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Phase 3A > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

illusion

A

false perception of a detectable stimulus

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2
Q

hallucination vs pseudo hallucination

A
  • an experience involving the apparent perception of something not present
  • pseudo - hallucination but they recognise it as being subjective and unreal
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3
Q

over-values idea

A

exaggerated beliefs that a person sustains beyond reasons, but are not as unbelievable and are not as persistently held as delusions

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4
Q

delusion

A

fixed beliefs that can’t be budged with evidence to the contrary, aren’t based of culturally accepted beliefs and are affecting interaction with reality

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5
Q

concrete thinking

A

very literal interpretation of information, and can be tested by asking a patient to interpret proverbs

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6
Q

loosening of association

A

a thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea

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7
Q

circumstantiality

A

wandering away from the original idea, but eventually returning to it

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8
Q

perseverance

A

uncontrollable repetition of a particular response or repeatedly returning to the same topic

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9
Q

confabulation

A

confusion of imagination with memory

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10
Q

somatic passivity

A
  • Experience of bodily sensations (including actions, thoughts, or emotions) imposed by external agency
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11
Q

pressure of speech

A

rapid and difficult to understand

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12
Q

anhedonia

A

inability to experience pleasure

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13
Q

incongruity of affect

A

facial expressions don’t match reported mood

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14
Q

blunting of affect

A

decreased facial expressiveness

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15
Q

belle indifference

A

lack of concern and felling of indifference

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16
Q

depersonalisation

A

self doesn’t feel real

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17
Q

thought insertion or withdrawal

A

believes that thought are being put/taken out of head

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18
Q

thought echo

A

thoughts seem to be spoken just after being produced

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19
Q

akathisia

A

subjective feeling of restlessness in the lower limbs that is related to abnormal activity in the extrapyramidal system in the brain, often due to antipsychotic medication

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20
Q

catatonia and stupor

A

markedly disrupted physical reactivity to the environment, stupor is complete lack of reaction

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21
Q

flight of ideas

A

excessive speech at a rapid rate that involves causal association between ideas, often rhymes/puns, mania

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22
Q

formal thought disorder

A

disorganized way of thinking that leads to abnormal ways of expressing language when speaking and writing

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23
Q

derealisation

A

sense surroundings aren’t fully real

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24
Q

knights move thinking

A

complete loosening of associations where there is no logical link between one idea and the next

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25
Q

section 2

A

assessment
* 28 days (unrenewable)
* 2 doctors (1 s12 approved), AMHP

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26
Q

section 3

A

treatment
* 6 months (can be renewed)
* 2 doctors, AMHP

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27
Q

section 4

A

emergency order
* 72 hours
* Only when urgently required – waiting for another doctor etc.
* 1 doctor, 1 AMHP

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28
Q

section 5(4)

A

nurse can do to keep patient on ward until doctor can attend
6h

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29
Q

section 5(2)

A

stops patient leaving ward until section 2/3
72h

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30
Q

section 135

A

police, court order to remove patient from their home to a place of safety for further assessment

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31
Q

section 136

A

police, in a public place is suspected of having a mental disorder

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32
Q

formulation model

A

4p (predisposing, precipiytating, perpetuating, protective)
biopsychosocial approach

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33
Q

Features of MSE

A
  • appearance
  • behaviour
  • speech
  • mood/affect
  • thoughts (possession/content/form)
  • perceptions
  • cognition
  • insight
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34
Q

thought disorders

A

word salad
tangentiality (never go back to topic)
circumstantiality (does eventually get to point)
flight of ideas (abrupt topic change with discernable links)
derailment (no apparent links)
blocking
distractable speech

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35
Q

assessment of suicide attempt

A

before, attempt and future

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36
Q

psychosis

A
  • group of symptoms - hallucinations and delusions associated with loss of connection to reality
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37
Q

hallucinations

A
  • perception experienced without an external stimulus
  • visual more common in organic disorders
  • auditory more common in psychiatric disorders
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38
Q

what hallucination can cocaine cause

A

formication (insects crawling under skin)

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39
Q

psychiatric symptoms of types of dementia

A
  • frontotemporal dementia – disinhibition, emotional blunting, language difficulty, paranoia, delusions
  • Alzheimer’s disease – depression, apathy, withdrawal
  • Lewy body dementia – visual hallucinations, illusions
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40
Q

endocrine causes of psychiatric disorders

A
  • hypothyroidism - depression and poor cognition (myxoedema madness – mania and psychosis)
  • hyperthyroidism - anxiety, irritability and in severe cases, psychosis
  • Cushing disease – depression with psychotic features
  • Adrenal insufficiency – psychotic disorder
  • Hyperparathyroidism – cognitive slowing, memory impairment, depression
  • Hypoparathyroidism – mood disorders
  • Pheochromocytoma – nervousness, anxiety, panic attacks, depression
  • Hyperprolactinaemia – depression, anxiety
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41
Q

nutritional deficiencies causing psychiatric symptoms

A
  • Wernicke/Korsakoff syndrome – mental status change
  • Zinc/vitamin D deficiency – depressive disorders, bipolar
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42
Q

ADHD

A
  • types = innattentiveness, hyperactivity/impulsiveness, both (lasting >6m)
  • associated with low dopamine/norepinephrine
  • stimulants to slowly release neurotransmitter - amphetamines (methylphenidate hydrochloride 1st, dexamfetamine 2nd) – behavioural therapy
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43
Q

autism spectrum disorder

A
  • difficulties in social interactions/communication, restricted/repetitive nature
  • psychotherapy, behavioural therapy, educational programmes
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44
Q

tourette syndrome

A
  • Tics – rapid, repeated, involuntary, often inappropriate movements/vocalisations, for >1y, starting before age 18
  • Treatment: antipsychotics/epilepsy medications if severe, botox injections for face movements, CBT, habit reversal training
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45
Q

fragile X syndrome

A
  • most common cause of inherited intellectual disability
  • AR, Xlinked, decrease in FMR protein synthesis (normally high in brain and testes), anticipation
  • diagnosis via DNA testing (prenatally at 12w)
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46
Q

signs of fragile x syndrome

A
  • Intellectual disability, long face/large chin and ears, macroorchidism (large testes)
  • Often have autism, ADHD, anxiety disorders, seizures, fragile X tremor/ataxia
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47
Q

generalised anxiety disorder

A

no identifiable cause, persistent and excessive worry about everyday issues, present for 6+ months

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48
Q

treatment of anxiety

A
  • Identify co-morbidities and treat
  • Psychoeducation
  • CBT (systemic desensitisation for phobias)
  • SSRI drugs
  • Avoid benzodiazepines
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49
Q

PTSD symptoms

A

flashbacks, nightmares, severe anxiety, uncontrollable thoughts about the event, avoidance of triggers, has for at least 1 month

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50
Q

treatment of PTSD

A
  • 1st line - psychoeducation, CBT, EMDR, group/family therapy
  • 2nd line - SSRI/SNRI
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51
Q

OCD

A
  • Pattern of unwanted thoughts and fears (obsessions) that lead to repetitive behaviours (compulsions)
52
Q

treatment for OCD

A
  • CBT – exposure and response prevention therapy (ERP)
  • Antidepressants – clomipramine (tricyclic antidepressant) or SSRI’s
53
Q

symptoms of anorexia nervosa

A
  • Dieting, Denial, Dread of gaining weight, Disturbed beliefs about weight, Doesn’t want help, Disinterested/socially withdrawn
  • Dual effect– dieting + over-exercise/diuretics, laxatives and self-induced vomiting
  • Decline in weight = rapid
  • Weight below 85% of predicted (adults <17.5)
54
Q

investigations for anorexia nervosa

A
  • Bloods – Cortisol ↑, Beta-carotene ↑, Potassium ↓, GH ↑, T3 ↓, Glucose ↓, Oestrogen ↓, Testosterone ↓, FSH ↓, LH ↓, Cholesterol ↑, Phosphate ↓
  • ECG – Bradycardia, Prolonged QT (if severe anorexia), T wave changes (hypokalaemia)
  • DXA: if underweight for a year (or if 2 years if adult)
55
Q

features of bulimia nervosa

A
  • recurrent binge eating
  • lack of control during episode
  • recurrent compensatory behaviour (vomiting, misuse of laxatives, diuretics, fasting, excessive exercise)
  • once a week for 3 months
  • self-evaluation is unduly influenced by body shape and weight
56
Q

changes caused by recurrent vomiting

A
  • metabolic alkalosis (cl loss)
  • hypokalaemia on ECG
57
Q

dopamine reward pathways

A
  • mesocortical (cognition, memory, attention, emotional behaviour, learning)
  • nigrostriatal (movement and sensory stimuli)
  • mesolimbic (pleasure/reward seeking behaviours, addiction, emotion, perception
58
Q

DSM IV criteria for addiction

A

3+ in 12m
* Tolerance
* Withdrawal
* Persistent desire/ unsuccessful attempt to stop
* Substance used for longer periods/larger amounts than intended
* Important vocational, social or recreational activities given up/reduced because of substance use
* Persistent use despite being aware substance is causing damage

59
Q

stages of change model

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
60
Q

alcohol withdrawal

A

– decreases GABA and increases NMDA glutamate transmission
* 6-12 hours: tremor, nausea, anxiety, insomnia, increase BPM, BP, temp
* 7-48 hours: seizures
* 48-72: delirium tremens

61
Q

delirium tremens

A

emergency, tremor, hallucinations (lilliputian- small animals), delusion, confusion, agitated

62
Q

Wernicke’s encephalopathy

A
  • Ataxia, ophthalmoplegia, confusion – caused by cell death secondary to thiamine deficiency
  • Can be fatal, need to avoid Korsakoff syndrome (inability to form/retain new memory)
  • 500mg IV thiamine (pabrinex) for 3 days then IM
63
Q

treatment of alcohol withdrawal

A
  • Benzodiazepines – chlordiazepoxide (20-40mg QDS reducing to 0 over 7-10 days)
  • long term can use acamprosate (anti-craving, neuroprotective), naltrexone (decreases reward from alcohol), disulfiram (hangover as soon as alcohol consumed)
64
Q

opiate withdrawal

A

o Start at 6h, peak at 36-72h
o In order of onset - Anxiety, craving, yawn, sweat, abdo pain, dilated pupils, aches, nausea and vomiting, diarrhoea
o Unpleasant but generally not dangerous

65
Q

opiate overdose symptoms and treatment

A

o Decreased consciousness, respiratory distress/arrest, pinpoint pupils
o Treat with naloxone – opiate antagonist, shorter half-life than opiates so need repeated doses or infusion

66
Q

treatment for opiate withdrawal

A
  • methadone (long acting opiate on reducing regime)
  • buprenorphine (partial agonist)
  • naltrexone (opiate antagonist to stop relapse)
67
Q

benzodiazepine misuse

A
  • Anxiolytic effect, resp depression
  • Risk of seizures on withdrawal
  • Gradual reduction over months
68
Q

stimulant misuse (cocaine, amphetamines)

A
  • Euphoria, increased energy, weight loss, exacerbates psychosis
  • Not dangerous in withdrawal
  • Lethargy/depression on withdrawal
69
Q

cannabis misuse

A
  • may cause/exacerbate psychosis
  • not dangerous on withdrawal
  • heavy long term use causes depression, anxiety, memory problems
70
Q

solvent/inhalant misuse

A
  • similar effect as alcohol
  • Very risky – laryngospasm due to cold temp, brain damage, hypoxia
71
Q

symptoms of depression

A
  • Sustained low mood
  • Reduced energy, motivation, anhedonia
  • Poor concentration and memory, thoughts and speech slowed down
  • Poor sleep – early morning waking
  • Diurnal mood variation – feel worst on waking and gradually improve
  • Cognitive distortions – worthlessness, hopelessness, guilt
  • Suicidal ideation/attempt
  • Psychotic symptoms – mood congruent, derogatory auditory hallucinations, delusions of guilt, nihilistic delusions (not existing any more), persecutory delusions
72
Q

ICD10 classification of mild/moderate/severe depression

A
  • Mild – 2/3 symptoms, managing most activities
  • Moderate – 4+ symptoms, only managing essential activities
  • Severe – with or without psychotic symptoms, multiple and marked symptoms, almost all activities impossible
73
Q

treatment of depression

A

mild- counselling/CBT/exercise etc
moderate - CBT, SSRI/SNRI
severe with psychotic symptoms - antidepressant + atypical antipsychotic (olanzapine), ECT

74
Q

Cotard’s syndrome

A
  • believes part/whole body is dead/non-existent
  • severe depression and psychotic disorders
75
Q

treatment of postnatal depression

A

psychotherapy, antidepressants (paroxetine or sertraline)

76
Q

postnatal psychosis and treatment

A
  • develops in first few weeks
  • normally inpatient with meds (antipsychotics, mood stabilizers, benzodiazepines) – may need to stop breastfeeding, ECT
77
Q

bipolar disorder

A

Periods of depression and mania – must have two discrete mood episodes, at least one of which must be manic or hypomanic

78
Q

types of bipolar

A
  • Type 1 (more common) - >7 days mania and depression
  • Type 2 - >4 days hypomania and depression
79
Q

mania

A

elated, irritable, increased energy, reduced need for sleep, distractible, pressured speech, grandiose, reckless, impacts functioning, poor insight

80
Q

what psychotic symptoms are typical of mania

A

Grandiose delusions, Delusions of reference
Auditory hallucinations usually confirming grandiose beliefs

81
Q

hypomania

A
  • like mania but continues to function
  • partial insight
  • no psychotic symptoms
82
Q

management of acute mania

A

atypical antipsychotic (olanzapine/quetiapine)
sodium valproate
+/- benzodiazepines

83
Q

treatment of bipolar disorder

A

mood stabilisers (lithium, valproate, carbamazepine), atypical antipsychotic, CBT, psychoeducation

84
Q

schizophrenia

A
  • interpret reality abnormally – combination of hallucinations, delusions, and extremely disordered thinking and behaviour that impairs daily functioning.
  • degenerative (need lifelong treatment)
85
Q

pathophysiology of schizophrenia

A
  • Increased dopamine in mesolimbic pathway produces psychotic positive symptoms
  • Decreased dopamine affects in mesocortical pathway produces negative symptoms
86
Q

first rank symptoms of schizophrenia

A
  • auditory hallucinations (third person, thought echo, commentary voices)
  • thought disorder
  • passivity phenomena
  • delusional perceptions
87
Q

second rank symptoms of schizophrenia

A
  • other delusions/hallucinations
  • breaks in thought fluency
  • catatonic behaviour
  • negative symptoms (apathy, blunted emotions, social withdrawal)
88
Q

Diagnostic criteria for schizophrenia

A
  • 1 1st rank or 2 2nd rank symptoms acutely for 1m with evidence of disturbed functioning for 6m
89
Q

bio/psycho/social treatment of schizophrenia

A

BIO - antipsychotics (block dopamine)
PSYCHO - CBT/DBT/psychoeducation/familt therapy
SOCIAL - housing/employment/social activities

90
Q

what is schizoaffective disorder

A

disorder with combination of schizophrenia and mood disorder symptoms

91
Q

types of schizoaffective disorder

A
  • bipolar type - includes episodes of mania and depression
  • depressive type - only major depressive episodes
92
Q

what is somatisation disorder and the treatment

A
  • extreme focus on symptom which is causing significant distress and problems functioning
  • CBT/psychotherapy
93
Q

stages of attachment

A
  1. pre-attachment (<3m)
  2. indiscriminate (6w-7m)
  3. discriminant (7-11m)
  4. multiple (>9m)
94
Q

4 patterns of attachment

A
  • ambivalent attachment (result of poor parental availability)
  • avoidant attachment (abuse/neglect from carer)
  • disorganised attachment (inconsistent carer behaviour)
  • secure attachment
95
Q

cluster A personality disorders

A
  • paranoid PD (excessive distrust)
  • schizoid PD (blunted emotions, preferes being alone)
  • schizotypal PD (unusual/magical thinking, self-centred)
96
Q

cluster B personality disorders

A
  • antisocial (outwardly normal, hidden hostility, ‘psychopath’)
  • borderline/EUPD (unstable mood, fear of abandonment, self-destructive impulses)
  • histrionic PD (attention seeking, maipulative, shallow, tantrums)
  • narcissistic (grandiose, arrogant, lacks empathy, exploits others)
97
Q

cluster C personality disorders

A
  • avoidant (shy, social inhibition, hypersensitive to rejection)
  • obsessive compulsive (happy being way they are)
  • dependant
98
Q

typical/first generation antipsychotics

A
  • Block D2 receptors – only treat high dopamine (positive symptoms)
  • Extrapyramidal side effects (parkinsonism)
  • Haloperdol (5-20mg), Zuclopentixol (20-50mg) and chlorpromazine (75-300mg)
99
Q

atypical/second generation antipsychotics

A
  • Block D2 receptors and serotonin (5HT2a) receptors in nigrostriatal pathway (increases dopamine in that pathway so treats positive and negative symptoms)
  • Metabolic SE such as weight gain
  • Olanzapine, Quetiapine, Aripiprazole (dopamine partial agonist- least side effects but only works in mild cases)
  • Clozapine: Only licensed for treatment resistant schizophrenia
100
Q

clozapine

A
  • only licenced for treatment resistant schizophrenia
  • risk of fatal agranulocytosis - regular blood monitoring (before, 1 weekly for 18w then every 2w)
  • probably most effective but can’t be given as depot
101
Q

neuroleptic malignant syndrome

A
  • emergency
  • acute onset of symptoms usually within 10d of antipsychotic treatment
102
Q

features of neuroleptic malignant syndrome

A

o CNS- fluctuating consciousness, stupor
o Autonomic- hyperreflexia, unstable BP, bradycardia, excessive sweating, salivation, urinary incontinence
o Motor- muscular rigidity, dysphasia, dyspnoea
o Lab results- Raised WBC, raised CPK
o Complications- Pneumonia, cardiovascular collapse, thromboembolism, renal failure

103
Q

management of neuroleptic malignant syndrome

A

o Stop drug
o Maintain fluid balance
o Diazepam for muscle rigidity
o Dantrolene for malignant hyperthermia – muscle relaxant
o Bromocriptine (dopamine agonist)

104
Q

acute dystonic reaction

A
  • can be caused by antipsychotics (mostly typicals)
  • oculogyric crisis (up and out eyes), torticollis (head held to one side), opisthotonos (painful forced extension of neck, possibly back arch too), macroglossia, trunk spasticity
  • can cause laryngospasm
  • stop med and give slow IV anticholinergic benztropine
105
Q

SSRIs

A

-Block serotonin reuptake receptors (5HT)
-Citalopram (risk of QT prolongation), escitalopram, fluoxetine, fluvoxamine, paroxetine (increases risk of congenital malformation during pregnancy) and sertraline (safe post-MI)
- need PPI if taking SSRI and NSAID

106
Q

SNRIs

A
  • Inhibit presynaptic reuptake of both serotonin and norepinephrine
  • Venlafaxine and duloxetine
107
Q

tricyclic antidepressants

A
  • Inhibit presynaptic reuptake of both serotonin and norepinephrine
  • Competitive antagonists of post-synaptic alpha cholinergic (alpha1 and alpha2), muscarinic, and histaminergic receptors (H1)
  • amitriptyline, nortriptyline
  • SE - cant see, pee, spit, shit (seizures in overdose)
108
Q

monoamine oxidase inhibitors

A
  • inhibit MAO enzyme (metabolised neurotransmitters when renters presynaptic neuron)
  • old antidepressant not really used
  • strict dietary restrictions and drug interactions
109
Q

serotonin syndrome

A
  • excess serotonin in CNS
  • often precipitated by the use of serotoneric drugs (often two or more): SSRIs, SNRIs, MAOIs, TCAs, amphetamines, tramadol, cocaine, MDMA
110
Q

symptoms of serotonin syndrome

A

o Cognitive: headaches, agitation, hallucinations, coma
o Autonomic: sweating, shivering, tachycardia, hypertension, nausea, diarrhoea.
o Somatic: myoclonus, hyperreflexia (clonus), tremor

111
Q

treatment of serotonin syndrome

A
  • remove causative agent
  • supportive (fluids, benzo etc)
  • cyproheptadine (serotonin antagonist) if severe
112
Q

comparison between serotonin syndrome and neuroleptic malignant syndrome

A
113
Q

benzodiazepines

A

Safe for short-term use but long-term use causes tolerance, dependence and adverse effects

114
Q

mechanism of benzodiazepines

A

increase GABA in CNS – open GABA-activated chloride channels – negative charge in neurons make them more resistant to excitation – decreases neuron activity causing sedative/anxiolytic effect

115
Q

4 types of drugs used as anxiolytics

A

all habit forming and addictive
- benzos
- barbiturates (stronger than benzos)
- non-benzo drugs (also target GABA, zopiclone)
- beta blockers (relive symptoms, propranolol not addictive)

116
Q

lithium for mood stabilisation

A
  • most effective (treats both mania/depression)
  • fine tremor, sedation, lethargy, GI, weight gain, hypothyroidism
  • regular blood tests (U&E, TFT, Ca every 6m, serum level after 1w then every 3m)
117
Q

lithium toxicity

A
  • levels >1.5mmol/L
  • Nausea, vomiting, diarrhoea, confusion, excessive sleeping, seizures, myoclonic jerks and coarse tremor
  • causes: dehydration (hot weather), changes in salt, reduced renal function, meds)
  • STOP lithium, rehydrate, consider haemodialysis
118
Q

anti-convulsants for mood stabilisation

A
  • sodium valproate (both mania/depression)
  • carbamazepine (not licenced)
  • lamotrigine (only depressive symptoms)
  • blood tests FBC, LFT every 6m
119
Q

HYPNOTICS

A
  • zopiclone 7.5mg at night for up to 4w
  • addictive
  • agonist at GABA receptors
120
Q

stimulants used medically

A
  • for ADHD and narcolepsy
  • increases dopamine and norepinephrine
  • not habit forming in the small doses used
  • amphetamines etc
121
Q

rapid tranquilisation steps

A
  1. Verbal de-escalation
  2. Offer oral lorazepam 1-2mg
  3. Lorazepam 1-2mg IM (takes 30 mins to work) – half dose in adolescent/elderly
  4. Repeat every 30-60minutes
  5. Be-aware benzo induced respiratory depression (Flumazenil)
122
Q

ELECTROCONVULSIVE THERAPY

A
  • under short acting GA
  • triggers brief seizure that changes chemistry in brain
  • highly effective after full course (2/3x weekly for 3/4w)
  • mostly for severe depression and bipolar disorder
123
Q

CBT

A

Identify troubling situations or conditions - thoughts, emotions and beliefs about these problems - identify negative or inaccurate thinking - reshape negative or inaccurate thinking
- 1st wave – behaviour therapy
- 2nd wave – cognitive therapy
- 3rd wave – mindfulness and acceptance/coping techniques

124
Q

cognitive analytical therapy

A

depression and emotional disorders
coping mechanisms

125
Q

eye movement desensitisation and reprocessing

A
  • PTSD
  • series of bilateral (side-to-side) eye movements as you recall traumatic or triggering experiences in small segments, until those memories no longer cause distress

Phase 3A (6 decks)

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