Psych VIVAs Flashcards
What are the 5 features of dependency?
- Compulsion - strong desire to have substance
- Tolerance – larger doses needed for same effect
- Salience (primary) – obtaining and using substance becomes so important other interests are neglected
- Continued Use despite harm - despite clear problems caused by the substance, the person can’t stop using
- Withdrawal – physiological withdrawal state when it is stopped
What do the following terms mean? Intoxication, Harmful use, dependency and Withdrawal?
- Intoxication: changes in emotions and behaviour after drug use (transient state, dose-dependent and time-limited)
- Harmful use: pattern of use likely to cause physical or psychological damage
- Dependency: when using the substance becomes more of a priority in their lives (than other things that used to be more important to them)
- Withdrawal: physical and psychological symptoms that arise after stopping drug use
When should opioid withdrawal not be routinely offered?
- Concurrent medical problem requiring urgent treatment
- In police custody
- Presenting in acute or emergency settings
- Be careful with pregnant women
Describe the withdrawal syndrome?
Unpleasant but not life-threatening
Symptoms can begin 6 hours after last dose
o with symptoms peaking at 36-72 hours
o subsided by 5 days
Opiod withdrawal sx?
- Feverish, goosebumps
- Aching joints and muscles
- Dilated pupils
- Insomnia
- Yawning irresistibly
- The runs – diarrhoea, vomiting, lacrimation and rhinorrhoea
What model can be used to assess an individuals motivation to change?
Prochaska & DiClemente’s Stages of Change Model – This involves pre-contemplation, contemplation, preparation, action, maintenance, relapse?
Relapses should be treated as - common problem and part of the overall learning process, rather than a sign of failure important to understand the triggers for relapse aids the next attempt at abstinence.
How long can different drugs be detected in urinary drug screens?
- Amphetamine: 2 days
- Heroin: 2 days
- Cocaine: 5-7 days
- Methadone: 7 days
- Cannabis: up to 1 month
What is the definition of Schizophrenia?
- Schizophrenia is a chronic psychotic disorder ≥ 1 month
- characterised by Schneider’s first rank symptoms (WASBID – Withdrawal, auditory hallucinations, somatic passivity / control, broadcasting, insertion and delusions)
- and cannot be due to physical cause or substance
Different types of schizo?
- Paranoid: classical = paranoid delusions, auditory hallucinations
- Hebephrenic: disorganised, chaotic mood, child-like behaviours
- Catatonic: psychomotor disturbance e.g. stupor, rigidity, waxy flexibility, perseveration
CT changes in AD, VD and LBD?
- AD = Generalised atrophy
- DLB = mild atrophy
- VD = multiple areas of hypodensity
Some reversible causes of dementia?
- Brain – SOL, subdural haematoma, hydrocephalus
- Endocrine – Addisons, Cushings
- Vit Deficiencies – B12, Folate
- Infection – Neurosyphilis
MMSE Score interpretation? –
In pseudodepression likely to say IDK vs trying to answer and getting it wrong in dementia
• 24-30 no cognitive impairment 21-26 mild AD
• 18-23 mild cognitive impairment 10-20 moderate AD
• 0-17 severe cognitive impairment <10 severe AD
What is refeeding syndrome?
This is when an extended period of catabolism (during starvation) end abruptly causing a switch from fat to carbohydrate metabolism.
This leads to an increase in insulin secretion leading to sudden intracellular movement of electrolytes (causing low phosphate, potassium and magnesium (causes hypocalcaemia). This has to be treated by reducing nutritional intake and correcting electrolyte abnormalities.
What is some good v bad prognositic factors for AN?
- Good – Early age of onset, good parent-child relationship, rapid detection + treatment
- Poor – Bulimic features, excessive weight loss, male
When to consider inpatient treatment in AN
- BMI <13
- Rapid weight loss >1kg/w
- High suicide risk
- Serious physical complications (purpuric rash, cold peripheries, hypotension, brady, electrolyte imbalances)
Severity grading of AN:
- Severe = BMI < 15, rapid weight loss, evidence of system failure Urgent CEDS referral
- Moderate = BMI 15-17, no evidence of system failure Routine referral to CEDS
- Mild = BMI > 17, no additional co-morbidity Monitor/advise for 8w, BEAT + routine referral to CEDS if no response
What is the prognosis of anxiety disorders?
- 1/3 recover completely
- 1/3 improve partially
- 1/3 fare poorly and suffer considerable disability
How is GAD7 used to scale anxiety?
• Mild (5-9), Moderate (10-14), Severe (15 or more)
How long do SSRIs take to act in GAD?
• 6-8 weeks
What’s the different between GAD and Panic Disorder?
- GAD is not triggered by a specific stimulus, it is continuous and generalised
- Panic disorder is characterised by sudden attacks of extreme anxiety lasting < 30 mins and patients are relatively free of anxiety in between attacks
What is Agoraphobia?
• Fear of being unable to easily escape to a safe place (usually home)
Prognosis for patients with BPAD?
- Manic episodes often begin abruptly and are normally shorter than depressive episodes (last between 4-5 months)
- Recovery is usually complete between episodes
- Remissions become shorter with age and depressions become more frequent
- Long-term treatment with lithium reduces risk of suicide to the same levels as the general population
- 90% of those who have a manic episode will eventually have a depressive episode
- 2-3 increased risk in diabetes, CVD and COPD
How is psychosis in depression different from psychosis in schizophrenia?
Psychosis is mood congruent in psychotic depression
Psychosis tends not to be mood congruent in schizophrenia as patients have blunted affect
How might the treatment be different if the patient has psychotic depression?
• Start an anti-psychotic (e.g. quetiapine) alongside the anti-depressants
Risk factors for suicide?
- Social factors: bereavement, isolation, occupation, social class
- Mental health: previous attempt, previous self-harm, depression, schizophrenia, personality disorder
- Substance misuse
- Physical health: chronic pain, terminal illness, Cushing’s, Parkinson’s, thyroid
What is DSPD?
This is Dangerous and Severe personality disorder which a very severe and high risk of form of anti-socia personality disorder.
The interventions for these people will involve: longer duration psychological interventions, boosters sessions with continued and close follow-up and monitoring
Prognosis for PDs?
- Personality disorders disrupt relationships, education and employment
- Although they are persistent, they may change in severity over time
When can you diagnose PDs?
Generally, can only diagnose PDs after 18 however BPD is a slight exception as it may be diagnosed if there’s enough evidence that the pt has fully overgone puberty
Why is early and effective treatment of PND w/ limited separation important?
It can affect the baby’s attachment and have lasting effects on development and personality
What monitoring is done for SNRI use?
• As SNRIs increases NA → monitor BP (blood pressure monitored at initiation and each dose titration of SNRI)
What is serotonin syndrome? + mx?
Side effect of SSRI / SNRI use due to large increase in the amount of serotonin available in the body
This can present with:
• Neuromuscular hyperactivity: tremor, fits, agitation
• Autonomic dysfunction e.g. sweating, tachycardia, BP fluctuation, high temp
• Altered mentation including hallucinations
Treat by stopping the medication responsible, airway management, IV fluids and lorazepam – consider cyproheptadine or gastric lavage / activated charcoal
What is discontinuation syndrome?
The constellation of sx that occurs when antidepressants are stopped abruptly instead of slowly weaning off them (FIRM STOP) • Flu-like illness • Insomnia • Restlessness • Mood swings • Sweating • Tummy problems (pain, cramps, D+V) • Off balance • Parasthaesia
Most at risk when using SSRIs w/ short ½ life eg paroxetine
What is catch-up phenomenon?
When someone who recovers from depression due to treatment suddenly stops relapse + likely to be worse
Why it is important to tell patients to continue mx for 6 months after remission before stopping
What are the three symptom categories of PTSD?
Re-experiencing: Flashbacks, nightmares, distressing images, reminders of traumatic events
provoke distress
Avoidance or rumination: Avoidance of reminders of trauma, situations or circumstances resembling the event. Others may ruminate excessively and prevent themselves from
coming to terms with the experience.
Hyperarousal or emotional numbing: Exaggerated responses, irritability, difficulty concentrating, sleep problems, feelings of detachment, difficulty expressing emotions, giving
up on activities
