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Phase 3a - Arun&Erin > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the two main classification systems for mental disorders?

A
  • ICD-10
  • DSM-5
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2
Q

Give 2 examples of biological approaches to psychiatric management

A
  • Pharmacological therapy
  • Electroconvulsive therapy (ECT)
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3
Q

Definition: ECT

A

Electroconvulsive therapy
* done under general anesthesia
* small electric currents are passed through the brain, triggering a brief seizure
* causes change in brain chemistry

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4
Q

Give 2 examples of psychological approaches to psychiatric management

A
  • Counselling
  • Psychoeducation
  • Psychotherapies e.g. CBT
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5
Q

Give 2 examples of social approaches to psychiatric management

A
  • Support groups/self-help groups
  • social services input e.g. financial, housing
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6
Q

Definition: Mood

A

Refers to a patient’s sustained, experienced emotional state over a period of time

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7
Q

Definition: Affect

A

Immediately expressed and observed emotion in response to stimulus (how we perceive someone else’s emotion)

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8
Q

When are fluctuations in mood considered as a mood disorder?

A

When the disturbance of mood is severe enough to cause impairment in the ADLs

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9
Q

Definition: Mood disorder

A

Any condition characterized by distorted, excessive or inappropriate moods or emotions for a sustained period of time
* also known as an affective disorder

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10
Q

Give 2 examples of affective disorders

A
  • Depression
  • Bipolar disorder
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11
Q

Definition: Depression

A

Mood disorder characterized by persistent:
* Low mood
* Anhedonia
* Lack of energy

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12
Q

Definition: Dysthymia

A

A milder, but more chronic form of depression for more than 2 years

Or for 1 year in adolescents or children

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13
Q

Name 7 risk factors for depression

A

Biological:
* Chronic conditions - Parkinson’s, MS, hypothyroidism
* Meds - beta-blockers, steroids
* family Hx,
* female

Psychological:
* childhood abuse/neglect
* Low self-esteem

Social:
* homeless
* unemployed
* divorced
* Poor social support

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14
Q

Clinical features: Name the 3 core symptoms of depression

A
  1. Low mood
  2. Anhedonia: lack of interest in previously enjoyed things
  3. Lack of energy
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15
Q

Clinical features: Name 5 biological symptoms of depression

(Biological meaning the physical manifestation of depression that arise due to impact of body’s physiological systems)

A
  • Sleep disturbance
  • Psychomotor retardation / agitation
  • Loss of libido
  • Weight & appetite change
  • Nihilistic thoughts / worthlessness / guilt
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16
Q

Clinical features: Name 2 psychotic symptoms of depression

A
  • Delusions
  • Hallucinations
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17
Q

DDx: Name some psychiatric differentials of depression

A
  • Depressive episode linked to substance/medication use
  • Bipolar affective disorder
  • Premenstrual dysphoric disorder
  • Bereavement
  • Anxiety disorders
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18
Q

DDx: Name 3 organic illness differentials of depression

A
  • Hypothyroidism
  • Cushing’s disease or syndrome
  • Vitamin B12 deficiency
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19
Q

What clinical investigations should you do for depression?

A
  • PHQ-9 questionnaire
  • FBC: anaemia
  • TFTs: hypothypothyroidism - elevated TSH
  • Vit B12 deficiency
  • Glucose: diabetes can cause anergia

MRI / CT (where there is atypical presentation or features of an intracranial lesion)

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20
Q

Tx: What is the management for depression?

A
  • Low -> high intensity psychosocial interventions: counselling -> CBT
  • FIRST LINE MEDS: Antidepressants: SSRIs (sertraline/fluoxetine/citalopram) in conjunction with psychoeducation
  • ECT in severe cases
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21
Q

Tx: What is the 1st line drug treatment for depression?

A

SSRI: Fluoxetine

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22
Q

What SSRI is best to give to someone after an MI?

A

Sertraline - doesn’t affect conduction of the heart (doesn’t prolong QT)

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23
Q

Who would you not give olanzapine to?

A

A diabetic because it can cause high blood sugar

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24
Q

When should Electroconvulsive therapy (ECT) be considered? (5)

A
  1. Severe depressive illness:
    -treatment resistant depression
    -catatonia
    -depression with psychotic sx
  2. Mania: In cases of manic episodes that do not respond to medication
  3. Schizophrenia: When antipsychotic medication proves ineffective in treating schizophrenia,
  4. Prolonged or severe episodes of agitation
  5. Urgent situations where rapid symptom reduction is needed such as high suicide risk or refusal to eat/drink.
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25
Q

Definition: Bipolar disorder

A

Chronic episodic mood disorder characterized by at least one episode of mania (or hypomania) and a further episode of mania or depression.

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26
Q

Aetiology: Give 5 risk factors for bipolar disorder

A
  • Genetics
  • 1st degree family Hx
  • Anxiety disorders
  • Drug or alcohol abuse
  • thyroid disorders
  • Stressful life events e.g divorce
  • Post-partum period - hormonal fluctuations
  • low socioeconomic status
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27
Q

What are the two main forms of bipolar disorder?

A
  • type 1
    -at least episode of mania
    -no depression needed
  • type 2
    -One episode of hypomania
    -Experienced at least one MAJOR episode of depression - for at least 2 Weeks
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28
Q

What is cyclothymia?

A

chronic mood disorder characterized by numerous periods of hypomanic symptoms and depressive symptoms that are not severe or long enough to meet the criteria for a hypomanic or major depressive episode

Milder but more chronic form of bipolar disorder

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29
Q

Clinical Features: Name 5 symptoms of mania

A
  • Elevated mood
  • Increased activity level
  • Grandiose delusions of self-importance
  • flight of ideas
  • Pressure of speech - fast speech
  • Decreased need for sleep
  • Marked distractibility
  • Increased libido
  • Reckless behaviour and spending
  • Can also occur alongside psychotic symptoms
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30
Q

Clinical Features: Name 4 symptoms of hypomania

A
  • Persistent, mild elevation of mood
  • Increased energy and activity
  • Increased sociability, talkativeness
  • Increased libido
  • impulsivity
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31
Q

DDx: Name some differentials for bipolar disorder

A
  • Schizophrenia (delusions and hallucinations)
  • Organic brain disorder (frontal lobe pathologies can result in a loss of social inhibitions)
  • substance use disorders e.g alcohol and stimulants
  • Recurrent depression
  • Emotionally unstable personality disorder
  • Cyclothymia
  • hyperthyroidism
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32
Q

What clinical
investigations would you do for bipolar disorder?

A
  • Baseline blood tests: FBC,U&E,LFTs,TFTs,CRP,B12,folate,vitD
  • HIV testing
  • Toxicology screen - detect substance misuse
  • Neurological exam
  • CT head
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33
Q

Tx: Name 3 medications to treat bipolar disorder

A
  • Antipsychotics: olanzapine, risperidone, quetiapine, haloperidol
  • Mood stabilisers: lithium, sodium valproate can be added
  • Benzodiazepines: lorazepam
  • SSRIs - fluoxetine
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34
Q

Tx: What non-pharmacological treatments are used for bipolar disorder?

A
  • ECT
  • CBT
  • support groups
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35
Q

What do you need to monitor for when treating a patient with lithium?

A

Kidney function and thyroid function and calcium

Every 6 months

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36
Q

Definition: Psychosis

A

A mental state in which reality is greatly distorted

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37
Q

Aetiology: Name 4 non-organic causes of psychosis

A
  • Schizophrenia
  • Schizoaffective disorder
  • Mood disorders with psychosis
  • Drug-induced psychosis
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38
Q

Aetiology: Name 5 organic causes of psychosis

A
  • Drug-induced psychosis: alcohol, cocaine, amphetamine, MDMA
  • Iatrogenic (medication)
  • Delerium
  • Dementia
  • Huntington’s disease
  • Endocrine disturbance e.g. Cushing’s syndrome
  • Systemic lupus erythematosus
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39
Q

Aetiology: Name 4 medicitions that can cause psychosis

A
  • Levodopa
  • Methyldopa
  • Steroids
  • Antimalarials - chloroquine enters the BBB
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40
Q

Clinical features: How does psychosis present?

A

“abnormality of perception/thought”
* Delusions
* Hallucinations
* Thought disorder

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41
Q

Definition: Delusion

A

A fixed, false belief in something that is not within their usual belief system

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42
Q

Definition: Hallucination

A

A perception in the absence of an external stimulus

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43
Q

Definition: Pseudohallucination

A

Involuntary sensory experience vivid enough to be regarded as a hallucination, but is recognised by the person as being subjective and unreal

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44
Q

Definition: Illusion

A

An incorrect perception of a ‘real’ external stimulus

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45
Q

Name 5 types of delusions

A
  • Persecutory: believing others want to harm them
  • Grandiose: exaggerated sense of one’s importance/power/knowledge/identity
  • Somatic: believing something is wrong with/missing on their body
  • Jealous: believing partner is unfaithful without reason (people with chronic alcohol abuse)
  • Erotomanic: believing someone of a higher social status is in love with them
  • reference: believing that they can pick up on other peoples thoughts, or things are directed against you (schizophrenia)
  • nihilistic: believing that there is no future for themself and very negative (severe depression)
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46
Q

Definition: Schizophrenia

A

Most common psychotic condition characterised by hallucinations, delusions and thought disorders, which lead to functional impairment

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47
Q

Definition: Schizoaffective disorder

A

Characterised by both symptoms of schizophrenia and a mood disorder (depression/mania) in the same episode of illness

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48
Q

Aetiology: Name 4 risk factors for developing schizophrenia

A
  • Family Hx
  • Obstetric complications/fetal injury/intrauterine infection
  • Stressful life events
  • Substance misuse e.g. cannabis
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49
Q

What are the 6 subtypes of schizophrenia?

A
  1. Paranoid (most common)
  2. Hebephrenic
  3. Catatonic
  4. Undifferentiated
  5. Simple
  6. Residual
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50
Q

Clinical features: What are Schneider’s first rank symptoms? (4)

A
  • Delusional perception
  • 3rd person auditory hallucinations
  • Thought interference: insertion, withdrawal, broadcasting
  • Passivity phenomenon/somatic passivity: feelings/actions/impulses are controlled by an external agent
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51
Q

Definition: Delusional perception

A

Person believes that a normal percept has a special meaning for them

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52
Q

Clinical features: What is the difference between positive and negative symptoms of schizophrenia?

A
  • Positive symptoms represent an excess or distortion of normal function (i.e. a change in behaviour or thought)
  • Negative symptoms refer to a decline in normal functioning
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53
Q

Clinical features: Name 5 positive symptoms of schizophrenia

A
  • Delusions
  • Hallucinations
  • Formal thought disorder
  • Thought interference
  • Passivity phenomenon
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54
Q

Clinical features: Name 5 negative symptoms of schizophrenia

A
  • Social isolation
  • Decreased motivation
  • Blunted affect
  • Alogia: poverty of speech
  • Anhedonia
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55
Q

Ix: What investigations are used to rule out other causes of psychotic symptoms in schizophrenia? (7)

A
  • Blood tests (FBC,TFTs,U&E,LFTs,CRP, fasting glucose)
  • Urine culture: rule out UTI causing delirium
  • Urine drug screen: rule out drug intoxication
  • HIV testing
  • Syphilis serology
  • Serum lipids: before starting antipsychotics
  • Relevant imaging: CT head
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56
Q

What is required to form a diagnosis of schizophrenia?

A
  1. A first-rank symptom or persistent delusion present for at least one month
  2. No other cause for psychosis e.g. drug intoxication/withdrawal, brain disease, extensive depressive or manic symptoms
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57
Q

Tx: What is the general management of schizophrenia?

A

Care programme approach
* Assessing health and social needs
* Creating a care plan
* Appointing a key worker to be the first point of contact
* Reviewing treatment

Several MDTs may be involved: early intervention team, community mental health team, crisis resolution team

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58
Q

Tx: What drug type is used to treat schizophrenia?

A

D2 receptor antagonists - first line pharmacological is ATYPICAL antipsychotics

D2 = dopamine

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59
Q

Tx: What is the difference between typical and atypical antipsychotics?

A
  • Typical antipsychotics cause generalised dopamine receptor blockade
  • Atypical antipsychotics are more selective in their dopamine blockade. They also block serotonin 5-HT2 receptors
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60
Q

Tx: Name 3 typical antipsychotics

A
  • Haloperidol
  • Chlorpromazine
  • Loxapine
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61
Q

Tx: Name 4 atypical antipsychotics

A
  • Olanzapine
  • Risperidone
  • Clozapine
  • Quetiapine
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62
Q

Tx: Why are atypical antipsychotics preferred over typical antipsychotics?

A

Fewer and less severe side effects

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63
Q

Tx: Name 5 side effects of typical antipsychotics

A
  • Extrapyramidal side effects (EPSEs): parkinsonism, akathisia, dystonia, dyskinesia
  • Hyperprolactinaemia: sexual dysfunction, increased risk of osteoporosis, amenorrhoea, gynaecomastia & hypogonadism in men
  • Metabolic SEs: weight gain, hyperlipidaemia
  • Anticholinergic SEs: tachycardia, dry mouth, urinary retention
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64
Q

Tx: What drug is used when both typical and atypical antipsychotics have been ineffective in treating schizophrenia?

A

Clozapine

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65
Q

What can clozapine cause?

A
  • Agranulocytosis
  • Reduced seizure threshold
  • hypersalivation
  • constipation
  • cardiomyopathy
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66
Q

Definition: Neurosis

A

Collective term for psychiatric disorders characterised by distress that are:

  • non-organic
  • have a discrete onset
  • where delusions and hallucinations are absent
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67
Q

Definition: Anxiety

A

An unpleasant emotional state involving subjective fear and somatic symptoms

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68
Q

When is anxiety described as an illness?

A

If it becomes excessive or inappropriate

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69
Q

What does the Yerkes-Dodson law state?

A

Anxiety can actually be beneficial up to a plateau of optimal functioning. Beyond this level, performance deteriorates

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70
Q

Clinical features: Name 5 common symptoms of neuroses

A
  • Psychological: fear of impending doom, worrying thoughts, restlessness, poor concentration/attention, irritability
  • Cardiovascular: palpitations, chest pain
  • Respiratory: hyperventilation, tight chest
  • GI: abdominal pain, N+V, loose stools
  • GU: more frequent urination, failure of erection
  • Neuromuscular: tremor, myalgia, headache, parasthesia
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71
Q

What are the 2 main categories anxiety disorders can be divided into?

A
  1. Generalised anxiety: present most of the time, not associated with specific objects/situations, typically longer duration
  2. Paroxysmal anxiety: has an abrupt onset, occurs in short-lived, discrete episodes
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72
Q

Name 5 medical conditions associated with anxiety

A
  • Hyperthyroidism
  • Hypoglycaemia
  • Anaemia
  • Phaeochromocytoma
  • Cushing’s disease
  • COPD
  • Malignancies
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73
Q

Name 3 substance-related conditions associated with anxiety

A
  • Intoxication: alcohol, cannabis, caffeine
  • Withdrawal: alcohol, caffeine
  • Side effects: thyroxine, steroids, adrenaline
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74
Q

Name 5 psychiatric conditions associated with anxiety

A
  • Eating disorders
  • Depression
  • Schizophrenia
  • OCD
  • PTSD
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75
Q

Definition: Generalised anxiety disorder

A

A syndrome of ongoing, uncontrollable, widespread worry about events or thoughts that the patient recognises as excessive and inappropriate

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76
Q

How long must symptoms be present for to be classified as GAD?

A

Most days for at least 6 months

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77
Q

Aetiology: Name 2 biological causes of GAD

A
  • Genetics: 5-fold increase in GAD in first degree relatives of Pt with GAD
  • Neurophysiological: autonomic NS dysfunction, exaggerated responses in amygdala and hippocampus
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78
Q

Aetiology: Name 2 environmental causes of GAD

A
  • Stressful life events: Hx of child abuse, relationship problems, personal illness, employment/finances, living alone/as a single parent
  • Substance dependence
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79
Q

Clinical features: Name some symptoms of GAD

A
  • Difficulty breathing
  • Chest pain/discomfort
  • Nausea
  • Abdominal pain
  • Feeling dizzy/light-headed
  • Fear of dying
  • Muscle tension, aches, pains
  • Restlessness
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80
Q

Ix: Name some investigations for GAD

A
  • Bloods: FBC (infection/anaemia), TFTs (hyperthyroidism), glucose (hypoglycaemia)
  • ECG: may show sinus tachycardia
  • Questionnaires: GAD-7, Beck anxiety inventory (BAI), Hospital anxiety and depression scale (HADS)
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81
Q

DDx: Name some differentials for GAD

A
  • Other neurotic disorders: panic disorder, specific phobias, OCD, PTSD
  • Depression
  • Schizophrenia
  • Personality disorder: anxious PD, dependent PD
  • Excessive caffeine or alcohol consumption
  • Withdrawal from drugs
  • Organic: anaemia, hyperthyroidism, hypoglycaemia, phaeochromocytoma
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82
Q

Tx: What is the stepped care model for the management of GAD?

A
  1. Psychoeducation and active monitoring
  2. Low-intensity psychological interventions: self-help
  3. High-intensity psychological interventions: CBT or drug treatment
  4. Combination of drug and psychological therapies
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83
Q

Tx: What is the first line drug used to treat GAD?

A

SSRI: sertraline

Has anxiolytic effects

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84
Q

Tx: What is the drug treatment of GAD?

A
  • SSRI: sertraline
  • If this doesn’t help –> SNRI: venlafaxine/duloxetine
  • If both ineffective –> pregabalin

Symptomatic tx is propranolol
## Footnote

Meds should be used for at least a year

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85
Q

Tx: When should benzodiazepines be offered to treat GAD?

A

Only as short-term measures during crises as they can cause dependence

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86
Q

Definition: Phobia

A

An intense, irrational fear of an object, situation, place or person that is recognised as excessive or unreasonable

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87
Q

Definition: Agoraphobia

A

Fear of public spaces from which immediate escape would be difficult in the event of a panic attack

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88
Q

Definition: Social phobia/ Social anxiety disorder

A

A fear of social situations which may lead to humiliation, critisism or embarrassment

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89
Q

Definition: Specific (isolated) phobia

A

A fear restricted to a specific object or situation e.g. animals, injury

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90
Q

Aetiology: Name 6 risk factors for phobias

A
  • Adverse experiences (with specific objects/situations)
  • Stress/ negative life events
  • Mood disorders
  • Other anxiety disorders
  • Substance misuse
  • Family Hx
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91
Q

Clinical features: Name 5 symptoms of phobias

A
  • Tachycardia (however in phobias of blood/injury/illness a vasovagal response is produced - bradycardia which can lead to syncope)
  • Unpleasant anticipatory anxiety
  • Inability to relax
  • Urge to avoid the feared situation
  • Fear of dying
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92
Q

Ix: What questionnaires are used when diagnosing phobias?

A
  • Social phobia inventory
  • Liebowitz social anxiety scale
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93
Q

DDx: Name 5 differentials of phobias

A
  • Panic disorder
  • PTSD
  • Anxious PD
  • Depression
  • Schizophrenia
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94
Q

Tx: What is the management of the 3 phobic anxiety disorders?

A
  • CBT
  • Gradual exposure
  • SSRIs for agoraphobia and social phobia
  • Benzodiazepines may be used in the short-term for specific phobias e.g. claustrophobic but need a CT scan
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95
Q

What are SNRIs?

A

Serotonin-noradrenaline reuptake inhibitors

venlafaxine, duloxetine

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96
Q

Tx: What drug is used to treat social phobia if SSRIs and SNRIs are ineffective?

A

MAOI: moclobemide

monoamine oxidase inhibitors

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97
Q

Definition: Panic disorder

A

Disorder characterised by recurrent, episodic, severe panic attacks, which are unpredictable and not restricted to any particular situation.

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98
Q

Aetiology: Name 3 biological causes of panic disorder

A
  • Genetics
  • Neurochemical: post synaptic hypersensitivity to serotonin and adrenaline
  • Sympathetic NS: fear/worry stimulates SNS –> increased cardiac output –> further anxiety
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99
Q

Aetiology: Name 8 risk factors for panic disorder

A
  • Family Hx
  • Female
  • White ethnicity
  • Age 20-30
  • Major life events
  • Recent trauma
  • Asthma
  • Medication e.g. benzodiazepine withdrawal
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100
Q

Clinical features: How long do panic disorder symptoms usually last?

A

Symptoms usually peak within 10 minutes and rarely persist beyond an hour

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101
Q

Clinical features: Name some symptoms of panic disorder

A
  • Palpitations
  • Intense fear of death
  • Chest pain
  • Sweating
  • Shaking
  • Shortness of breath
  • Abdominal distress
  • Depersonalisation/derealisation
  • Numbness
  • Nausea
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102
Q

DDx: Name some psychiatric and organic differentials for panic disorder

A
  • Psychiatric: other anxiety disorders, bipolar, depression, schizophrenia
  • Organic: Phaeochromocytoma, hyperthyroidism, hypoglycaemia, arrhythmias, alcohol/substance withdrawal
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103
Q

Tx: What is the drug management of panic disorder?

A
  • SSRI is 1st line
  • If these don’t work after 12 weeks, then consider a TCA (imipramine/clomipramine)
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104
Q

Tx: Name 2 examples of a TCA used to treat panic disorder

A
  • Imipramine
  • Clomipramine
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105
Q

Definition: Post traumatic stress disorder

A

An intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

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106
Q

Definition: Abnormal bereavement

A

Grief that Has a delayed onset, is more intense and is prolonged (>6 months)

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107
Q

Definition: Acute stress reaction

A

An abnormal reaction to sudden stressful events

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108
Q

Definition: Adjustment disorder

A

When there is significant distress accompanied by an impairment in social functioning when adapting to new circumstances

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109
Q

Give 5 risk factors for PTSD

A
  • Exposure to a major traumatic event: professions at risk (army, police, doctors), groups at risk (refugees, asylum seekers)
  • Previous trauma
  • Hx of mental illness
  • Childhood abuse
  • Post-trauma –> absence of social support, concurrent life stressors
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110
Q

Clinical features: Name the 4 categories of PTSD symptoms

Must occur within 6 months of the event

A
  • Reliving the situation: flashbacks, vivid memories, nightmares
  • Avoidance: avoiding reminders of trauma (e.g. associated people/locations), inability to recall aspects of the trauma
  • Hyperarousal: irritability/outbursts, difficulty concentrating, difficulty sleeping, hypervigilance, exaggerated startle response
  • Emotional numbing: negative thoughts about oneself, difficulty experiencing emotions, feeling detached from others, giving up previously enjoyed activities
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111
Q

Ix: Name 3 investigations for PTSD

A
  • Trauma screening questionnaire (TSQ)
  • ** Post-traumatic diagnostic scale**
  • CT head (if head injury suspected)
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112
Q

DDx: Name 5 differentials for PTSD (8)

A
  • Adjustment disorder
  • Acute stress reaction
  • Bereavement
  • Dissociative disorder
  • Mood or anxiety disorders
  • Personality disorder
  • Head injury
  • Alcohol/substance misuse
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113
Q

Tx: What is the management of PTSD where symptoms are present within 3 months of trauma?

A
  • Watchful waiting (< 4 weeks)
  • Trauma-focused CBT (8-12 sessions)
  • Short-term drug Tx for managing sleep disturbance (e.g. zopiclone)
  • Risk assessment (assess risk for neglect/suicide)
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114
Q

Tx: What is the management of PTSD where symptoms have been present > 3 months after trauma?

A

Trauma-focused psychological intervention
2 options:
* CBT
* EMDR

Drug Tx considered when:
* Little benefit from psychological therapy
* Patient preference
* Co-morbid depression / severe hyperarousal

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115
Q

Tx: What is EMDR?

A

Eye Movement Desensitisation and Reprocessing
* helps patient access and process traumatic memories
* involves recalling emotionally traumatic material while focusing on an external stimulus

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116
Q

Tx: Name 4 drugs used to treat PTSD

A
  • velafaxine = 1st line
  • Sertraline
  • Paroxetine
  • Venlafaxine
  • Fluoxetine
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117
Q

Definition: Obsessive-compulsive disorder (OCD)

A

Disorder characterised by recurrent obsessional thoughts and/or compulsive acts

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118
Q

Definition: Obsessions

A

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

They are distressing for the Pt who attempts to resist them and recognises them as absurd (egodystonic) and a product of their own mind

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119
Q

Definition: Compulsions

A

Repetitive, stereotyped behaviours or mental acts that a person feels driven to perform.

  • They are overt (observable by others) or covert (mental acts not observable)
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120
Q

Aetiology: Name 3 potential causes of OCD

A
  • Family Hx
  • Streptococcal infections
  • Stressful life events
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121
Q

Clinical features: Name the 4 features that obsessions/compulsions always share

A
  1. Failure to resist
  2. Originate from the patient’s mind
  3. Repetitive and distressing
  4. Carrying out the obsessive thought/compulsive act is not in itself pleasurable, but reduces anxiety levels
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122
Q

What is the OCD cycle?

A

Obsession > Anxiety > Compulsion > Relief

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123
Q

Name 4 common obsessions in OCD

A
  • Contamination
  • Fear of harm (door locks)
  • Excessive concern with order/symmetry
  • Others: sex, blasphemy, violence, doubt
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124
Q

Name 5 common compulsions in OCD

A
  • Checking (e.g. taps, doors)
  • Cleaning/washing
  • Repeating acts (e.g. counting/arranging objects)
  • Mental compulsions (e.g. special words repeated in a set manner)
  • Hoarding
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125
Q

Ix: What investigations are used to diagnose OCD?

A

Yale-Brown obsessive-compulsive scale (Y-BOCS)

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126
Q

DDx: Name 5 differentials for OCD (9)

A
  • Both obsessions and compulsions: eating disorders
  • Primarily obsessions: anxiety disorders, depression, schizophrenia
  • Primarily compulsions: Tourette’s syndrome, kleptomania
  • Organic: Dementia, epilepsy, head injury
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127
Q

Tx: What is the management for OCD?

A
  • CBT including ERP (exposure and response prevention)
  • SSRIs: fluoxetine, sertraline
  • Clomipramine (TCA)
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128
Q

Definition: Somatisation disorder

A

Multiple, recurrent and frequently changing physical symptoms not explained by a physical illness over 6 months

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129
Q

Definition: Dissociation

A

A process of separating off certain memories from normal consciousness.

This is a physiological defence mechanism used to cope with emotional conflict that is so distressing to the patient, it is prevented from entering their conscious mind.

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130
Q

Definition: Conversion (in terms of psychiatric Sx)

A

Distressing events are transformed into physical symptoms

E.g anxiety may manifest into GI symptoms

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131
Q

Name 6 risk factors for somatoform and dissociative disorders

A
  • Childhood abuse
  • Reinforcement of illness behaviours
  • Anxiety disorders
  • Mood disorders
  • Personality disorders
  • Social stressors
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132
Q

Tx: Name 4 managements for somatoform and dissociative disorders

A
  • SSRIs (antidepressants)
  • Physical exercise
  • CBT
  • Encouraging stress-relieving activities
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133
Q

Definition: Acute intoxication

A

Theacute, usually transient, effect of the substance

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134
Q

Definition: Dependence syndrome

A

Prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal symptoms

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135
Q

Definition: Withdrawal state

A

Physical and/or psychological effects from complete (or partial) cessation of a substance after prolonged, repeated or high level of use

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136
Q

Definition: Substance-induced psychotic disorder

A

Onset of psychotic symptoms within 2 weeks of substance use.
Must persist for > 48 hrs

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137
Q

Name 5 environmental factors that can lead to substance dependence

A
  • Peer pressure
  • Life stressors
  • Parental drug use
  • Cultural acceptability
  • Personal vulnerability
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138
Q

What is the chain of events leading to substance dependence?

A
  1. Takes substance
  2. Positive reinforcement: psychosocial (from peers/ pleasurable effects of the drug), biological (activates mesolimbic dopaminergic reward pathways)
  3. Dependence
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139
Q

Name 4 examples of opiates

A
  • Morphine
  • Heroin
  • Codeine
  • Methadone
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140
Q

Name 3 psychological effects of opiates

A
  • Apathy
  • Disinhibition
  • Psychomotor retardation
  • Impaired judgement/attention
  • Drowsiness
  • Slurred speech
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141
Q

Name 3 physical effects of opiates

A
  • Respiratory depression
  • Hypoxia
  • Decreased BP
  • Hypothermia
  • Coma
  • Pupillary constriction
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142
Q

Name some symptoms of opiate withdrawal
FLAPPY HANDS

A

Fever and chills
Lacrimation
Agitation
Piloerection
Pupillary dilation
Yawning

Hypertension and tachychardia
Aches
Nausea
Diarrhea
Sweating

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143
Q

Name a cannabinoid

A

Cannabis

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144
Q

Name 3 psychological effects of cannabinoids

A
  • Euphoria
  • Disinhibition
  • Paranoid ideation
  • Temporal slowing (time passes slowly)
  • Imparied judgement/attention/reaction time
  • Illusions
  • Hallucinations
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145
Q

Name 4 physical effects of cannabinoids

A
  • Increased appetite
  • Dry mouth
  • Conjunctival injection (eye redness)
  • Increased HR
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146
Q

Name 5 symptoms of cannabinoid withdrawal

A
  • Anxiety
  • Irritability
  • Tremor of outstretched hands
  • Sweating
  • Myalgia
147
Q

Name a sedative-hypnotic drug

A

Benzodiazepines

148
Q

Name 3 psychological effects of sedative-hypnotics

A
  • Euphoria
  • Disinhibition
  • Apathy
  • Aggression
  • Anterograde amnesia (can’t form new memories)
  • Labile mood (unpredictable, uncontrollable, rapid shifts in emotions)
149
Q

Name 3 physical effects of sedative-hypnotics

A
  • Unsteady gait
  • Difficulty standing
  • Slurred speech
  • Nystagmus
  • Erythematous skin lesions
  • Decreased BP
  • Hypothermia
  • Depression of gag reflex
  • Coma
150
Q

Name 5 symptoms of sedative-hypnotic withdrawal (10)

A
  • Tremor of hands/tongue/eyelids
  • N+V
  • Increased HR
  • Postural hypotension
  • Headache
  • Agitation
  • Malaise
  • Transient illusions/hallucinations
  • Paranoid ideation
  • Grand mal convulsions
151
Q

Name 4 examples of stimulants

A
  • Cocaine
  • Crack cocaine
  • Ecstasy (MDMA)
  • Amphetamine
  • nicotine
152
Q

Name 3 psychological effects of stimulants

A
  • Euphoria
  • Increased energy
  • Grandiose beliefs
  • Aggression/argumentative
  • Illusions/hallucinations
  • Paranoid ideation
  • Labile mood
153
Q

Name 3 physical effects of stimulants

A
  • Increased HR / BP
  • Arrhythmias
  • Sweating
  • N+V
  • Pupillary dilatation
  • Psychomotor agitation
  • Muscular weakness
  • Chest pain
  • Convulsions
154
Q

Name some symptoms of stimulant withdrawal

A
  • Dysphoric mood
  • Lethargy
  • Psychomotor agitation
  • Craving
  • Increased appetite
  • Insomnia / hypersomnia
  • Bizarre/unpleasant dreams
155
Q

Name 2 examples of hallucinogens

A
  • LSD
  • Magic mushrooms
156
Q

Name 3 psychological effects of hallucinogens

A
  • Anxiety
  • Illusions/hallucinations
  • Depersonalisation/derealisation
  • Paranoia
  • Ideas of reference
  • Hyperactivity
  • Impulsivity
  • Inattention
157
Q

Name 3 physical effects of stimulants

A
  • Increased HR
  • Palpitations
  • Sweating
  • Tremor
  • Blurred vision
  • Pupillary dilatation
  • Incoordination
158
Q

Name 4 examples of volatile solvents

A
  • Aerosols
  • Paint
  • Glue
  • Petrol
159
Q

Name 3 psychological effects of volatile solvents

A
  • Apathy
  • Lethargy
  • Aggression
  • Impaired attention/judgement
  • Psychomotor retardation
160
Q

Name 3 physical effects of volatile solvents

A
  • Unsteady gait
  • Diplopia
  • Nystagmus
  • Decreased consciousness
  • Muscle weakness
161
Q

Name 3 examples of anabolic steroids

A
  • Testosterone
  • Androstenedione
  • Danazol
162
Q

Name 3 psychological effects of anabolic steroids

A
  • Euphoria
  • Depression
  • Aggression
  • Hyperactivity
  • Mood swings
  • Hallucinations
  • Delusions
163
Q

Name 3 physical effects of anabolic steroids

A
  • Increased muscle mass
  • Reduced fat
  • Acne
  • Male pattern baldness
  • Reduced sperm count/infertility
  • Stunted growth
164
Q

Ix: Name 3 investigations for substance misuse

A
  • Bloods: blood-bourne infections through needle sharing(HIV screen, Hep B, Hep C, TB), renal function (U+Es), hepatic function (LTFs, clotting), drug levels
  • Urinalysis: drug metabolites can be detected in urine (e.g. cannabis, opioids)
  • ECG: arrhythmias, ECHO if endocarditis suspected (secondary to needle sharing)
165
Q

DDx: Name some differentials of substance misuse

A
  • Psychiatric: psychosis, mood disorders, anxiety disorders, delirium
  • Organic: hyperthyroidism, CVA, intracranial haemorrhage
166
Q

Tx: What is the management of substance misuse?

A
  • Hep B immunisation for those at risk
  • Motivational interviewing/CBT
  • Housing/finance/employment support
  • Self-help groups (e.g. narcotics anonymous and cocaine anonymous)
  • Consider issue of driving: review DVLA
167
Q

Tx: Name 3 managements of opioid dependence

A
  • Biological therapies: methadone (1st line) or buprenorphine for detoxification AND maintenance
  • Naltrexone: formerly opioid-dependent but have now stopped and want to continue abstinence
  • IV naloxone (opioid antagonist): antidote to opioid overdose
168
Q

Definition: Alcohol abuse

A

Consumption of alcohol at a level sufficient to cause physical, psychiatric and/or social harm

169
Q

Definition: Binge drinking

A

Drinking over twice the recommended level of alcohol per day in one session

> 8 units for men, > 6 units for women

170
Q

Definition: Harmful alcohol use

A

Drinking above safe levels with evidence of alcohol-related problems

> 50 units/week for men, > 35 units/week for women

171
Q

Name 5 risk factors for alcohol abuse

A
  • Male: increased metabolism of alcohol
  • Younger adults
  • Antisocial behaviour
  • Lack of facial flushing: risk of alcoholism is decreased in individuals who show alcohol-induced facial flushing
  • Life stressors: e.g. financial problems, marital issues, certain occupations
172
Q

Clinical features: Name 4 symptoms of alcohol intoxication

A
  • Slurred speech
  • Labile affect
  • Impaired judgement
  • Poor coordination

In severe cases: hypoglycaemia, stupor, coma

173
Q

Clinical features: What are the 7 signs of Edward and Gross criteria for alcohol dependence?

A
  • Subjective awareness of compulsion to drink
  • Avoidance or relief of withdrawal Sx by further drinking
  • Withdrawal Sx
  • Drink-seeking behaviour predominates
  • Reinstatement of drinking after attempted abstinence
  • Increased tolerance to alcohol
  • Narrowing of drinking repertoire (i.e. a stereotyped pattern of drinking - fixed times for drinking with reduced influence from environmental cues)
174
Q

Clinical features: Name 6 symptoms of alcohol withdrawal

A
  • Malaise
  • Tremor
  • Nausea
  • Insomnia
  • Transient hallucinations
  • Autonomic hyperactivity

Occur at 6-12 hours after abstinence

175
Q

When is peak incidence of seizures after alcohol withdrawal?

A

36 hours

176
Q

Definition: Delirium tremens

A
  • Severe end of the spectrum of withdrawal
  • Peak incidence is at 72 hours
177
Q

Name 5 symptoms of delirium tremens

A
  • Cognitive impairment
  • Vivid perceptual abnormalities: hallucinations and/or illusions - feel bugs on their skin
  • Paranoid delusions
  • Marked tremor
  • Autonomic arousal: tachycardia, fever, pupillary dilatation, increased sweating
178
Q

Tx: What is the management of delirium tremens?

A
  • Benzodiazepines e.g. chlordiazepoxide
  • Haloperidol for any psychotic features
  • IV Pabrinex contains water soluble vitamins (C,B1,B2,B3,B6)
179
Q

Ix: Name 4 investigations for alcohol abuse

A
  • Bloods: blood alcohol level, FBC, U&Es, LFTs, MCV, hepatitis serology, glucose
  • Alcohol questionnaire: CAGE, AUDIT, SADQ
  • CT head: is head injury suspected
  • ECG: arrhythmias
180
Q

DDx: Name some differentials for alcohol abuse

A
  • Psychiatric: psychosis, mood disorders, anxiety disorders, delirium
  • Medical: head injury, cerebral tumour, CVA (e.g. stroke)
181
Q

Definition: Wernicke’s encephalopathy

A

An acute encephalopathy due to thiamine deficiency

182
Q

Clinical features: Name 5 symptoms of Wernicke’s encephalopathy

A
  • Delirium / altered mental status
  • Nystagmus
  • Ophthalmoplegia
  • Hypothermia
  • Ataxia
183
Q

Tx: What is the management of Wernicke’s encephalopathy?

A

Parenteral thiamine

184
Q

Definition: Korsakoff’s psychosis

A

Profound, irreversible short-term memory loss with:
* confabulation (unconscious filling of gaps in momory with imaginary events)
* disorientation to time

185
Q

Tx: What is the management of alcohol dependence?

A
  • Disulfiram / Naltrexone / Acamprosate
  • Motivational interviewing
  • CBT
  • Alcoholics Anonymous
  • Social support including family involvement
186
Q

Tx: What is the management of alcohol withdrawal?

A
  • Chlordiazepoxide detox regime
  • Thiamine

Chlordiazepoxide = high dose benzodiazepine

187
Q

Name some examples of behavioural addictions

A
  • Food
  • Exercise
  • Gambling
  • Internet
  • Plastic surgery
  • Porn
  • Sex
  • Shopping
  • Social media
  • Video games
188
Q

Name some signs of behavioural addiction

A
  • Prioritising time spent engaging in the behaviour
  • Becoming increasingly dependent on the behaviour to cope with emotions
  • Having difficulty changing behaviour despite wanting to do so
  • Continuing behaviour despite attempts to stop
  • Neglecting or avoiding work/family/school to engage in the behaviour or hide its effects on your life
  • Denying, minimising, hiding the full truth about your addiction
  • Experiencing unpleasant feelings/sensations when trying to stop (withdrawal Sx)
189
Q

Tx: What is the management for addictive behaviours?

A
  • CBT
  • Group therapy
190
Q

Definition: Deliberate self-harm

A

An intentional act of self-poisoning or self-injury, irrespective of the motivation.

Usually an expression of emotional distress

191
Q

Name some methods of self-injury

A
  • Cutting
  • Burning
  • Hanging
  • Stabbing
  • Swallowing objects
  • Shooting
  • Jumping from heights/in front of vehicles
192
Q

Name 4 methods of self-poisoning

A
  • Medication
  • Illicit drugs
  • Household substances
  • Plant material
193
Q

Name 8 risk factors for deliberate self-harm

A
  • Divorced/single/living alone
  • Severe life stressors
  • Harmful drug/alcohol use
  • < 35 y.o.
  • Chronic physical health problems
  • DV or childhood abuse
  • Socioeconomic disadvantage
  • Psychiatric illness e.g. depression, psychosis
194
Q

Ix: Name 4 investigations for ruling out self-harm

A
  • Bloods: paracetamol levels, salicylate levels if suspected overdose, U&Es (renal function), LFTs and clotting (hepatic funtion)
  • Urinalysis: toxicological analysis
  • CT head: if an intracranial cause for altered consciousness is suspected
  • Lumbar puncture: if intracranial infection is suspected (e.g. meningitis)
195
Q

Tx: What is the management of self-harm?

A
  • Acute Tx: treating any overdose with specific antidotes, suturing
  • Manage high suicide risk: full risk assessment!
  • Treat any psychiatric disorder: antidepressants/CBT/psychodynamic psychotherapy
  • Psychosocial assessment: offer help for psychosocial needs e.g. counselling/social services input
  • Follow-up within 48 hours
196
Q

Antidote to paracetamol overdose?

A

N-Acetylcysteine

197
Q

Antidote to opiates overdose?

A

Naloxone

198
Q

Antidote to benzodiazepine overdose?

A

Flumazenil

199
Q

Antidote to warfarin overdose?

A

Vitamin K

200
Q

Antidote to beta-blocker overdose?

A

Glucagon

201
Q

Antidote to TCA overdose?

e.g. amitriptyline

A

Sodium bicarbonate

202
Q

Definition: Suicide

A

A fatal act of self-harm initiated with the intention of ending one’s own life

203
Q

Definition: Attempted suicide

A

The act of intentionally trying to take one’s own life with the primary aim of dying, but failing to succeed in this endeavour

204
Q

Definition: Risk assessment

In a psychiatric context

A

Assessing the risk of self-harm, suicide and/or risk to others

205
Q

Name 5 protective factors which can reduce the risk of suicide (12)

A
  • Children at home
  • Pregnancy
  • Strong religious/spiritual beliefs
  • Strong social support
  • Positive coping skills
  • Positive therapeutic relationship
  • Supportive living arrangements
  • Life satisfaction
  • Fear of the physical act of suicide
  • Fear of disapproval from society
  • Responsibility for others
  • Hope for the future
206
Q

Name 5 clinical risk factors of suicide

A
  • Hx of DSH or attempted suicide
  • Psychiatric illness: depression, schizophrenia, substance misuse, alcohol abuse, personality disorder
  • Childhood abuse
  • Family Hx
  • Medical illness: physically disabling/painful/terminal illness
207
Q

Name 5 socio-demographic risk factors of suicide (8)

A
  • Males 3x more likely
  • Age: 40 - 44 in men
  • Unemployed / low socioeconomic status
  • Occupation: vets, doctors, nurses, farmers
  • Access to lethal means: firearms, hanging, strangling, suffocation
  • Low social support, living alone, institutionalised (e.g. prisons, soldiers)
  • Single/widowed/separated/divorced
  • Recent life crisis: bereavement, family breakdown
208
Q

Clinical features: Name 6 characteristics of someone who is suicidal

A
  • Preoccupation with death
  • Sense of isolation and withdrawal from society
  • Emotional distance from others
  • Distraction and lack of pleasure
  • Focus on the past
  • Feelings of hopelessness and helplessness
209
Q

Name 6 things that can be used to determine the risk of suicide following DSH

A
  1. Note left behind
  2. Planned attempt of suicide
  3. Attempts to avoid being discovered
  4. Afterwards help was not sought
  5. Violent method
  6. Final acts: sorting out finances, writing a will
210
Q

Tx: What is the management for someone who has attempted suicide?

A
  • Ensure safety: remove any means for suicide
  • Pt who has attempted and failed suicide should be medically stabilised: Tx of drug overdose/physical injury
  • Risk assessment
  • Admission to hospital
  • Referral to secondary care
  • Psychiatric Tx
  • Support from Crisis Resolution and Home Treatment team
  • Outpatient and community Tx
211
Q

Name 3 individual suicide prevention strategies

A
  • Detect and treat psychiatric disorders
  • Urgent hospitilisation under the Mental Health Act
  • Involvement of the Crisis Resolution and Home Treatment team
212
Q

Name 5 population level suicide prevention strategies

A
  • Public education/discussion
  • Reducing access to means of suicide: e.g. encourage Pts to dispose of unwanted tablets, safety rails at high places
  • Easy, rapid access to psychiatric care/support groups
  • Decreasing social stressors: e.g. unemployment, DV
  • Reducing substance misuse
213
Q

Definition: Delirium

A

An acute, transient, reversible state of confusion and impaired consciousness and attention

214
Q

What are the 3 subtypes of delirium?

A
  • Hypoactive: lethargy, decreased motor activity, apathy
  • Hyperactive: agitation, irritability, restlessness, aggression, hallucinations/delusions
  • Mixed: signs of both
215
Q

Name 10 causes of delirium

mnemonic: HE IS NOT MAAD

A
  • Hypoxia: resp failure, MI, PE
  • Endocrine: hyper/hypothyroidism, hyper/hypoglycaemia, Cushing’s
  • Infection: UTI, pneumonia, meningitis
  • Stroke/intracranial events: raised ICP, haemorrhage, SOL, head trauma, epilepsy
  • Nutritional: decreased thiamine, vit B12
  • Others: severe pain, sensory deprivation, sleep deprivation
  • Theatre/post-op: anaesthetic, opiate analgesics
  • Metabolic: hepatic/renal impairment, electrolyte disturbance
  • Abdominal: urinary retention, bladder catheterisation, malnutrition, faecal impaction
  • Alcohol: intoxication, withdrawal
  • Drugs: benzodiazepines, opioids, steroids, anti-parkinsonian meds, anticholinergics
216
Q

Name 5 risk factors for delirium (10)

A
  • Old age > 65
  • Multiple co-morbidities
  • Dementia
  • Physical frailty
  • Renal impairment
  • Male sex
  • Sensory impairment
  • Previous episodes
  • Recent surgery
  • Severe illness
217
Q

Clinical features: Name 8 symptoms of delirium

Mnemonic: DELIRIUM

A
  • Disordered thinking: slowed, irrational, incoherent thoughts
  • Emotional disturbances: euphoric, fearful, depressed, angry
  • Language impaired: rambling, repetitive, disruptive
  • Illusions, delusions, hallucinations
  • Reversal of sleep-wake pattern: tired during day, hyper-vigilant at night
  • Inattention: inability to focus, clouding of consciousness
  • Unaware/disoriented: to time, place, person
  • Memory deficits
218
Q

Ix: Name 3 investigations for delirium

A
  • Routine Ix: urinalysis, bloods (FBC,U&E,LFT,, glucose,CRP,TFT etc), infection screen (blood & urine culture)
  • Ix based on Hx/examination: ABG (hypoxia), CT head, lumbar puncture (meningitis), EEG (epilepsy)
  • Questionnaires: Abbreviated Mental Test (AMT), Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE)
219
Q

DDx: Name 5 differentials for delirium

A
  • Dementia
  • Mood disorder
  • Late onset schizophrenia
  • Dissociative disorders
  • Hypo/hyperthyroidism
220
Q

Tx: What is the management of delirium?

A
  • Treat underlying cause: treat any infections, laxatives for faecal impaction, temporary catheterisation for urinary retention
  • Reassurance and re-orientation
  • Provide appropriate environment
  • Manage disturbed, violent, destressed behaviour: low-dose haloperidol or olanzapine
  • Avoid benzodiazepines
221
Q

Definition: Personality disorder

A

A deeply ingrained and enduring pattern of inner experience and behaviour that deviates from expectations in the individual’s culture.
* It is pervasive and inflexible
* Onset in early adulthood
* Is stable over time and leads to distress or impairment

222
Q

What are the 3 clusters of PDs?

A

Cluster A: odd/eccentric
* Paranoid
* Schizoid

Cluster B: dramatic/emotional
* Emotionally unstable (borderline)
* Dissocial (antisocial)
* Histrionic

Cluster C: anxious/fearful
* Dependent
* Avoidant (anxious)
* Anankastic (obsessional)

223
Q

Name 4 risk factors for personality disorder

A
  • Low socioeconomic status
  • Genetics: family Hx
  • Dysfunctional family: poor parenting, parental deprivation
  • Childhood abuse: physical, sexual, emotional, neglect
224
Q

Clinical features: Name the features of cluster A PDs

Cluster A (weird)

A

Paranoid
* suspicious
* unforgiving
* questions fidelity
* jealous
* doesn’t like criticism
* reduced trust

Schizoid
* detached affect
* indifferent to praise/criticism
* reduced libido
* does tasks alone
* no emotion
* takes pleasure in few activities
* absence of close friends

225
Q

Clinical features: Name the features of cluster B PDs

Cluster B (wild)

A

EUPD
* fear of abandonment
* mood instability
* suicidal behaviour
* unstable relationships
* intense relationships
* poor anger control
* impulsive
* disturbed sense of identity
* chronic emptiness

Dissocial (antisocial)
* callous
* blames others
* reckless - disregard for safety
* lack of guilt (remorseless)
* deceitful
* impulsive
* temper/ tendency to violence

Histrionic
* provocative behaviour
* concern for physical attractiveness
* attention seeking
* easily influenced
* shallow/ inappropriate seductive
* egocentric (vain)
* exaggerated emotions

226
Q

Clinical features: Name the features of cluster C PDs

Cluster C (worriers)

A

Dependent
* reassurance required
* difficulty expressing disagreement
* lack of self-confidence
* difficulty initiating projects
* fear of abandonmnent
* seeks companionship
* exaggerated fears

Anxious (avoidant)
* certainty of being liked needed before becoming involved with people
* restriction to lifestyle in order to maintain security
* feels inadequate
* potential to be embarrassed prevents involvement in new activities
* social inhibition

Anankastic (obsessional)
* loses point of activity due to preoccupation with detail
* compromised ability to complete tasks due to perfectionism
* workaholic at the expense of leisure
* fussy
* inflexible/ rigid
* meticulous attention to detail
* stubborn

227
Q

Ix: Name 3 investigations for PD

A
  • Questionnaires: Personality Diagnostic test, Eysenck Personality test
  • Psychological testing: Minnesota Multiphasic Personality Inventory (MMPI)
  • CT head/MRI: rule out organic causes e.g. frontal lobe tumours/intracranial bleeds
228
Q

DDx: Name 3 differentials for PD

A
  • Mood disorders: mania, depression
  • Psychotic disorders: schizophrenia, schizoaffective disorder
  • Substance misuse
229
Q

Tx: What is the management for PD?

A
  • Identify and treat any psychiatric illness and substance misuse
  • Risk assessment: psychosocial interventions to reduce stressors
  • Pharmacological (control Sx): low-dose antipsychotics, mood stabilisers, antidepressants
  • Psychological: CBT, psychodynamic psychotherapy, Dialectical behavioural therapy (DBT)
  • Social: support groups, assistance with social problems (housing/finance/employment), access to education
230
Q

What is DBT?

A

Dialectical Behavioural Therapy

  • Emphasis on developing coping strategies to improve impulse control and reduce self-harm
  • Used in EUPD
231
Q

Definition: Dementia

A
  • A syndrome of generalised decline of memory, intellect and personality
  • Without impairment of consciousness
  • Leading to functional impairment
232
Q

What are the 4 types of dementias from most prevalent to least?

A
  • Alzheimer’s disease
  • Vascular dementia
  • Dementia with Lewy bodies (DLB)
  • Fronto-temporal dementia
233
Q

Name 5 irreversible causes of dementia

A
  • Neurodegenerative: Alzheimer’s, F-T dementia, DLB, Parkinson’s, Huntington’s
  • Infections: HIV, encephalitis, syphilis
  • Toxins: alcohol, barbiturates, benzodiazepines
  • Vascular: vascular dementia, CVD
  • Head trauma
234
Q

Name 3 reversible causes of dementia

A
  • Neurological: normal pressure hydrocephalus, intracranial tumours, CSH
  • Vitamin deficiencies: B12, folic acid, thiamine, nicotinic acid
  • Endocrine: Cushing’s, hypothyroidism
235
Q

What is the pathophysiology of Alzheimer’s disease?

A
  • Degeneration of cholinergic neurons in the nucleus basalis of Meynert leading to acetylcholine deficiency
236
Q

What are 2 microscopic physiological changes seen in Alzheimer’s disease?

A
  • Neurofibrillary tangles (intracellularly)
  • Beta-amyloid plaque formation (extracellularly)

These are pathological lesions progressively distributed around the brain

237
Q

What are 3 macroscopic physiological changes seen in Alzheimer’s disease?

A
  • Cortical atrophy (commonly hippocampus)
  • Widened sulci
  • Enlarged ventricles
238
Q

Aetiology: What is the cause of vascular dementia?

A

Cerebrovascular disease due to:
* stroke
* multi-infarcts
* chronic changes in small vessels (arteriosclerosis)

239
Q

Aetiology: What is the cause of Lewy body dementia?

A

Abnormal deposition of protein (Lewy body) within the neurons of the:
* brainstem
* substantia nigra
* neocortex

240
Q

Aetiology: What is the cause of fronto-temporal dementia?

A

Specific degeneration (atrophy) of the frontal and temporal lobes.

241
Q

What is Pick’s disease?

A

A type of fronto-temporal dementia, where protein tangles (Pick’s bodies) are seen histologically

242
Q

What are the cortical, subcortical and mixed dementias?

A
  • Cortical: AD, fronto-temporal
  • Subcortical: DLB
  • Mixed: vascular
243
Q

Name 7 risk factors for Alzheimer’s disease

A
  • Advancing age
  • Family Hx
  • Genetics
  • CAUCASIAN
  • Down’s syndrome
  • Low IQ
  • CVD
  • Vascular RFs: stroke/MI, smoking, HTN, DM, high cholesterol
244
Q

Clinical features: Name 3 symptoms in early stages of AD

A
  • Memory lapses
  • Difficulty finding words
  • Forgetting names of people/places
245
Q

Clinical features: Name 4 symptoms during disease progression of AD

A
  • Apraxia
  • Agnosia
  • Confusion
  • Language problems
  • Impairment of executive functions
246
Q

Clinical features: Name 7 symptoms in later stages of AD

A
  • Disorientation to time/place
  • Wandering
  • Apathy
  • Incontinence
  • Eating problems
  • Depression
  • Agitation
247
Q

Name 6 clinical features of vascular dementia

A
  • Stepwise rather than continuous deterioration
  • Memory loss
  • Emotional and personality changes
  • Confusion
  • Neurological signs/Sx
  • On examination –> focal neurology (UMN signs) and signs of CVD
248
Q

Name 4 clinical features of DLB

A
  • Day to day fluctuations in cognitive performance
  • Recurrent visual hallucinations
  • Motor signs of parkinsonism (tremor, rigidity, bradykinesia)
  • Recurrent falls / syncope
249
Q

Name 6 clinical features of fronto-temporal dementia

A
  • Family Hx is positive
  • onset before 65
  • Early personality changes: disinhibition (reduced control over one’s behaviour), apathy/restlessness
  • Worsening of social conduct
  • Repetitive behaviour
  • Language problems
  • Memory is preserved
250
Q

Name 3 clinical features of Huntington’s disease

A
  • Autosomal dominant: strong family Hx
  • Abnormal choreiform movements of face, hands, shoulders and gait abnormalities
  • Dementia presents later
251
Q

Name the triad of clinical features in normal pressure hydrocephalus

A
  1. Dementia with prominent frontal lobe dysfunction
  2. Urinary incontinence
  3. Gait disturbance (wide gait)
252
Q

Ix: Name 10 investigations for dementia

A

Blood tests: FBC,CRP,U&E,calcium,LFT,glucose,vit B12 & folate,TFT

Non-routine Ix:
* Urine dipstick
* Chest Xray
* Syphilis serology & HIV testing
* CT/ MRI/ SPECT (to differentiate between AD, VascD and F-TD)
* ECG
* EEG
* Lumbar puncture
* Genetic tests
* Cognitive assessment

253
Q

DDx: Name 5 differentials for dementia (9)

A
  • Normal ageing/ mild cognitive impairment
  • Delirium
  • Trauma: stroke, hypoxic, brain injury
  • Depression: poor concentration/impaired memory common in depression in the elderly
  • Late onset schizophrenia
  • Amnesic syndrome: severe disruption in memory with minimal deterioration in cognitive function
  • Learning disability
  • Substance misuse
  • Drug side effects: opiate, benzodiazepine
254
Q

After a diagnosis of dementia, what are patients legally obliged to do?

A

Contact DVLA

255
Q

Tx: What are 5 non-pharmacological managements of dementia?

A
  • Social support
  • Increasing assistance with day-to-day activities
  • Education
  • Community dementia teams & services
  • Home nursing and personal care
256
Q

What are the aims of dementia treatment?

A
  • Promote independence
  • Maintain function
  • Treat symptoms
257
Q

Tx: What is the pharmacological management of dementia?

A
  • Acetylcholinesterase inhibitors (mild/moderate AD)
  • N-methyl-D-aspartate receptor antagonist (moderate AD in those who are intolerant/contraindication to AChE inhibitors / severe AD)
  • Antipsychotic for challenging behaviour (risperidone)
  • Antidepressant for low mood (sertraline)
258
Q

Tx: Name 3 AChE inhibitors

A
  • Donepezil
  • Galantamine
  • Rivastigmine
259
Q

Tx: Name an NMDA receptor antagonist

A

Memantine

260
Q

Definition: Mild cognitive impairment (MCI)

A

Cognitive impairment without functional impairment
* Characterised by problems with language, memory and thinking

261
Q

Definition: Frontal lobe syndrome

A

Impairment of the frontal lobe of the brain due to disease or frontal lobe injury

262
Q

Definition: Autism

A

Pervasive developmental disorder characterised by a triad of:

  • impairment in social interaction
  • impairment in communication
  • restricted, stereotyped interests and behaviours
263
Q

Aetiology: What are some pre-/ante-/post-natal causes of autism?

A

Prenatal:
* Genetics
* Parental age: 40 y.o.
* Drugs: sodium valproate
* Infection

Antenatal:
* Hypoxia during childbirth
* Prematurity: before 35 weeks’ gestation
* Very low birthweight

Postnatal:
* Toxins: lead, mercury

264
Q

Name the triad of clinical features associated with autism

A

Asocial:
* Few social gestures
* Lack of eye contact
* Lack of interest in others
* Lack of emotional expression

Behaviour restricted:
* Restricted, repetitive and stereotyped behaviour
* Upset at any change in daily routine
* May prefer same foods/same clothes/same games
* Fascination with sensory aspects of environment

Communication impaired:
* Distorted / delayed speech
* Echolalia (repetition of words)

265
Q

Ix: Name 3 investigations for autism

A

Full developmental assessment:
- family Hx
- pregnancy
- birth
- medical Hx
- developmental milestones
- daily living skills
- assessment of communication/social interaction/stereotyped behaviours

Hearing tests

Screening tools: CHAT (checklist for autism in toddlers)

266
Q

DDx: Name 6 differentials for autism

A
  • Asperger’s syndrome
  • Rett’s syndrome
  • Childhood disintegrative disorder
  • Learning disability
  • Deafness
  • Childhood schizophrenia
267
Q

Tx: What is the management of autism? (7)

A
  • Modification of environmental factors
  • Treat co-existing disorders
  • Psychoeducation / CBT
  • Social-communication intervention
  • Special schooling
  • Antipsychotics for challenging behaviour
  • Melatonin for sleep
268
Q

Definition: ADHD

Attention deficit hyperactivity disorder

A

Characterised by an early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development

269
Q

Name 3 risk factors for developing ADHD

A
  • Male: 3x more likely
  • Family Hx
  • Environmental RFs: social deprivation, family conflict, parental cannabis/alcohol exposure
270
Q

Clinical features: Name the 3 core symptoms of ADHD

A

Inattention
* Not listening when spoken to
* Highly distractable
* Reluctant to engage in activities that require persistent mental effort
* Forgetting/regularly losing belongings

Hyperactivity
* Restlessness/fidgeting/tapping
* Recklessness
* Running/jumping around in inappropriate places
* Difficulty engaging in quiet activities
* Excessive talking/noisiness

Impulsivity
* Difficulty waiting their turn
* Interrupting others
* Prematurely blurting out answers
* Temper tantrums/aggression
* Disobedient
* Running into the street without looking

271
Q

Ix: Name 3 investigations for ADHD

A
  • Bloods : TFTs (rule out thyroid disease)
  • Hearing tests
  • Questionnaires/ Rating scales
272
Q

DDx: Name 5 differentials for ADHD (8)

A
  • Learning disabilities/dyslexia
  • Oppositional defiant disorder
  • Conduct disorder
  • Autism
  • Sleep disorders
  • Mood disorders (bipolar)
  • Anxiety disorder
  • Hearing impairment
273
Q

Tx: What is the management of ADHD?

A
  • Psychoeducation
  • CBT and/or social skills training
  • In severe ADHD in school-age children, drug Tx is first line (CNS stimulant)
274
Q

Tx: Name the drugs used to treat ADHD

A
  • Methylphenidate
  • if this fails: Atomoxetine
  • if this fails: dexamfetamine
275
Q

Name 4 side effects of CNS stimulants

A
  • Headache
  • Insomnia
  • Loss of appetite
  • Weight loss
    -stunted growth due to suppressed appetite
276
Q

Definition: Learning disability

A

incomplete development of the mind, characterised by impairment of skills manifested during the developmental period

277
Q

What are the 4 categories of LD?

A

Mild: IQ 50-70
Moderate: IQ 35-49
Severe: IQ 20-34
Profound: IQ < 20

278
Q

What is the triad that must exist to constitute a LD?

A
  • Low intellectual performance
  • Onset at birth or during early childhood
  • Wide range of functional impairment
279
Q

Aetiology: Name 7 causes of LD

A
  • Genetic: Down’s, fragile X syndrome, Cri du chat
  • Antenatal: congenital infection, nutritional deficiency, intoxication, endocrine disorders, pre-eclampsia
  • Perinatal: birth asphyxia, intraventricular haemorrhage, neonatal sepsis
  • Neonatal: hypoglycaemia, meningitis
  • Postnatal: infection, metabolic, anoxia, cerebral palsy
  • Environmental: neglect/non-accidental injury, malnutrition
  • Psychiatric: autism, Rett’s syndrome
280
Q

What are the clinical features of LDs ranging from mild to profound?

A

Mild:
* Adequate language abilities, social skills, self-care
* May be difficulties in academic work
* Most live independently, but may need housing/employment support

Moderate:
* Limited language
* May need supervision for self-care

Severe:
* Motor impairment
* Little/no speech in early childhood
* May have associated physical disorders

Profound:
* Severe motor impairment
* Severe difficulties in communication
* Little/no self-care
* Frequently have physical disorders

281
Q

Ix: Name 4 investigations for LDs before birth

A
  • Amniocentesis
  • Chorionic villus sampling
  • Genetic testing
  • Karyotyping
282
Q

Ix: Name 3 investigations for LDs after birth

A
  • Bloods: FBC, TFTs, glucose, serology
  • Brain imaging: CT head / MRI
  • IQ test
283
Q

Tx: What is the management of learning disabilities?

A
  • Multidisciplinary approach
  • Treat co-morbid medical/psychiatric conditions
  • Behavioural techniques: applied behavioural analysis, positive behaviour support, CBT
  • Family education]
  • Prevention: genetic counselling, antenatal diagnosis
284
Q

Definition: Down’s syndrome

A

A genetic disorder (trisomy 21) characterised by:
* LD
* Dysmorphic facial features
* Multiple structural abnormalities

285
Q

What are 5 physical features of Down’s syndrome? (11)

A
  • Palpebral fissure (up slanting of eye)
  • Round face
  • Occipital + nasal flattening
  • Brushfield spots (pigmented spots on iris)
  • Brachycephaly
  • Low-set small ears
  • Epicanthic folds (monolid)
  • Mouth open and protruding tongue
  • Strabismus (squint)
  • Sandal gap deformity (space between big toe and other toes)
  • Single palmar crease
286
Q

Name 7 medical problems associated with Down’s syndrome

A
  • Heart defects: ventricular/atrial septal defects, ToF
  • Hearing loss
  • Visual disturbance: cataracts, strabismus
  • GI problems: oesophageal/duodenal atresia, coeliac
  • Hypothyroidism
  • Haematological malignancies: AML, ALL
  • Increased incidence of Alzheimer’s
287
Q

Ix: Name 3 investigations for Down’s syndrome

A
  • Serum screening: beta-HCG & pregnancy-associated plasma protein A
  • Nuchal translucency
  • Quad test: beta-HCG, alpha-fetoprotein, inhibin A, estriol
288
Q

What is the MOA for SSRIs?

A
  • Inhibit reuptake of serotonin from the synaptic cleft into pre-synaptic neurones
  • Increase the concentration of serotonin in the synaptic cleft
289
Q

Definition: Serotonin syndrome

A
  • Rare, life-threatening complication of increased serotonin activity
  • Usually rapidly occuring - within minutes of taking meds
290
Q

Clinical features: What are the cognitive/autonomic/somatic effects of serotonin syndrome?

A
  • Cognitive effects: headache, agitation, hypomania, confusion, hallucinations, coma
  • Autonomic effects: shivering, sweating, hyperthermia, HTN, tachycardia
  • Somatic effects: myoclonus, hyperreflexia, tremor
291
Q

What is the MOA for SNRIs?

A
  • Prevent reuptake of noradrenaline and serotonin, but don’t block cholinergic receptors
  • Therefore don’t have as many anti-cholinergic SEs as TCAs
292
Q

What is the MOA for TCAs?

A
  • Inhibit reuptake of adrenaline and serotonin in the synaptic cleft
293
Q

What is the MOA for MAOIs?

A

Inactivate monoamine oxidase enzymes that oxidise the monoamine neurotransmitters dopamine, noradrenaline, serotonin and tyramine

294
Q

Definition: Lithium toxicity

A

Medical emergency which can lead to seizures, coma, death

Enhanced by 4D’s:
* Dehydration
* Drugs (ACE inhibitors, NSAIDs, metronidazole)
* Diuretics (thiazide)
* Depletion of sodium

295
Q

Tx: What is the management of lithium toxicity?

A
  • Stop lithium immediately
  • High fluid intake inc IV sodium chloride to stimulate osmotic diuresis
  • Renal dialysis may be needed in severe cases
296
Q

Definition: Neuroleptic malignant syndrome

A
  • Rare, life-threatening condition seen in patients taking dopamine antagonist (e.g antipsychotics) or withdrawal of dopamine agonist
  • Onset of Sx usually in first 10 days of Tx or after increasing dose/ abrupt withdrawal
297
Q

Clinical features: Name 5 symptoms of neuroleptic malignant syndrome

A
  • Pyrexia
  • Muscular rigidity
  • Confusion
  • Fluctiating consciousness
  • Autonomic instability (e.g. tachycardia, fluctuating BP)
  • May have delirium
298
Q

Ix: Name 3 investigations for neuroleptic malignant syndrome

A
  • Creatinine kinase: increased
  • FBC: leucocytosis may be seen
  • LFTs: deranged
  • ECG: prolonged QT - ventricular arrhythmia
299
Q

Tx: What is the management of neuroleptic malignant syndrome? (5)

A
  • Stop antipsychotic
  • Monitor vital signs
  • IV fluids to prevent renal failure + rhabdomyolysis
  • cooling - antipyrexials, ice packs
  • Dantrolene (muscle relaxant)
  • Bromocriptine (dopamine agonist)
300
Q

Definition: Acute dystonic reaction

A

Medication induced movement disorder characterised by involuntary muscle contractions

301
Q

Clinical features: What are the symptoms of acute dystonic reaction?

A

Extrapyramidal side effects
* Onset of atypical posture / position of muscles
* Within minutes/hours of taking medications

302
Q

Tx: What is the treatment of acute dystonic reaction?

A
  • IV meds: anticholinergic agents procyclidine, benzodiazepines
  • Stop triggering medication
303
Q

Definition: Mental capacity

A
  • One’s ability to make decisions
  • Time specific
  • Decision specific
304
Q

What is section 2 of the MHA?

A

Admission for assessment
Duration: 28 days

305
Q

What is section 3 of the MHA?

A

Admission for treatment
Duration: 6 months

306
Q

What is section 136 of the MHA?

A

Someone found in a public place who appears to have a mental disorder can be taken by the police to a place of safety up to 72 hours

307
Q

Definition: Overvalued idea

A

False belief that is maintained despite strong evidence that is is untrue

308
Q

Definition: Loosening of association

A

Type of formal thought disorder characterised by speech that shifts between topics only minimally related to one another.

309
Q

Definition: Circumstantiality

A

when the focus of a conversation drifts, but often comes back to the point

310
Q

Definition: Perseveration

A

Inappropraite repetition of behaviour

e.g. rocking from side to side, finger wiggling, repetition of words

311
Q

Definition: Confabulation

A

When a person generates a false memory without the intention of deceit

312
Q

Definition: Incongruity of affect

A

Lack of correlation between a person’s affect and their stated mood

e.g. may have happy thoughts/look happy when talking about a sad event

313
Q

Definition: Blunted affect

A

Demonstrating limited intensity of emotions

314
Q

Definition: La Belle indifference

A

A state of being indifferent to physical symptoms or abnormalities that are usually associated with anxiety

315
Q

Definition: Depersonalisation

A

A feeling of being outside yourself and observing your actions/feelings/thoughts from a distance

316
Q

Definition: Derealisation

A

Feel the world is unreal. Things around you may seem foggy/lifeless

317
Q

Definition: Flight of ideas

A

When someone talks quickly and erratically, jumping rapidly between ideas and thoughts

-associated with Mania

318
Q

Definition: Catatonia

A

State in which someone is awake but doesn’t respond to other stimuli

Psychomotor disorder that affects speech and behaviour functions

319
Q

Definition: Stupor

A
  • State of decreased cognitive functioning, sensory capacity and awareness
  • State of lethargy and impaired consciousness
320
Q

Definition: Akathisia

A

Movement disorder causing a feeling of restlessness and an inability to stay still

321
Q

What is neologism

A

Commonly seen in schizophrenia- when they make up new words and think they make sense

322
Q

Circumstantial thinking definition

A

Where someone starts off with thought goes around the houses with thoughts and then returns to original thought

323
Q

What is capgras syndrome

A

A delusional misidentification syndrome where a close member of there life have been replaced by imposters

324
Q

Definition of thought insertion

A

Think that their thoughts are not their own but someone else’s and have been inserted into ones mind

325
Q

Definition: thought withdrawal

A

the delusion that thoughts have been taken out of the patient’s mind.
Often has thought block where the missing piece of information is believed to have been withdrawn

326
Q

Definition: thought broadcasting

A

Type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence.

327
Q

What is a passivity experience

A

Feelings and thoughts and actions thought to be controlled by an external agency

328
Q

How does disulfuram work

A

Blocks enzymes that metabolise alcohol. Increasing the acetaldehyde which is toxic and causing illness and vomiting used for alcohol addiction

329
Q

What type of antipsychotic is aripiprazole

A

Partial dopamine agonist - regulate dopamines receptors

330
Q

48 hour rule for clozapine

A

If they miss dose for 48 hours then they have to get dose retitrated

331
Q

Tx for mania

A

1st line olanzapine for acute attacks
Mood stabilisers:
Lithium
Sodium valproate
Carbamazepine

332
Q

Lithium side effects

A

LITHIUM

L-leukocytosis
I-idiopathic intracranial HTN
T-tremor
H-hypothyroidism
I-insipidus (diabetes)
U-upset stomach (N+V)
M-metabolic - weight gain

333
Q

When can you stop antidepressants

A

-6 months after a remission

-if side effects too severe

334
Q

What is a section 2 in the mental health act

A

Where a patient is admitted to hospital for mental health assessment by 2 doctors and an AMPH for UP TO 28 DAYS

335
Q

What is a section three of the mental health act

A

Where a patient who has a mental health disorder is detained for treatment up to 6 months due risk to yourself or others

336
Q

What is a section 5.4 in mental health act

A

nurses holding power can keep patient in hospital until doctor can assess them - up to 6 hours only mental health nurse or learning disability nurse

337
Q

What is section 5.2 in mental health act

A

doctor/ approved clinician can detain patients for up to 72 hours pending a MHA assessment

338
Q

What is a section 135.1 in the mental health act

A

warrant provides police officers with power to enter premises to remove them and assess them or get them to a place of safety - lasts 24 hours

339
Q

What is a section 135.2 in mental health act

A

Warrant allows police to enter private property if they have previously escaped and they need returning

340
Q

What is a section 136

A

if person appears to a constable to be suffering from mental disorder and to be in immediate need of care of control - up to 24 hours. Used anywhere other than a house or flat

341
Q

Citalopram main side effect

A

Long QT

342
Q

First line SSRI given for teens and children

A

Fluoxetine

Think fluoxeteeeen

343
Q

SNRI main side effect

A

Hypertension - measure BP should be monitored

344
Q

Citalopram side effect and how do you monitor them

A

*monitor using ECG
-QT prolongation
-torsades de pointes

345
Q

Main side effect monitored for in SSRI and how do you monitor

A

*monitor using U+Es
Hyponatraemia

346
Q

What is the most common cause of serotonin syndrome

A

SSRI e.g setraline, fluoxetine, citalopram

347
Q

Causes of serotonin syndrome

A

SSRI
MOA inhibitors - most severe
SNRI
TCA
Drugs - opioids, cocaine, amphetamines

348
Q

Investigations for serotonin syndrome

A

Bloods - FBC, renal function, creatine kinase

Urinalysis - myoglobinuria (rhabdomyolysis)
- toxicology - which drug is causing it

349
Q

Side effects of lithium

A

GI- N+V
- diarrhoea

ADH blocked - nephrogenic diabetes insipidus leads to polydypsia and Polyuria

Hypothyroidism sx

Ataxia

350
Q

Methanol poisoning tx

A

fomepizole or ethanol
haemodialysis

351
Q

What makes Schizophrenia a worse prognosis (4)

A

-low IQ
-gradual onset of
-lack of cause
-social withdrawal

352
Q

Haloperidol main contraindications and side effect

A

Main side effect - QT prolongation
Contraindication - people with heart problems

353
Q

Four drug treatment for people with alcohol abuse (4)

A

Disulfuram
Alcomposate
Diazepam
Naltrexone

354
Q

At what age can personality disorders be diagnosed

A

Over the age of 18

355
Q

What is a section 4

A

72 hours emergency outpatient section when waiting for a section 2 would involve an unacceptable delay by 1 AMP and 1 Dr

356
Q

What is tangeniality

A

Going from one idea to the next with no relevance to the actual question at hand

357
Q

Lithium toxicity effects

A

TRUCKS

T- tremor that is coarse
R-reflexes increase/ hyperreflexia
U-urination increase
C-coma
K-
S-seizures

358
Q

Short term side effects of ECT (5)

A

-headache
-nausea
-short term memory impairment
-memory loss of events prior to ECT
-cardiac arrhythmia

359
Q

Long term side effects of ECT

A

impaired memory

360
Q

Co morbidities for bipolar disorder

A

T2 diabetes
cardiovascular disease
COPD

361
Q

Management for bipolar disorder

A

Mood stabiliser - lithium
Alternative is sodium valproate

management of mania/hypomania
- stopping antidepressant
- antipsychotic therapy e.g. olanzapine or haloperidol

management of depression
-talking therapies - CBT
-fluoxetine is the antidepressant of choice

362
Q

In bipolar why must caution be taken when using antidepressants

A

Fluoxetine usually used
- they can precipitate manic episodes so should undergo close monitoring

363
Q

In bipolar why must caution be taken when using antidepressants

A

Fluoxetine usually used
- they can precipitate manic episodes so should undergo close monitoring

Phase 3a - Arun&Erin (16 decks)

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