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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What plasma level of lithium is the target?

A

0.6-1mmol/L

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2
Q

What are the contraindications to Lithium?

A

Arrhythmia

Brugada Syndrome

Renal impairment (significant)

Hypothyroidism

Hyponatraemia

Addison’s disease

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3
Q

Which groups of people should lithium treatment be used with caution in?

A 
Elderly 
Epilepsy
ECT
QT interval prolongation 
Cardiac disease
Myaesthenia 
Psoriasis 
Diuretics
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4
Q

When should the dose of Lithium be reviewed?

A 
Annual check up (or 3 month if starting)
Diarrhoea 
Vomiting 
Intercurrent infection
Following surgery
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5
Q

List 3 adverse effects of Lithium.

A

Initial SEs: diarrhoea; nausea; vomiting; muscle weakness

Mnemonic: LITHIUM

  • Leukocytosis
  • Increased Weight/Dryness/ Increased risk of Renal tumours
  • Taste/Thirst (Nephrogenic Diabetes Insipidus)
  • Hypo and Hyperthyroidism/ Hyperparathyroidism/Hypercalcemia
  • Increased Urine Output (Polyuria)/ Increased CK
  • Movement/Memory change
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6
Q

Which drugs my Lithium interact with?

A 
Diuretics 
ACEi 
NSAIDs 
Antidepressants: SSRIs; TCAs; NSRIs
Carbamazepine 
Haloperidol
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7
Q

State 5 RFs for Mental Illness.

A
  • ACE: 4 ≤ = 3x lung disease/14x suicide attempts/4.5x depression/4x begin intercourse by 15/ 2x liver disease
  • Genetic
  • Uncertainty
  • Financial difficulty
  • Physical ill health
  • Unfavourable work/working environment
  • Prejudice
  • Social exclusion
  • Pregnancy and birth: 1/5 mothers w/i 1 year post-partum
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8
Q

Describe what CBT is.

A

Type of psychotherapy focusing on behaviours, thoughts and feelings and teaching coping skills for dealing with different problems – focus on behavioural therapy. Combination of cognitive therapy and behavioural therapy.

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9
Q

What is the Cognitive Triangle in CBT?

A

• Cognitive Triangle: Behaviour, Feelings and Thought

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10
Q

What are the 6 thought distortions?

A
  1. Magnification: Blowing things out of proportion
  2. Overgeneralisation: Sweeping generalisations based on single event
  3. Personalisation: Personal responsibility for events beyond their control
  4. Self Abstraction: Drawing conclusions from just one element of many
  5. Arbitrary interference: Conclusions when little or no evidence
  6. Minimisation: Downplaying importance of positive thoughts, emotions or events
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11
Q

Describe Mindfulness.

A

Type of psychotherapy using mindfulness (awareness of thoughts, feelings and actions hindering daily life) to promote good mental, physical and social healthy. Can often be couples with other therapies – CBT, ACT etc.

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12
Q

What is Sleep Hygiene?

A

behaviours and practices to change the environmental factors which may be beneficial or detrimental to sleep

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13
Q

Outline the stages of change.

A

1) Pre-contemplation = No need to change behaviour
2) Contemplation = Consider behaviour is problematic
3) Preparation = Evaluate how to make a change
4) Action = Engage in real efforts to change
5) Maintenance = Successful at changing behaviour and attempting to maintain new skills
6) Termination = Eradicated old behaviours through adopted behavioural changes and continue to maintain these positive changes

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14
Q

What class of drug is Phenelzine?

A

MAOi

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15
Q

What is the MOA of Phenelzine?

A

• Inhibit MAO enzymes ≈ reduce breakdown of NE/serotonin and dopamine ≈ increase levels of serotonin/dopamine/NE

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16
Q

State the side effects of Phenelzine/Selegeline.

A
  • Weakness
  • Headache
  • Weight gain
  • Dizziness
  • Fatigue
  • Impotence
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17
Q

What food types should you be careful with when taking Phenelzine?

A

• High-tyramine foods (cheese/venison/meats/alcohol/green vegetables) as may lead to a hypertensive crisis

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18
Q

What class of drug is Moclobemide?

A

RIMA

Reversible mono amine oxidase type A

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19
Q

What are the side effects of Moclobemide?

A
  • Weakness
  • Headaches
  • Dizziness
  • Fatigue
  • Weight gain
  • Impotence
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20
Q

What class of drug is Nortriptyline?

A

TCA

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21
Q

What is the MOA of Nortriptyline?

A

Blocks 5HT, NE reuptake and mACHR thus inhibits re-uptake and increases levels of serotonin and NE whilst blocking effect of ACh

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22
Q

What are the main side effects of Nortryptiline?

A

Anticholinergic (thus SLUDGE Sx)

  • Blurred vision
  • Dry mouth
  • Constipation
  • Bronchodilation
  • Reduced bronchial secretions
  • Urinary retention
  • Weight gain/loss
  • Hypotension
  • Rash
  • Hives
  • Tachycardia
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23
Q

What class of drug is Paroxetine?

A

SSRI

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24
Q

What class of drug is Escitalopram?

A

SSRIs

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25
Q

What class of drug is Fluoxetine?

A

SSRI

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26
Q

What is the MOA of Fluoxetine?

A

• Bind to Serotonin re-uptake transporter ≈ reduce reuptake ≈ increase [Serotonin]

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27
Q

What is the MOA of Citalopram?

A

• Bind to Serotonin re-uptake transporter ≈ reduce reuptake ≈ increase [Serotonin]

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28
Q

What are the main side effects of Citalopram?

A
  • Nausea
  • Rash
  • Muscle aches
  • Insomnia***
  • Aggression
  • Anxiety
  • Cognition
  • Learning memory
  • Mood
  • Sleep
  • Sweating
  • Epilepsy
  • Reduced libido
  • Sexual dysfunction
  • LQTS (Citalopram)
  • GI bleed risk increased
  • Overdose
  • Suicide
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29
Q

What class of drug is Duloxetine?

A

SNRI

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30
Q

What are the main side effects of SNRIs?

A
  • Nausea
  • Headaches
  • Insomnia
  • Hypersomnia/Drowsiness
  • Dizziness
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31
Q

What class of drug is Mirtazipine?

A

Tetracyclic Antidepressants

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32
Q

What are he side effects of Mirtazapine?

A
  • Low doses (15mg) taken at night -> drowsiness
  • Higher doses (30/50mg) taken in morning -> stimulant
  • Orexigenic  Appetite ***
  • Weight gain
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33
Q

Define drug Tolerance.

A

physiological reaction (neuroadaption) characterized by decrease in effects of drug with chronic administration

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34
Q

Define drug Dependence.

A

Induces a rewarding experience thus physiologically/physically required

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35
Q

Define drug Withdrawal.

A

Adverse effects (anxiety/depression exacerbation/disturbed sleep/pain/stiffness/convulsions) upon removal of a drug

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36
Q

What is the MOA of Diazepam?

A

Bind BZD binding site on pentameric GABA (GABRA1-3/GABRB1-2) ≈ Cl- ion influx ≈ hyperpolarisation

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37
Q

What class of drug is Lorazepam?

A

Benzodiazepine

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38
Q

What is the half life of Diazepam?

A

20-100 hours

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39
Q

What is the half life of Lorazepam?

A

10-20 hours

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40
Q

What is the half life of Zopiclone?

A

5-6 hours

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41
Q

What are the side effects of Benzodiazepines?

A 
Reduced Alertness
Confusion
Dizziness
Drowsiness
Fatigue
Headache
Nausea
Hypotension
Muscle weakness
Respiratory depression 
Sleep disorders 
Tremor 
Vision disorders
Withdrawal syndrome
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42
Q

What class of drugs is Zopiclone?

A

Z drugs

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43
Q

Describe Neuroleptic Malignant Syndrome.

A

Condition following treatment of Psychotic disorder such as Schizophrenia with antipsychotics caused by dopamine antagonists resulting in:

  • Altered mental status: confusion; delirium; stupor
  • Muscle rigidity
  • Hyperthermia
  • SNS lability: BP elevation; sweating; urinary incontinence
  • Hypermetabolism
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44
Q

How do you manage a patient with Neuroleptic Malignant Syndrome?

A

Supportive: Stop offending dopamine antagonist; alert critical care team; IV fluids; cooling; Ibuprofen; Monitor (bloods and urine every 1-2 hours);
+
Diazepam

or

Dantrolene

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45
Q

Describe Serotonin Syndrome?

A

Excess of synaptic serotonin (due to a substance) which results in a triad of altered mental status, autonomic effects (tachycardia; brisk reflexes; diaphoresis; shivering) and neuromuscular excitation (clonus; muscle rigidity)

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46
Q

How may you diagnose Serotonin Syndrome?

A

Clinical diagnosis

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47
Q

How do you manage Serotonin Syndrome?

A

Supportive: Remove offending agent; Admit; IV Fluids; Monitor
+
Benzodiazepine: Chlorpromazine

± (Intoxication within last hour)

Activated charcoal

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48
Q

By what process does activated charcoal work?

A

Activated charcoal binds the toxic compounds via adsorption, allowing the toxic compounds to be taken up, and excreted via defaecation with the charcoal

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49
Q

What are the side effects of the Antipsychotics in general?

A

Antipsychotics have effects at 5HT3, D2, ACh, H1 and Alpha receptors thus pleiotropic adverse effects

Behavioural: apathy/ drowsy
Motor: Parkinsonian like (D2A - Parkinsonism features); Extrapyramidal symptoms
Endocrine: Gynaecomastia and galactorrhea (Increased PL secretion in Tuberohypophyseal pathway)
Antimuscarinic: SLUDGE
Alpha adrenoceptor: Orthostatic hypotension/Dizziness
H1 Blocking actions: Sedative and anti-emetic actions

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50
Q

How may you describe someones general appearance?

A
  • Age (concordant)
  • Weight
  • Personal hygiene
  • Clothing
  • Objects
  • Stigmata of disease
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51
Q

What types of gait are there?

A

Antalgic

Hemiplegic

Diplegic

Parkinsonian

Neuropathic (High-Stepping)

Ataxic

Trendelenberg

Hyperkinetic

Sensory

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52
Q

How may you describe psychomotor activity?

A

Reduced or Increased

Reduced:

  • Retardation
  • Stupor

Increased:

  • Hyperactivity
  • Agitation
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53
Q

How may you describe mood?

A

Depression (low)

Irritable

Anxious

Panic attacks

Apathy

Affective blunting

Elation

Emotional lability

Euphoria

Ecstasy

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54
Q

What disorders of perception are there?

A

Sensory

Illusions

Hallucinations

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55
Q

What is the difference between an illusion and a hallucination?

A

Illusion is a misinterpretation of stimuli from a perceived object whereas a hallucination is a false perception in the absence of a stimulus

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56
Q

What is the difference between depersonalisation and derealisation?

A

Depersonalisation is being detached from yourself whereas derealisation is being disconnected from reality

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57
Q

State and explain 3 types of hallucinations.

A

A hallucination is a distortion of perception in which you anticipate an event in the absence of a stimulus.

Sensory - tactile hallucinations

Gustatory - taste

Olfactory - smell

Reflex - misinterpretation of stimuli in a different sensory modality (synaesthesia)

Doppleganger

Extracampine - misperception of stimuli outside normal limits of sensory fields/detection

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58
Q

What 3 areas are there for thought?

A

Content

Form

Possession

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59
Q

How can you describe disorders of thought in Psychiatry?

A

Thought speed, content and possession was normal

Speed
Thought blocking - interruption and pause of speech

Retardation - thinking is slowed and idea generation reduced

Flight of ideas - ideas flow rapidly and spontaneous connections are understandable

Form:
Poverty - restricted speech

Poverty of content

Neologism - new words or phrases

Circumstantiality - tedious detail, indirect and delayed

Tangentiality - thoughts and speech are oblique, loose and random

Derailment = combination of flight of ideas and loose associations

Thought content:
Delusions = fixed, false beliefs

Overvalued ideas = pre-occupied beliefs with strong affective response threatening goal/objective of belief

Obsessions = intrusive, recurrent thoughts

Possession:
Though alienation = involuntary thoughts and beliefs - insertion; broadcasting; withdrawal; echo

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60
Q

What types of delusions are there within Psychiatry?

A

Grandeur

Reference

Bizarre

Religious

Persecution

Guilt

Hypochondriacal

Love

Infidelity

Nihilistic

Doubles

Infestation

Shared delusions

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61
Q

How can you classify a patients insight?

A

Unaware

Conscious

Aware

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62
Q

What descriptive types of cognition exist in Psychiatry?

A

Comatose

Lethargic

Somnolent

Clouded

Alert

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63
Q

How may judgement be described in Psychiatry?

A

Abnormal

Impaired

Normal

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64
Q

What process is used to conduct a Mini-MSE?

A

Mnemonic: ASEPTIC

Appearance + Behaviour: weight/age/appearance/ dressed appropriately

Behaviour: psychomotor activity; Gait

Emotions: ecstasy/ elated/apathy/ affective blunting/depressive/ anxious/ irritable/ emotional lability

Perception: Sensory/ False (illusions/ hallucinations/ pseudohallucinations)

Thought: Speed; Form; Content; Possession

Insight: Aware; Conscious; Unaware

Cognition: Alert; Somnolent; Lethargic; Clouded; Comatose

Judgement: Normal; Impaired; Abnormal

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65
Q

Describe a Learning Disability?

A

Umbrella term for a significantly reduced ability to understand and acquire knowledge (understand new/complex information), impaired intelligence (new skills), impaired social functioning (coping independently) which started prior to adulthood and has a lasting effect on development

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66
Q

What is the normal IQ Test score?

A

70-130

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67
Q

What is a categorises as a mild learning disability?

A

• Mild Learning Disability = 50-69

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68
Q

What is categorised as a moderate learning disability?

A

• Moderate Learning Disability = 35-49

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69
Q

What is categorised as a severe learning disability?

A

• Severe Learning Disability = 20-34

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70
Q

How do you diagnose a learning disability?

A

• IQ Test: ≤ 70 = Learning Impairment cf ≤ 50 = Severe Learning Impairment

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71
Q

How do you manage a learning disability?

A

• Supportive: Education/Family/CBT/Counselling/
±
• Tx any MHDs

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72
Q

What is ADHD?

A

Chronic neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity which is present in early childhood and persists into adult life. Often, comorbidities exist such as: Autism Spectrum Disorder/Oppositional Defiant Disorder/Conduct disorder/Substance abuse/Mood disorders (Depression/Anxiety/Mania/Psychosis)

Triad of features: Hyperactivity + Inactivity + Impulsivity

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73
Q

What is the management for ADHD?

A

• Behavioural therapy: Behavioural parenting training (younger)/Behaviour management programme (Older)
+
• Stimulant: Methylphenidate

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74
Q

Should a patient experience tics due to the as a side effect of the Methylphenidate used to treat ADHD, what pharmacological management is there?

A

• Guanfacine/Clonidine

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75
Q

What are the adverse effects of Methylphenidate?

A

Appetite suppression
Weight loss
Insomnia
Mood

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76
Q

What is Conduct Disorder?

Outline the types

A

Behavioural child psychiatric condition typified by persistent difficult behaviour outside of social norms

  • Socialised conduct disorder (involves peers at same level)
  • Unsocialised conduct disorder (not involving peers)
  • Oppositional defiant disorder (frequent anger towards a person of authority)
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77
Q

How do you manage Conduct Disorder?

A

• Supportive: Parental training/Family therapy/Individual therapy (Counselling/Mindfulness/CBT)

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78
Q

What is Autism Spectrum Disorder?

A

Neurodevelopmental condition typified by impaired social communication, restricted behavioural pattern, interest or activity with abnormal development (speech/regression). The disorder can usually have comorbidities such as epilepsy, ADHD and MHDs.

Features: Impaired social communication + Restricted behaviour pattern/interest; Abnormal development

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79
Q

What are the clinical features of Autism?

A
  • Communication impairment: Verbal + Non-verbal -> Not play social games; reduced pointing; mood difficult to interpret/show
  • Social impairment -> Uninterested in others + not socially motivated
  • Repetitive/stereotyped interests: Verbal rituals/Behavioural rituals  way of living + ∆ = distress
  • Abnormal development: language delay or regression
  • Motor stereotypies: repeated gestures (‘stimming’)
  • Insomnia/Disturbed sleep
  • MHDs: Anxiety/Depression
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80
Q

How is Autism managed?

What is used to manage any relevant co-morbidities?

A

• Applied Behaviour Analysis (ABA): Behavioural programme reinforcing positive behaviour and discouraging negative behaviours
±
• Pharmacological behavioural: For relevant morbidity Risperidone (neuroleptic)/Aripiprazole (neuroleptic) /Fluoxetine (SSRI)/Methylphenidate (stimulant)/Atomoxetine (NRI)/Melatonin (3-alkylindoles)

+ (Anxiety/OCD)
• SSRIs: Sertraline/Fluoxetine

+ (Psychosis/Aggression)
• Neuroleptics: Risperidone/Aripiprazole

+ (Sleep dysfunction/Insomnia)
• 3-alkindoles: Melatonin

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81
Q

What is the fundamental difference between Asperger’s Syndrome and Autism?

A

Asperger’s is mild autism with no language delay, and is often diagnosed later (7/8) cf Autism features neurodevelopmental delay, restricted interest and hobbies, impaired social activity and is diagnosed earlier (3-5)

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82
Q

Describe Encopresis?

A

Passage of normal stools in abnormal places

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83
Q

How may you manage Encopresis?

A

• Supportive: Behavioural therapy (star charts/regimes)/Family therapy
+
• Dietary: Increased fibre

± Constipation
• Oral laxative (stool softener): Magnesium citrate/Polyethylene glycol
+
• Oral laxative (stimulant): Senna glycoside

± Diarrhoea
• Antidiarrheal agent: Loperamide (opioid receptor agonist to increase anal sphincter pressure)

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84
Q

Describe Enuresis.

A

Involuntary passage of urine in the absence of physical abnormalities after 5 years old

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85
Q

What are the clinical features of Enuresis?

A
  • Increased fluid intake at night
  • Bladder irritants: Caffeine/Food colourings
  • Urinary frequency
  • Urinary urgency
  • Constipation
  • Abnormal voiding habits
  • Abnormal breathing habits at night: Upper Airway Obstruction associated with enuresis
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86
Q

How is Enuresis managed?

A

• Supportive: Lifestyle change (reduce intake prior to bed/remove precipitants/toilet training/bladder training)
+
• Alarm Therapy: Bed-wetting alarms

± Stress Urinary Incontinence
Duloxetine

± Urgency Urinary Incontinence
Oxybutynin; Tolterodine

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87
Q

What is a Tic?

A

Rapid, involuntary, repetitive, stereotyped motor movements or phonic production

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88
Q

Describe Tourettes Syndrome.

A

Neurodevelopmental disorder beginning in childhood characterised by tics (motor + vocal) ± other psychiatric problems (OCD/ADHD) with presentation in childhood, persisting for at least 1 year, and attenuating later in adolescence.

Diagnosis: 2 motor + 1 vocal for 1 year

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89
Q

What are the clinical features of Tourettes Syndrome?

A
  • Abnormal non-rhythmic, repetitive movements: Eye blinking/Facial grimacing/Shoulder shrugging
  • Ritualistic behaviours: Desire to repeat behaviour
  • Copropraxia (obscene gestures)
  • Self-harm
  • Repetitive sounds: Sniffing/Coughing/Throat clearing/Coprolalia (obscene language)/Echolalia (repeated language)/ Palilalia (repeating yourself)
  • Echopraxia (repetition of another person’s behaviour or movements)
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90
Q

How is Tourettes Syndrome diagnosed?

A

Clinical diagnosis

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91
Q

How may Tourettes be managed?

How may the associated comorbidities be managed?

A

• CBT

+ (Tics)
1st
• Alpha agonists: Guanfacine/Clonidine

+ (ADHD)
• Stimulant: Methylphenidate

+ (OCD)
• CBT
±
• SSRI: Fluoxetine/Sertraline/Clomipramine

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92
Q

Describe Elective Mutism.

A

Child psychiatric condition typified by marked reduction in speaking which is emotionally determined

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93
Q

Describe elective mutism.

A

Child psychiatric condition typified by marked reduction in speaking which is emotionally determined

94
Q

How is elective mutism diagnosed?

A
  • Hearing Test

* Clinical Diagnosis

95
Q

How may you manage elective mutism?

A

• Supportive: SLT/CBT
±
• Anti-depressants (SSRIs): Citalopram/Sertraline/Fluoxetine

96
Q

What types of child maltreatment are there?

A

Physical

Emotional

Sexual

Neglect

97
Q

What are the clinical features of physical abuse?

A
  • Vague account
  • Incongruent stories
  • Story incompatible to injury
  • Delay in seeking help
  • Parent does not reflect level of caring: Too little or Too much
  • Child’s affect: Sad/Withdrawn/Fearful/Trusting in strangers
98
Q

What are the clinical features of sexual abuse?

A
  • Persistent/recurrent dysuria
  • HBV/HDV
  • Anogenital warts (HPV)
  • STIs
  • Unusual sexualised behaviours in prepubertal child
99
Q

What are the clinical features of Emotional Abuse?

A
  • Fearful emotional state
  • Habitual body rocking
  • Indiscriminate contact
  • Failure to seek comfort when distressed
  • Age-inappropriate responsibilities
100
Q

What are the clinical features of Neglect?

A
  • Inadequately fed
  • Poor dress
  • Poor hygiene
  • Deprived of satisfactory contact with parents/guardian
  • Deprived of social contact with friends and children
  • Failure to meet milestones
101
Q

Describe Munchausen Syndrome by Proxy.

A

Syndrome whereby a parent fabricates illness in her child and presents for medical attention

102
Q

Describe what Insomnia is.

A

sleep disorder by which you have trouble falling asleep ± staying asleep.

103
Q

Outline the clinical features of Insomnia.

A
  • Partner sleep complaints
  • Delayed sleep onset
  • Multiple/long awakenings
  • Accidents
  • Impairments of functioning
  • Decreased sleep time
104
Q

What is the gold-standard investigation used to diagnose Insomnia?

A

• Epworth Sleepiness Scale: ≥ 9

105
Q

How is Insomnia managed?

A 
Supportive: Sleep hygiene; Relaxation techniques
\+
CBT
\+ 
Z-Drugs: Zolpidem
106
Q

What is a personality disorder?

A

The accentuation of personality traits under stress which encompasses behaviours, thoughts, feelings which is independent of organic illness or psychotic disorders causing significant personal and social distress

107
Q

How can Personality disorders be classified?

A

Classified by ‘Cluster’

Cluster A = Schizoid type; Paranoid; Schizotypal

Cluster B = Dissocial; BPD (EUPD); Histrionic; Narcissistic

Cluster C = Dependent; Anxious; OCD;

108
Q

How is Personality disorder diagnosed?

A

Clinically

109
Q

How do you manage Personality Disorder?

A

Supportive: Relationship management strategies/Communication/CBT/Psychotherapy

± Cluster A (schizoid/schizotypal/paranoid)
Antipsychotics: Aripiprazole

± Cluster B (dissocial/narcissistic/histrionic/ borderline)
MSD: Topiramate/Valproate/ Lithium

± Cluster C (obsessive/ anxious/ dependent)
Antidepressants: Fluoxetine/Sertraline/Venlafaxine

110
Q

Describe what Panic Disorder is.

Outline the diagnostic criteria for this.

A

Form of Anxiety disorder characterised by recurring unexpected panic attacks over 1-month period and associated worry about recurrence or implications thus behavioural change – e.g. fear avoiding. Panic symptoms must be organic and not attributable to substance abuse or another medical condition.

111
Q

Outline the clinical features of Panic Disorder.

A
  • Rapid onset
  • Discrete time period
  • Worry/Fear/Apprehension
  • Behavioural avoidance: External + Internal situations
  • Nausea and vomiting
  • Dizziness
  • SOB
  • Tachycardia
  • Palpitations/Pounding heart
  • Tremulous
  • Sweating
  • Hyperventilation/SOB/Choking
  • Chills/Hot flushes
  • Muscle shaking
112
Q

How is Panic Disorder diagnosed?

A

• Clinical Diagnosis

113
Q

How is Panic Disorder managed?

A

• Supportive: Reassurance/CBT
±
• SSRIs/SNRIs: Sertraline/Paroxetine/Fluoxetine/ Citalopram/ Venlafaxine

114
Q

Describe Agoraphobia.

A

Anxiety disorder typified by intense fear of a specific place from which escape may be difficult in addition to fear avoiding behaviour which is not caused by substance or other disorder

115
Q

What is the first line treatment for Agoraphobia?

A

Exposure-based therapy

116
Q

What is a Specific Phobia?

A

Specific intense fear of specific objects or situations that are triggered upon exposure to phobic stimuli resulting in fear avoiding behaviour of phobic cues

117
Q

What is Acrophobia?

A

Fear of heights

118
Q

What is Haemophobia?

A

Fear of blood

119
Q

What is Claustrophobia?

A

Fear of confined spaces/places

120
Q

What is Hydrophobia?

A

Fear of water

121
Q

What is Zoophobia?

A

Fear of animals

122
Q

What is Autophobia?

A

Fear of being alone

123
Q

What is Aerophobia?

A

Fear of flying

124
Q

What is the fear of snakes called?

A

Ophidiophobia

125
Q

What is the management of a specific phobia?

A

• Supportive: Education + Monitoring/ CBT + Exposure therapy

+ (Concurrent vasovagal syncope)
• Applied tension: Tensing and releasing large muscle groups to increase BP and promote circulation

± (Frequent Sx interfering in Life)
• Benzodiazepines: Diazepam/Lorazepam/Clonazepam/Alprazolam

126
Q

Describe OCD?

A

Anxiety disorder characterised by obsessions, unwanted excessive or impulsive desires, compulsions, repetitive mental acts and behaviours to reduce obsessions and emotional distress, which causes significant distress and impairment on daily functioning.

127
Q

What is the difference between an Obsession and a Compulsion?

A

Obsession = Unwanted excessive or impulsive desires and thoughts which are seen as irrational or unwanted

Compulsions = Repetitive behaviours which aim to neutralise obsessions and emotional distress

128
Q

How are compulsions and obsessions linked?

A

An obsession is an unwanted excessive desire whilst a compulsion is the urge to act on these desires which causes emotional distress

129
Q

What is the first line investigation to diagnose OCD?

A

Clinical Diagnosis

130
Q

How do you manage OCD?

A

• CBT
±
SSRIs: Fluoxetine/Paroxetine/Sertraline/Clomipramine

131
Q

Describe PTSD.

A

Anxiety disorder characterised a traumatic event(s) causing 1-month of symptoms of intense fear, helplessness or horror, intrusive recollection of event, acting as if the event were occurring, distress from exposure to event cues, avoidance of trauma-associated stimuli and persistent increased arousal which wasn’t present prior to traumatic event.

132
Q

How long do you have to experience symptoms before PTSD can be diagnosed?

A

1 month of intense fear, helplessness, intrusive memories, hyperarousal at cues and disturbed sleep with fear-avoidance behaviour

133
Q

Outline the clinical features of PTSD.

A

Mnemonic: TRAUMA
Traumatic event
Re-experience: intrusion; flashbacks; sensory impressions; reacting to external and internal cues
Avoidance: avoidance behaviour
Unable to function -> Sx
Month (at least)
Arousal: hyperarousal; hypervigilant; easily startled; irritable

134
Q

How is PTSD diagnosed?

A

Clinical diagnosis using PTSD Checklist (DSM-5)

135
Q

How do you manage PTSD?

A

≤ 3 months = Monitor

≥ 3 months =
• TFCBT + Pharmacotherapy: 12 sessions with cognitive triad regarding trauma and aftermath
±
• SSRIs: Paroxetine/Fluoxetine/Sertraline/Venlafaxine

OR
• Exposure therapy: Confront traumatic memories
• Trauma-focused cognitive therapy: ID misrepresentation of trauma and aftermath resulting in perception of threat

136
Q

How long must a patient have PTSD for before being offered TFCBT?

A

3 months of symptoms

137
Q

What are the clinical features of Generalised Anxiety Disorder?

A
  • Excessive worry ≥ 6 months
  • Poor concentration
  • Restlessness
  • Irritability
  • Muscle tension
  • Easily Fatigued
  • Sleep disturbance
  • Headache
  • Sweating
  • Dizziness
  • GI Symptoms: Nausea/Vomiting/Increased urinary urge/Tenesmus
  • Rash
  • Muscle aches
  • SOB
  • Trembling
  • Exaggerated startle response
138
Q

How is Generalised Anxiety Disorder diagnosed?

A

Clinical diagnosis: ≥6 months of intense worry/fear + 3/6 of diagnostic criteria

Poor concentration 
Restlessness
Irritability 
Muscle fatigue 
Easily fatigued 
Sleep disturbance
139
Q

How is Generalised Anxiety Disorder managed?

A

• Lifestyle: Reduce caffeine/Reduce alcohol/Sleep hygiene/Exercise/Self-help
• Psychotherapy: CBT/ Mindfulness
±
• SSRI/SNRI/Antidepressant: Escitalopram/Duloxetine/Venlafaxine/Sertraline/Fluoxetine/ Mirtazapine

140
Q

Define a Psychosis.

A

Umbrella term for a disorder whereby patient loses contact with external reality, associated with abnormal functioning of frontal and temporal lobes and disorganised thoughts and actions

141
Q

What are the two main categories of Psychosis.

A

Primary

Secondary

142
Q

Describe Schizophrenia.

A

MHD characterised by co-occurrence of: delusions, hallucinations, disorganised speech, catatonic/disorganised behaviour or negative symptoms (anhedonia/affective flattening/avolition/cognitive deficit or alogia) occurring for significant proportion of 1 month period (active phase), associated with continuous problems over ≥ 6 month period.

Positive Sx + Negative Sx for 1 month with continuous symptoms over a 6 month period

143
Q

What are the clinical features of Schizophrenia.

A

Mnemonic: THREAD LESS

Tangentiality/ Thought processing 
Hallucinations (auditory/visual)
Reduced reality (Delusions)/Repetition of words (Verbigeration)
Emotional control: Incongruous effect?
Arousal 
Disorganised/ Catatonic Behaviour
Loss of volition/social settings/ Pleasure
Emotional flatness (Affective Blunting) 
Speech reduced (Alogia)
Slowness in thought (cognitive deficit)/Somatisation (physical Sx – expressed in body)
144
Q

How is Schizophrenia managed?

A

• Anti-psychotic medication: Aripiprazole
+
• Psychological Interventions: Family/CBT/Social-skills training

± Acute Attack
• Diazepam

145
Q

What is the main difference between Schizotypal Behaviour and Schizophrenia?

Outline the clinical features of Schizotypal behaviour.

A

Schizotypal Disorder ≠ Schizophrenia as Schizotypal Disorder have insight into illness and awareness that experiences are false cf delusions in Schizophrenia

  • Eccentric behaviour
  • Aloofness
  • Asocial behaviour
  • Depersonalisation
  • Derealisation
  • Illusions
  • Transient auditory hallucinations
  • Obsessive ruminations
  • Paranoia
146
Q

How do you manage Schizotypal behaviour?

A

• Aripiprazole (10-15mg PO OD)/Risperidone (1mg PO BD)/ Quetiapine (25mg PO BD)
+ (adjunct)
• Diazepam (2-10mg PO BDS-QDS)/ Clonazepam (0.25mg BD)
+
• Psychotherapy: CBT

147
Q

Describe Schizoaffective Disorder.

Outline the types of Schizoaffective Disorder.

A

Mental health illness characterised by schizophrenia symptoms concurrent with affective symptoms lasting for ≥ 1 months - which may be present in the absence of schizophrenia symptoms at times.

Schizophrenia symptoms AND symptoms of mania or depression

  • Schizomanic Disorders: Manic Sx prominent
  • Schizodepressive Disorders: Depressive Sx prominent
148
Q

How is Schizoaffective Disorder diagnosed?

A

Clinical diagnosis using DSM-V criteria

149
Q

How is Schizoaffective disorder managed?

A

• Anti-psychotics: Aripiprazole (10-15mg PO OD)/Risperidone (1mg PO BD)/ Quetiapine (25mg PO BD)

± (Mania)
• Mood-stabilisers: Lithium/Sodium Valproate/Carbamazepine

± (Depression)
• Anti-depressants: Onlazapine + Fluoxetine/ Citalopram/ Paroxetine

± (Acute Agitation)
• Benzodiazepines: Lorazepam/Diazepam/Onlazapine/Haloperidol

150
Q

Describe Brief Psychotic Disorder.

A

MHD characterised by co-occurrence of: delusions, hallucinations, disorganised speech, catatonic/disorganised behaviour or negative symptoms (anhedonia/affective flattening/avolition/cognitive deficit or alogia) occurring for between one day and one month.

151
Q

How may Brief Psychotic Disorder be managed?

A

• Aripiprazole (10-15mg PO OD)/Risperidone (1mg PO BD)/ Quetiapine (25mg PO BD)
+ (adjunct)
• Lorazepam: 1-2mg IM per 8 hours

152
Q

What is the key difference between Brief Psychotic Disorder and Schizophrenia?

A

Both have positive and negative symptoms however Brief Psychotic Disorder gives symptoms for 1 day to 1 week whereas Schizophrenia is 1 month of symptoms in a period of 6 months whereby symptoms are also experienced during that time

153
Q

What is a Persistent Delusional Disorder?

A

Umbrella term for mental health disorders typified by persistent, often life-long, delusions which have an insidious onset usually in later adult life. The conditions may be stratified as Eponymous or Non-Eponymous e.g. Capgras Syndrome or Paranoia.

154
Q

How are persistent Delusional Disorders managed?

A
  • Mood-Stabilisers: Lithium/Olanzapine/Valproic Acid/ Sodium Valproate
  • Neuroleptics: Aripiprazole/ Risperidone
  • Anti-depressants: Sertraline/Citalopram/Escitalopram/ Fluoxetine/ Paroxetine/ Duloxetine/ Venlafaxine
155
Q

Describe depression.

A

Depressive orders (MHD), characterized by persistent low mood, anhedonia, neurovegetative disturbance, reduced energy and varying levels of social and biological dysfunction.

156
Q

What are the subtypes of depression?

A
  • Major Depressive Disorder: ≥ 5 Sx
  • Minor Depression: 2-4 Sx for 2+ weeks
  • Persistent Depressive Disorder (Dysthymic Disorder): ≥ 2 years of ¾ dysthymic symptoms for more days than not
157
Q

What are the clinical features of depression?

A

• Persistent Low Mood
• Anhedonia (marked loss of interest/pleasure)
• Anergia
+

  • Tearfulness
  • Irritability
  • Poor concentration
  • Anxiety (Physical + Mental components)
  • Slowed thought (cognitive impairment/decline)  ‘Depressive pseudodementia’
  • Thought blocking
  • Reduced speech
  • Reduced tone of voice
  • Thought content (negative cognitive triad): Self-blame (self)/ Negativism (world)/ Pessimism (future)
  • Suicidal ideation
  • Sleep disturbance: insomnia/hypersomnia
  • Weight gain
  • Psychomotor agitation/retardation (restlessness)
  • Fatigue
158
Q

What are the triad of symptoms involved in Depression?

A

Persistent low mood

Anhedonia

Anergia

159
Q

What is the management for Depression?

A

Supportive: Self-help; Exercise; Diet
+
SSRI: Citalopram (20mg PO OD); Escitalopram (10mg PO OD)

160
Q

When is ECT used?

A

Depressive illness refractory to multiple treatments

Catatonia

Schizophrenia

161
Q

What does ECT involve?

Outline what happens before, any adjuncts and potential side-effects.

A

Pre-op consultation abd assessment
Consent

Administration of Short acting anaesthetic; Administration of a muscle relaxant e.g. Suxamethonium (reduce risk of convulsions); attach to EEG machine for monitoring

ECT may be unilateral (non-dominant part of brain) or bilateral
Electrical charge passed for 5 seconds with seizure lasting around 20 seconds

After ECT - wake up. Side effects: retrograde amnesia; anterograde amnesia; headache; drowsiness/confusion

162
Q

A patient requires ECT counselling. They ask:

  • What is ECT?
  • How does it work?
  • What will happen after?

Advise them accordingly

A

Pre-op consultation abd assessment
Consent

Administration of Short acting anaesthetic; Administration of a muscle relaxant e.g. Suxamethonium (reduce risk of convulsions); attach to EEG machine for monitoring

ECT may be unilateral (non-dominant part of brain) or bilateral
Electrical charge passed for 5 seconds with seizure lasting around 20 seconds

After ECT - wake up. Side effects: retrograde amnesia; anterograde amnesia; headache; drowsiness/confusion

163
Q

What are the key aspects of Dysthymia?

A

Form of unipolar depression with same symptoms only the symptoms last for 4/7 days and are present over an overall period of 2 years

164
Q

What is the difference between Dysthymia and Cyclothymia?

A

Dysthymia is fluctuant depressive symptoms for more days than they are absent (4/7) over a period of 2 years cf Cyclothymia is a chronic, fluctuating course of mood disturbance featuring hypomania and depressive episodes

165
Q

What types of Bipolar disorder are there?

A
  • Bipolar I Disorder (At least 1 manic/mixed episode)
  • Bipolar II Disorder (At least 1 hypomanic + 1 major depressive disorder)
  • Cyclothymia (Chronic, fluctuating course of mood disturbance – numerous periods of hypomania and depressive episodes)
166
Q

What are the clinical features of Bipolar Disorder?

A
  • Grandiosity
  • Decreased need for sleep
  • More talkative
  • Flight of ideas
  • Increase in goal-directed activity
  • Risk-taking behaviours: buying sprees/sexual indiscretions/foolish business investments
  • No underlying medical cause
167
Q

How is Bipolar Disorder managed?

A

• Aripiprazole (10-15mg PO OD)/Risperidone (1mg PO BD)/ Quetiapine (50mg PO BD)/Lithium (300mg BDS-TDS)/ Olanzapine (5mg PO OD)/ Carbamazepine (100-400mg/day PO BD)
+ (adjunct)
• Clonazepam (1mg/day in 2-3 doses)

168
Q

What is Alcohol Use Disorder?

A

Mental health condition featuring maladaptive pattern of alcohol use featuring dependence, characterised by ≥ Sx in 12 months of: increased consumption; increased duration; impulses alcohol; craving alcohol; missing obligations/roles; hazardous alcohol use; development of tolerance and withdrawal symptoms.

169
Q

How is alcohol metabolised?

A
  • Common pathway: Ethanol (+ Alcohol Dehydrogenase - ADH) –> Acetaldehyde (+ Aldehyde Dehydrogenase – ALDH)
  • Microsomal Ethanol-Oxidising System via cyt. P450 2E1 (CYP2E1): Ethanol (+ CYP2E1) -> Acetaldehyde
  • Catalase: Ethanol (+ Catalase) -> Acetaldehyde
170
Q

Calculate the amount of units in 3x 25mL shots of 40% vodka.

A

25 x 3 = 75

0.075 x 40 = 3 units

171
Q

Outline the clinical features of alcohol dependence.

A

• Withdrawal (hyperexcitability develops when use reduced - AWS): Seizures/Delirium/Hallucinations/Mood swings/Depression/Anxiety

  • Tolerance (physiological adaptation)
  • Recurrent intoxication/Admissions
  • Impulsivity: Drink driving/Accidents/Crime/Domestic violence
  • Anxiety
  • Insomnia
  • Nausea + Vomiting: Alcohol-related gastritis / Pancreatitis
  • Abdominal pain: Alcohol-related gastritis / Pancreatitis
  • Haematemesis: Alcohol-related gastritis / Pancreatitis
  • Muscle cramps/Pain/Tenderness/Paraesthesia: Peripheral neuropathy from B1 (thiamine) deficiency
  • Skin changes: Telangiectasia/Spider naevi/Flushing/Psoriasis/Pruritus
  • Hepatosplenomegaly: Steatosis/Hepatitis
  • Liver shrinking: Cirrhosis
  • Jaundice
  • Ascites
  • Tremor
  • Sweating
  • Malnutrition: Sarcopenia/Atrophy
172
Q

How may alcohol dependence be diagnosed?

A

CAGE Questionnaire:

1) Cut down (suggested)
2) Annoyed (others)
3) Guilty (felt guilty)
4) Eye-opener (drink in the morning)

Note: Positive = ≥ 2 Yes responses

FAST Screening Tool

1) Fucked (Binge Drinking)
2) Anti-social (Unable to complete activity)
3) Shit memory (forgetful)
4) Thought (others concerned)

Alcohol levels

173
Q

How do you manage acute alcohol withdrawal?

A

• Supportive care: Reassurance/Low-stimulation environment/Hydration/Vitamin infusion (Pabrinex – Vitamin B and C) for 3/5 or Oral Thiamine (B1) TDS
+
• Detoxification: Chlordiazepoxide/Diazepam/Lorazepam + Thiamine (IV 100mg OD)
±
• Skeletal muscle relaxants: Baclofen

174
Q

How do you manage alcohol dependence?

A

• Supportive: Advice to reduce intake (motivational interviewing + SMART goals)
±
• Therapy: AA/CBT/MET
+
• Alcohol antagonist: Disulfiram (“Antabuse”)
or
• Sulfonic Acid: Acamprosate

175
Q

What is a drug?

A

Psychoactive substance causing alteration in mood, behaviour, perception and consciousness

176
Q

What is tolerance?

A

State of reduced responsiveness resulting in increased doses of substance to feel effects previously felt due to repeated administration

177
Q

What is dependence?

A

State of psychological or physiological dependence from psychoactive substance characterised by impulses and motivations to take the drug to seek resulting effects

178
Q

What is addiction?

A

Dependence on a substance whereby tolerance increases (amount needed to detect substance’s effects) and removal of substance leads to withdrawal effects (unpleasant physiological side-effects).

179
Q

What are the clinical features of Opiate overdose?

A
  • Sedation
  • Nausea
  • Vomiting
  • Mood change: Euphoria/Intense pleasure
  • Analgesia
  • Pupillary constriction
  • Respiratory depression
  • Bradycardia (Decreased SNS outflow)
  • Hypotension (Decreased SNS outflow)
  • Hypothermia
  • Cough reflex suppression
  • Analgesia
180
Q

How do you manage Opioid overdose?

A

Supportive: admission; A-E assessment; monitoring
+
Naloxone

181
Q

How do you manage a patient with Opioid Dependence?

A

• CBT: 3Ps (Predisposing + Ppt + Protective) + Situation + Cognitive Triad (Thoughts/Feelings/Behaviours)
+
• Opiate analgesics: Methadone
-> Competitive antagonist of Mu receptor

OR

• Partial agonist: Buprenorphine
-> Partial mu-receptor agonist with ceiling effect

182
Q

What are the clinical features of Amphetamine ingestion?

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Dry mouth
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration -> Xerostomia
183
Q

What is the management for amphetamine dependence?

A

• CBT

184
Q

What are the symptoms of Cocaine abuse?

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration
  • Agitation
185
Q

What is the management for a patient with Cocaine overdose?

A

• Benzodiazepines: Lorazepam/Diazepam
+
• CBT

186
Q

What are the clinical features of MDMA ingestion?

A
  • Euphoria
  • Nausea
  • Vomiting
  • Hallucinations: Visual + Auditory
  • Insomnia
  • Impulsivity
  • Anorexia
  • Weight loss
  • Psychological Sx: Anxiety/Paranoia/Psychosis  Suicidal feelings
  • Low mood (come down)
  • Dilated pupils
  • Blurred vision
  • Dry mouth
  • Teeth grinding
  • Jaw tightening (bruxism)
  • Tachycardia
  • Hypertension
  • Tachypnoea
  • Hyperthermia
  • Hyperhidrosis
  • Dehydration
  • Tremor
  • Psychomotor activity increased
  • Agitation
187
Q

What is the management of MDMA dependence?

A

• CBT

188
Q

What are the clinical features of LSD ingestion?

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
Higher doses… -> Sympathomimetic effects 
•	Dilated pupils
•	Tachycardia
•	Hypertension
•	Hyperreflexia
•	Hyperthermia
189
Q

What is the management for a patient on LSD?

A

• Supportive: Sugar/Safe environment/Reassuring
±
• Anxiolytics: Lorazepam/Diazepam

190
Q

What are the clinical features of ketamine use?

A
  • Hallucinations/Near-death
  • Out-of-body experience: Derealisation/Depersonalisation
  • Psychosis
  • Emergence phenomena
  • Cognitive impairment
  • Synaesthesia
  • Hypersalivation
  • Tachycardia
  • Hypertension
191
Q

How doyle manage a patient who has a Ketamine addiction?

A

• Supportive: Sugar/Safe environment/Reassuring

192
Q

What is the active substance in magic mushrooms?

A

Psilocybin and Psilocin

193
Q

What are the clinical features of Magic Mushroom use?

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
  • Panic
  • Amnesia
  • Psychosis
  • Mydriasis
  • Acute stuporous state
194
Q

How do you manage a patient who is showing clinical features of Magic Mushroom use?

A

• Supportive: Sugar/Safe environment/Reassuring
±
• Anxiolytics: Lorazepam/Diazepam

195
Q

Give an example of a Benzodiazepine.

A
  • Chlordiazepoxide
  • Diazepam
  • Lorazepam
  • Temazepam
  • Clonazepam
  • Alprazolam
196
Q

What are the clinical features of benzodiazepine intoxication?

A
  • Impaired mental status: Attention; Memory; Inappropriate behaviour
  • Drowsiness
  • Slurred speech
  • Ataxia
  • Respiratory depression
  • Coma
  • Decreased deep tendon reflexes
  • Nystagmus
197
Q

How do you manage Benzodiazepine toxidrome?

A 
•	Supportive: Airway maintenance; Cardiorespiratory monitoring; IV fluids/ Dose-tapering
\+
•	BZD antagonist: Flumazenil
\+ 
•	CBT
198
Q

What is the reversal agent for Benzodiazepine overdose?

A

Flumazenil

199
Q

What are the clinical features of Cannabis?

A
  • Euphoria
  • Increased appetite
  • Sedation
  • Perceptual awareness
  • Hallucinations -> Psychosis
  • Tachycardia
  • Hypertension
  • Bronchodilation
200
Q

What is the management for Cannabis toxidrome?

A

• Supportive: Nutrition/Reassurance/Calm environment
±
• Anxiolytics: Lorazepam/Diazepam

201
Q

How do you calculate a MUST score?

A

Use the malnutrition universal screening tool

1) BMI (0-2): ≥ 20/ 18.5-20/ ≤ 18.5
2) Weight loss (0-2): ≤5%/ 5-10%/ ≥ 10%
3) Acutely unwell/no nutritional intake ≥ 5 days (0 or 2): Yes/ No
4) Add scores
5) Stratify (0/1/2 ≤): Low risk/ Medium/ High

202
Q

What framework can be used when taking a Social History from an Adolescent?

A

Mnemonic: HEEADSSS

Home
Education + Employment
Eating 
Activities + hobbies 
Drugs (Alcohol + Tobacco)
Sex 
Self-harm + self-image
Safety
203
Q

Describe Avoidant-Restrictive Food Intake Disorder.

A

Eating disorder characterised by lack of interest in food, fears of negative consequences of eating and selective eating with 1 Sx ≤ weight loss, nutritional deficiency, supplement dependency and interference with psychosocial functioning.

204
Q

What are the clinical features of ARFID?

A
  • Selective eating (fussy eating)
  • Fear of negative consequences of eating
  • Dependence on nutritional supplements

• Weight loss

205
Q

What is the management of ARFID?

A

• Family-based therapy
±
• Nutrition

206
Q

What is Anorexia Nervosa?

A

Eating disorder characterised by caloric intake restriction leading to low body weight, intense fear of gaining weight, body dysmorphia

Sx Triad: Weight + Fear + Body

207
Q

What are the clinical features of Anorexia Nervosa?

A
  • Low body weight: ≤ 18.5 kg/m2
  • Fear of gaining weight
  • Disturbed body image (body dysmorphia)
  • Calorie restriction
  • Purging (behaviours to counteract food): Psychogenic vomiting; Diet pills; Laxatives; Diuretics)
  • Fatigue
  • Poor concentration
  • Amenorrhoea
  • Loss of libido
  • Orthostatic hypotension
  • Non-specific GI: Constipation/Fullness/Bloating/Cramping gas
  • Cardiac Sx: QTc prolongation/1st degree AV heart block; T-wave changes
  • Decreased SC fat
  • Lanugo
  • Cracked nails
  • Hair thinning
208
Q

The fine, light hair which appears in Anorexia is called?

A

Lanugo

209
Q

What group of questions may be used to aid the diagnosis of Anorexia Nervosa?

A

SCOFF Qs

Sick 
Control 
One stone 
Fat 
Food
210
Q

What is the general management for Anorexia Nervosa?

A

• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: Counselling/CBT

211
Q

What is the management of Anorexia Nervosa in a medically unstable scenario?

A

• Admission: Oral/Enteral/Parenteral nutrition
±
• Fluid intake correction
±
• Potassium Repletion: 40-100mEq PO OD or IV PRN
-> KCl
±
• Magnesium Repletion: 10-20mmol IV OD
-> Mg(SO4)2
±
• Calcium Repletion: 100-1000mg IV every 6 hours
-> Calcium gluconate
±
• Sodium Repletion: Fluid restriction + balanced nutrition/ Hypertonic Saline (if severe Sx – seizures; confusion; coma)

212
Q

Describe Bulimia Nervosa.

A

Eating disorder typified by recurrent episodic binge eating in conjunction with compensatory purging behaviours (– psychogenic vomiting; fasting; excessive exercise; misuse of laxatives; diuretics; enemas or other medication), lasting at least weekly for 3 months.

213
Q

What are the clinical features of Bulimia Nervosa?

A

• Recurrent episodic binge eating: Discrete period time + ≥ Normal intake – speed/amounts/fullness/cephalic/embarrassed/guilty

  • Purging behaviour: Psychogenic vomiting/Laxatives/ Enemas/ Suppositories
  • Compensatory behaviour: Fasting/ Excessive exercise
  • Body dysmorphia: Weight/Shape-conscious
  • Depression: Persistent low mood + Anergia + Anhedonia
  • Menstrual irregularity
  • Misuse of insulin
  • Self-harm
  • GI Sx: GORD/Diarrhoea/Constipation/Abdominal pain
  • Dental erosion: Abrasive food/ HCl/ Night-grinding
  • Russel Sign: Calluses on dorsum of hand from psychogenic vomiting
  • Parotid hypertrophy
  • Arrhythmia
214
Q

What is the term for the calluses/plaques present in the knuckles in Bulimia Nervosa?

A

Russel Sign

215
Q

How do you manage Bulimia Nervosa?

A

• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: CBT

+ (Depression)
• SSRI/SNRI: Fluoxetine/ Sertraline/ Venlafaxine

216
Q

Describe Binge Eating Disorder.

A

Eating disorder characterised by regular, episodic binge eating which may be planned and commonly leads to weight gain.

217
Q

Outline the clinical features of Binge Eating Disorder.

A
  • Impulsivity: Buying large quantities/Eating rapidly/Eating when not hungry
  • Obsession: Organising life around food/ Eating when not hungry/ Time talking about food
  • Asocial behaviour: Eating in isolation
  • Irritability
  • Mood lability: Mood swings
  • Low self-esteem/confidence
  • Co-morbid MHDs
  • Tiredness
  • Fatigue
  • Weight gain
  • Bloating
  • Constipation
  • Abdominal pain
218
Q

How is binge eating disorder managed?

A

• CBT
+ (Depression)
• SSRIs/SNRIs: Sertraline/Citalopram/Fluoxetine/Venlafaxine

219
Q

Describe the concept of Gender Dysphoria?

A

mismatch between gender and sex assigned at birth

220
Q

What are the clinical features of Gender Dysphoria?

A
  • Gender dysphoria: Dissatisfaction with gender + desire to live as another gender
  • Transvestitism
  • Altered appearance
  • Reduced libido
  • Atypical speech + vocal quality
221
Q

What is the management involved in Male to Female transitions?

A

• Observation: 1 year + Capacity + Gender dysphoria + Controlled PMHx + 1 year continuous hormone therapy

• Successful role change ≥ 1 year
±
• Augmentation mammoplasty
±
• Genital Surgery: Transfeminine bottom surgery  Vulvoplasty + Vaginoplasty
•
• Oestrogens: Estradiol transdermal OR Estradiol valerate
±
• Androgen suppression therapy: Goserelin
±
• Hair removal: Electrolysis + Laser
±
• Head and Neck surgery: Thyroid cartilage reduction (Cricothyroid approximation procedure)

222
Q

What is the management involved in Female to Male transitions?

A

• Observation: 1 year + Capacity + Gender dysphoria + Controlled PMHx + 1 year continuous hormone therapy

•	Androgens: Testosterone 
±
•	Bilateral mastectomy
±
•	Hysterectomy + Bilateral oophorectomy 
±
•	Phalloplasty 
±
•	Craniofacial surgery
223
Q

What is the criteria for detention under the mental health act?

A

Mental disorder

No capacity (poor decision making)

Significant risk

Informal/voluntary care not appropriate

Determining treatment required

224
Q

What are the options for detaining someone under the Mental Health Act in Scotland?

A

Emergency detention

Short-term detention

Compulsory treatment order

225
Q

Which of the following is false regarding emergency detention orders?

A. Allows 72 hours of assessment

B. You can never give treatment

C. There is no right to appeal

D. An F2 can authorise this

A

B

226
Q

Which of the following is false regarding short term detention orders?

A. Allows 28 days of assessment and treatment

B. You believe there is a likely mental disorder

C. There is a right to appeal

D. An F2 alone can authorise this

A

D. F2 < + MHO required

227
Q

Which of the following is false regarding Compulsory Treatment Order?

A. Allows 6 months of treatment

B. Mandatory tribunal occurs

C. You can renew this at 6 months

D. You suspect a mental disorder is present

A

D, a mental disorder must be present

228
Q

Give 3 RFs for Suicide.

A

Gender - males are three times as likely to take their own life as females
Age - people aged 35-49 years now have the highest suicide rate
Mental illness
The treatment and care they receive after making a suicide attempt
Physically disabling or painful illnesses including chronic pain
Alcohol and drug misuse
The loss of a job
Debt
Living alone - becoming socially excluded or isolated;
Bereavement
Family breakdown and conflict including divorce and family mental health problems
Imprisonment

229
Q

When do alcohol withdrawal symptoms occur?

A

Rule of 6s

Symptoms = 6-12 hours

Seizures = 36 hours

Delirium tremens = 72 hours

230
Q

How long should antidepressants be continued for following symptom remission?

A

6 months

Medicine (18 decks)

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