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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
What are some risk factors for EUPD?
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
25
What are some symptoms of BPD?
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
26
What is the criteria for a delusion
Held with certainty - cannot be rationalized Incorrigibility - not changeable Impossibility of content Doesn't make sense in context of social cultural and religious upbringing
27
What is the difference between a primary and secondary delusion?
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
28
What are the first rank symptoms of schizophrenia?
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 -
29
What is psychomotor retardation
Everything slows down, little movement and tasks are done very very slowly
30
What is Catatonia
Seen in schizophrenia Periods of motor excitation and then non responding like being in a coma but will respond to pain
31
What is waxy flexibility?
Bend an arm into a position and it stays there like wax Encephalitic type problems
32
What are some abnormal movements
Tremors , tics
33
What is Akathisia
Restlessness - side effect of antipsychotics
34
What is tardive dyskinesia
Late onsent Unusual chewing movements Neurological side effect of antipsychotics Grimacing Patient unaware
35
What is Poverty of thought
Not many thoughts - speech is very slow
36
What is flight of ideas
One thought after another Often presents with pressured speech
37
What is clang associations
One association after another
38
What is rhyming
Rhyming words
39
What is Perseveration
Same answer to every question - cognitive impairment like dementia
40
What is loosing of association
Tangential thinking Loose association but doesnt answer the question
41
What is circumstantial
Go round and round but come at an answer
42
What is Knights move thinking
Thinking is not connected to what you asked about it moves off to a side
43
What is a word salad
Disintegration from knights thinking Miss match of thinking
44
What is a Delusion
A fixed illogical belief out of keeping with a persons social cultural background Not amenable to anything
45
What is morbid jealousy
Delusional jealousy where people think there partners cheating
46
What is a grandiose delusion
Belief that you have importance or powers
47
What is a Persecutory Delusion
Paranoid, people out to harm and set traps
48
What is Nihilistic delusions
Loss of internal organs, rotting from inside
49
What are mood congruent delusions
Delusions fit into mood - Manic - grandiose type/ persecutory - Depression - nihilistic , persecutory , guilt , delusions of poverty and worthlessness
50
What are delusion of poverty
Believe you dont have enough money
51
What is a delusional mood
Feeling that something bad is going to happen
52
What is delusional perception
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
What is an overvalued idea
A belief not as intense as a delusion but it preoccupies you
54
What is thought alienation
Somebody is in possession of your thoughts
55
What is thought insertion
People putting thoughts into your head that arnt yours
56
What is thought withdrawal
People taking thoughts out your head
57
What is thought broadcast
Everyone in the room can read your thoughts
58
What is thought blocking
Block to thoughts
59
What is Passivity
Somebody is controlling movements and thought Often comes with delusion explanations
60
What is made action
Somebody made me do it
61
What is depersonalisation
Out of body
62
What is derealisation
In a play
63
What is an obsession
Distressing thoughts and images
64
What are compulsions
Actions that arise to mitigate obsessions
65
What is a hallucination
Perception in an absence of a stimulus
66
What is an illusion
Misperceiving a stimulus
67
When can hallucinations be normal
Hypnagogic Hypnapompic
68
What are the modalities of halllucinations
Auditory Visual - often organic Olfactory - temporal lobe epilepsy Gustatory Tactile - amphetamines ( Formication crawling under skin )
69
What Is a functional hallucination
Another hallucination in same modality
70
What is a reflex stimulus
One modality stimulus results in another
71
What is extracampine?
Hallucination outside of a sensory field
72
What is a third person hallucination
Auditory hallucinations but its she/he/they /it
73
What is a running commentary
Running commentary of what your doing
74
What is thought echo
Speech echos
75
What are eating disorders?
Eating disorders are mental health conditions that involve unhealthy relationship with food and a feta of being overweight
76
What’s the epidemiology of anorexia nervosa?
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
What causes anorexia nervosa?
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
DSM 5 ANorexia?
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
What is the anorexia subtypes
Binge purge Restriction
80
Bulimia DSM-5 criteria?
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
Bulimia Epidemiology?
1-4% 10-15% men can affect children Men are less likely to seek help 9-12 in children 3.9% mortality rates
82
How do eating disorders affect the body?
Fluids: Dehydration, low potassium , magnesium and sodium Skin: Bruise, fry skin,yellow skin and abrasion of knuckles Brain Anything
83
What’s the treatment of bulimia?
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
What is binge eating disorder?
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
WHat is the treatment for BED?
Weight control BEAT support group CBT Meal planing Work on triggers Change and manage negative body feelings New eating habits
86
What is ARFID?
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
Epidemiology of ARFID?
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
What is PICA
Eating non food substabcs
89
What is orthorexia
Restricted eating with a goal of sporting
90
What is bigorexia
Disordered eating to get bigger and stronger
91
Which homeostasis systems regulate mental health
Limbic system Autonomic systemic - arousal Hippocampus. Median terminal lobe brain stem Perception - temporal lobe
92
What’s involved in the limbic system
Caudate Amygdala Hippocampus Limbic system
93
What does emotional dysregulation look like
Extreme emotional outbursts Uncontrollable temper Self harm Difficulty maintang relationships
94
What can cause emotional dysregualtion
Disrupted attachement PTSD Temporary trauma
95
What is attachement?
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
What regulates attachement
Oxytocin Limbic system Right hemisphere Autonomic system regulation - separation, increased pulse, decreased tempurature, prolonged or frequent chnagescorisol and affects stress and increases infection
97
What are the 4 attachement
Secure Anxious Ambivalent Avoidant
98
What can affect attachement
Unemotional caregiver - anxious Drugs and alcohol - ambivalent t Abuse and neglect -avoidant
99
What is secure attachement
Able to internally self regulate the emotional neural systems and responses to enviroment from 5 years upwards
100
What is PTSD
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
What’s the Epidemiology of PTSD
1/3 2ho suffer a traumatic event General population incidence 3% Young people 1/13 50% who access therapy get better
102
What are the S+S of PTSD
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
What is the DSM diagnosis
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
Whats the mechanism of PTSD
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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