Psychiatry

Question 1

define ANXIETY

Answer 1

a state consisting of psychological and physical symptoms brought about by a sense of apprehension at a perceived threat

Question 2

Characteristic features of Generalised Anxiety disorders

Answer 2

long standing, free floating anxiety, that may fluctuate, but is neither situational nor episodic

Question 3

Characteristic features of Panic Disorder

Answer 3

repeated, sudden attacks of overwhelming anxiety, accompanied by severe physical symptoms

There is fear of the implications and consequences of a panic attack - e.g. having a heart attack; this fear in itself triggers further panic attacks.

Question 4

What is a phobia?

Answer 4

intense fear/anxiety is triggered by a stimulus, or group of stimuli, that are predictable and normally cause no particular concern to others

• leads to avoidance behaviour
• pt knows fear is irrational but can’t help it

Question 5

What is an Obsession?

Answer 5

intrusive thoughts that can cause anxiety

Question 6

What is a Compulsion?

Answer 6

repetitive behaviours/rituals that neutralise anxiety

Question 7

Psychological Therapy for OCD

Answer 7

CBT focussing on exposure and response prevention

Question 8

Bipolar Disorder Type 1

Answer 8

At least 1 manic or mixed episode

Question 9

Bipolar Disorder Type 2

Answer 9

Never had a full manic episode; at least 1 hypomanic episode and at least 1 major depressive episode

Question 10

For what duration must symptoms be present for a dx of Mania to be made

Answer 10

> 1 week

Question 11

For what duration must symptoms be present for a dx of Hypomania to be made

Answer 11

at least 4 days

Question 12

What are the core symptoms of depression?

Answer 12

low mood
Anhedonia
Fatiguability

Question 13

ICD-10 definition of Depressive Disorder

Answer 13

presence of at least twocore symptomsplusat least two others symptoms, for at least 2weeks.
each symptom should be present at sufficient severity for most of every day.

Question 14

Mild Depression

Answer 14

2 core symptoms + 2 associated symptoms

Question 15

Moderate Depression

Answer 15

2 core symptoms + 3+ associated symptoms

Question 16

Severe Depression

Answer 16

3 core symptoms + 4+ associated symptoms

Question 17

Define Illusion

Answer 17

False interpretation of a real perception

Question 18

Define Hallucination

Answer 18

False sensory perception in the absence of a real external stimulus
perceived as being located in objective space (i.e. outside head)

Question 19

What is a Nilhilistic Delusion?

Answer 19

delusional belief of being dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being

Question 20

What is a psuedohallucination?

Answer 20

A form of imagery arising in the subjective inner space of the mind and lacking the substantiality of normal perceptions
perceived as from inside mind

Question 21

What is a Delusion

Answer 21

false fixed belief that is not amenable to change in light of conflicting evidence

Question 22

What is Catatonia?

Answer 22

A state of increased muscle tone affecting extension and flexion and abolished by voluntary movement.

Question 23

What are the negative features of Schizophrenia?

Answer 23

Affective flattening
Apathy
Avolition (lack of motivation)
Anergy
Anhedonia
Alogia (poverty of words and thoughts)
Asociality
Attentional impairment"

Question 24

What are the disorganised symptoms of schizophrenia?

When are these symptoms present?

Answer 24

disorganised thinking/speech
Disorganised behaviour
inappropriate affect

often detectable in the prodromal phase before the onset of positive symptoms

Question 25

Describe factors associated with poor prognosis in Psychosis/Schizophrenia

Answer 25

fam hx
Personal hx of any psychiatric disorder
Eccentric shy personality
Poor social and psychosexual adjustment
Single civil status
Unstable work record
Young age
insidious onset
Blunted affect
Prolonged episode

Question 26

What is Acute Dystonia?

Answer 26

spastic contraction which is often painful of certain muscle (groups) most commonly affecting the head and neck

Question 27

What is Akathisia?

Answer 27

motor restlessness

Question 28

What is Tardive dyskinesia

Answer 28

involuntary, repetitive, purposeless movements of the tongue, lips, face and extremities

Question 29

What are the features of Neuroleptic Malignant Syndrome?

Answer 29

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

occurs within hours to days of starting an antipsychotic
A raised creatine kinase is present in most cases.
Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases.
leukocytosis may also be seen

Question 30

Section 2

Answer 30

admission for up to 28 days for assessment ± treatment

Question 31

Section 3

Answer 31

treatment for up to 6 months for treatment

Question 32

Section 4

Answer 32

72 hour assessment order

used as an emergency, when a section 2 would involve an unacceptable delay

Question 33

Section 5(2)

Answer 33

a patient who is a voluntary patient in hospital (for physical or mental health problem) can be legally detained by a doctor for 72 hours

Question 34

Section 5(4)

Answer 34

voluntary patients can be detained by a nurse for up to 6 hours

Question 35

Section 17a

Answer 35

Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

Question 36

Section 135

Answer 36

Used if there is belief that the person has a mental disorder and is at risk of harm.

Requires warrant, authorising a police officer (+ Dr and AMHP) to enter premises and take to/keep at place of safety

Question 37

Section 136

Answer 37

someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

Question 38

Which 3 professionals are required for undertaking MHA assessments?

Answer 38

• approved mental health practicioner (mental health professionals who have been approved by a local social services authority to carry out duties under the Mental Health Act, such as social workers)
• Registered medical practicioner
• Section 12 Dr - doctor trained and qualified in the use of the Mental Health Act, usually a psychiatrist