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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

personality disorder

A

Persistent, Pervasive and Pathological

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2
Q

Avoidant personality disorder

A

involves strong feelings of inadequacy and fear of social situations. These patients are extremely sensitive to criticism.

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3
Q

Schizoid personality disorder

A

Characterised by a lack of interest in others, apathy and a lack emotional breadth.
They tend to have few friends and do not form relationships, preferring solitary activities.

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4
Q

Schizotypal personality disorder

A

Characterised by a pattern of extreme difficulty interacting socially, bizarre or magical thinking and distorted perceptions.
Inappropriate behaviour and strange speech and affect can cause others to perceive them as strange.
They share some features with schizophrenics, but maintain a better grasp on reality.

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5
Q

Paranoid personality disorder

A

Characterised by irrational suspicion and mistrust of others
Often hypersensitive to criticism
Reluctant to confide and preoccupied with perceived conspiracies against themselves

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6
Q

Narcissistic personality disorder

A

involves a pattern of grandiosity, need for admiration of others and a lack of empathy.

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7
Q

Antisocial personality disorder

A

characterised by a pattern of disregard and violation of the rights of other’s. Individuals lack empathy and are often manipulative and impulsive.
Aggressive and unremorseful
Consistently irresponsible with failure to obey laws and social norms

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8
Q

Histrionic personality disorder

A

characterised by attention seeking behaviour and excessive displays of emotions.
Often sexually inappropriate
Shallow and self-dramatising
Relationships are considered to be more intimate than they really are

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9
Q

The Mental Health Act (Criteria that must be met)

A

They must have a mental disorder
There must be a risk to their health/safety or the safety of others
There must be a treatment (however this can include nursing care, not just drugs)

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10
Q

Section 4 of MHA

A

Used in emergencies where a section 2 would cause “an undesirable delay”
It requires the recommendation of only one doctor and either an AMHP or the nearest relative
Allows a person to be detained for up to 72 hours, whereby it is usually converted to a section 2

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11
Q

Section 2 of MHA

A

Admission for assessment for up to 28 days, non-renewable
The application for admission is made by an Approved Mental Health Professional (AMHP) or the patient’s nearest relative
Requires the recommendation of 2 doctors, one of whom must be ‘approved’ under Section 12(2) of the MHA

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12
Q

Section 3 of MHA

A

Admission for treatment for up to 6 months, renewable
Requires an AMHP and 2 doctors, both of whom must have seen the patient in the past 24 hours

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13
Q

Section 5(2) of MHA

A

A voluntary patient in hospital may be legally detained by a doctor for 72 hours

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14
Q

Section 5(4) of MHA

A

A section 5(4) is similar to a section 5(2) but is used by nurses and only lasts for 6 hours.

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15
Q

Section 135 of MHA

A

A court order that allows the police to enter a property to remove a person to a Place of Safety (either the police station or more commonly A&E)

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16
Q

Section 136 of MHA

A

The police can bring someone from a public place who appears to have a mental disorder to a Place of Safety (either the police station or more commonly A&E)

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17
Q

Section 17

A

allows leave from hospital,The responsible clinician in charge of your care can place conditions on the leave

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18
Q

CTO

A

Supervised community treatment may be used to facilitate the discharge of a patient detained under s3

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19
Q

Obsessions

A

unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore.

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20
Q

Compulsions

A

repetitive actions the person feels they must do, generating anxiety if they are not done.

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21
Q

Symptoms of anxiety

A

Psychological: Fears, worries, poor concentration, irritability, depersonalization, derealisation, insomnia (can’t fall asleep), night terrors
Motor symptoms: Restlessness, fidgeting, feeling on edge
Neuromuscular: tremor, tension headache, muscle ache, dizziness, tinnitus
GI: Dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loose motions
CVS: Chest discomfort, palpitation
Respiratory: Difficulty inhaling, Tight/constricted chest
GI: Urinary frequency, erectile dysfunction, Amenorrhoea

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22
Q

Differential Diagnosis anxiety

A

Hyperthyroidism (look for goitre, tremor, tachycardia, weight loss, arrrythmia, exopthalmos)
Substance misuse (intoxication – amphetamines; withdrawal – benzo, alcohol)
Excess caffeine
Depression: anxiety common feature of depression and likewise. Which came first and which is currently more prominent are useful clues. If both, diagnose mixed anciety and depressive disorder
Anxious (avoidant) personality disorder: patient describes themselves as an anxious person with no recent major increase in anxiety levels. (note this disorder can predispose)
Dementia (early)
Schizophrenia (early)

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23
Q

Opiate Withdrawal features

A

Agitation
Anxiety
Muscle aches or cramps
Chills
Runny eyes
Runny nose
Sweating
Yawning
Insomnia
Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting
Dilated pupils
‘Goose bump’ skin
Increased heart rate and blood pressure

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24
Q

Acute stress reaction (ASR)

A

Transient disorder that develops in an individual with no other apparent mental disorder in response to exceptional physical and/or mental stress; usually subsides within hours or days. It should last no more than one month.

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25
Q

adjustment disorder.

A

stressor need not be severe or outside the “normal” human experience eg bereavement.
1-6m in duration

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26
Q

PTSD features

A

last for at least one month but onset should be not more than six months after stressor:

trauma, flashbacks, numbness, avoidance, autonomic arousal eg hyper vigilance

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27
Q

Mx PTSD

A

Advise on sleep hygiene and consider prescribing a hypnotic for short-term use if sleep is an issue
Peer support groups
watchful waiting
antidepressants – such as venlafaxine paroxetine or mirtazapine
risperidone in addition to psychological therapies if PTSD involves psychotic symptoms
psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)

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28
Q

GRIEF REACTION

A

REACTION- most grief reactions last in the neighborhood of 6 to 12 months,
Denial and isolation
Anger
Bargaining- guilt and if only statements
Depression
Acceptance

29
Q

Conversion disorder

A

is a psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological caus

30
Q

Bipolar 1 disorder dx

A

Bipolar I disorder is characterized by at least one manic episode with or without a history of major depressive episodes.

31
Q

Bipolar II disorder DX

A

Bipolar II disorder is characterized by one or more major depressive episodes and by at least one hypomanic episode, but no evidence of mania.

32
Q

Mania symptoms

A

(1) Increased activity/ restlessness;
(2) Increased talkativeness (‘pressure of speech’);
(3) Flight of ideas
(4) Loss of normal social inhibitions resulting in behaviour which is inappropriate
(5) Decreased need for sleep;
(6) Inflated self-esteem or grandiosity;
(7) Distractibility or constant changes in activity or plans;
(8) Behaviour which is reckless and whose risks the subject does not recognize e.g. spending sprees
(9) Marked sexual energy

33
Q

depression features

A

Depressed mood or irritable most of the day
Decreased interest or pleasure
Changes in appetite or weight
Changes in sleep
Changes in psychomotor activity
Decreased energy
Feelings of worthlessness or guilt
Trouble thinking, concentrating, or making decisions
Thoughts of death or suicidal plans or attempts

34
Q

dx depression

A

At least two of the following three symptoms must be present:
(1) depressed mood for at least 2w
(2) anhedonia
(3) decreased energy

An additional symptom or symptoms from the following list should be present, to give a total of at least four:
(1) loss of confidence/self-esteem;
(2) unreasonable feelings of self-reproach or excessive and inappropriate guilt;
(3) recurrent thoughts of death or suicide
(4) complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation;
(5) change in psychomotor activity, with agitation or retardation
(6) sleep disturbance
(7) change in appetite

35
Q

First Rank Features of schizophrenia

A

Auditory hallucinations
Thought disorders
Delusional perceptions
Passivity phenomena

36
Q

Negative symptoms of schizophrenia

A

flat/blunting affect
reduced social interaction
anhedonia
alogia
catatonia
Avolition (poor motivation)
( hypofunction of mesocortical pathway linked to -ve symptoms )

37
Q

Positive symptoms of schizophrenia

A

hallucinations
delusions
disorganised thought and nonsensical speech
bizarre behaviours
(mesolimbic pathway)

38
Q

Schizophrenia dx

A

A first-rank symptom or persistent delusion present for at least one month:
- Delusional perception
- Passivity
- Delusions of thought interference: insertion/withdrawal/broadcasting
- Auditory hallucinations

No other cause for psychosis such as drug intoxication or withdrawal, brain disease

Or instead of first rank symptoms has at least 2 of the following symptoms:
- Persistent hallucinations
- Neologisms
- Catatonic behavior
- “Negative” symptoms

39
Q

Schizophrenia tx

A

Psychological intervention - cat, arts for negative symptoms
Antipsychotic
Social interventions eg social support

40
Q

Differential diagnosis of schizophrenia (organic and psychiatric)

A

Delirium (e.g. infection, toxic, metabolic, endocrine, neurological)
Metabolic disorders such as hyperthyroidism and hyperparathyroidism
Organic psychosis caused by infection, brain injury and CNS diseases such as Wilson’s disease
Acute drug-related psychoses (commonly drugs of abuse, but can be iatrogenic e.g. steroids)
Alcoholic hallucinations
Mania
Encephalitis
Panic disorder
Psychotic depression
Temporal lobe epilepsy
Dementia
Cerebral syphilis ( can be associated with mania, depression and psychosis)
Schizoptypal / schizoid personalities ( especially personality changes after 50)
Autism
Prolonged catatonia
Movement disorder or unknown aetiology

41
Q

factors indicating better prognosis in schizophrenia

A

Factors such as a high IQ or level of education, sudden onset of symptoms, obvious precipitating factors, a strong support network and predominantly positive symptoms can indicate a better prognosis.

42
Q

Capgras delusion

A

efers to a delusion that either oneself or another person has been replaced by an exact clone. It may be part of a psychotic illness or as a result of trauma to the brain.

43
Q

Ekbom’s syndrome

A

delusional belief where a patient feels that they are infested with parasites. They often complain of feeling “crawling” in the skin. It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders.

44
Q

Cotard delusion

A

refers to the belief that a patient is dead, non-existent or ‘rotting’. Again, it may occur in psychosis but can appear as a result of parietal lobe lesions.

45
Q

•SCOFF questionnaire: screens for eating disorders

A
  • do you make yourself Sick because you feel uncomfortably full?
  • do you worry that you have lost Control over how much you eat?
  • have you lost more than One stone in a 3-month period?
  • Do you believe yourself to be Fat when others say you’re too thin?
  • Would you say Food dominates your life?
46
Q

Suicide risk

A

Risk factors: unemployed, unmarried, male
Precipitating/perpetuating factors: substance misuse, abusive relationships, chronic pain/associated physical or mental conditions
Protective factors: supportive network, children and sense of responsibility, dreams of future

47
Q

Factors that increase suicide risk
about the act itself

A

The patient carried out final acts (e.g. writing a will)
The patient has researched methods and prepared for the act (e.g. stockpiling tablets)
The patient perceived the act to have a high lethality
The patient took precautions against being found
The patient used a violent method of suicide (e.g. firearms, jumping from a height)
The patient’s attempt is discovered by chance
The patient resists/tries to evade medical intervention
The patient downplays the seriousness of the attempt

48
Q

Advanced Decision

A

short for Advanced Decision to Refuse Treatment, is a legally binding document,​ It must be written down, be signed and witnessed (if it concerns a refusal of life-saving treatment)

49
Q

Advanced Statement

A

general statements about their wishes, not legally binding

50
Q

A Learning disabled person will have all 3 criteria

A

A. An IQ under 70 ( to assess intellectual impairment use Wechselr adult intelligence scale ( WAIS) 4 Changes as the population changes)
B. Loss of Adaptive social functioning.
C. Onset before the age of 18

51
Q

Impairment

A
  • Temporary or permanent loss or abnormality of body structure or function
  • May be functional, physiological or psychological
52
Q

Disability

A

Lack of ability to perform an activity in the manner/within a range considered normal

53
Q

Handicap

A

Limits or prevents the fulfilment of a role that is normal for that individual

54
Q

All individuals on the autistic spectrum demonstrate deficits in three core domains:

A

reciprocal social interactions,
verbal and nonverbal communication,
restricted and repetitive behaviours or interests

55
Q

ADHD features

A

Onset before age 7 with symptoms > 6months
Hyperactivity
Impulsivity
Inattention

56
Q

Conduct disorder

A

child or young person repeatedly (over several months or more) carrying out antisocial acts that cause distress and social impairment to themself, and disruption and damage to others.
Common presentations include stealing, bullying, lying, fighting, fire-setting and cruelty to animals.

57
Q

Oppositional defiant disorder

A

defiant, disobedient, disruptive but not aggressive or antisocial behaviour, ‘naughty’ children. it is a sub-type and milder variation of conduct disorder seen in younger children.

58
Q

serotonin syndrome

A

Autonomic hypersensitivity
Altered mental state
Neuromuscular excitation/hyperreflexia

59
Q

neuroleptic malignant syndrome

A

characterised by rigidity, confusion, autonomic dysregulation and pyrexia

60
Q

Drugs used for managing opioid withdrawal

A

Methadone ( long acting opioid agonist )
Buprenorphine ( partial agonist) available alone (subutex) or with naloxone ( suboxone , quick acting opioid antagonist)
Naltrexone is a long acting opioid antagonist

61
Q

Typical antipsychotic drugs side effects

A

extrapyramidal effects
- acute dystonic reactions
- akathisia (inner restlessness)
- tardive dyskinesia eg lip smacking
Drowsiness, hypotension
QT interval prolongation, erectile dysfunction, hyperprolactinemia symptoms
Metabolic
- weight gain
- increased risk of T2DM, - hyperlipidaemia
Anticholinergic
- tachycardia, blurred vision, dry mouth, constipation, urinary retention
Neurological - seizures, neuroleptic malignant syndrome

62
Q

Atypical antipsychotic drugs side effects

A

Side effects: metabolic disturbances like weight gain,diabetes,lipid changes, QT interval prolongation, sexual dysfunction
Clozapine has a risk of agranulocytosis

63
Q

Delusions

A

firm, fixed false belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms

64
Q

Hallucinations

A

false sensory perception in the absence of a real external stimulus

65
Q

Illusion

A

false perception of a real external stimulus

66
Q

Delusional perception

A

patient attaches new and delusional significance to a familiar real perception, without any logical reason

67
Q

Risk assessment

A

Risk to self → falls, accidents, self-harm, suicide, neglect, vulnerability, wandering, risk to physical health and mental health ,disengagement from services
Risk to other others→are they thinking about harming others, driving, effect on kids if they are caregivers.
Risk from others→ exploitation eg financial abuse, violence from ex partner

68
Q

causes of wernickes encephalopathy

A

Thiamine deficiency leading to Wernicke’s encephalopathy has a variety of causes, eg. prolonged starvation, anorexia nervosa, hyperemesis gravidarum, gastrointestinal diseases and malabsorption, other than chronic alcoholism.

Medicine (72 decks)

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