Psych VIVAs Flashcards
mechanism of alcohol’s effects
anxiolytic: increased GABA
euphoric: increased dopamine
amnesic: decreased NMDA mediated glutamate
recommended alcohol limit in UK
14 units/week w. several alcohol free days
M: 3-4 units/day
F: 2-3 units/day
signs of alcohol dependency
compulsion
aware of harm but continues
neglect of other activities
tolerance
sx of withdrawal
time w. substance incrases
out of control use
past sobriety attempts failed
signs of acute alcohol intoxication
labile mood
aggression
impaired judgement
slurred speech
unsteady gait
ataxia
signs of acute alcohol poisoning
cold clammy skin
unconscious
puking
slow breathing
risks assoc. w. excessive drinking
liver disease
cardiovascular disease
malnutrition
signs of alcohol withdrawal
autonomic: tachycardia, hypertensive, sweating, tremor
GI: n&v
mood: anxious + irritable
sleep disturbance: insomnia + nightmares
psych: hallucinations
what is delirium tremens
acute confusional state secondary to alcohol withdrawal 48hr after abstinence
delirium
extreme fear
autonomic disturbance
tremor
hallucinations
why is pabrinex given to alcoholics
prevent Wernicke’s
what is Wernicke’s encephalopathy
acute onset
confusion + opthalmoplegia + ataxia
secondary to neuronal damage due to thiamine deficiency
what is Korsakoff’s psychosis
consequence of Wernicke’s
irreversible anterograde amnesia + confabulation
tools for assessing alcohol dependence
AUDIT - identify disorder
SAD-Q - assess severity
Physical complications of AN
bradycardia + hypotension
GI upset
amenorrhoea + infertility
osteoporosis
peripheral neuropathy
mortality of AN
10%
when to admit for inpatient treatment of AN
BMI <13 or rapid weight loss
serious physical complications
high suicide risk
RFs for self harm
age
stressors
abuse
personality disorders
outline MHA of 1983
2: up to 28 days for assessment, requires AMHP + Dr
3: up to 6 months for treatment, requires Dr + Sec12 approved Dr
5(2): detention for 72hrs for further detention assessment under MHA
136: police power, public place
137: police power, forced entry into private property
key points of consent in children
Gillick competence in <16s
can consent if deemed capacitous
cannot refuse treatment
aetiology of Alzheimers
late onset - apolipoprotein E4 allele
early onset - AD mutation of beta-amyloid
RFs for Alzheimer’s
age
female
vascular RFs
head injury
low IQ
Clusters of personality disorders
A - odd
B - dramatic
C - anxious
personality disorder vs personality trait
disorder is:
pervasive
persistent
pathological
big five personality traits
openness
conscientiousness
extroversion
agreeableness
neuroticism
dxic criteria for BPAD
≥2 episodes, one of which is mania/hypomania w. complete recovery between
types of BPAD
1: manic + depressive
2: hypomanic + depressive
rapid cycling: >4 eps/year
mixed: both in single episode, present every day for ≥1/52
therapeutic range of lithium
0.6-1.0 mmol/L
toxicity > 1.2
SEs of lithium
lethargy
insipidus diabetes
tremor
hypothyroidism
intestinal
urine increased
metallic taste
precipitating factors of lithium OD/toxicity
dehydration
ACEi
ARBs
dialysis
long term consequences of lithium use
renal impairment
hypothyroidism
teratogenic effects of mood stabilisers
lithium - Ebstein’s anomaly
valproate/carbamazepine - spina bifida
SEs of clozapine
agranulocytosis
neutropenia
lower seizure trheshold
how does smoking affect clozapine therpay
requires higher dose
define delirium
acute confusional state from physical cause
drugs that may cause psychosis
steroids
ethambutol
cannabis
cocaine
define delusional disorder
fixed firm false belief outside relevant cultural norms and other than those which are schizophrenic
criteria for delusional disorder
present for 3 months
no persistent hallucinations
delusions persist without mood disturbances
core symptoms of depression
low mood
anergia
anhedonia
physical causes of depression
anaemia
hypothyroidism
Cushing’s
dementia
cognitive symptoms of depression
selective memory for negative events
pathological guilt
pessimism
Beck’s cognitive triad
negative views about:
self
world
future
features of abnormal grief
disabling
>6 months duration
delayed
psychosis in depression vs schizophrenia
depression: mood congruent
route of administration of drugs for opiate withdrawal
methadone - oral liquid
buprenorphine - sublingual tablet
MoA of methadone and buprenorphine
methadone - full mu agonist
buprenorphine - partial mu agonist
GAD vs panic disorder
GAD: no specific triggering stimulus
continuous and generalised
panic: sudden attacks of extreme anxiety
define agoraphobia
fear of being unable to easily escape to a safe place
define social phobia
fear of being scrutinised/criticised by others
prognosis of anxiety disorder
1/3 - full recovery
1/3 - partial improvement
1/3 - considerable disability
define mild LD
IQ 50-69
struggle at school
delayed development
live/work independently w. appropriate support
define moderate LD
IQ 35-49
language/cognition: less developed
motor: limited, reduced self-care
simple practical work if supported
long term supported accom
define severe LD
IQ 20-34
language: little/none
motor: markers impairment
simple tasks w. support
24 hr support
define profound LD
IQ <20
severely limited language and mobility
significant assoc. medical conditions
high support level
associated conditions of LDs
epilepsy
mental health problems
ASD
mood/anxiety disorders
obsession vs delusional belief
obsession: repetitive intrusive thoughts
evidence of resistance and avoidance
incidence of puerperal psychosis
1 in 1000
main SEs of atypical antipsychotics
metabolic
extrapyramidal
MoA of atypical antipsychotics
blocks dopamine and serotonin receptors
defin schizoid personality disorder
avoid interpersonal relationships
difficulty expressing emotions
define somatisation
multiple recurrent frequently changing physical symptoms caused by psychological distress
define hypochondrial disorder
persistent preoccupation on specific condition
examples of medically-unexplained symptoms
conversion disorder
fibromyalgia
chronic fatigue syndrome
medications to avoid on SSRIs
NSAIDs + aspirin
triptans
warfarin/heparin
SEs of SSRIs
n & v
appetite/weight changes
anxiety/agitation
headache
sweating
hyponatraemia
cardinal features of PTSD
reliving
hyperarousal
avoidance
define adjustment disorder
greater than expected reaction to life changes but not severe enough to diagnose anxiety disorder/depression
physical manifestations of anxiety
tremor
palpitations
sweating
hyperventilation
