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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What’s the difference between bipolar 1 and 2?

A

Bipolar 1 will experience a full manic episode but bipolar 2 will experience a hypomanic episode

Bipolar 1 will have a major depressive
Bipolar 2 wont

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2
Q

What would you expect in a manic mental state exam

A

A: Flamboyantly dressed/ self neglect ( unkempt/dehydrated)
B: Overactive and hard to interview - may eat and drink greedily
S: High speech pressure, increased rate and amount, hard to interupt
M: Elated and angry mood and affect
Thought content: Inflated view, may have grandiose delusions
Form: Verbal associations, alliteration, clang association
P: Delusion either grandiose or persecutory/auditory
Insight absent

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3
Q

What is the ICD-10 Bipolar criteria

A

-

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4
Q

What are some differentials for bipolar?

A

Amphetamines, cocaine, schizophrenia

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5
Q

How do you treat bipolar?

A

Rapid access to support, consider MHA, education, review
Mood stabilisers:
- Lithium ( 0.4-1 mmol/L
- Anticonvulsants ( S.valporate, carbamazepine, lamotrigine )
- Anti psychotics in acute mania

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6
Q

What tests need to be carried out on a patient on lithium?

A

Renal function
TFT

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7
Q

What are the side effects lithium?

A

Leucocytosis
Insipid diabetes
Tremors
hypothyroidism
Increased urine
Mums! teratogenic

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8
Q

What do you see in lithium toxicity

A

Blurred vision
Coarse tremor
Muscle weakness
Ataxia
N and V
Hyperreflexia
Circulatory failure
oliguria
Seizures
Coma

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9
Q

How do you diagnose depression using ICD-10?

A

Major Symptoms:
Depressed mood
Anhedonia
Loss of energy

Minor:
Disturbed sleep
Lack of concentration
Low self confidence
Increased/ decreased appetite
Suicidal thoughts or actions
Slowing of movement or speech
Feelings of guilt, worthlessness or self reproach

2 major needed + 2 minor ( mild ) 3-4 ( moderate ) greater than 5 ( severe)

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10
Q

How do you treat mild/moderate depression?

A
  1. Low intensity psychological interventions
    -Individual CBT
    - Structured group activity
  2. High intensity psychological intervention and/or CBT
    - CBT with a proffesional
    -Interpersonal therapy
    - Couples therapy
  3. Consider different AD therapy or escalate

Skip to AD is its been over 2 years

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11
Q

Why are SSRI’s first line instead of TCA?

A

TCA are dangerous in an overdose ( lofepramine has best safety profile)

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11
Q

Why are SSRI’s first line instead of TCA?

A

TCA are dangerous in an overdose ( lofepramine has best safety profile)

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12
Q

What the different types of therapy?

A

CBT: A type of talking behaviours’ that changes the processes underpinning the thoughts and behaviours related to a patients on symptoms, 1-1 with a mental health individual or in a group

Interpersonal: Adresses communication between people

Behavioural Activation: Identifies depression loops to make small changes in lifestyle ( LINK BETWEEN ACTIVITES AND MOOD)

Mindfulness and meditation

Counselling: Focus on emotional processing and helps people find there own solutions

STPP: Difficult feelings in significant relationships and patterns

Individual problem solving: Goal orientated and structures, resolving current issues

Couples therapy: Relationship problems

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13
Q

What puts you at an increased risk for a depressive episode relapse?

A

History of recurrent episodes over the last 2 years
Incomplete response to treatment
Avoidance and rumination unhelpful coping styles
History of severe depression
Depression has functional impairment
Chronic Physical health
Mental health problems
Chronic physical health and mental health problems
Personal/social and environmental factors that are ongoing

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14
Q

What happens if a person has not responded after 4 weeks of AD’s?

A

Ask about:
- Any external factors, physical or mental health conditions
- adherence and side effects
-Review diagnosis and think about comorbid conditions
- Increasing dose and think about switching to a different class

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15
Q

What are some names and side effects of SSRI’s?

A

Sertraline, citalopram and fluoxetine
Nausea, indigestion, worsening sexual function, increases suicidal ideation, serotonin syndrome

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16
Q

What are some names and side effects of SNRI?

A

Venlafaxine and Duloxetine
V - Raised BP and is CI in heart disease
same as SSRI

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17
Q

What are some names and SE of TCA?

A

Amitryiptyline and Dosulepin
Dry mouth, tachycardia, constipation, sleepiness, weight gain and worse in an overdose

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18
Q

What are some names and SE of MAO-I?

A

Phenelzine and moclobemide
Can cause high BP if taken with tyramine found in cheese, meats and broad beans

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19
Q

What is an atypical antidepressant?

A

Mirtazipine - drowsy and weight gain

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20
Q

What are some risk factors for suicide?

A

Alcohol or substance misuse
Bipolar
Personality disorder
Previous attempts
Physical or sexual abuse
Possession of firearms
Incarceration
Chronic Pain
Isolation
Age
Depression
Violent methods
Physical health problems
High risk employment
Bereavement
Relationship changes

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21
Q

What are some warning sines of suicide?

A

Obsessive thoughts surrounding death
Feelings of hopelessness, worthlessness and helplessness
Final acts - financial affairs, saying goodbye, writing wills

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22
Q

What are some examples of protective factors?

A

Supportive relationships
Children
Pets
Religion
Coping

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23
Q

How do you manage self harm risk?

A

No immediate risk - refer to crisis and home treatment
Mental health disorder of severity requiring management - community mental health or CAMHS
High Risk: if they decline - MHA and admit inpatient

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24
Q

What are some risk factors for EUPD?

A

Family history of BPD, bipolar or addiction
Brain development - amygdala, hippocampus, orbitofrontal cortex
Emotional, physical or sexual abuse
Exposed to fear or distress as a child
neglect

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25
Q

What are some symptoms of BPD?

A

Emotional Instability - Affective dysregulation
Disturbed patterns of thinking or perception - cognitive distortions or perceptual distortions
Impulsive behaviour
Intense and unstable relationships with others

Severe mood swings over short time periods e.g. suicidal then positive
low self esteem and intense feel of rejection , abandonment and unloved
Can develop intense feelings for people but lose them, hard to control emotions
Engage in risky behaviours - self harm, overdose, sexual activities
Hard to cope with life

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26
Q

What is the criteria for a delusion

A

Held with certainty - cannot be rationalized
Incorrigibility - not changeable
Impossibility of content
Doesn’t make sense in context of social cultural and religious upbringing

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27
Q

What is the difference between a primary and secondary delusion?

A

Secondary can be understood in the light of an abnormal mental state - delusions of poverty in a depressed patient

Primary cannot be understood this way and must have come from a pathological process

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28
Q

What are the first rank symptoms of schizophrenia?

A
  1. Auditory Hallucinations
    - Voices heard arguing
    - Thought echo
    -Running commentary
  2. Delusions of thought interference
    - Thought insertion
    - thought withdrawal
    - thought broadcasting
  3. Delusions of control
    - Passivity of affect
    - Passivity of impulse
    - Passivity of volitions
    - Somatic passivity
  4. Delusional Perception
    - primary delusion that is reported after the experience of normal perception
    -
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29
Q

What is psychomotor retardation

A

Everything slows down, little movement and tasks are done very very slowly

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30
Q

What is Catatonia

A

Seen in schizophrenia
Periods of motor excitation and then non responding like being in a coma but will respond to pain

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31
Q

What is waxy flexibility?

A

Bend an arm into a position and it stays there like wax
Encephalitic type problems

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32
Q

What are some abnormal movements

A

Tremors , tics

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33
Q

What is Akathisia

A

Restlessness - side effect of antipsychotics

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34
Q

What is tardive dyskinesia

A

Late onsent
Unusual chewing movements
Neurological side effect of antipsychotics
Grimacing
Patient unaware

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35
Q

What is Poverty of thought

A

Not many thoughts - speech is very slow

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36
Q

What is flight of ideas

A

One thought after another
Often presents with pressured speech

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37
Q

What is clang associations

A

One association after another

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38
Q

What is rhyming

A

Rhyming words

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39
Q

What is Perseveration

A

Same answer to every question - cognitive impairment like dementia

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40
Q

What is loosing of association

A

Tangential thinking
Loose association but doesnt answer the question

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41
Q

What is circumstantial

A

Go round and round but come at an answer

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42
Q

What is Knights move thinking

A

Thinking is not connected to what you asked about it moves off to a side

43
Q

What is a word salad

A

Disintegration from knights thinking
Miss match of thinking

44
Q

What is a Delusion

A

A fixed illogical belief out of keeping with a persons social cultural background
Not amenable to anything

45
Q

What is morbid jealousy

A

Delusional jealousy where people think there partners cheating

46
Q

What is a grandiose delusion

A

Belief that you have importance or powers

47
Q

What is a Persecutory Delusion

A

Paranoid, people out to harm and set traps

48
Q

What is Nihilistic delusions

A

Loss of internal organs, rotting from inside

49
Q

What are mood congruent delusions

A

Delusions fit into mood
- Manic - grandiose type/ persecutory
- Depression - nihilistic , persecutory , guilt , delusions of poverty and worthlessness

50
Q

What are delusion of poverty

A

Believe you dont have enough money

51
Q

What is a delusional mood

A

Feeling that something bad is going to happen

52
Q

What is delusional perception

A

Perceives a real stimulus correctly and deriving a delusional unconnected belief
E.g. salt pot moved from right to left and now everyone in the pub knows he’s gay

53
Q

What is an overvalued idea

A

A belief not as intense as a delusion but it preoccupies you

54
Q

What is thought alienation

A

Somebody is in possession of your thoughts

55
Q

What is thought insertion

A

People putting thoughts into your head that arnt yours

56
Q

What is thought withdrawal

A

People taking thoughts out your head

57
Q

What is thought broadcast

A

Everyone in the room can read your thoughts

58
Q

What is thought blocking

A

Block to thoughts

59
Q

What is Passivity

A

Somebody is controlling movements and thought
Often comes with delusion explanations

60
Q

What is made action

A

Somebody made me do it

61
Q

What is depersonalisation

A

Out of body

62
Q

What is derealisation

A

In a play

63
Q

What is an obsession

A

Distressing thoughts and images

64
Q

What are compulsions

A

Actions that arise to mitigate obsessions

65
Q

What is a hallucination

A

Perception in an absence of a stimulus

66
Q

What is an illusion

A

Misperceiving a stimulus

67
Q

When can hallucinations be normal

A

Hypnagogic

Hypnapompic

68
Q

What are the modalities of halllucinations

A

Auditory
Visual - often organic
Olfactory - temporal lobe epilepsy
Gustatory
Tactile - amphetamines ( Formication crawling under skin )

69
Q

What Is a functional hallucination

A

Another hallucination in same modality

70
Q

What is a reflex stimulus

A

One modality stimulus results in another

71
Q

What is extracampine?

A

Hallucination outside of a sensory field

72
Q

What is a third person hallucination

A

Auditory hallucinations but its she/he/they /it

73
Q

What is a running commentary

A

Running commentary of what your doing

74
Q

What is thought echo

A

Speech echos

75
Q

What are eating disorders?

A

Eating disorders are mental health conditions that involve unhealthy relationship with food and a feta of being overweight

76
Q

What’s the epidemiology of anorexia nervosa?

A

6-60 most 14-20
1-4%
90% female
Increase in prevalence - 4x higher
Most common cause of death is sudden a Ventricular arrhythmia - low potassium and suicide
Mortality rates 6x higher than normal population and then T1 diabetes and asthma

77
Q

What causes anorexia nervosa?

A

Biological - physical health and mental health
Psychological - mood, personality, behaviour
Social - culture ,family, socioeconomic

Low self esteem
Complex family dynamics - over critical mother and high expressed emotion
Loss/ Bereveament/trauma
Pressures of education + transitions of school , exams ,puberty
Social pressure - media, social media, peers, size 0
Genetic and enviromental risk
Abuse
Perfectionist / OC traits
Comorbidites - gender dysphoria, depression, anxiety, OCD< ASD, attachement , emerging EUPD

78
Q

DSM 5 ANorexia?

A

Restriction of energy intake real-time to requirements - low body weight
Intense fear of gaining weight
Distrubed by ones body weight or shape or self worth

79
Q

What is the anorexia subtypes

A

Binge purge
Restriction

80
Q

Bulimia DSM-5 criteria?

A

Recurrent episodes of uncontrollable binge eating in 2 hours more than a normal
Then laxative, diuretic, vomiting, fasting , exercise
3 months
Not justified by body weight and shape
Doesn’t occur during episodes of anorexia - what is a binge ?

81
Q

Bulimia Epidemiology?

A

1-4% 10-15% men can affect children
Men are less likely to seek help
9-12 in children
3.9% mortality rates

82
Q

How do eating disorders affect the body?

A

Fluids: Dehydration, low potassium , magnesium and sodium
Skin: Bruise, fry skin,yellow skin and abrasion of knuckles
Brain
Anything

83
Q

What’s the treatment of bulimia?

A

Guided self help
- monitor what eating
- realistic meal plans
- learn about triggers
- identify cause
- find ways of coping

CBT
Family therapy
Fluoxetine - adults only with comorbid depression in kids

84
Q

What is binge eating disorder?

A

Eating in a two hours period that is larger than most
Lack of control and marked distress
More rapid
Uncomfortable food
Not hungry
Eating alone
Disgusted
Depressed
Guilty
Once a week for 3 months
Retain weight
No compensation
1.5% women 0.3% men
Comorbid conditions - suicidal thoughts , mental health mood disorders, anxiety

85
Q

WHat is the treatment for BED?

A

Weight control
BEAT support group
CBT
Meal planing
Work on triggers
Change and manage negative body feelings
New eating habits

86
Q

What is ARFID?

A

An eating or feeding disorder manifested by failure to meet nutritional or energy needs
- weight loss]
- nutritional defiency
- dependace on enteral feeding
- interferes with psychosocial functioning
No evidence of body weight or shape
Not attributable to a medical condition or mental disorder

87
Q

Epidemiology of ARFID?

A

1.5 percent
Higher rates in autism - distress by senses
Comorbid ASD, anxiety, OCD, ADHD
History of GI problems - acid reflux and vomiting
Fear of choking
Increased brain activity and attention, rewards, emotional regulation
Meet physica and nutritional needs whilst addressing anxiety

88
Q

What is PICA

A

Eating non food substabcs

89
Q

What is orthorexia

A

Restricted eating with a goal of sporting

90
Q

What is bigorexia

A

Disordered eating to get bigger and stronger

91
Q

Which homeostasis systems regulate mental health

A

Limbic system
Autonomic systemic - arousal
Hippocampus. Median terminal lobe brain stem
Perception - temporal lobe

92
Q

What’s involved in the limbic system

A

Caudate
Amygdala
Hippocampus
Limbic system

93
Q

What does emotional dysregulation look like

A

Extreme emotional outbursts
Uncontrollable temper
Self harm
Difficulty maintang relationships

94
Q

What can cause emotional dysregualtion

A

Disrupted attachement
PTSD
Temporary trauma

95
Q

What is attachement?

A

Humans and animals get attached to caregivers - monkey experiment
Attachement functions to protect from external dangers
Emotional connection
Essential for development
Affects throughout lifecuycle

96
Q

What regulates attachement

A

Oxytocin
Limbic system
Right hemisphere
Autonomic system regulation - separation, increased pulse, decreased tempurature, prolonged or frequent chnagescorisol and affects stress and increases infection

97
Q

What are the 4 attachement

A

Secure
Anxious
Ambivalent
Avoidant

98
Q

What can affect attachement

A

Unemotional caregiver - anxious
Drugs and alcohol - ambivalent t
Abuse and neglect -avoidant

99
Q

What is secure attachement

A

Able to internally self regulate the emotional neural systems and responses to enviroment from 5 years upwards

100
Q

What is PTSD

A

Occurs in people who have experienced a traumatic event such as a natural disaster, accident, terrorist act, war /combat, rape, serious injury or the threat
- shell shock
Combat fatigue

101
Q

What’s the Epidemiology of PTSD

A

1/3 2ho suffer a traumatic event
General population incidence 3%
Young people 1/13
50% who access therapy get better

102
Q

What are the S+S of PTSD

A

Flashbacks
Intrusive memories
Nightmare
Psychological and physiological distress at real or symbolic reminders of trauma
Alertness nad hyper vigilance
Jumpy and startled
Disturbed and lack of sleep
Irritability
Poor concentration

103
Q

What is the DSM diagnosis

A

A: Exposure to trauma
B: Unwanted upsetting memories
Nightmares
Flashbacks and dissociation
Intense distress after exposure to traumatic reminders
Physiological reaction to trauma reminders

104
Q

Whats the mechanism of PTSD

A

PTSD symptoms is an over reactive adrenaline response - deep neurological brain patterns that can persist making the individual hyper response to future situation
High catecholamine and CRF- abnormality in HPA axis
Maladaptive learning pathway and hypereactivy
Reduced hippocampus volume

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