Psychiatry Flashcards
Term that describes a fluctuating mood
labile
what is the term for a normal, tranquil mental state or mood.
euthymia
term for loss of enjoyment in life
Anhedonia
what is the definition of a delusion
fixed, false belief that is not understandable within the persons sociocultural setting
What test do you use to assess someones cognition
MoCA
What are hallucinations
Abnormalities of our perception. common features of neurological and psychiatric disorders. External object represented by sensory percept and brain combines memory and experience to produce a meaningful internal percept
What are the different types of perceptual abnormalities
Altered perceptions: sensory distortions and illusions, distorted internal perception of a REAL object
False Perceptions: hallucinations and pseudo hallucinations where there is internal perception without external object
What are the four modalities of hallucinations
- Visual hallucinations
- Auditory hallucinations (can be 1st, 2nd, 3rd person or command)
- Gustatory or olfactory hallucinations
- Tactile hallucinations
what is the difference between hallucinations and pseudo hallucinations
hallucinations: you really believe its there
pseudo-hallucinations: see something but know its not real
What is delirium
organic cerebral syndrome: disturbs consciousness, attention, perception, thinking, memory, emotion, sleep-wake schedule everything
is a psychiatric ,infestation of a physical illness
What causes delirium and what are the risk factors
Risk Factors: infection, environment change, medication, alcholo withdrawal, surgery, pain, stroke, low Na+, depression, advanced age, dementia, immobility, sensory impairment, urinary catheter, malnutrition
Have a critical illness which increases cortisol, starts a systemic inflammatory response and thus causes cerebral hypoxia especially in older patients whose brain is more vulnerable. This causes less ACh synthesis and dysfunction of hippocampal and neocortical areas leading to delirium. Get insanely high dopamine and adrenergic output
How is delirium managed
anticipate that it will happen and modify risk factors
treat the cause.
good nursing: well lit room and familiar faces
medication : want to reduce dopamine without affecting ACh
then give it time
What is the definition of stigma
challenges faced by people with mental illness related to knowledge attitudes and behaviour of people they meet
What is post-stroke psychosis
Neuropsychiatric symptoms forllowing vascular insult to brain, usually right sidded middle cerebral artery lesions which affect frontal and temporal lobes.
causes delusions that are persecutory and Othello’s syndrome (jealousy)
usually auditory hallucinations followed by visual
How is post stroke psychosis managed
Not knows, some respond to antipsychotics but have to be careful giving antipsychotics to dementia patients as can lead to stroke
What is the general interplay between mental and physical health
long term conditions are risk factors for the developement of mental and vica versa
Can be an organic cause like hypothyroidim of cushings causing depression etc, or can be an effect of the medication like steroids, dopamine agonists leading to psychosis
What is the mortality gap
Patients suffering with severe mental illness have a reduced life expectancy compared to general population
can be due to medication affects, increased rates of smoking and alcohol, poor diet and exercise, chaotic lifestyle and low socioeconomic status
How should mental health be managed
Choose medication that minimises impact of physical health
monitor cardiometabolic factors
smokign cessation, dietary advice, drug and alcohol sevices
What factors may affect diagnosis of physical disorders in those with mental health issues
Illness behaviour
Diagnostic overshadowing: think physical symptoms are psychiatric
stigma
lack of resources/ access to services
What is psychosis
difficulty perceiving and interpreting reality
seein in bipolar, Schizoaffective disorder and schizophrenia, depression with psychotic symptoms, delusional disorder, drug induced
What are the types of symptoms psychosis with examples
- Positive Symptoms
halluncinations: perception in absence of a stimulus, any sensory moditality. within auditory can get 1st person which is a thought echo, 2nd or 3rd person, a running commentary or command hallucinations
Delusions: fixed false belief not in keeping with social/cultural norms. Have a theme such as persecutory, grandiosity, religious, nihilistic/guilt, somatic, erotomanic or passivity experiences which are 1st rank symptoms (includes thought broadcasting- others can hear ur thoughts, thought withdrawal- thoughts have been taken, thought insertion- not own thoughts) - Negative Symptoms
Alogia: paucity/pausing in speech, little speech content, slow respond
Avolition/apathy: lack of drive, lack of motivation, poor self care
Anhedonia/asociality: few close friends, few hobbies/interests, impaired social functioning
Affective flattening: unchanging facial expressions, few expressive gesture, poor eye contact, lack of vocal intonations, limited emotional - Disorganisation
Bizzare behaviour: bizarre social behaviour, clothing/appearance, shows aggression/agitation, repetitive/stereotyped behaviour
Formal Thought disorder: lack of logical connection between thoughts such as word salads, derailment, flight of ideas, tangential thought, circumstantial thought
How does psychosis usually present
at any age, usually early 20’s, peaks later later in women
often crhonic and episodic
impacts education, employment, functioning and increases risk of health problems and morbidity
suicide rate higher and mortality rate higher
What symptoms precedes psychosis
Prodronal symptoms: often misdiagnosed as depression
changes in social behaviour and functioning impairments precede onset. Often have had mental disorders previously
What are the risk factors for psychosis
Genetics: Family history of schizophrenia : is highly heritable and highly polygenic (lots of genes, small risk but add up)
Environment: drug use- cannabis, birth complications, maternal infections, migrant status, socioeconomic deprivation, childhood trauma
What symptoms of psychosis might you look for in appearance and behaviour in the MSE?
Bizarre or inappropriate clothing, agitation, abnormal movements, self-neglect, self-harm injuries, facial expression range, echo phenomena like echopraxia 9repeating movements), echolalia), eye contact, if able to establish rapport, looking around the room
What symptoms of psychosis may you see in speech?
Reduced volume, reduced intonations, normal rate
Why must mood be assessed in someone with psychosis?
Other mental disorders can cause psychosis, depression often comes with schizophrenia. Schizophrenia patients are at risk of suicide
What cognitive impairments are associated with schizophrenia
dementa praecox : described as dementia of the young so :
working memory and executive function impairments
poorer educational attainment
cognitive impairments are stable over time and independent of psychotic symptoms, are difficult to treat too
What difficulties may there be when treating someone with psychosis
may have poor insight into this and thinks there is nothing wrong with them: this leads to less follow up appointments, not staying in hospital, not getting treated, impacts ability to have capacity to consent
How would schizophrenia be diagnosed
cannot diagnose on one consultation would be an acute and transient psychotic episode
have to look for heterogenity within disorder categories
observe
What antipsychotics are used to treat psychosis and how do they work?
Dopamine antagonists or partial agonists to block dopamine receptors as there is more dopamine and elevated presynaptic dopamine in the striatum which causes psychotic symptoms. Using an agonists can cause psychotic symptoms as enhances effect
Example: risperidone
What are the side effects of anti psychotics?
Extrapyramidal side effects, as reduced dopamine everywhere.
Dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (helps to maintain posture and tone).
Can lead to
- Parkinsonism : bradykinesia. Postural instability, rigidity, slow and shuffling gait : destination, lack of arm swing, pill-rolling tremor (move thumb across other fingers)
- Acute dystonic reactions : involuntary contractions of muscles
- Tardive dyskinesia : face and body make irregular movements that you can’t control
- Akathisia : cannot remain still
- Sedation
- Constipation
- Higher prolactin releases suppressing dopamine
- Dysrhythmia - long QT
- Increased appetite, weight gain and diabetes
- Agranulocytosis
- Neutropenia
What is the difference between typical and atypical antipsychotics?
Typical have an increased risk of extrapyramidal side effects, atypical are less likely to cause
How should psychosis be managed?
Lowest therapeutic dose of atypical antipsychotics, change the medication, anticholinergic medications may help. Counsel patients about risks
Should follow up, usually have episodic courses with periods of wellness and relapse, could recover completely. Keep managing the side effect and use health promotion to try to stop smoking and fix diet,
What treatment options are there for someone who as been experiencing psychosis
Pharmacological: antipsychotic medications
Psychological: CBT for psychosis, avatar therapy
Social support: supportive environments, housing benefits, budgeting and employment support
What are the two disease classification books
US manual: DSM
WHO manual: ICD
Definition for mood disorders
change in mood to depression or elation activity level usually changes with it, usually recurrent and related to stressful events
What is the criteria for depressive episode
2 weeks or more of depressed mood
4 of the following: appetite change, sleep change, anhedonia, less concentration, low energy, guilt, agitation/retardation, suicidal thoughts.
What is the criteria for major depressive disorder
depressive episode but no manic or hypomanic episodes cave 3 subtypes:
- atypical features: inc sleep and appetite with heightened mood
- melancholic features: no mood reactivity with marked psychomotor retardation and anhedonia
- psychotic features : delusions and halllucinations
Describe the cycle of low mood
Thoughts, Feelings, Physiological symptoms, Behaviours all changed to negative
How are manic and hypomanic episodes diagnosed
For one week with fucntional impairment
euphoric or irritable mood, 3/7 of following: decreased need for sleep with increased energy, distractibility, gradnsiosity/inflated self esteem, racing thoughts, increased talkativeness, increased goal directed activities, impulse behaviour = MANIC
4 days with symptoms, without functional impairment = HYPOMANIC
Difference between type 1 bipolar, type II bipolar and unspecified bipolar disorder and cyclothymia diagnosis
Bipolar I: manic and hypomanic episodes (one week with functional impairment) usually starts with hypomaniac/depressive first episode
Bipolar II= four days with no functional impairment, no manic episodes only hypomanic with at least one major depressive episode
Cyclothymia: swings in mood but not enough to meet thresholds
^ these three cycle more than four times per year
Unspecified bipolar disorder= symptoms for less than four days , thresholds for manic or hypomanic episodes not met
How can manic episodes be characterised
manic will have hallucinations, hospitalisation or psychotic features that affect daily life, hypomanic will not
What is the difference in heritability and insight between bipolar disorder and depression
Bipolar highly heriditary, depression not
Insight preserved in depression, impaired in mania (will deny any mania= more hypomanic or manic they are the more they will deny)
why can insight cause misdiagnosis in bipolar disorder and why is this important
Will deny as lack insight so easy to miss diagnosis, if dignose with MDD and give antidepressants then may trigger and episode and worsen the long term course
What biases are seen in patients with depression
Attention biases: typical of anxiety more. but maintaining/shifting attention bias in depressed people, harder to disengage from negative material, and less attention to positive material.
Memory biases: recall negative more than positive
Perceptual biases: recognise negative/sad faces more than happy or any other
What area of the brain is affected in maintaining/shifting attention biases
Amygdala response prolonged to negative stimuli
Prefrontal cortex: anterior cingulate cortex mediates attentional biases, lateral inferior frontal cortex impairs ability to divert attention from task irrelevant negative info
What area of the brain is affected in perception bias
Amygdala response to negative stimuli is prolonged
