Psychiatry Flashcards

Question

Anxiety disorders: Definition & types?

Answer 1

• Definition: A syndrome of over-worry which manifests with psychological and physiological components, and which significantly impacts on one’s life • Types: o Panic: No specific trigger o Phobic: Specific trigger(s) and response occurs in predictable fashion (e.g. spider) o GAD: Anxious nearly all the time to most stimuli o OCD: Intrusive thoughts, anxiety relieved by performing certain meaningless actions o PTSD: A traumatizing event in past with flooding of memories, avoidance + hyperarousal

Answer 2

``` o Psychological  Worrying  Fear of dying/impending doom  Restlessness  Concentration decreased  Sleep decreased ``` o Physiological: ↑↑sympathetic drive/adrenaline  Chest pain (mimicking MI – radiation to arm, jaw)  Palpitations + ↑HR  SOB/hyperventilation + tingling in peripheries (hyperventilation phenomenon)  Tremor, sweating, dry mouth

Answer 3

• Definition of Panic Attack: A very large burst of anxiety lasting often <30min, often in young patient • Features: o Very significant and short burst anxiety which occurs out of the blue o Feeling of impending doom/death • Types: o Panic disorder with agoraphobia (25%) o Panic disorder without agoraphobia (75%) • Ix: Do not extensively investigate – consider only relevant things (e.g. ECG, but not Ix for pheo)

Answer 4

o Active ATTACK: Explain  Will subside spontaneously  Breath slow but not deep + distract yourself + stay in situation (unless unsafe)  Don’t use alcohol; DO NOT prescribe benzo’s o Chronic DISORDER:  Non-Pharm: • Lifestyle  ↓stress, ↓alcohol, ↓coffee, ↑exercise • Psychotherapy  CBT  Pharm: SSRI (best)

Answer 5

``` • Definition/Features: o Anxiety (psych + physio) in a abnormally large number of normal life circumstances lasting >6mo  3 of 6 on most days for >6mo: • On edge • Easily fatigued • Irritability • Muscle tension • Poor concentration • Sleep disturbances ``` • Ix: o GAD-7 (screening questionnaire) o Consider TFTs, urine free catecholamines, tox screen • Rx: o Non-Pharm: CBT (MOST important) o Pharm: SSRI

Answer 6

• Definition: Egodystonic disease (patient does NOT like that they have disorder and have to do rituals) o Obsession (thoughts)  Anxiety-provoking intrusive thoughts which are constant, repetitive and senseless o Compulsion (motor)  Odd but seemingly purposeful behaviour which is time-consuming but pt is compelled to perform and decreased anxiety by performing • Rx: o Non-Pharm: CBT, Exposure + Response Prevention (ERP; e.g. make dirty, do not allow to wash) o Pharm: SSRI

Answer 7

Anxiety: Phobias • Definition: Irrational fear and avoidance of stimuli/objects/situations which results in a panic-like reaction/anxiety when in contact with particular stimuli and predicted response occurs • Common types: o Social phobia  Fear of humiliations or embarrassment in general or specific social situations o Specific phobias • Rx: o For all: CBT, systematic de-sensitization for specific phobias

Answer 8

• Definition: Anxiety/fear/horror following a severe/threatening/catastrophic event (war, rape, etc) • Features: o Re-experiencing/flooding of memories: Nightmares, intrusive flashbacks o Avoidance of stimuli associated with the trauma (people, similar circumstances) o Hyperarousal: ↑anxiety, waking from sleep, hypervigilance for threat, poor concentration o Emotional numbing: Indifferent to stimuli, feeling detached • Rx: o Non-Pharm: MOST IMPORTANT  CBT  Eye movement desensitization and reprocessing (EMDR) • Ask to remember flashback + emotion + centre it (e.g. “some people feel it in chest, in abdo”) • Ask pt to follow object side-to-side min 20x o Some pt may not be able to continue, this is okay • Repeat over course of weeks until pt does not outpour when confronted o Pharm: SSRI (less important)

Answer 9

• Definition: Multiple symptoms affecting multiple organs without a medical explanation after investigation, and patient often does not accept professional reassurance (can go on for years with pt seeking advice) o Criteria  Must have complained of:  4+ pain symptoms  2+ GI symptoms  1+ sexual symptoms  1+ neurological symptom Often should be >2yr with no conclusive diagnosis, but pt does not accept this • Rx: Psychotherapy (e.g. CBT)

Answer 10

• Definition: One or more neurological symptoms (often sensory or motor) which cannot be explained medically and are always precipitated by a life stressor o Patients also experience “la belle indifference” – lack of concern for neuro deficit (as opposed to anxiety in other conditions) • Rx: o Psychotherapy (e.g. CBT)

Answer 11

• Definition: Consistently thinking one has a health issue (e.g. a diagnosis like cancer; NOT symptoms) due to a misinterpretation of symptoms (e.g. “I’m tired = cancer”) + despite regular professional reassurance o Pre-occupations with their health issues o Level of functioning affected o >6mo • Rx: Psychotherapy (e.g. CBT)

Answer 12

• Definition: Consciously faking symptoms to attain attention/nurturing from healthcare staff WITHOUT motivation from secondary gain o More common in men, and healthcare workers o Methods to fake may seem atrocious to us, but patients will do ANYTHING sometimes o Demand treatment in hospital o Angry when confronted/about to be confronted, then leave

Answer 13

Malingering (NOT a psych disorder) • Definition: Consciously faking symptoms due to motivation for a secondary gain (e.g. avoid school, work) o E.g. faking symptoms, coming into A+E for morphine

Answer 14

``` • Common ways to lose weight: o Diet o Exercise o Laxatives o Diuretics o Fasting o Purging ``` • Epidemiology: o 90% are female, 10% male o Age 15 (but up to 30) o Most common cause for admission to child psychiatric wards

Answer 15

• Types: o Restricting: Limiting food, no vomiting o Binge-eating/purging: Regularly binge on food and vomit afterwards • Features: Triad for anorexia o BMI <17.5 o Body image distortion (check mirror/scale often; deny thin appearance) o Amenorrhea x3 consecutive cycles (almost ALWAYS occurs with BMI <17.5)  Occurs due to HYPOTHALAMIC dysfunction (LOW GnRH)

Answer 16

o First: Correct physiology (re-feed)  NB: Monitor for re-feeding syndrome o Second: Psychotherapy (CBT

Answer 17

• Definition: Frequent binge eating and purging, and a self-image that is heavily influenced by weight with a NORMAL BMI • Types + Features: o Restricting: Fasting and/or exercise, but no purging o Purging: Self-induced vomiting, use of laxatives/diuretics/enemas o Pre-occupation with weight o Prefer to eat alone + when others not around  If forced to eat with others will serve less food/hide rest o Poor dentition + Russell’s sign (calluses on back of hand from repeated self-induced vomiting) • Rx: OP treatment: SSRI (fluoxetine) o Second: Psychotherapy (CBT) with focus on eating disorders

Answer 18

``` • Cluster A: Odd and Eccentric o Paranoid:  Features: (like Gollum from LoTR) • Distrust + suspiciousness of others • Secretive + isolated • “Odd” personality • NO psychotic symptoms ``` o Schizoid:  Features: (more like depressive + seclusion) • Detachment from society/interpersonal relationships (e.g. restaurant/vacation/movies by self) NOT due to rejection o I.e. disinterested in other people • Anhedonia • Indifferent to praise or criticism o Schizotypal:  Features: (more like seclusion + schizo) • Uncomfortable w/ social relationships even if familiar, prefers social isolation • Odd pre-occupations with specific things; believe these things are “special” • Odd speech + affect • Delusional, but only for limited period or type (unlike schizophrenia – extended bouts of psychosis) o *Reference* o Persecution/paranoid

Answer 19

• Cluster B: Dramatic and Emotional o Histrionic: Centre of attention  Features: • Dresses colorfully, has exaggerated behaviours  become centre of attention o Easily excitable – everything is dramatic/exciting • Uses physical appearance to draw attention + sexually seductive • Uncomfortable in situations where she (more common in women) is not the centre of attention o Borderline: Emotions easily swing to extremes  Features: • Unstable affect, rapid mood swings (inc inappropriate anger) • Recurrent “suicidal behaviour”  feel relieved when cut themselves/see blood, i.e. not trying to kill self (hence may be many “suicide attempts” in past) • Unstable + intense relationships, boredom o Can throw away long-term relationship no problem o Can also do everything possible to avoid abandonment • Impulsivity (substance abuse, physical violence, promiscuity) • Splitting (black-and-white or all-or-nothing thinking; e.g. something is either good OR bad, not in the middle) o Antisocial: Does not follow social rules/norms  Features: • Does not follow rules, breaks law, lies frequently • Disregards rights of others, does not feel remorse for acts • Acts on impulse (even if risks own safety), not responsible • MUST have occurred since <15 and individual MUST be >18 to diagnose o NB: If <18, “conduct disorder” o Narcissistic: “Inflated ideas of self-importance”, fantasies of success  Features: • Inflated sense of self-importance, borderline grandiosity even • Pre-occupation with fantasies of success/being better than others (NB: may sometimes break law in order to get ahead) • Believes he/she is special, requiring admiration • Reacts with rage when criticized, lacks empathy, envious of others • Exploitive of others (uses people via their charisma/charm)

Answer 20

• Cluster C: Anxious and Fearful o Avoidant: Can’t stand criticism  Features: • Social avoidance due to feelings of inadequacy or hypersensitivity to criticism • Shy away from relationships because of fear of feeling inadequate • Feel lonely and sub-par, pre-occupied with rejection o Dependent: Can’t be alone  Features: • Neglect their needs and wellbeing for the needs and wellbeing of others • Unable to make decisions, seek constant advice + reassurance • Anxiety on being alone/left alone o Obsessive Compulsive Personality: Can’t let others take control  Features: • Pre-occupied with orderliness, perfectionism, control • Inflexible with pre-occupations, hesitant to delegate tasks • Consumed by details, lose sense of overall goals • DO NOT FEEL ANXIETY AND INNER UNREST as per OCD