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3a Exam > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What 2 classification systems are used for psychiatric conditions?

A
  1. DSM5
  2. ICD10
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2
Q

What can you ask the patient to recall in an abbreviated mental test?

A
  • Recall an address
  • Age and DOB
  • What time is it?
  • What year is it?
  • Dates of WW2
  • Name of present monarch
  • Count backwards from 20
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3
Q

What are the components of the Mental State Examination?

A

ASEPTIC:
Attitude
Appearance & Behaviour (body language, eye contact, rapport, facial expressions)
Speech (rate, rhyme, tone, volume)
Emotions (mood, affect)
Perceptions (dissociative symptoms, illusions and hallucinations)
Thoughts (stream, form, content)
Insight and compliance
Cognition (capacity)

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4
Q

What is the Biopsychosocial formulation?

A

Takes biological, psychological and social factors to form a diagnosis.
4P’s:
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

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5
Q

Name 10 examples of psychosocial therapies

A
  • Psychotherapy
  • CBT
  • Counselling
  • Cognitive analytic therapy
  • Interpersonal therapy
  • Dialectic behaviour therapy
  • Family therapy
  • Counselling
  • Psychodynamic Therapy
  • Electro-convulsive Therapy
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6
Q

What is suicide?

A

Intentional self-inflicted death

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7
Q

How could you breakdown the components of thought?

A

Stream
Form
Content

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8
Q

What is deliberate self harm?

A

Intentional non-fatal self-inflicted harm

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9
Q

What is an Illusion?

A

Misperception of real external stimulus

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10
Q

What is a hallucination?

A

Disorder of perception

Perception experienced in absence of external stimuli

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11
Q

What are the 5 types of Hallucinations

A

Auditory
Visual
Olfactory
Gustatory
Tactile

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12
Q

What are the 5 subtypes of Hallucinations

A

Hypnogogic = on falling asleep

Hypnopompic = on waking up

Autoscopic = seeing oneself

Reflex = stimulation in one modality produces hallucination in other

Extracampine - hallucinations outside of sensory fields

Charles Bonnet = visual hallucinations associated with eye disease

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13
Q

What is a Delusion?

A

Disorder of thought

A belief that is:
1) Firmly held
2) Not affected by rational argument/evidence
3) Not a conventional belief

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14
Q

Name 8 types of Delusions

A

Persecutory (think someone is going to hurt them)
Grandiose (inflated self-importance e.g. I am God)
Reference (events/actions take on special significance to patient (e.g. black cars monitoring me)
Nihilistic (delusion of almost nothingness e.g. nothing in bank account)
Hypochrondriacal (firm belief they have a disease)
Guilt or worthlessness (has done something shameful based on an innocent error)
Control (controlled by an outside agency)
Possession of thoughts

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15
Q

State the 5 types of possession of thoughts

A

Thought Insertion

Thought Withdrawal (someone removing their thoughts)

Thought Broadcast

Thought Echo

Thought Block (can’t continue idea)

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16
Q

What is Psychosis?

A

Severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

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17
Q

What is an ‘over-valued idea’?

A

False or exaggerated belief beyond logic or reason

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18
Q

Define loosening of association

A

A lack of logical association between thoughts

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19
Q

What is perseveration?

A

Repetition

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20
Q

Describe dissociation

A

Disconnection from surroundings

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21
Q

What is depersonalisation?

A

Feelings of detachment from one’s own body

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22
Q

Describe derealisation

A

A sense of one’s surroundings lacking reality

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23
Q

What is Lilliputian?

A

Visual hallucinations of small animals

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24
Q

What is Formication?

A

Insects crawling on skin

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25
Q

What is Neurosis?

A

Mild mental illness involving symptoms of stress, but not a radical loss of touch with reality

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26
Q

What is passivity Phenomena?

A

Actions are controlled by someone else

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27
Q

What is catatonia?

A

Significantly excited/inhibited motor activity

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28
Q

What is psychomotor retardation?

A

Slowing of thoughts/movements

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29
Q

What is concrete thinking?

A

Lack of abstract thinking
Most commonly in Aspergers

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30
Q

What is Confabulation?

A

False accounts to fill gap in memory
Most commonly in Korsakoff

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31
Q

What is a Neologism?

A

New word formation (to them it seems like it fits)

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32
Q

What is Anhedonia?

A

Inability to experience pleasure

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33
Q

What is Akathisia?

A

Inner restlessness and always in motion (rocking)

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34
Q

What does the Mesolimbic pathway cause?

A

Positive symptoms

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35
Q

What does the Mesocortical pathway cause?

A

Negative symptoms

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36
Q

What is Echolalia?

A

Meaningless repetition of another persons spoken words

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37
Q

What is Incongruity of affect?

A

Emotional responses that don’t match the situation

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38
Q

What is flat affect?

A

No emotional expression

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39
Q

What is Mannerism?

A

Repeated involuntary movements

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40
Q

What is Belle indifference?

A

Lack of concern for implications of symptoms

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41
Q

What is Pharmacodynamics?

A

What the drug does to the body (receptor sensitivity or agonism/antagonism)

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42
Q

What is Pharmacokinetics?

A

What the body does to the drug: ADME
Absorption
Distribution
Metabolism
Elimination

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43
Q

What are examples of anti-depressants?

A

Selective Serotonin Reuptake Inhibitors (SSRIs):
- Fluoxetine
- Sertraline
Tricyclic Antidepressants:
- Amitriptyline
- Clomipramine
Serotonin-noradrenaline reuptake inhibitors (SNRIs):
Noradrenaline and specific serotonergic antidepressants (NASSAs):
Monoamine oxidase inhibitors (MAOIs)

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44
Q

What are 3 side-effects of SSRIs?

A
  • Headache
  • Nausea
  • Insomnia
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45
Q

What are the causes of Serotonin syndrome?

A

SSRIs
MAOIs
Ecstasy

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46
Q

What is the clinical presentation of Serotonin syndrome?

A

INCREASED ACTIVITY:
- Clonus/myoclonus
- Hypereflexia
- Tremor
- Muscle rigidity
- Dilated pupils
- Autonomic dysfunction (tachycardia/ unstable BP)

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47
Q

What investigations would you perform for Serotonin Syndrome?

A

Similar to NMS:
- CK: elevated
- FBC: elevated WCC
- LFTs: deranged
- ABG: Metabolic acidosis

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48
Q

What is the management of serotonin syndrome?

A

Benzodiazepines
5HT-2a antagonist (Cyproheptidine)

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49
Q

Define Dependance

A

Cluster of physiological, behavioural and cognitive phenomena in which a substance takes on a higher priority than other behaviours that once had greater value

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50
Q

What are 10 risk factors for Dependance?

A
  • Male
  • Low standard of education
  • Unemployment
  • Younger age of usage
  • Mental illness
  • Peer pressure
  • Low self esteem
  • High stress
  • FHx of alcoholism / substance addiction
  • Genetics
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51
Q

What is the clinical presentation of dependence?

A

Compulsion to drink

Tolerance (need more to get same effect)

Difficulties controlling alcohol consumption

Physiological withdrawal

Neglect of alternatives to drinking

Persistent use of alcohol despite harm

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52
Q

How can you assess alcohol dependance?

A

CAGE (cut down, annoyed, guilt, eye-opener)

Audit

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53
Q

What does Tweak stand for in alcohol dependence?

A

Tolerance (>6 drinks = 2pts)

Worried (yes = 2pts)

Eye-opener = 1pt

Amnesia = 1pt

Cut down = 1pt

> 3 = problem with alcohol

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54
Q

How would you investigate alcohol dependence?

A

Raised MCV: macrocytic anaemia
Vitamin B12 + folate deficiency
Deranged LFTs: GGT, AST/ALT
Thrombocytopenia: reduced platelets
Breath test
Screening

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55
Q

How would you manage Alcohol dependance?

A

Acomprosate: reduces craving
Disulfiram: gives hangover SE if alcohol consumed
Naltrexone: reduces pleasure alcohol brings
Support groups
CBT
Motivational interviewing

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56
Q

What is the clinical presentation of alcohol withdrawal?

A

Tremors
Sweating
Nausea/vomiting
Sound sensitivity (hyperacusis)
Insomnia
Mood disturbance (anxiety, on edge, depression)
Autonomic hyperactivity (tachycardia, HTN, pyrexia and mydriasis (pupil dilation))
Seizures seen -(at 36hrs)

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57
Q

How would you manage alcohol withdrawal?

A

Chlordiazepoxide (Benzodiazepine)
IV Pabrinex 5 days (vitamin B+C)
Thiamine 100mg BD
Inpatient: e.g. seizures with medical assisted detox

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58
Q

What is Wernicke’s encephalopathy?

A

A neurological emergency resulting from thiamine deficiency (vit B1)

Acute, reversible stage

Triad:
1. Ophthalmoparesis with nystagmus
2. Ataxia
3. Confusion

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59
Q

What triad is found in Korsakoff’s Syndrome?

A

▪ Anterograde amnesia
▪ Confabulation
▪ Psychosis (Lilliputian/formication)

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60
Q

What is Wernicke’s–Korsakoff syndrome?

A

A combination of Wernicke’s encephalopathy and alcoholic Korsakoff syndrome.

Chronic, irreversible stage

Severe memory impairment

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61
Q

What is the clinical presentation of opiate intoxication?

A

Drowsy

Mood change

Bradycardia

HTN

Pupil constriction

Respiratory depression

Decreased body temperature

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62
Q

What is the clinical presentation of opiate withdrawal?

A

Muscle cramps

Low mood

Insomnia

Agitation

Diarrhoea

Shivering

Flu like symptoms

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63
Q

What is the treatment for Wernicke’s encephalopathy?

A

IV Pabrinex (high potency B1 replacement)
Chlordiazepoxide
Alcohol abstinence

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64
Q

What is the management of Opioid overdose/dependance?

A

IV/IM naloxone (rapid)
Opioid dependance: detoxification (4 weeks in residential/12weeks in community)
Methadone
Buprenorphrine

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65
Q

What are the complications of Opioid misuse?

A

Infection: sharing needles
VTE
Overdose: respiratory depression
Crime/prostitution

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66
Q

What is delirium?

A

An acute confusional state often with changes in consciousness

Medical emergency

Often reversible

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67
Q

What are the causes of delirium?

A

PINCH ME
Pain
Infection/Intoxication
Nutrition (vit deficiency: thiamine, B12, folate)
Constipation
Hypoxia/hydration
Medication/substance abuse (benzodiazepines, anticholinergics, opiates, anticonvulsants)
Environmental

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68
Q

What is the clinical presentation of delerium?

A

Inattention
Disorientated
Visual hallucinations
Paranoia

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69
Q

What are the 3 clinical syndromes seen in delirium?

A

1) Hypoactive
* Apathy
* Withdrawal
* Quiet confusion
* Easily missed (often misdiagnosed as depression)
2) Hyperactive
* Agitation
* Lack of co-operation
* Delusions
* Disorientation
* Confused with schizophrenia
3) Mixed

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70
Q

How can you differentiate delirium from dementia?

A

Delirium vs Dementia

Acute vs gradual

Outside of brain vs brain pathology

Can improve vs can’t improve

Inattention vs still alert

Impaired consciousness vs conscious

Fluctuating symptoms vs stable

Treatable vs untreatable

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71
Q

How would you manage delirium?

A

Treat precipitating cause
Educate family and make environment safe
Anti-psychotics:
- Haloperidol
- Olanzapine
BDZs = Chlordiazepoxide (ONLY in alcohol withdrawal otherwise worsens delirium)
Regular follow ups

72
Q

What is generalised anxiety disorder?

A

Anxiety not specific to an environmental circumstance

Excessive worry about every day events/problems

73
Q

What is the clinical presentation of generalised anxiety disorder?

A

≥3:
- Restlessness/on edge
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance

74
Q

What are somatic symptoms of anxiety?

A

Chest tightness
Dyspnoea
Palpitations
‘Butterflies’
Tremor
Tingling of fingers
Aches and pains
N&V

75
Q

What are risk factors for generalised anxiety disorders?

A
  • Female
  • 35-54
  • Divorced/alone
76
Q

What are investigations for generalised anxiety disorders?

A

Rule out physical illness:
- Thyroid
- B12/folate
- Medication
- Alcoholism (withdrawal symptoms)

77
Q

What is the management of a generalised anxiety disorder?

A

Step 1:
- Educate
- Exercise
- Stop smoking/drinking
Step 2:
- Psychological support/groups
Step 3:
- High intensity support CBT
- Medication
- Rapid response:
- Benzodiazepine
- Long term:
- Sertraline/SSRIs
- Clomipramine

78
Q

What must you never prescribe anxiety patients?

A

Benzodiazepine for sleep: can cause delirium if they are abruptly stopped

79
Q

What is a panic attack?

A

Period of intense fear characterised by a group of symptoms that develop rapidly, peak at 10min and last <30min

80
Q

What are the risk factors for panic disorders?

A
  • Loneliness
  • Living in a city
  • Poor education
  • Early parental loss
  • Sexual/physical abuse
81
Q

Give 5 physical signs and 4 psychological signs of panic disorder

A

Physical:
1. Palpitations
2. Chest pain
3. Tachypnoea
4. Dry mouth
5. Dizziness
Psychological:
1. Feeling of impending doom
2. Fear of dying
3. Fear of losing control
4. Derealisation

82
Q

What is the management of panic disorders?

A

CBT
1st: SSRIs (Sertraline)
2nd: Clomipramine

83
Q

What is Agoraphobia?

A

Anxiety/panic over public places that are difficult to escape

84
Q

What is the management of Agoraphobia?

A

Short term = BDZ
SSRIs
Relaxation and exposure training/techniques

85
Q

What are obsessions?

A

Unwanted intrusive thoughts, images or urges that repeatedly enter the person’s mind

86
Q

What are compulsions?

A

Repetitive behaviours or mental acts that the person feels drive to perform

87
Q

What is the clinical presentation of OCD?

A

Must be present on most days for at least two weeks
- Not imposed by outside influences
- Repetitive and unpleasant/ excessive
- Interfere with individual functioning e.g. wasting time

88
Q

What is the management of OCD?

A

CBT
Exposure + response prevention (ERP)
SSRI
TCA: Clomipramine (has specific non-obsessional action)

89
Q

What is PTSD?

A

Delayed response to exceptional stressors months or years after trauma

90
Q

What is the clinical presentation of PTSD?

A
  • Re-experiencing (flashbacks, nightmares)
  • Avoidance (avoiding people or circumstances resembling the traumatic event)
  • Hyperarousal (exaggerates responses to small threats)
  • Emotional numbing (feeling detached)
  • Irritability
  • Insomnia
91
Q

How is PTSD diagnosed using ICD-10?

A

Symptoms arise within 6m of traumatic event
Symptoms present for at least 1 month → significant distress/impaired daily functioning

92
Q

What is the management of PTSD?

A

1st line: trauma-focused CBT
SSRIs or BDZs: for anxiety
Carbamazepine: intrusive/impulsive thoughts
Anti-psychotics
EMDR: Eye movement desensitisation and reprocessing
Mirtazapine: for sleep

93
Q

What are eating disorders?

A

An unhealthy and distorted obsession with body image and food

94
Q

What is anorexia nervosa?

A

An eating disorder where an individual feels that they are overweight despite evidence of normal/low body weight.

95
Q

What is the clinical presentation of Anorexia Nervosa?

A

Excessive weight loss
Amenorrhoea
Lanugo fine hair
Soft body hair
Hypokalaemia
Hypotension
Hypothermia
Changes in mood, anxiety and depression
Solitude

96
Q

What is the diagnostic criteria for anorexia nervosa?

A

Weight <85% of predicted

BMI <17.5

Intense fear of gaining weight

Feeling fat when actually underweight

97
Q

What is the SCOFF questionnaire in anorexia nervosa?

A

Used to assess eating disorders: ≥2 =anorexia nervosa or bulimia
1) Sick (make yourself)
2) Control (lost over eating)
3) One stone lost in 3 months
4) Feel fat
5) Food (dominates life)
-
1) Do you make yourself Sick because you feel uncomfortably full?
2) Do you worry you have lost Control over how much you eat?
3) Have you recently lost more than One stone in a 3 month period?
3) Do you believe yourself to be Fat when others say you are too thin?
4) Would you say that Food dominates your life?

98
Q

What are red flags seen in anorexia nervosa?

A

BMI <13 or <2nd centile
Weight loss >1kg / week
Temperature <34.5°
BP <80/50
Sa02 <92%
Long QT, flat T waves
Weakness in muscles

99
Q

What is the management of anorexia nervosa?

A

Restore nutritional balance
Involve carers
Eating disorder focussed CBT (ED-CBT)
Maudsley anorexia nervosa treatment for adults (MANTRA)
Admission

100
Q

What is bulimia nervosa?

A

Bing eating followed “purging” (often involving laxatives or induced vomiting to prevent calories being absorbed)

101
Q

What is the management of Bulimia Nervosa?

A

Same as anorexia +

  • NORMAL WEIGHT
  • Oesophagitis (vomiting)
  • Russell’s sign (callouses on back of hands)
  • Swollen salivary glands
  • Cardiomyopathy (laxatives)
  • Alkalosis: HLC from vomiting
  • Erosion of teeth
  • Mouth ulcers
  • Russell’s sign (Calluses on the knuckles where they have scraped teeth)
102
Q

What can laxatives and vomiting cause metabolically in Bulimia Nervosa?

A

Metabolic alkalosis = vomiting (hypochloraemia/ hypokalaemia)

Metabolic acidosis = laxatives

103
Q

What is the management of Bulimia Nervosa?

A

Anorexia treatment+
EDU for severe

104
Q

What are complications of eating disorders?

A

Refeeding Syndrome
Cardiac complications:
- Arrhythmia
- Cardiac atrophy
- Sudden cardiac death

105
Q

What is depression?

A

Persistent core symptoms: low mood, anergia and anhedonia

106
Q

What is the clinical presentation of depression?

A

DEADSWAMP:
* Depressed low mood)
* Energy low
* Anhedonia
* Death thoughts (suicide)
* Sleep disturbance (insomnia /hypersomnia)
* Worthlessness/guilt/hopelessness
* Appetite/weight change
* Mentation decreased (lack of concentration)
* Psychomotor agitation / retardation

107
Q

What is the criteria for depression being:
Mild?
Moderate?
Severe?

A

Mild = 2 core + 2 other

Moderate = 2 core + 3 other

Severe = 3 core + 4 other

108
Q

How is depression investigated?

A

PHQ-9
HADs (Hospital Anxiety and Depression Scale)

109
Q

What is the management of depression?

A

Sleep hygiene
Anxiety management
Exercise
Computerised CBT
IAPT
SSRI’s (switch to another SSRI BEFORE changing antidepressant class)
ECT (SEVERE ONLY)
Rapid specialist mental health assessment + admission (SEVERE)

110
Q

What are the side effects of Anti-cholinergics/muscarinics?

A
  • Tachycardia
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Drowsiness
111
Q

Define Bipolar disorder

A

Periods of elevated mood (hypo/mania) and depression

Requires at least two episode- one must be mania/hypomania for a diagnosis

112
Q

Describe the types of Bipolar Disorder

A

Bipolar I = Mania + Depression
- Psychotic symptoms

Bipolar II = Hypomania
- Depression
- No psychosis

113
Q

What is hypomania?

A

Does not meet full criteria of mania

114
Q

What is Cyclothymia?

A

Cyclic mood swings with subclinical features

115
Q

What is the diagnostic criteria of Mania?

A

> 1 week elevated mood + >3 of:
I DIG FASTER

Irritability

Disinhibited (sexual, financial)
Insight impaired
Grandiose delusions

Flight of ideas
Activity/Appetite increased
Sleep decreased
Talkative (pressure of speech)
Elevated mood/energy increase
Reduced concentration/risk taking (Distractibility)

116
Q

What are possible causes of bipolar disorder?

A
  • Post-partum female
  • Substance misuse
  • Chronic illness
  • Hx trauma/mental health
117
Q

What is the acute and long-term management of bipolar disorder?

A

Acute:
Antipsychotics/ BDZs due to delayed effect:
- Risperidone
- Olanzapine
- Haloperidol
Long-term
Lithium (check TSH, U&Es, hydration every 6m)
2nd = Valproate/Lamotrigine if not tolerated
CBT
ECT: SEVERE mania

118
Q

What are 7 side-effects of lithium?

A

N&V
Diarrhoea
Confusion
Excessive Sleeping
Seizures
Myoclonic Jerks
Coarse Tremors

119
Q

What is schizophrenia?

A

Disorder of thinking, perception and affect

120
Q

Name 6 subtypes of schizophrenia

A
  • Paranoid
  • Hebephrenic
  • Catatonic
  • Undifferentiated
  • Residual (low intensity)
  • Simple (progressive)
121
Q

What are the main dopamine and serotonin receptors seen in schizophrenia?

A

D = D2

S = 5HT2a

122
Q

What is the pathophysiology of schizophrenia?

A

Excess dopamine production

Neuronal overactivity → Mesolimbic → Hallucinations/delusions

Neuronal underactivity → Mesocortical → Blunted/anhedonia/apathy

123
Q

What does dopamine inhibit?

A

Prolactin
Dopamine inhibition → hyperprolactinaemia
Side Effects:
- Galactorrhoea
- Amenorrhoea and infertility
- Sexual dysfunction

124
Q

What is the strongest risk factor for schizophrenia?

125
Q

What are 4 First Rank symptoms seen in schizophrenia?

A

Passivity phenomena

Thought disorders: insertion, broadcast or withdrawal

Hallucinations: 3rd person auditory

Delusions: passivity, influence or control

126
Q

How does the ICD-10 define schizophrenia?

A

≥1:
- Passivity phenomena
- Thought disorders
- Hallucinations (3rd person auditory)
- Delusional perception

OR
2≥:

  • Any hallucination
  • Catatonic behaviour
  • Negative symptoms ( no talking, acting incorrectly, no pleasure/motivation)
  • Breaks in train of thought
  • Change in behaviour
  • Impaired insight
  • Neologisms (coining words)
127
Q

What investigations would you order for schizophrenia?

A

Rule out drugs = urine screen
Rule out alcohol = LFTs, FBC, macrocytosis, thrombocytopenia
Rule out syphilis = sero test
Rule out brain lesion = CT head

128
Q

What is the Psychosis risk assessment?

A

Risk to:
Self
Others
From others
Criminal damage to property

129
Q

What is the management of schizophrenia?

A

CBT: early in 3rd person hallucinations

1st line: Atypical
2nd line: Typical
3rd line: Clozapine

130
Q

What are atypical anti-psychotics and when are they indicated?

A

1st episode

Aripiprazole
Olanzapine

131
Q

What are examples of typical anti-psychotics?

A

2nd line: haloperidol

132
Q

What medication is used for treatment resistant schizophrenia?

A

3rd line treatment: clozapine (atypical)

133
Q

What are the side-effects of clozapine?

A

Agranulocytosis (high risk of infection)

Reduced seizure threshold

Sedating

Postural Hypotension

Toxic Megacolon

Cardiomyopathy

Extreme salivating

134
Q

What is Schizoaffective disorder?

A

Schizophrenia + mood disorders

Mania and depression symptoms in small time frame

135
Q

What is the management of schizoaffective disorder?

A

Mood stabilisers (e.g. lithium) + antipsychotics

136
Q

What are the different features between paranoid and simple schizophrenia?

A

Paranoid = positive symptoms

Simple = negative symptoms + psychosis

137
Q

What is hebephrenic schizophrenia?

A

Predominated by thought

138
Q

What extra pyramidal side effects (EPSEs) can anti-psychotics cause?

A

Acute dystonic reaction Parkinsonism
Akasthesia (inner restlessness)
Tardive dyskinesia

139
Q

What is the treatment of EPSEs from anti-psychotics?

A

Procycladine

140
Q

What are personality disorders?

A

Severe disturbance of a persons characteristics and behavioural tendencies that interfere with everyday functioning

141
Q

What is the diagnositc criteria for personality disorders?

A
  • Inhibition of self and social functioning
  • 1≥ pathological personality traits
  • Stable impairments
  • Impairments are not “normal” for the individual’s developmental stage or socio-cultural environment
142
Q

What are risk factors for personality disorders?

A
  • Past abuse
  • Bullying
  • Childhood trauma
  • Self-harm
143
Q

What is the main type of personality disorder?

A

Emotionally unstable personality disorder (borderline)
Cluster B

144
Q

Give 6 symptoms of borderline type personality disorder

A
  1. Emotional instability
  2. Difficult, intense relationships
  3. Feelings of emptiness
  4. Impulsive
  5. Self injurious behaviour
  6. Fear of abandonment/rejection
145
Q

What is the management of personality disorders?

A

Dialectical behavioural therapy (DBT): especially borderline/cluster B personalities

Medication is not mainstay: Benzos for short term

146
Q

What are Cluster A, B and C personalities?

A

A = Eccentric MAD
B = Flamboyant BAD
C = Fearful/anxious SAD

147
Q

Name 3 cluster A personalities

A
  • Paranoid (delusional, jealousy, conspiracies)
  • Schizotypal (weird and magical, circumstantial, bizarre, peculiar)
  • Schizoid (voluntarily withdraws from social interaction)
148
Q

Name 4 cluster B personalities

A
  • Antisocial (impulsive, lack of guilt, low anger tolerance)
  • Borderline
  • Histrionic (dramatic, shallow, extrovert, sexually inappropriate)
  • Narcissistic (grandiosity, egotistical)
149
Q

Name 3 cluster C personalities

A
  • Avoidant (tense and apprehensive)
  • Dependant (need to be cared for, can’t make own decisions)
  • Anankastic (stubborn, perfectionism, egosyntonic, inflexibility) OCPD
150
Q

What is the difference between Avoidant and Schizoid personalities?

A

Schizoid:VOLUNTARILY withdraws

Avoidant: desires companionship but too afraid of rejection

151
Q

What is the difference between OCPD and OCD?

A

Obsessive compulsive personality disorder = they’re okay with how they are

OCD= do not like the obsessions/ compulsions (egodystonic)

152
Q

Define Egosystonic

A

Consistent with self image
(likes their own thoughts/behaviours)

153
Q

Define Egodystonic

A

Conflict with self image (does not like their own thoughts /behaviours)

154
Q

Name 4 types of Sleep Disorders

A

Narcolepsy
Sleep apnoea
Circadian rhythm disorder
Parasomnia

155
Q

What is Narcolepsy?

A

Sleepy throughout the day

156
Q

What is sleep apnoea?

A

Intermittent upper air collapse during sleep

157
Q

What is circadian rhythm disorder?

A

Mismatch between sleep-wake cycle and circadian rhythms (jet lag/shift work)

158
Q

What is parasomnia?

A

State between sleep and wakefulness:
Restless leg syndrome

Nightmares/ night tremors

Sleep walking/talking

159
Q

Name 4 pieces of advice for sleep hygiene

A

1) Limit caffeine, alcohol and cigarettes
2) Less noise/lights/screen use
3) Reduce sleep
4) Regular pattern

160
Q

What medications can be used for sedation?

A

Benzodiazepine e.g diazepam

161
Q

How would you assess suicide risk?

A

SADPERSONS:

Sex (males > females)
Age (peaks in young and old)
Depression
Previous attempts and severity of means
Ethanol abuse (alcohol)
Rational thinking loss (e.g. Schizophrenia)
Support network loss
Organised plans
No significant others
Sickness

Score:
0-2: no problems- keep watch
3-4: send home- but check frequently
5-6: consider hospitalisation- involuntary or voluntary
7-10: Hospitalise- involuntary or voluntary

162
Q

In Section 2 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

28 days

Assessment

2 Drs + 1 AMHP

Patient suffers from disorder and detained for own and others safety

163
Q

In Section 3 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

6 months

Treatment
2 Drs + 1 AMHP

Patient suffers from disorder and detained for own and others safety

164
Q

In Section 4 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

72hrs

Emergency order: waiting for 2nd Dr would cause undesirable delay

1 Dr and 1 AMHP

Patient suffers from disorder and detained for own and others safety + not enough time for 2nd Dr

165
Q

In Section 5 (4) of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

6hrs

Patient admitted but wanting to leave

Nurse holding power

Cannot be coercively treated

166
Q

In Section 5 (2) of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

72hrs

Allows time for section 2 & 3

Doctors holding power

Cannot be coercively treated

167
Q

In Section 136 of the Mental Health Act, what is the?
- Reason?
- Approved by?

A

Found in public space + brought into hospital for assessment

Police sections

168
Q

In Section 135 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?

A

Mental disorder at home : brought to hospital for further assessment

Police sections

Needs court order to access and remove from patient home

169
Q

What are the 5 Principles of the Mental Health Act?

A
  1. Assume capacity
  2. Individual supported to make own decision
  3. Unwise decisions do not mean lack of capacity
  4. Best interests
  5. Least restrictive practice
170
Q

What does having capacity mean?

A

Able to:

1) Understand
2) Retain
3) weigh up
4) Communicate decision

171
Q

What are advanced statements and advanced decisions?

A

Statements: NOT legally binding. Person documents their wishes should they lack capacity in the future.

Decisions: LEGALLY binding.
Made with capacity + witness

172
Q

What is a last power of attorney?

A

Person to make decisions for them if they lack capacity in future

173
Q

What is the court of protection?

A

Makes decisions if no lasting power of attorney

174
Q

What is DOLS?

A

Deprivation of Liberty Guards

Allows deprivation liberty in patients lacking capacity in hospital or care environment if its in their BEST interests

175
Q

What are some indications for use of ECT?

A
  • Severe depression
  • Mania unresponsive to treatment
  • Catatonia
  • Moderate depression
  • Unresponsive to treatment
176
Q

What is a major contraindication for Electroconvulsive Therapy?

A

Raised ICP!

177
Q

What is attachment disorder?

A

When a child is unable to develop relationships with parents/carers

3a Exam (9 decks)

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