Psychiatry Flashcards

Question

What are the 3 core symptoms of depression?

Answer 1

Low mood Anhedonia: low interest or pleasure in most activities of the day Lack of energy (anergia)

Answer 2

Weight change: exclusion of intentional dieting Disturbed sleep: insomnia or hypersomnia Psychomotor retardation (slowed down actions) or psychomotor agitation (increased restlessness) Reduced libido Worthlessness or guilt feelings Decreased concentration Recurring thoughts of harm, death or suicide: nihilistic thoughts

Answer 3

Anhedonia Loss of emotional reactivity Diurnal mood changes: mood often worse in the morning Early morning wakening: typically 2-3 hours earlier than usual Psychomotor retardation or psychomotor agitation Appetite loss Weight loss

Answer 4

if present, these are usually mood-congruent and may include: Delusions: often revolving around guilt and personal inadequacy Hallucinations: can be auditory, olfactory or visual

Answer 5

Substance/medication use Bipolar affective disorder Premenstrual dysphoric disorder Bereavement Anxiety disorders Alcohol-use disorder Physical health illness or organic illness differentials include: - Hypothyroidism - Cushing’s disease or syndrome - Vitamin B12 deficiency

Answer 6

Screening tool = PHQ-9 Risk assessment to self, others and from others Exclude organic causes if indicated: - Full blood count: anaemia - Thyroid function test: hypothyroidism (elevated thyroid stimulating hormone) - Vitamin B12: vitamin b12 deficiency - Imaging and other investigations (e.g. a CT head) may be performed in patients with atypical features and signs indicative of an organic pathology

Answer 7

First-line management should involve initiating primarily low-intensity psychosocial interventions. Antidepressants should not be routinely offered unless that is the patient’s preference. Exceptional cases to consider starting on biological therapy (i.e. antidepressants) include: Past history of moderate or severe depression Presence of mild depression that has been present for at least 2 years Presence of mild depressive symptoms after other interventions

Answer 8

Risk assessment Ongoing review: response to low-intensity psychosocial intervention, compliance and symptoms. An SSRI antidepressant should provide benefit within 4-6 weeks. Measurement scales to assess response to treatment and quality of life Relapse prevention plan Assess for social support, and review previous issues flagged up during consultations If taking antidepressant therapy review compliance, side effects and adjust doses if appropriate

Answer 9

may include a combination of antidepressant therapy (biological treatment) and high-intensity psychosocial interventions. Combination of individual CBT and an antidepressant (e.g. SSRI) Individual CBT Individual behavioural activation Antidepressants (e.g. SSRI) alone Individual problem-solving Counselling Short-term psychodynamic psychotherapy Interpersonal psychotherapy Guided self-help Group exercise

Answer 10

If presenting with psychotic symptoms, then treatment should be augmented with an antipsychotic (quetiapine or olanzapine). Electroconvulsive therapy (ECT) should be considered in severe cases of depression where: The patient has a strong preference for ECT: this usually applies when patients have responded to ECT well before Rapid treatment of the patient is needed: cases of life-threatening depression where the patient is not eating or drinking Multiple other treatments have been trialled unsuccessfully

Answer 11

SSRIs like citalopram will be offered first line. Sertraline may be used in co-morbid patients as it has fewer drug-drug interactions Fluoxetine is first line in kids General rule is that antidepressants should be continued for 6 months minimum unless there are adverse effects. When stopping, they need to be tapered off.

Answer 12

avoid certain antidepressants in patients with suicide risk or a history of overdose (e.g. tricyclics, venlafaxine).

Answer 13

Bipolar disorder is a cyclical mood disorder that fluctuates between episodes of mania/hypomania and depression. Bimodal incidence, peaks from 15-24 and 45-54. Same incidence in men and women. Likely to be comorbid with other mental health issues and increases risk of physical conditions such as CV disease.

Answer 14

Genetic - Having a 1st degree relative with bipolar increases your risk of depression, bipolar and schizoaffective disorders. Heritability is around 60% in monozygotic twins and around 20% in dizygotic twins. Environmental - nothing specific just the same predisposers of all mental health conditions. Negative life events can trigger an episode in someone with bipolar. Neurobiological - Increased dopaminergic signalling, disturbance of the HPA axis leading to higher cortisol and corticosteroid use all linked to mania

Answer 15

Genetic factors Prenatal exposure to Toxoplasma gondii (the parasite that causes toxoplasmosis) Premature birth <32 weeks gestation Childhood maltreatment Postpartum period Cannabis use

Answer 16

In bipolar I, the person has experienced at least one episode of mania In bipolar II, the person has experienced at least one episode of hypomania, but never an episode of mania. They must have also experienced at least one episode of major depression.

Answer 17

Elevated mood Increased energy resulting in overactivity, pressure of speech, and a decreased need for sleep Inability to maintain attention, often with marked distractibility Self-esteem which is often inflated with grandiosity and increased confidence Loss of normal social inhibitions Mood congruent psychotic symptoms The manic episode should last for at least seven days and have a significant negative functional effect on work and social activities

Answer 18

Persistent, mild elevation of mood Increased energy and activity, usually with marked feelings of wellbeing Increased sociability, talkativeness, over-familiarly, increased sexual energy and a decreased need for sleep Irritability may be present Absence of psychotic features Should last for at least 4 days

Answer 19

Refers to chronic mood disturbance with depression and hypomania symptoms that do not meet the criteria for a full episode

Answer 20

- Mental health disorders: schizophrenia, unipolar depression, personality disorder or anxiety disorder. - Substance misuse: cocaine, ecstasy or amphetamines - ‘Organic’ causes: thyroid disorder, multiple sclerosis, Cushing’s, Addison’s, cerebrovascular disease, dementia, epilepsy, SLE, encephalitis. - Iatrogenic causes: antidepressants, corticosteroids, levodopa or dopamine agonists.

Answer 21

Trial of oral antipsychotics: Haloperidol Olanzapine Quetiapine Risperidone If on antidepressant medication, this should be tapered off and discontinued. Benzodiazepines may be used as an adjunct to manage symptoms of increased activity and allow for better sleep.

Answer 22

Antidepressants can induce mania or rapid cycling so different to the manangement in unipolar derpression. Fluoxetine + olanzapine Quetiapine alone Olanzapine alone Lamotrigine alone

Answer 23

Mood stabilising medication such as lithium. If lithium is not effective, sodium valproate may be added but this is highly teratogenic. Structured psychotherapy is also important.

Answer 24

Obsessive compulsive disorder is characterised by the presence of obsessions and/or compulsions. Obsessions: intrusive thoughts, urges and images that cause anxiety and distress. Compulsions: repetitive behaviours that one feels compelled to perform, these may be observable or occur in the mind (e.g. repeating a phrase).

Answer 25

- intrusive unwanted anxiogenic thoughts - patients typically recognise these are irrational thoughts - repetitive behavioural or mental acts to neutralise anxiety caused by obsessions - compulsions give brief relief and are self-enforcing - higher frequency of compulsions related to treatment resistance - concomitant schizotypal personality disorder and Tic disorder related to worse outcomes

Answer 26

Body dysmorphic disorder (BDD) Body-focused repetitive behaviour disorders (ie. trichotillomania, dermatillomania) Hypochondriasis (health anxiety disorder) Hoarding disorder

Answer 27

Do you wash or clean a lot? Do you check things a lot? Is there any thought that keeps bothering you that you would like to get rid of, but cannot? Do your daily activities take a long time to finish? Interference of over an hour a day Are you concerned about putting things in a special order, or are you upset by mess? Do these problems trouble you?

Answer 28

Do risk assessment and screen for other MHx Mild - refer for low-intensity CBT with Exposure and Response Prevention (ERP) is commonly offered. Moderate - offer intensive CBT with ERP or an SSRI. Clomipramine may be used as second-line therapy. Severe - refer for specialist input. Consider an SSRI (e.g escitalopram) combined with CBT in the interim. Clomipramine may be used as second-line therapy.

Answer 29

Yale Brown Obsessive Compulsive Scale Should be used on patients about to start treatment for OCD and then every 6 months after that to track

Answer 30

A disorder that may develop following exposure to a stressful event or a situation of exceptionally threatening or catastrophic nature. It is thought to result from impaired memory consolidation of experiences too traumatic to be processed normally, which leads to a chronic hyperarousal of fear circuits.

Answer 31

Traumatic events, DV, bullying, natural disaster, torture, terrorism, combat, traumatic brain injury, sudden death of loved one, sexual assault, multiple major stressors, lack of social support, history of substance abuse or mental health disorders

Answer 32

HARD: - Hyperarousal: persistently heightened perception of current threat (may include enhanced startle reaction) - Avoidance of situations/activities reminiscent of the events, or of thoughts/memories of the events - Re-experiencing the traumatic events (vivid intrusive memories, flashbacks, or nightmares). - Distress: strong/overwhelming fear and physical sensations when re-experiencing Also, impaired memory of event, anhedonia, detachment from others, irritable/outbursts, reckless behaviour, exaggerated startle response, depression and anxiety, substance misuse

Answer 33

ASR is usually less than a month after an event

Answer 34

PTSD checklist DSM-V, there are military, civillian or specific ones

Answer 35

Mild/moderate = ACS active monitoring Severe = 1) Trauma-focused CBT OR Eye-Movement Desensitization and Reprocessing (EMDR) therapy with SSRI OR venlafaxine (possible adjunctive antipsychotic) Plus psychoeducation/sleep hygiene/ relaxation etc. as above.

Answer 36

Personality disorder (PD) is an umbrella term that covers a number of variations of maladaptive personality traits that are lifelong, persistent, deeply ingrained maladaptive behaviours that characterises an individual, deviate markedly from culturally expected or accepted ‘normal’ range and have an onset in late childhood or early adolescence

Answer 37

Cluster A - Odd/Eccentric Cluster B - Dramatic/Emotional Cluster C - Fearful/Anxious

Answer 38

Odd and Eccentric - Paranoid - Schizoid - Schizotypal

Answer 39

Suspicious of others Unforgiving Spouse Infidelity Perceives attack Envious Cold affect/Criticism poorly taken Trust in others reduced

Answer 40

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. Flattened affect, indifferent, low sex drive, little pleasure taken in activities

Answer 41

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.

Answer 42

Dramatic/Emotional - Antisocial - Borderline - Histrionic - Narcissistic

Answer 43

Characterised by a patterns 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

Answer 44

Pattern of abrupt mood swings, unstable and intense relationships and instability in self-image Self harm is common, recurrent suicidal feelings Relationships alternate between idealization and devaluation (splitting) Inability to control temper and general affect Chronic feeling of emptiness

Answer 45

Characterised by provocative/attention seeking behaviours and excessive displays of emotions Often sexually inappropriate Vain/Shallow and self-dramatising Relationships are considered to be more intimate than they really are Easily influenced

Answer 46

Involves a pattern of grandiosity, need for admiration of others and a lack of empathy Has a sense of entitlement and will take advantages of others to achieve their own wants Arrogant and preoccupied by their own fantasies and desires

Answer 47

Involves strong feelings of inadequacy and fear of social situations where they may be criticised Patients are extremely sensitive to criticism Often self impose isolation while craving acceptance and social contact

Answer 48

Characterised by an intense psychological need to be cared for by others Lack initiative and need others to make decisions on their behalf Urgently search for new relationships as soon as one ends to provide care and support

Answer 49

A personality disorder in which the individual is occupied with control, it is NOT associated with recurrent, intrusive thoughts unlike the classical "OCD" Signs include: strict cleaniness, perfectionism It is often at the detriment of social/leisure activities Symptoms are often persistent and without distress

Answer 50

Has to be over 18 Standardised Assessment of Personality Abbreviated Scale (SAPAS) Millon Clinical Multiaxial Inventory III - MCMI-III Suicide Risk MRI/CT, urine and bloods - Pattern manifests in 2 or more areas: Cognition, Affectivity, Interpersonal Functioning, Impulse Control - The enduring pattern is inflexible and pervasive across a broad range of personal/social situations AND causes significant distress or impairment in social, occupational or other important areas of functioning

Answer 51

- Cognitive behavioural therapy (CBT) and psychoeducation is the key management option of choice. - Dialectical behaviour therapy for EUPD - Psychodynamic psychotherapy - Supportive care can be provided during crises to help keep the patient safe. - There are no medical treatments recommended for personality disorders

Answer 52

S – Do you make yourself SICK because you feel uncomfortably full? C – Do you worry you have lost CONTROL over how much you eat O – Have you recently lost more than ONE STONE (6kgs) in a three month period F – Do you believe yourself to be FAT when other say you are thin? F – Would you say FOOD dominates your life?

Answer 53

Anorexia Nervosa is a disorder characterised by deliberate weight loss, induced and sustained by the patient. There must be clear concerns from the individual regarding their weight and shape, with a fear of becoming fat as an intrusive overvalued idea. Patients may have weight or calorie goals in mind and are often determined to achieve this no matter what, and regardless of the impact on their physical health.

Answer 54

Female gender Age (most commonly affects adolescents and young people) Family history of eating disorders, depression, or substance abuse Previous criticism of eating habits and weight Increased pressures to be slim (e.g. ballet dancers, models, athletes) History of sexual abuse Low self-esteem Obsessive personality Emotionally unstable personality disorder

Answer 55

Excessive weight loss Amenorrhoea Lanugo hair is fine, soft hair across most of the body Hypokalaemia Hypotension Hypothermia Changes in mood, anxiety and depression Solitude Cardiac complications include arrhythmia, cardiac atrophy and sudden cardiac death.

Answer 56

Hypokalaemia Low sex hormone levels (FSH, LH, oestrogen and testosterone) Raised growth hormone and cortisol levels Hypercholesterolaemia

Answer 57

MEEDs- Medical Emergencies in Eating Disorders MARSIPAN is outdated

Answer 58

reduce energy expenditure with minimal calorie intake, bradycardia and hypotension are commonly seen, as well as a prolonged QT interval. A prolonged QT interval increases the risk of a fatal arrhythmia such as Ventricular Fibrillation.

Answer 59

Restriction of energy intake relative to requirements leading to a significantly low weight in the context of age, sex, developmental trajectory, and physical health Intense fear of gaining weight or persistent behaviour that interferes with weight gain, even though at a significantly low weight Disturbance in the way in which one's body weight or shape is experienced, undue influence of bodyweight or shape in self-evaluation, or persistent lack of the recognition of the seriousness of the current body weight.

Answer 60

Mild: BMI ≥17 kg/m² Moderate: BMI 16-16.99 kg/m² Severe: BMI 15-15.99 kg/m² Extreme: BMI <15 kg/m².

Answer 61

FBC - shows neutropenia before anaemia U+E - metabolic changes TFT - Thyroxine abuse ESR - Exclude infection Hormones

Answer 62

Rapid weight loss, failure of outpatient treatment, marked change in mental status, psychosis, hight risk of suicide or serious physiological change such as: T<36 BPM<40 Hypotension Raised LFTs

Answer 63

Encourage weight gain Psychoeducation and therapy: SSCM, MANTRA or CBT-E

Answer 64

- Eating must be in a discrete period of time and must be of an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. - There must be a sense of lack of control over the eating during the episode. - There is recurrent inappropriate compensatory behaviour to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; excessive exercise. - The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months. - Self-evaluation is unduly influenced by body shape and weight. - The disturbance does not occur exclusively during episodes of anorexia nervosa.

Answer 65

Alkalosis, due to vomiting hydrochloric acid from the stomach Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers Gastro-oesophageal reflux and irritation Calluses on the knuckles where they have been scraped across the teeth. This is called Russell’s sign.

Answer 66

Same as AN ECG - look for tall P, flat T - hypoK

Answer 67

CBT + Fluoxetine, interpersonal psychotherapy, family therapy if under 18

Answer 68

Binge eating disorder is characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight. Binges may involve: - A planned binge involving “binge foods” - Eating very quickly - Unrelated to whether they are hungry or not - Becoming uncomfortably full - Eating in a “dazed state”

Answer 69

Refeeding syndrome occurs in people that have been in a severe nutritional deficit for an extended period, when they start to eat again. Patients are at higher risk if they have a BMI below 20 and have had little to eat for the past 5 days. The lower the BMI and the longer the period of malnutrition, the higher the risk. As the starved cells start to process glucose, protein and fats again they use up magnesium, potassium and phosphorus. This shift in nutrients from extracellular to intracellular causes Hypomagnesaemia, Hypokalaemia, Hypophosphataemia These patients are also at risk of cardiac arrhythmias, heart failure and fluid overload.

Answer 70

- Slowly reintroducing food with restricted calories - Magnesium, potassium, phosphate and glucose monitoring along with other routine bloods - Fluid balance monitoring - ECG monitoring - Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine

Answer 71

Delirium refers to an acute confusional state that causes disturbed consciousness, attention, cognition & perception. Delirium is characterised by: - Acute onset (hour to days) - Fluctuating symptoms (alters throughout the day) - Disturbance in awareness and attention (reduced awareness, distractible) - Disturbance in cognition (e.g. memory, language, disorientation) - Evidence of an organic cause (e.g. medical condition, medication, intoxication)

Answer 72

Hyperactive delirium: characterised by inappropriate behaviour, agitation or hallucinations. Wandering and restlessness are common Hypoactive delirium: characterised by reduced activity. Patients may appear quiet, lethargic, withdrawn and have reduced concentration Mixed delirium: characterised by the presence of both hypoactive and hyperactive features

Answer 73

Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment

Answer 74

- Abnormal consciousness: Reduced level of awareness and focus, drowsy or semicomatose, hyperactive - Abnormal cognition: Memory loss, disorientation (e.g. to place, person or time), poor language (e.g. loss ability to speak a second language), poor speech - Abnormal thinking: Distractible and inattention (e.g. unable to follow commands), disorganised thinking (e.g. poor flow of ideas, disorganised speech, unable to express their needs) - Abnormal perception: Visual or auditory hallucinations, paranoid delusions, misperception - Other features: Labile changes in mood (e.g. irritable, paranoid, fear, depression), agitation, sleep-cycle disturbances, hypersensitive (light/sound)

Answer 75

Confusion Assessment Method (CAM) The 4A’s test (4AT) Abbreviated mental test (AMT)

Answer 76

Features supportive of dementia: changes are slowly progressive with limited fluctuation. Attention is usually in tact and very early memories may be preserved (i.e. short term memory more affected). Features supportive of delirium: changes are acute, transient and usually reversible. There is often an associated acute illness.

Answer 77

- Bedside: Observations, ECG, Cultures: sputum, urine, stool, Capillary blood glucose - Bloods: FBC, U+E, LFT, Bone profile, Ca2+, HbA1c, B12, Folate, TFT, CRP, ESR, Drugs, Syphilis - Imaging: CXR, CT head, Echo

Answer 78

- Mental Capacity Act - Treat underlying cause/co-morbidities - Environmental management - Minimise sensory deficits - glasses/hearing aids - Agitation can be managed with haloperidol (0.5-1.0mg PO) or lorazepam (0.5-1.0mg PO), however, they should be avoided as they may worsen or prolong delirium.

Answer 79

Alzheimer's Vascular

Answer 80

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that causes significant deterioration in mental performance. This leads to impairment in normal social and occupational function. It's caused by a build up of amyloid protein deposits around brain cells and tau protein tangles within brain cells.

Answer 81

- Cognitive impairment: poor memory, disorientation, language problems - Behavioural and psychological symptoms of dementia (BPSD): agitation, depression, sleep cycle disturbance, motor disturbance - AD is characterised by early impairment of memory. This manifests as short-term memory loss and difficulty learning new information - Activities of daily living: an increasing reliance on others for assistance, problems with high-level functioning (e.g. work, finance), problems with basic personal care

Answer 82

Mild-to-moderate AD: acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine). Moderate-to-severe AD: N-methyl-D-aspartic acid receptor antagonist (e.g. memantine). May be used in combination with acetylcholinesterase inhibitors.

Answer 83

- Assess capacity - Advanced care planning - Treat concurrent mood disorders - Inform DVLA - Programmes to improve/maintain cognitive function (e.g. structured group cognitive stimulation programmes). Also exercise, aromatherapy, therapeutic use of music/dancing, massage. - End of life care

Answer 84

Vascular dementia is a result of multiple infarcts in the brain tends to present with sudden onset cognitive decline and stepwise deterioration in someone with previous cardiovascular illness or events, as a result of the developing infarcts. Any condition that affects the brain parenchyma by impairing cerebral blood flow (i.e. ischaemia) or causing haemorrhage can lead to vascular cognitive impairment, and therefore, VD.

Answer 85

- Can be Post-stroke or Vascular dementia without recent stroke: - Cognitive impairment: poor memory, disorientation, language problems - Behavioural and psychological symptoms of dementia (BPSD): agitation, depression, sleep cycle disturbance, motor disturbance - VD is characterised by a ‘stepwise’ decline in function. There are predominant gait abnormalities, attention, and personality changes. May have focal neurological signs (e.g. due to previous stroke) - Activities of daily living compromised

Answer 86

Routine bloods, MRI Head, other tests if indicated: ECG Virology (e.g. HIV) ECHO (e.g. if suspected heart failure or coronary artery disease) Syphilis testing CXR

Answer 87

Lewy body dementia, is a common subtype of dementia that is characterised by the histopathological findings of intracytoplasmic inclusions known as Lewy bodies that contain alpha-synuclein. 3rd most common, M>F

Answer 88

Parkinson’s disease dementia: dementia occurring in the setting of established Parkinson’s disease. This is defined as having Parkinson’s disease for more than one year before the onset of dementia. Dementia with Lewy body: development of dementia and Parkinsonism concurrently. This is defined as developing dementia within one year of Parkinsonism features

Answer 89

DLB is characterised by: - Fluctuating cognition with pronounced variations in attention and alertness - Recurrent visual hallucinations that are typically well formed and detailed - REM sleep behaviour disorder, which may precede cognitive decline - One or more spontaneous cardinal features of parkinsonism (e.g. bradykinesia, rest tremor, rigidity) Severe sensitivity to antipsychotic agents Postural instability and repeated falls Syncope or other transient episodes of unresponsiveness Severe autonomic dysfunction (eg, constipation, orthostatic hypotension, urinary incontinence) Hypersomnia (i.e. excessive daytime sleepiness) Hyposmia (i.e. decreased sense of smell) Other symptoms are the same as other dementias

Answer 90

- Cholinesterase inhibitors (e.g. Rivastigmine, Donepezil): generally offered as first-line treatments - Memantine: often used in severe AD or VD but limited efficacy in DLB - Anti-psychotics (e.g. Quetiapine) generally reserved for severe, refractory behavioural symptoms - Melatonin: may be used in refractory REM sleep disorders - Levodopa: this is an antiparkinson medication that may be used for severe, disabling Parkinsonism features

Answer 91

Fronto-temporal dementia presents with cognitive impairment, personality change and disinbition, in keeping with the frontal area of the brain which is affected. Atrophy of the frontal and temporal lobes is seen. FTD shows a strong genetic predisposition. In 10-25% of cases, there is an autosomal dominant pattern of inheritance. In up to 40% of cases there is a family history of dementia or neuropsychiatric conditions without a clear inheritance pattern.

Answer 92

Disinhibition (e.g. socially inappropriate behaviour) Loss of empathy Apathy (losing interest and/or motivation) Hyperorality (e.g. dietary changes, attempt to consume non-edible products, eat beyond satiety) Compulsive behaviour (e.g. cleaning, checking, hoarding)

Answer 93

Effortful speech Halting speech Speech-sound errors Speech apraxia (i.e. difficulty in articulation) Word-finding difficulty Surface dyslexia or dysgraphia: mispronouncing difficult words (e.g. yacht)

Answer 94

- No disease modifying drugs - Might use SSRIs or atypical antipsychotics - Financial advice/lasting power of attorney - Supervision particularly if behaviour is problematic - Exercise and Mobility - Speech and language: assessment by a speech and language therapist is important with communication aids and swallow assessment in later stages of disease - Behavioural modification: variety of methods effective, keeping a behaviour chart can be useful and ensuring carers get respite.

Answer 95

A psychotic disorder characterised with delusions, hallucinations and thought disorder. Incidence is roughly the same in men and women but men tend to get it early (before 25) and women get it before 35. Pathophysiology and aetiology are poorly understood. Strong genetic links, stress diathesis model, obstetric complications, adverse childhood events, use of hallucinogens

Answer 96

General risk – 1% If sibling has condition – 9% If parent has condition – 13% If both parents have condition – 48% If monozygotic twin has it - 50% If dizygotic twin has it - 15%

Answer 97

Enlarged ventricles, small amounts of grey matter loss and smaller, lighter brains.

Answer 98

Paranoid schizophrenia Hebephrenic schizophrenia Catatonic schizophrenia Undifferentiated schizophrenia Residual schizophrenia Simple schizophrenia

Answer 99

A psychotic episode lasting at least a month with 1 of these: - Thought echo, thought insertion or withdrawal, or thought broadcasting. - Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception. - Hallucinatory voices 3rd party, running commentary on the patient's behaviour, or discussing or coming from some part of the body. - Persistent delusions of other kinds that are culturally inappropriate and completely impossible Or a psychotic episode lasting at least a month with 2: - Persistent hallucinations in any modality, when occurring every day for at least one month accompanied by delusions - Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech. - Catatonic behaviour - "Negative" symptoms

Answer 100

Thought echo (hearing your own thoughts out loud)* Thought insertion or withdrawal* Thought broadcasting* 3rd person auditory hallucinations* Delusional perception * Passivity and somatic passivity* Odd behaviour Thought disorder Lack of insight

Answer 101

Blunted affect Apathy Social isolation Poverty of speech Poor self-care

Answer 102

- Third person – talking about the individual who hears them. May be single or multiple voices. These are the most common type of auditory hallucination in schizophrenia. - Thought echo – the individual hears their thoughts spoken aloud, either simultaneously (as thinking the thought) or just afterwards. - Second person – talking to the individual – can still occur in schizophrenia, but also present in lots of other mental disorders.

Answer 103

The patient believes that their movements, emotions or will is being altered in a similar way to the thought issues, for examples, they believe their movements are being controlled.

Answer 104

The patient may burst out laughing or become very angry for no apparent reason, or they may have inappropriate emotional reactions – e.g. laughing at bad news.

Answer 105

- A state where the person may not respond to stimuli and exhibits strange physical behaviour. Can be associated with any mental health condition. Includes: - Stupor – the patient is unable to move or speak except for moving their eyes. - Strange postures – that are normally very difficult to hold - Negativism – the patient does the exact opposite of what they are asked - Automatic obedience - Waxy flexibility – the patient has strange muscle tone that allows the doctor to put the patient into physical position that would otherwise be very difficult and/or painful.

Answer 106

FBC, TFTs, U&Es, LFTs, CRP and a fasting glucose Urine culture: to rule out urinary tract infection causing delirium Urine drug screen: to rule out drug intoxication HIV testing if applicable Syphilis serology if applicable Serum lipids: before starting antipsychotics CT head: if an organic neurological cause is suspected

Answer 107

There are four stages to a CPA: Assessing health and social needs Creating a care plan Appointing a key worker to be the first point of contact Reviewing treatment

Answer 108

Fasting blood glucose HbA1c Blood lipid profile Prolactin levels

Answer 109

NICE does advise the use of clozapine if the patient has failed to respond adequately to 2 different antipsychotics (one of which is an atypical antipsychotic that is not clozapine).

Answer 110

Blockade of dopamine receptors (D2). Commonly used examples include haloperidol and chlorpromazine. They can cause a number of significant side effects. Extrapyramidal side effects may occur resulting in dystonia and tremor. Tardive dyskinesia, which refers to uncontrolled repetitive movements such as smacking lips together, may develop with prolonged use.

Answer 111

Block dopamine receptors (D2), and many act on serotonin receptors. Commonly used examples include clozapine and olanzapine. Extrapyramidal side-effects and tardive dyskinesia are less common, however, they are associated with significant weight gain and insulin resistance. Agranulocytosis and bone marrow suppression may occur.

Answer 112

2hrs 2500lux light in morning for 1-2 weeks Maintenance 30 mins 2500lux every 1-2days If light therapy does not help then trial an SSRI

Answer 113

Patients hold the delusional belief that their partner is cheating on them. Affects males more than females. They may be threatening towards their partner and stalk or have them followed.

Answer 114

In this delusional disorder, patients believe that parts of their own body are dead or decaying. Typically associated with severe depression and suicidal tendency.

Answer 115

Patients hold the delusional belief that a friend or relative (often their partner) has been replaced by an exact double.

Answer 116

Classically effects women. Patients believe that another individual (often a celebrity) is deeply in love with them, and is incapable of living without them.

Answer 117

Characterised by the subjective experience of visual hallucinations secondary to sight loss.

Answer 118

Edinburgh Postnatal Depression Scale (EPDS) PHQ9

Answer 119

SSRI + CBT Paroxetine, sertraline or citalopram - Lowest levels present in breast milk

Answer 120

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 121

MBU admission CBT Antipsychotics Mood stabiliser Antidepressants ECT

Answer 122

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 123

The presence of physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder. It is an unconscious process. Common presenting symptoms are gastrointestinal symptoms and abdominal pain, fatigue, weakness and musculoskeletal symptoms. Patients can present with inconsistent examination findings, strange neurological symptoms that don't conform to myotome/dermatome distribution.

Answer 124

A psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes). It is not an intentional process, and the symptoms are very much "real" to the patient. It is linked to emotional stress and usually after a precipitating event.

Answer 125

Patients have excessive concern that they will develop a serious illness despite a lack of evidence. Patients often demand unnecessary tests and investigations, and can be quite debilitated as a result of their constant worrying.

Answer 126

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 127

Patients with hypochondriasis typically have no or very few symptoms unlike Somatoform disorder where patients experience dramatic physical symptoms and experience a degree of disfunction.

Answer 128

Patients intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain) in order to adopt "the patient role".

Answer 129

Patients intentionally fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time. NOT a mental health problem.

Answer 130

A learning disability constitutes a condition which affects learning and intelligence across all areas of life. a learning difficulty constitutes a condition which creates an obstacle to a specific form of learning, but does not affect the overall IQ of an individual. E.g. Down's Syndrome = disability, dyslexia = difficulty, depression = MH e.g. Fragile X, Praeder Willi, Down's

Answer 131

Drowsiness Confusion Decreased respiratory rate Decreased heart rate Constricted pupils Track marks

Answer 132

drowsiness, impaired memory, slowed reflexes and motor skills, bloodshot eyes, increased appetite, dry mouth, increased heart rate and paranoia. Cannabis acts at cannabinoid receptors.

Answer 133

Labile mood Hallucinations Increased blood pressure Increased heart rate Increased temperature Sweating Insomnia Dry mouth LSD primarily acts at dopamine receptors.

Answer 134

Euphoria Increased blood pressure Increased heart rate Increased temperature Cocaine acts at dopamine receptors. Methamphetamine acts at TAAR1 (Trace Amine-Associated Receptor 1) receptors. Both increase the available amount of dopamine in the brain

Answer 135

Agitation Anxiety and irritability Muscle aches or cramps Chills Runny eyes Runny nose Sweating Hypersalivation Yawning Insomnia Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting Dilated pupils Piloerection Increased heart rate and blood pressure

Answer 136

alpha 2 receptor agonist Minimises symptoms of opiate withdrawl

Answer 137

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.