poorly at work (social Sx too)
7
Q
DEPRESSION
What are some investigations for depression?
A
- FBC, ESR, B12/folate, U+Es, LFTs, TFTs, glucose, Ca2+
- ECG, MSE + risk assessment
- Urine drug screen
- PHQ-9 + HADS to screen for depression
8
Q
DEPRESSION
What is the management of psychotic depression?
A
- ECT first line + v effective in severe cases followed by antidepressant
- Antipsychotic initiated before antidepressant if ?primary psychotic disorder then add SSRI
9
Q
DEPRESSION
What is atypical depression?
What is the management?
A
- Mood depressed but reactive
- Hypersomnia (>10h/day)
- Hyperphagia (excessive eating + weight gain)
- Leaden paralysis (heaviness in limbs ≥1h/day)
- Oversensitivity to perceived rejection
- Phenelzine or another MAOI, if not SSRI
10
Q
DEPRESSION
What is dysthymia?
What is the management?
A
- Chronic, low-grade or sub-threshold depressive Sx which don’t meet diagnostic criteria over a long period of time
- Typically >2y of mildly depressed mood + diminished enjoyment, less severe but more chronic
- SSRIs + CBT first line
11
Q
SELF-HARM + SUICIDE
What are some risk factors for suicide?
A
SAD PERSONS –
- Sex (M>F)
- Age (peaks in young + old)
- Depression
- Previous attempt
- Ethanol
- Rational thinking loss (psychotic illness)
- Social support lacking (unemployed, homeless)
- Organised plan (avoid discovery, plan, notes, final acts)
- No spouse
- Sickness (physical illness)
0–4 low, 5–6 mod (?hospital), ≥7 high
12
Q
SELF-HARM + SUICIDE
What are some protective factors for suicide?
A
- Married men
- Active religious beliefs
- Social support
- Good employment
13
Q
BIPOLAR DISORDER
What are the 4 types of bipolar?
A
- Bipolar 1 = mania + depression in equal proportions, M>F
- Bipolar 2 = more episodes of depression, mild hypomania (easy to miss), F>M
- Cyclothymia = chronic mood fluctuations over ≥2y (episodes of depression + hypomania, can be subclinical)
- Rapid cycling = ≥4 episodes of (hypo)mania or depression in 1 year
14
Q
BIPOLAR DISORDER
What are some potential causes of bipolar?
A
- Structural brain abnormalities, neurotransmitter imbalances
15
Q
SCHIZOPHRENIA
What is schizophrenia?
A
- Splitting or dissociation of thoughts, loss of contact with reality
16
Q
SCHIZOPHRENIA
What is the neurodevelopmental hypothesis in schizophrenia?
A
- Hypoxic brain injury, viral infections in-utero, TLE + cannabis smoking = risk of schizophrenia indicating brain development link
- Imaging has showed enlarged ventricles (poor prognostic feature), small amounts of grey matter loss + smaller, lighter brains
17
Q
SCHIZOPHRENIA
What is the neurotransmitter hypothesis in schizophrenia?
A
- Excess dopamine + overactivity in mesolimbic tract = +ve Sx
- Lack of dopamine + underactivity in mesocortical tracts = -ve Sx
- Overactivity of dopamine, serotonin, noradrenaline + underactivity of glutamate + GABA
18
Q
SCHIZOPHRENIA
What are the 6 different types of schizophrenia?
A
- Paranoid (most common)
- Hebephrenic
- Simple
- Catatonic
- Undifferentiated
- Residual (‘burnt out’)
19
Q
SCHIZOPHRENIA
What are the features of…
i) catatonic
ii) undifferentiated
iii) residual
schizophrenia?
A
i) Psychomotor disturbance such as posturing, rigidity + stupor
ii) Sx do not fit neatly into other subtypes
iii) Previous +ve symptoms less marked, prominent -ve Sx
20
Q
SCHIZOPHRENIA
What are the first rank symptoms of schizophrenia?
What is the relevance?
A
- Delusional perceptions
- Auditory hallucinations (3 types)
- Thought alienation (insertion, withdrawal + broadcasting)
- Passivity phenomenon, incl. somatic
- ≥1 for at least 1m is strongly suggestive Dx
21
Q
SCHIZOPHRENIA
What are some secondary symptoms of schizophrenia?
What is the relevance?
A
- 2nd person auditory or hallucinations in other modalities
- Other delusions (persecutory, reference)
- Formal thought disorder
- Lack of insight
- Negative Sx (incl. catatonia)
- ≥2 for at least 1m is strongly suggestive Dx
22
Q
SCHIZOPHRENIA
What is the difference between positive and negative symptoms of schizophrenia?
A
- +ve = presence of change in behaviour or thought, something added (all of the first rank + secondary Sx)
- -ve = decline in normal functioning, something removed
23
Q
SCHIZOPHRENIA
What are the negative symptoms of schizophrenia?
A
Often early prodromal, 5As –
- Affect blunting, flattening or incongruity
- Anhedonia + amotivation
- Asociality
- Alogia (poverty of speech)
- Apathy
(Delusional mood = ominous feeling of something impending)
24
Q
SCHIZOPHRENIA
What are some…
i) psychiatric
ii) organic
iii) substance
differentials for schizophrenia?
A
i) Delusional disorder, transient psychosis, mania, psychotic depression
ii) TLE, encephalitis, delirium, syphilis/HIV, SOL
iii) Drug-induced psychosis, alcoholic hallucinosis, steroid-induced
25
PARAPHRENIA
What is paraphrenia?
How does it compare to schizophrenia?
- Late-onset schizophrenia >45y
- Less emotional blunting + personality decline, F>M
26
GAD
What are 3 cardinal features of GAD?
- Symptoms of muscle + psychic tension
- Causes significant distress + functional impairment
- No particular stimulus
27
GAD
What model can be used to explain the causes of GAD?
Triple vulnerability –
- Generalised biological
- Generalised psychological (diminished sense of control)
- Specific psychological (stressful events)
28
GAD
What are some organic differentials for GAD?
- Endo = hyperthyroidism, pheochromocytoma, hypoglycaemia
- CVS = arrhythmias, cardiac failure, anti-hypertensives, MI
- Resp = asthma (excessive salbutamol), COPD, PE
29
GAD
What is the ICD criteria of GAD?
What are the groups of symptoms present in GAD?
- Difficulty controlling worry, present for more days than not for ≥6m
- ≥4 symptoms with ≥1 from autonomic arousal section
- Autonomic arousal, physical, mental, general, tension, other
30
GAD
What are the investigations for GAD?
- History, MSE + risk assessment
- GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire
- Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)
31
PANIC DISORDER
What is panic disorder associated with?
What are some risk factors?
- Meds like SSRIs, BDZs, zopiclone withdrawal
- Widowed, divorced or separated, living in city, limited education, physical or sexual abuse, FHx
32
PANIC DISORDER
What are the 3 key elements of panic disorder?
- Sudden onset panic attack with ≥4 characterised Sx
- Not necessarily associated with a specific stimulus
- Pt preoccupied with suffering death or severe life-threatening illness
33
PTSD
What are the 4 core symptoms of PTSD?
How long do they need to be present for to diagnose?
HEAR (≥1m) –
- Hyperarousal
- Emotional numbing
- Avoidance + rumination
- Re-experiencing (involuntary)
34
ANOREXIA NERVOSA
What is the diagnostic criteria for anorexia?
FEED ≥3m with absence of binge eating –
- Fear of fatness
- Endocrine disturbance
- Extreme weight loss
- Deliberate weight loss
35
ANOREXIA NERVOSA
How may endocrine disturbance present?
- Amenorrhoea
- Reduced libido/fertility
- Abnormal insulin secretion
- Delayed/arrested puberty if onset pre-pubertal
36
ANOREXIA NERVOSA
What are some complications of anorexia?
- Osteoporosis, thyroid issues, cardiac atrophy
- Electrolyte disturbances (hypokalaemia > arrhythmias)
- Decrease in WBC > increased infections
- Death due to health complications or suicide
37
ANOREXIA NERVOSA
What screening tool can be used in anorexia?
SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you've lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you're FAT when others say you're thin?
- Does FOOD dominate your life?
38
ANOREXIA NERVOSA
In anorexia, most things are low apart from what?
Gs + Cs –
- GH, Glucose, salivary Glands
- Cortisol, Cholesterol, Carotinaemia
39
ANOREXIA NERVOSA
What risk assessment tool can be used for assessing if a patient with anorexia needs inpatient psychiatric admission?
Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)
40
ANOREXIA NERVOSA
What are the MARSIPAN indicators of admission?
- BMI <13, severe malnutrition or dehydration
- HR <40, ECG changes
- BP <90 systolic, <70 diastolic esp with postural drop
- Temp <35
- Severe electrolyte disturbances (K+, Na+, Mg2+, phosphate = low)
- SUSS test of 0 or 1
- Significant suicide or serious self-harm risk
41
ANOREXIA NERVOSA
What are the biological treatments for anorexia nervosa?
- Fluoxetine, chlorpromazine + TCAs may be used for weight gain
42
ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?
- Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
- Electrolyte stores depleted as needed to convert glucose>energy
- Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
43
ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?
- Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
- Abdo pain, vomiting, constipation, infections
44
ANOREXIA NERVOSA
What are the biochemical features of refeeding syndrome?
- Hypophosphataemia main disturbance due to role of converting glucose>energy
- Hypokalaemia, hypomagnesaemia + thiamine deficiency too
- Abnormal fluid balance
45
ANOREXIA NERVOSA
What should be monitored before + during refeeding?
- U+Es (Na+, K+), phosphate, magnesium, glucose, ECG, fluid balance
46
BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?
BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week
47
BULIMIA NERVOSA
What are some investigations for bulimia?
- SCOFF
- BP (low), temp, SUSS test
- ECG (arrhythmias from hypokalaemia)
- FBC (anaemia), LFTs, urinalysis, serum proteins
- Monitor U+Es, calcium, magnesium, phosphate in vomiting, laxative abuse, diuretics or waterloading (for deceitful weighing)
48
BULIMIA NERVOSA
What metabolic abnormalities may be present?
- Hypochloraemic hypokalaemic metabolic alkalosis due to vomiting
- Hypokalaemia > muscle weakness + arrhythmias
49
PERSONALITY DISORDERS
What are cluster A personality disorders?
- Characterised by odd, eccentric thinking or behaviour
- MAD
50
PERSONALITY DISORDERS
What are some differentials of schizotypal personality disorder?
- Autism
- Asperger's
- Schizophrenia (50% may develop it)
51
PERSONALITY DISORDERS
What are cluster B personality disorders?
- Characterised by dramatic, overly emotional or unpredictable thinking or behaviour (BAD)
52
PERSONALITY DISORDERS
What is a psychopath?
What is a sociopath?
- When they get in trouble with the law
- Same traits but without law involvement
53
PERSONALITY DISORDERS
In terms of EUPD, what is the difference between...
i) impulsive type?
ii) borderline type?
i) Difficulties with impulsive + risky behaviours (unsafe sex, gambling) + anger
ii) Difficulties with relationships, self-harm + feelings of emptiness
54
PERSONALITY DISORDERS
What are cluster C personality disorders?
- Characterised by anxious, fearful thinking or behaviour (SAD)
55
PERSONALITY DISORDERS
What are some investigations for personality disorders?
- Assessed (Hx + MSE) more than once
- Minnesota Multiphasic Personality Inventory (MMPI)
- Eysenck Personality Inventory + Personality Diagnostic Questionnaire
56
PERSONALITY DISORDERS
What is the biological management of personality disorders?
- Only use to treat comorbid conditions or if Sx distressing (e.g. antipsychotics in group A to reduce suspiciousness)
57
PERSONALITY DISORDERS
What are the psychological therapies for personality disorders?
- Dialectical behavioural therapy for EUPD
- CBT (change unhelpful ways of thinking)
- Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours)
- Psychodynamic therapy (looks at how past experiences affect present behaviour)
58
WERNICKE'S
How does Wernicke's present?
Triad –
- Ataxia
- Confusion
- Ophthalmoplegia + nystagmus
59
KORSAKOFF'S
What are some causes of Korsakoff's?
- Heavy alcohol drinkers
- Head injury, post-anaesthesia
- Basal or temporal lobe encephalitis
- CO poisoning
- Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)
60
LITHIUM TOXICITY
What is lithium toxicity?
What can precipitate it?
- Serum lithium >1.5mmol/L
- >2mmol/L = life-threatening
- Dehydration, renal failure, diuretics, anti-HTNs + NSAIDs
61
LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?
- Ataxia, dysarthria, confusion (drunk)
- COARSE tremor, blurred vision, hyperreflexia
- N+V, diarrhoea
- Myoclonus, seizures + coma if severe
62
LITHIUM TOXICITY
What are some complications of lithium toxicity?
- Arrhythmias (VT)
- Acute renal failure
- Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination
63
LITHIUM TOXICITY
What is the management of lithium toxicity?
- ABCDE approach as emergency
- Stop + check lithium levels, serum creatinine, U+Es
- IV fluids (bolus + 1.5–2x maintenance
- ?Whole bowel irrigation with polyethene glycol for severe, acute ingestion
- Haemodialysis
64
LITHIUM TOXICITY
When would you do haemodialysis in lithium toxicity?
- Serum [Li] >5mmol/L
OR >4 + renal dysfunction
OR severe toxicity (seizures, coma, life-threatening arrhythmias)
65
ACUTE DYSTONIA
What is an acute dystonic reaction?
- Sustained painful muscle contraction in ≥1 muscle groups
66
ACUTE DYSTONIA
What is the management of acute dystonia?
- ABCDE approach as emergency
- Anticholinergic – IM procyclidine
- Stop antipsychotic (switch to atypical as less EPSEs)
67
NMS
What is the pathophysiology of neuroleptic malignant syndrome (NMS)?
- Dopamine antagonism often due to typical antipsychotic OD or acute withdrawal of Parkinson's meds
68
NMS
How quickly does NMS present?
- Onset within 2w of drug or dose change (onset + progression slow)
- May last 7–10d after PO or 21d after depot
69
NMS
What is the clinical presentation?
Bodybuilder–
- Pyrexia >38 + diaphoresis
- Muscle rigidity (diffuse "lead-pipe" rigidity)
- Confusion, agitation, altered consciousness
- Tachycardia, high/low BP
- Hyporeflexia
70
SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?
Sx onset + recovery fast –
- Neuro = confusion, agitation
- Neuromuscular = myoclonus, tremors (incl. shivering), hyperreflexia, ataxia
- Autonomic = hyperthermia, diarrhoea, tachycardia, mydriasis
71
SEROTONIN SYNDROME
What are some investigations for serotonin syndrome?
- FBC, U+Es, biochemistry (Ca2+, Mg2+, phosphate), CK, drug toxicology scren
- ECG monitoring for prolonged QRS or QTc interval
72
SEROTONIN SYNDROME
What is the management of serotonin syndrome?
- ABCDE
- Stop offending agent
- IV access to correct volume + reduce risk of rhabdomyolysis as in NMS
- BDZs like slow IV lorazepam for agitation, seizures + myoclonus
- Serotonin receptor antagonists like PO cyproheptadine or chlorpromazine if severe
73
SEROTONIN SYNDROME
What is the management of serotonergic drug OD?
- ?Gastric lavage ± activated charcoal
74
LEARNING DISABILITIES
What is a learning disability?
- Condition of arrested or incomplete development of mind, characterised by impairment of skills that contribute to overall intelligence (language, cognition, social) which has manifested during developmental period
75
LEARNING DISABILITIES
How is a learning disability different to learning difficulties?
- Learning difficulties (dyslexia) are difficulties in acquiring knowledge + skills to the normal level expected of those of the same age, especially due to a mental disability or cognitive disorder
76
LEARNING DISABILITIES
What is the triad in learning disabilities?
- Low intellectual performance (IQ < 70)
- Onset during birth or early childhood
- Wide range of functional impairment
77
LEARNING DISABILITIES
What physical disorders may be present in those with learning disabilities?
- Motor disabilities (ataxia, spasticity)
- Epilepsy
- Impaired hearing/vision
- Incontinence
78
LEARNING DISABILITIES
How is mild learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 50–69
ii) 9–12
iii) Mobile
iv) Mostly adequate
v) Difficulties reading + writing
vi) Most independent
79
LEARNING DISABILITIES
How is moderate learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 35–49
ii) 6–9
iii) Mobile
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support
80
LEARNING DISABILITIES
How is severe learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) 20–34
ii) 3–6
iii) Marked impairment
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support
81
LEARNING DISABILITIES
How is profound learning disability characterised by...
i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?
i) <20
ii) <3
iii) Severe impairment
iv) Basic non-verbal comms, understands basic commands
v) None
vi) Complete dependency
82
ADHD
What are some risk factors for ADHD?
- Epilepsy, low socioeconomic status, learning difficulties
- Premature or LBW
- Brain damage (in vitro or after severe head injury later)
83
ADHD
What is the triad of symptoms in ADHD?
- Inattention
- Impulsivity
- Hyperactivity
84
DBT
What are the two components to DBT?
- Individual therapy = therapist validates pt's responses, reinforces adaptive behaviours + facilitates analysis of maladaptive behaviours + their triggers
- Group therapy = teaching on mindfulness, interpersonal effectiveness skills (problem solving, communication), emotional modulation skills
85
GENDER DYSPHORIA
What act is relevant to gender dysphoria?
- Gender recognition act 2004
- Allows transsexual people to legally change their gender
- Have to demonstrate Dx of gender dysphoria + have lived as gender role for ≥2y
86
GENDER DYSPHORIA
What are some risks of the hormone therapy?
- Oestrogen = clots, gallstones, high triglycerides
- Testosterone = polycythaemia, acne, dyslipidaemia
- Both = elevated LFTs, infertility, weight gain
87
SELF-HARM
What are some risk factors for self-harm?
Female
Social deprivation,
Single or divorced,
LGBTQ+,
mental illness
88
SCHIZOPHRENIA
What are the features of hebephrenic schizophrenia?
Dx in adolescents with mood changes, unpredictable behaviour, shallow affect + fragmentary hallucinations, poor outlook as -ve Sx may develop rapidly
89
SCHIZOPHRENIA
What are the features of simple schizophrenia?
Pts never really experienced +ve Sx, mostly -ve
90
TIC DISORDERS
What might cause them?
- Stress, gestational + perinatal insults, PANDAS
91
ANOREXIA NERVOSA
What are the consequences of refeeding syndrome?
Can lead to cardiac arrhythmias, convulsions, cardiac failure, coma + death
92
OCD
What is a potential cause of OCD?
Neurochemical dysregulation of 5-HT system
