psych vol 1

Question 1

delerium overview

Answer 1

acute, transient and reversable state of confusion, usually as a result of other organic processes. highly fluctuant cognition.

2 types- hyperactive and hypoactive

hyper- agitation, delusion, hallucinatio wandering and aggression

hypo- lethargy, slowness, excessive sleeping, inattention

Question 2

aertiology and risk factors for delerium

Answer 2

pretty much anything can lead to it.

change location
constipation, drugs infection ect.

Question 3

Ax, Ix, Rx delirium

Answer 3

acute mental test score- assess cognition and can be used to chart progress.
4ats can be used.
DSM5- disturbance in attention, developed over short period of time, congative disturbance, not better explained by anything else, as a consequence of another acute condition

confusion screen (bloods, urinanalysis imaging- think CT hear chext x-ray to ax for infection.)

identify and rx underlying cause.
gentle re-orientation, ensure sensory needs are met (glasses etc)

Question 4

overview of dementia

Answer 4

irreversable, progressive decline of more than one aspect of higher brain function (conc, mem, language personality, emotion) - no impairment of consiousness

4 types
alzheimers- amyloid plaques + neurfibrilliary tangles

fronto temportal- tau protein defect- neuro tangles

vasc- small vessel disease- stepwise deterioration

lewy body- parkinsons associated.

Question 5

differential diagnosis of dementia

Answer 5

prion- creutzfeldt-jakob disease
HIV- related cognative decline
normal pressure hydrocephalus
depression

Question 6

pathology of the different types of dementias

Answer 6

alzheimers- beta amyloid is cleaved by Beta not alpha secretase- resulting in different length proteins to normal- causes toxicity

Fronto temportal- tau proteins are hyperphosphorylated causing them to alter shape and cause tangles

Vasc- diffuse small vessel disease

Lewy- the lewy bodies that are normally in the substansia nigra spread to different areas of the brain causing dementia type symptoms

Question 7

diagnosis and management of dementia

Answer 7

exculde other diagnosis
use cognative assessmenet tool (10 point cognative screener etc)
collateral history - slow onset of symtoms as opposed to big decline.

Mx: consider anticholinesterase inhibitors, memantadine.
reduce polypharmacy
elderly care psychaitrist

Question 8

S+S and risk factor for dementia

Answer 8

mem loss, comm issues, reasoning issues, decision making issues, dysphasia, coordination diffs

risk factors:
age, mild cognstive impairment
Learning disability (downs syndrome espesially)
genetics
cvs diseases
PD
lower educational attainment
depression
alchol, TBI

Question 9

prognosis of dementia different types

Answer 9

alzhimers 8-10 year
vasc 5
lewy- 5-8 years
FTD- 7-13

Question 10

substance misue disorder alcohol definition.
risk factors for developing AMD

Answer 10

impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences, encompassess alcohol abuse, dependence and addiction.

RF: early age drinking (before 15)
genetics + environment
mental health and history of trauma.

Question 11

diagnosis of alcohol misuse disorder.

Answer 11

DSM-5 criteria at least 2 is mild, 4 is mod, 6 is severe.
remission is when no criteria other than cravings are present for 3/12 (early) or 12/12 (late)

larger amounts than intended, or longer time
desire to cut down but unnsuccesful attempts
sig time obtaining, using and recovering from alcohol
craving
recurrent use leading to social responsibility faiures
continued use despite persistent/ recurring social/ psych problems cause/worsened by alcohol (above is two seperate ones)

giving up social activities (work, school, recreational) for more alcohol
alcohol use is hazardous situations
tolerance
withdrawal

Question 12

what makes a drug addictive.
what are the brain changes in alcohol misuse disorder

Answer 12

crosses BBB, acts on pleasure pathway
the shorter the half life the more addicive.
in detox- give long half life drugs that have the same effect.

alcohol acts on GABAa receptors + antagnoises NMDA
inhibits cells from firing
- downreg of gaba, + upreg NDMA (presence of alcohol firing rates return to normal)
in abscence of alcohol- balance shifts to excitation and physical symptoms emerge (seziures agitation etc etc)

peaks / binges of alcohol are more damaging than long term low level use.

Question 13

what are the types of alcohol users

Answer 13

hazadarous- binging 20 units in one go. men 33-50 years women 15-25 years
harmful- no dependency features and function well, but exceed 50 units a week- they wake up yellow in liver faliure
dependant user- the obvious

Question 14

overview of delerium tremens and detoxing

Answer 14

severe alcohol withdrawal syndrome - medical emergency 48-96 hrs after last drink last 1-5/7. 5% mortality
overactivity ad glutamate NMDA receptors. more common in the elderly + acutely ill.

S+S- confusion (sundwoning) autonomic hyperactivity (fever, swet tacy, htn) visual/ tacile hallucinations (snakes etc)

Rx: in HDU
IV pabrinex (wernicks prevention) - parenterally always.

benzoz (loraz), halloperidol.

general Detox management: benzoz- chlordiazepoxiade or diazepam (long half lifes)
lorazapam if liver faliure slow 7-10/7 wean.

Question 15

what is wernicks encephalopathy

Answer 15

a thiamine deficiency caused by inhibition of uptake by alcohol + inefficient use.

need thiamine in the metabolism of glucose
no thiamine- no brain food- bad- leads to haemmorhage- wernickes is a medical emergency.

S+S- ataxia, nystagmus opthalmoplegia. coma, confusion, hypothermia + tension.

Rx: IV pabrinex BD for 5-7/7 continue OD after this untill no further immprovement.

untreated wernickes leads to korsikoffs- which is irreversable and bad.

must give pabrinex before glucose- as if give glucose you will use up the last bit of it and you could induce wernickes.

Question 16

overview of the harms of smoking

Answer 16

75-100 000 people die every year from smoking

half of people who smoke will die from it. main reason for the health inequality in the uk.

causes lung cancer
COPD
coronary heart disease.

Question 17

why continue to smoke and what is the criteria for tobacco dependance

Answer 17

operant conditioning (puff–> dopamine–> more puff. also puff–> withdrawal symptom releaf –> more puff)
classical conditioning –> routines drive use.

need at least 2 of the criteria for 12 months

extended/ higher use than intended
unsuccessful efforts to quit ot reduce
inordinate amount of time using/ aquiring
tolerance for nicotine (incs in first few months then staibilises)
withdrawal
faliure to attend responsibilities
prioritising smoking over social occupational or recreational duties
use despite knowing its harmful
use despite physical or psychological negative symptoms
smoking in hazardous situations

Question 18

overview of withdrawal from smoking

Answer 18

mix of transient/ permanent

depression + urges to smoke (last 3-4/52)

nocotine peaks immediately, then 30 mins later is back at baseline. immediate withdrawal symptoms.

peaks and troughs cause cortisol and adrenaline swings–> mood swings

smoking a ciggy to releave stress creates more stress later, you are just releaving self induced stress. 1/52 after stopping smokers say they feel less stressed.

Physiological effects
drop in HR (stimulant effect of smoking)
dec adrenaline and cortisol
BMR dec- people put on weight
constipation
cold + mouth ulcers (smoking can be antibac)
dec insulin resistance
inc resting BP long term

Question 19

discuss nicotine repacement therapy

Answer 19

7 products that can be prescribed
patch, gum, inhalator, microtabs, lozenge, nasal spray, mouth spray.—> they should be used regularly like a medication rather than to satisfy cravings.

patch has lowest cravings.

Bupropion- prescription–> antidepressant + reduces cravings (dopamine re-uptake blocker)

Varenicline–> a partial/ full (depending on which one) nAChR agonist. maintains dopamine levels–> counteracts withdrawal. 12/52 course– start 2/52 before quit day.
decreaces satisfaction + reward.

Question 20

NICE guidelines on smoking sessation

Answer 20

offer NRT, Varenciline or bupropion – need a firm commitment and a stop smoking date. Dont offer combination of them

should only prescribe enough to last 2/52 after the target stop date. (2/52 after starting NRT or 4 after the others)

should only give again to people who demonstrate good efforts to stop. dont offer again within 6/12

Question 21

management of opioid dependance + the various overdoses

Answer 21

naloxone- long acting agonist- given as sugar syrup as the tablets are abusable

buprenorphine is given sublingulally - partial agonist - reduced highs.

can give both as subonxone

post detox- naltrexone is given to block receptors.

Question 22

drugs of abuse, effects and side effects.

Answer 22

Methamphetamine

Increased arousal (BP/HR/RR); decreased appetite (ST)

Anxiety; confusion; insomnia; mood disturbances (LT)

Depression; anxiety; Tiredness

Tobacco

Increased BP/RR/HR (ST)

Increased risk of cancer; emphysema; chronic bronchitis (LT)

Irritability; attention/sleep problems; depression; increased appetite

Alcohol

Risky behaviour; impaired judgement; slurred speech/incoordination; memory problems (ST)

Stroke; HTN; cirrhosis (LT)

Trouble sleeping; nausea; tremor; sweating; depression; anxiety

Question 23

definition and core symptoms of bipolar

Answer 23

a mood disturbance characterised by episodes of mania/ hypomania and major depression. interspersed with periods of normal functioning.

core features:
Increased goal setting activity (sexually, at work, socially), psychomotor agitation
Increased talkativeness or pressure of speech
Flight of ideas or racing thoughts
Loss of social inhibitions, socially inappropriate and reckless behaviour, aggressiveness
Decreased need for sleep
Heightened self-esteem/ grandiosity
Distractibility

Question 24

definitions of mania, hypomania and epidaemiology

Answer 24

Mania- lacks capacity more severe, lasts greater than 1 week, for most of each day

hypomania- less severe symptoms, lasts more than 4 days, for most of each day.

bipolar type 1 –> mania + depression
bipolar 2 –> hypomania + depression.

Question 25

epidaemiology +aetiology of bipolar disorder

Answer 25

men and women affected equally
strong genetic component
avg age of onset is 20
frequency of mania/ depressive episodes increces in age.

Aetiology: increaced paternal age (increaced sperm mutations)

triggered: by childhood traumatic experainces
psychosocial stress
sleep disturbances
physical illness.

Question 26

signs and symptoms, Mx, Ix of bipolar diosrder

Answer 26

core symptoms + superhuman feeling, no guilt, hopeful, able. big money spending.

Risks of manic episode- to self- spending all money, suicide, harmful activity (reckless driving, etc)
to others- aggression, sexually inappropriate,

Ix: assess suicide risk (ask prev self harm), sometimes assess homicide risk.

Mx: acute mania is an emergency- admit.
calm environ, assess for substances of abuse. limit access to cars, bank, phone.

Drug Mx: lithium or atypical antipsychotics
if severe lithium or valporate + antipsychotic
long term: lithium, valporic acid, carbamazepine.
no antidepress in acute mania.

Question 27

mechanism of carbamazepine and sodium valporate

Answer 27

carba- voltage gated Na blocker.
valporate- GABA reuptake blocker.

Question 28

how to identify alcohol use disorder

Answer 28

th alcohol use disorders identification test- identifies 90% of hazardous drinkers.