Psychiatry Flashcards

Question

What are the physiological reactions to anxiety?

Answer 1

- Decreased blood flow to gut - Smooth muscle contraction in the gut - Increased blood flow to skeletal muscle - Increased muscle tension - Pupil dilatation - Nausea - Increased HR - Increased BP

Answer 2

- psychoeducation - avoid exacerbating lifestyle factors - advise regular exercise - stress reduction techniques - CBT - pharmacological

Answer 3

- pedantic language - repetitive use of words - delay, absence in language development - lack of appropriate non-verbal communication such as smiling, eye contact

Answer 4

- Obsessive thinking about death - Feelings of hopelessness, worthlessness, helplessness - Behaviours suggestive of absolute death wish: 1. Putting financial affairs in order 2. Visiting people to say goodbye

Answer 5

High risk of imminent suicide attempt: consider inpatient treatment Medium risk: consider home crisis plan & provide details of crisis team

Answer 6

suicide = behaviour involved in part some wish to end one's life Non-suicidal self-injurious behaviour = intent to harm without an attempt to end life

Answer 7

Demographics: Male Older adolescent age Non-heterosexual orientation Clinical: - Dx of psychiatric disorder - Recent discharge from psychiatric institution - Previous suicide attempt - FHx of suicide - PMHx of sexual abuse - Childhood trauma - Insomnia - Poor physical health - Low self-esteem - Poor treatment compliance Family and environment: - Life stress – especially unemployment, legal issues or school issues - Lack of social support - Exposure to other with suicidal behaviour - Recent friend or relative with suicide attempt / suicide - Split family (e.g. divorce) - Parental mental illness Mental State: - Suicidal thoughts, especially is specific acts planned - Homicidal ideation - Drug and alcohol use - Impulsivity

Answer 8

Talk to the patient – but remember they may still be drowsy after any drugs they have taken (both in the suicide attempt, and afterward at hospital) History from friend or relative if present: - Look for evidence of continued suicide intention - Is the patient happy to still be alive? - If they took an overdose, - What did they take? - Did they think this would be enough to die? - What did they take it with? (e.g. water, alcohol) - Did they want to be found? - Who found them? Was this person expected home? In the house? Did they phone them? - Did they leave a note? - Have they been planning it? E.g. giving away possessions Stocking up on pills over several weeks/days/months

Answer 9

- detainment = if they try to leave and are risk tot themselves or others - some can be discharged - Inform community care e.g. GP, CMHT - don't prescribe any lethal drugs - speak to psychiatrist

Answer 10

1. Can the patient understand the information relevant to the decision? 2. Can the patient retain the information long enough to make a decision? 3. Can the patient weight up the information as part of the decision making process? 4. Can the patient communicate that decision?

Answer 11

3 of symptoms present at all times: - restlessness - nervousness - fatigue easily - poor concentration - irritability - muscle tension - sleep disturbance

Answer 12

GAD-7 anxiety questionnaire helps establish the severity of the diagnosis

Answer 13

A) The patient must have a 6-month Hx of tension, worry and anxiety about everyday issues. B) 4 of the following Sx must be present: 1. Autonomic Sx: palpitations, sweating, trembling, dry mouth 2. Chest/Abdomen Sx: breathing difficulty, choking sensation, chest pain/discomfort, nausea 3. Brain/Mind Sx: dizzy, unsteady, derealisation, depersonalization, fear of losing control or passing out, fear of dying 4. Tension Sx: muscle tension, aches, restlessness, globus hystericus 5. General Sx: tingling/numbness, hot flushes C) The criteria for panic disorder, hypochondriasis and OCD are not fulfilled D) No physical medical condition or medication could be responsible for these symptoms

Answer 14

1. communicate the diagnosis early, provide info 2. refer for counselling, guided self help, groups 3. High intensity CBT OR Medication = sertraline SSRI acutely anxious = benzodiazepine (not longer than 4 weeks) beta blockers e.g. bisoprolol (physical Sx) 4. psych referral for specialist care

Answer 15

Anxiety related to health issues

Answer 16

Obsessive- compulsive disorder = recurrent obsessional thoughts or compulsive acts/ both may cause functional impairment +/ distress Obsession = unwanted, intrusive thought, image or urge that repeatedly enters the person’s mind and that causes anxiety/ distress compulsions = repetitive behaviours or rituals that the person feels driven to perform by their obsession that must be applied rigidly or to achieve a sense of ‘completeness’

Answer 17

Do you wash or clean a lot? Do you check things a lot? Is there any thought that keeps bothering you that you would like to get rid of, but cannot? Do your daily activities take a long time to finish? Are you concerned about putting things in a special order, or are you upset by mess? Do these problems trouble you? ICD-11 and DSM- 5 criteria

Answer 18

- present on most days - at least 2 weeks - acknowledge that they originate in the mind - tries to resist them but is unsuccessful - doing the act itself is not pleasurable - interferes with functioning

Answer 19

depends on functioning level 1. mild (can still work + socialise) - CBT + ERP (exposure response) OR group CBT - SSRI added if unable to engage 2. Moderate (late to work + sees friends less) - high intensity CBT + ERP - pt can choose to have SSRI instead of therapy 3. Severe (lost job + stays in) - high intensity CBT + ERP - SSRI always given in combo first line = SSRI second line = TCA e.g. clomipramine

Answer 20

All avoid a place/situation All involve over checking GAD - slowly progress starting in the teenage years OCD - develop in the early 20's - might take awhile to develop after an incident - need symptoms for 2 weeks PTSD - can develop straight after an incident - flashbacks - need symptoms for 1 month before diagnosis

Answer 21

- frequent panic attacks - fear apprehension - dyspnoea --> tachycardia, palpitations, sweating, tremor, nausea, chest pain, derealisation, fear of impending death

Answer 22

Encompasses a number of symptoms associated with significant alterations to a person's perception, thoughts, mood and behaviour

Answer 23

Schizophrenia. Delusional disorder. Schizotypal disorder. Depressive psychosis. Manic psychosis. Organic psychosis.

Answer 24

- stress - trauma - severe depression - mania - drugs - personality disorders - PTSD

Answer 25

- hallucinations = auditory MC - Delusions = fixed or falsely held beliefs - Disorganised behaviour, speech and or thoughts - Negative symptoms = emotional blunting, reduced speech, loss of motivation, self-neglect, social withdrawal

Answer 26

Hallucinations. Delusions. Passivity phenomena. Thought alienation. Lack of insight. Mood disturbance.

Answer 27

Blunting of affect. Amotivation. Poverty of speech and/or thought. Self-neglect. Lack of insight. Poor non-verbal communication.

Answer 28

- Assess the person's risk of unintentional harm to themselves - Assess risk of harm to others - refer to psychosis service - CBT - anti-psychotic drugs

Answer 29

- auditory - visual - tactile - olfactory - gustatory (taste)

Answer 30

Most common type of psychotic disorder - diagnose made when certain symptoms present most of the time for 1 month or more

Answer 31

1) 1st rank symptoms for at least one month: - Thought alienation. - Passivity phenomena. - 3rd person auditory hallucinations. - Delusional perception. 2) no other causes for psychosis such as drug intoxication, brain disease, or extensive depression

Answer 32

Delusions. 2nd person auditory hallucinations. Thought disorder. Negative symptoms.

Answer 33

In the 2nd or 3rd decade.

Answer 34

A lack of abstract thinking, in adults this may be due to organic disease or schizophrenia.

Answer 35

Unknown - it may be caused by emotional life experiences that can act as a trigger

Answer 36

1. Neurodevelopmental hypothesis - people who experienced hypoxic brain injury at birth, temporal lobe epilepsy, smoke cannabis are at greater risk 2. Neurotransmitter hypothesis - excess of dopamine and overactivity in the mesocorticolimbic system --> trigger positive symptoms - less dopamine activity in mesocortiyal tracts --> trigger negative symptoms - increase in serotonin activity and decrease in glutamate activity

Answer 37

ICD-10 lists six types of schizophrenia: 1. Paranoid schizophrenia (MC include persecutory hallucinations/delusions, but no effect on speech or emotion) 2. Hebephrenic schizophrenia (disorganised behaviours, thoughts, speech) 3. Catatonic schizophrenia (rare, unusual, limited, sudden movements) 4. Undifferentiated schizophrenia (mix) 5. Residual schizophrenia (psychosis but only have negative symptoms) 6. Simple schizophrenia (positive symptoms rarely experienced)

Answer 38

- most common - characterised by paranoid delusions and auditory hallucinations

Answer 39

- diagnosed in adolescents and young adults - characterised by mood changes, unpredictable behaviour, shallow effects and fragmentary hallucinations

Answer 40

Characterised by negative symptoms - patients have never experience positive symptoms

Answer 41

Characterised by psychomotor features e.g. posturing, rigidity and stupor

Answer 42

When a patients symptoms do not fit into one of the categories of schizophrenia

Answer 43

characterised by negative symptoms - occurs when the positive symptoms have 'burnt out'

Answer 44

- family history - malnutrition + viral infections in pregnancies - drug abuse esp. cannabis - stressful life experiences - afrocarribean men most affected

Answer 45

Used to rule out other causes of confusion/psychotic symptoms - bloods, urine culture, HIV testing,. urine drug screen, syphilis serology, serum lipids - CT head = if organic neurological cause suspected

Answer 46

- Early intervention team, community mental health team and crisis resolution team - Care Programme approach = create a care plan - Voluntary and compulsory hospital admission - Antipsychotic medication = D2 Dopamine receptor antagonists - CBT and family therapy

Answer 47

Older and cause generalised dopamine receptor blockade - Haloperidol - Chlorpromazine - Flupentixol decanoate Broad SE - sexual dysfunction - amenorrhoea - neurological SE = seizures etc. - extrapyramidal SE = Parkinsonism, akathisia, dystonia

Answer 48

More selective in their dopamine blockade + block serotonin 5-HT2 receptors - olanzapine - Risperidone - Amisulpride - Quetiapine - Clozapine (used when atypical and typical meds are ineffective)

Answer 49

Need regular blood tests to check neutrophil levels - can trigger agranulocytosis (low levels of WBC neutrophils) Myocarditis Chronic severe constipation (spontaneous bowel perforation)

Answer 50

where symptoms of schizophrenia and a mood disorder (e.g. depressed or manic) are equally prominent

Answer 51

- Major depression - Dysthymia - Bipolar disorder - Mood disorder related to another health condition - Substance- induced mood disorder - Seasonal affective disorder - Premenstrual dysphoric disorder - Disruptive mood dysregulation disorder

Answer 52

A mood disorder characterised by episodes of depression, mania and hypomania

Answer 53

- genetic factors = single nucleotide polymorphisms - prenatal exposure to Toxoplasmosis - Premature birth <32 weeks - childhood maltreatment - postpartum period - cannabis use

Answer 54

Bipolar I - more severe - person has experienced at least one episode of mania - mania and depression 1:1 ratio Bipolar II - person has experienced at least one episode of hypomania and major depression, but never an episode of mania. - depression to mania is 5:1 Rapid cycling bipolar/cyclothymia - >4 episodes/year of mania + depression - mild form of bipolar - no period is long/severe enough to be diagnosed

Answer 55

- elevated mood - increased activity level - grandiose ideas of self-importance - inability to maintain attention - pressured speech - not sleeping - increased risk behaviour Must last for at least 7 days and have significant negative functional effect on life

Answer 56

less severe than mania - elevation of mood to a lesser extent - increased energy increased sociability, talkativeness, over familiarity, increased sexual energy and decreased need for sleep - irritability may be present - absence of psychotic features No significant negative effect on functioning at work or socially (slight impairment)

Answer 57

Mood congruent - the psychotic symptoms in bipolar that is consistent with their mood e.g. delusions of grandiose in mania Mood incongruent - the actions of the person do not match either the situation or emotional state e.g. laughing when their dog dies

Answer 58

Appearance – bright coloured clothes, eccentric Behaviour – over friendly, perhaps inappropriate Speech – fast, and difficult to interrupt Mood – elated/irritable Thought – fast, sentences may be logical, but linked by puns and similar sounding words, and not by ideas, patient may be very self important and have grandiose ideas. Perception – Hallucinations – usually occur with elated mood Cognition – distractability

Answer 59

- corticosteroids - SSRI - levodopa

Answer 60

Exclude organic causes - baseline blood tests - HIV testing - Toxicology screen - physical neuro exam - CT head

Answer 61

Mania = symptoms last for at least 7 days Hypomania = last for at least 4 days Depression = low mood ect. with a history of manic or hypomanic episodes

Answer 62

- Unipolar depression (i.e. ‘regular’ depression) - Schizophrenia - Borderline personality disorder = Can mimic the cycling moods of bipolar disorder. However, bipolar disorder tends to episodic, which BPD tends to be chronic Organic causes of mania: - Endocrine – thyroid, pituitary or adrenal disorders - Neurological – MS, CVA, Epilepsy, tumour – particularly those things that affect the frontal and subcortical areas. - Drugs – steroids, stimulants, anti-depressives

Answer 63

Factors that increase risk: Reckless behaviour Aggression Promiscuous sexual behaviour (STI’s, pregnancy) Lack of self care (can be a big risk e.g. in diabetes)

Answer 64

Clinical diagnosis but rule out organic causes on first presentation - Bloods = FBC, U+Es, LFTs, TSH, urinary drug screen - PET scan = excessive post synaptic dopamine 2 activity in mania - Increased serotonin and noradrenaline levels in mania - Inositol phosphate = chemical increased metabolism of lithium is icnreased in mania - Cortisol = increased in mania - white matter hyperintesities = poor prognosis, increased manic episodes

Answer 65

Acute management of mania 1. Oral psychotics * Clozapine (careful of agranulocytosis) * 1. olanzipine * 1. Quetiapine * risperidone (antidepressant meds should be tapered off and stopped) 2. typical antipsychotics e.g. valproate, lamotrigine or lithium Acute management of depression in bipolar - fluoxetine + olanzapine - Quetiapine alone - Olanzapine alone -Lamotrigine alone (usually avoid antidepressants only > rapid cycling mood) Psychotic symptoms: - antipsychotics

Answer 66

1. Mood stabilising medication - lithium (patient needs to be on board due to risks so start with anti-psychotics) - anti-epileptic = can add sodium valproate or carbamazepine 2. Psychotherapies

Answer 67

LITHIUM Leukocytosis Insipidus (diabetic) Tremors (fine tremor normal but coarse tremor bad) Hypothyroidism Increased urine Moms beware (teratogenic = Ebstein's anomaly) - nephrotoxic

Answer 68

very narrow therapeutic range can be caused by: - fluid depletion - changes in salt level in diet - reduced renal function - neprhotoxic medication - change in brand of lithium

Answer 69

1. first sample taken 12 hours after last dose 2. after starting lithium levels should be checked weekly until stabilise 3. Once stable serum lithium level every 3 months 4. Urea & Electrolytes measure of kidney function and Thyroid function test TFTs every 6 months 5. Weight or BMI or waist circumference during the last year

Answer 70

- Increased risk of death by suicide - Increased risk of death by general medical conditions such as cardiovascular disease - Side effects of antipsychotic drugs: these can include metabolic effects, weight gain and extrapyramidal symptoms - Socioeconomic effects: major mental illness is associated with a negative drift down the socioeconomic ladder

Answer 71

Consumption of substances that leads to involvement of social, psychological, physical and legal problems - MC substance = cannabis in ages 16-59 - alcohol misuse MC across all ages

Answer 72

Substance dependence requires at least two of the following: 1. Impaired control over substance use 2. Increasing priority over other aspects of life or responsibility 3. Psychological features suggestive of tolerance and withdrawal

Answer 73

1. Release of dopamine gives of pleasurable feelings 2. interact with inhibitory neurotransmitter GABA - more sedative hormones 3. When chronically exposed results in neuroadaptation - brain in will up regulate the natural stimulants to achieve equilibrium 4. Withdrawal symptoms occur when there is a sudden drop in GABA resulting in too much glutamate and no homeostasis

Answer 74

Hazardous drinking = an individual consumes more than 14 units a week Harmful drinking = pattern of drinking consumption directly causes physiological complications and illnesses Alcohol dependence = characterised by craving and tolerance of alcohol consumption

Answer 75

- Ever tried/felt the need to CUT down? - Ever got ANNOYED at someone asking about his drinking? - Have you ever felt GUILTY about your drinking? - EYEOPENER = have you ever felt you needed a drink in the morning?

Answer 76

Units = ABV (%) X Volume (ml))/1000

Answer 77

short term: - alcohol poisoning - accidents long term - liver cirrhosis - bleeding oesophageal varices - hepatic failure - stigmata of liver disease

Answer 78

Decreased inhibitory GABA and increased NMDA glutamate transmission

Answer 79

- restlessness - anxiety - sweating - insomnia - nausea/ vomiting - Delirium tremens - Wernicke's encephalopathy - autonomic arousal = tachycardia, pupillary dilation, sweating - seizures

Answer 80

Medical emergency - characterised by agitation, confusion, paranoia, and visual and auditory hallucinations Treatment: 1. Oral lorazepam 2. Vitamin B

Answer 81

ACE 1. Ataxia 2. Confusion 3. Eyes - ophthalmoplegia - nystagmus all affect cerebellar

Answer 82

- FBC = raised MCV, raised platelets, anaemia - LFTs = increased GGT, AST:ALT >2:1 - haematinics B12/folate (alcohol can cause folate deficiency) - thyroid function tests

Answer 83

1. Long-acting benzodiazepine - chlordiazepoxide hydrochloride - diazepam Fixed dose reducing regimens are used 2. IV Pabrinex - contains vitamin B (thiamine) + C - Naltrexone = makes alcohol less enjoyable - Acamprosate = increases GABA and decreases excitatory glutamate which reduce cravings - Disulfiram = inhibits acetaldehyde dehydrogenase, must avoid alcohol while taking

Answer 84

1. Psychological intervention e.g. CBT 2. Pharmacological - Acamprosate calcium + disulfiram (help those to maintain abstinence) - oral Naltrexone hydrochloride Either help mild alcohol dependence or used for relapse prevention in patients with moderate to severe alcohol dependence

Answer 85

- thiamine (vit B1) deficiency caused by alcohol misuse - alcohol prevents the absorption of thiamine Symptoms: - ataxia - confusion - ophthalmoplegia Treatment: - IV replacement of thiamine (Pabrinex) - then oral thiamine

Answer 86

A state of impaired memory function that is present after the signs of Wernicke's encephalopathy have subsided - anterograde memory disorder meaning that old memories can be accessed but that new memories cannot be made - disorientation to time - confabulation = make up answers - peripheral neuropathy

Answer 87

Life long chronic illness - PO thiamine and multivitamins - no treatment - most eventually require care

Answer 88

Physiological = euphoria, reduced pain, sedation, respiratory depression, mitosis, constipation Psychological = apathy, disinhibition, drowsiness, impaired judgement + attention withdrawal causes = rhinorrhoea, lacrimation, diarrhoea, pupillary dilation, piloerection, tachycardia

Answer 89

Three or more of the following must occur for >1mth: 1. Desire for substance 2. Preoccupation with substance use 3. Withdrawal state 4. Incapability to control substance 5. Tolerance to substance 6. Evidence of harmful effects

Answer 90

- HIV + Hep B/C = increased risk of blood borne infection - TB testing - Urea + electrolytes - LFTs - urine = drug toxicity - ECG, ECHO, CXR Screening - CAGE-AID - addiction severity index - drug abuse screening test - clinical opiate withdrawal scale

Answer 91

Methadone reduction or Buprenorphine reduction

Answer 92

Lofexidine - alpha-adrenergic agonist Can choose to add - Loperamide for diarrhoea - Metoclopramide for N&V - Ibuprofen for headaches and muscle cramp

Answer 93

1. ABCDE 2. Naloxone IV (if come or resp depression) 3. oral activated charcoal if have ingested a load

Answer 94

Naltrexone

Answer 95

1. Acetylcysteine (NAC) 2. psychiatric referral 3. Bloods - check paracetamol level

Answer 96

Provides a legal framework for both informal and compulsory care and treatment of people diagnosed with a mental disorder

Answer 97

- protect vulnerable people - gives patients human rights - protect staff

Answer 98

A mental disorder includes: - Mental illness - schizophrenia, bipolar, dementia, delirium - eating disorders - Personality disorder - Learning disability - Disorders of sexual preference (e.g. paedophilia) People of any age Anyone under the influence of drugs and/or alcohol is specifically excluded from detainment under the act

Answer 99

Any disorder or disability of the mind

Answer 100

Approved mental health professionals = are experiences and specialist mental health professionals trained to undertake assessments under the framework of MHA alongside Drs mainly social workers with extra qualifications and some nurses - AMPHS ultimately decide if detainment is necessary after 2 Drs have agreed (work under local authority, not the NHS)

Answer 101

A person in urgent need for a mental health disorder and are at risk to themselves or others 1. 2 Drs with section 12 and an AMHP 2. AMHP must interview a patient and consider any alternative detention 3. Drs assess the patient 4. needs to be the last option, all other options tested 5. AMHP coordinates transport and logistics e.g. child care, pets

Answer 102

It gives one member of your family rights and responsibilities if you are: - detained in hospital under sections 2, 3, 4 or 37 - under a community treatment order or - under a guardianship.

Answer 103

- S26 has a hierarchy of blood relatives - preference is given to age not gender e.g. if mother is older than father - preference given to the relative who live with/provide care - Not the same as next of kin

Answer 104

Informal admission of patients - a patient can be admitted for care and treatment without formal restrictions and are free to leave at any time To be admitted under section 131: 1. The patient must have capacity 2. The patient must consent to the admission 3. The patient must not resist the admission

Answer 105

Compulsory detention for ASSESSMENT (can still receive treatment) Detained if BOTH apply: 1.The person suffers from a mental disorder that warrants detention in hospital for assessment for at least a limited period. 2. The person ought to be detained in the interests of their own health or safety or the protection of others. (nearest relative cannot object) Maximum detainment of 28 days Professionals involved: 2 Drs, AMHP (- apply to tribunal within 14 days - can't be renewed)

Answer 106

Compulsory detention for TREATMENT Detained if ALL apply: 1. person suffers a mental disorder of nature that makes it appropriate to receive treatment in hospital 2. necessary for the health or safety of the person or protection of others 3. appropriate medical treatment is available for them (nearest realtime can object and prevent detainment) Maximum detainment of 6 months professional involved: 2 Drs, AMHP

Answer 107

1. Purpose: admission in emergency. 2. Duration: 72 hours. 3. Professionals involved: 1 Dr and 1 AMHP. (often gives enough time to get another Dr involved to perform a section 2)

Answer 108

provides police officers power to enter a private premise to remove a person to a place of safety for a mental health assessment

Answer 109

warrant provides police officers with power to entry premises to remove someone who is already under hospital liability

Answer 110

a person suffering with a mental disorder and to be in immediate need of care or control , the police may remove the person to a place fo safety for up to 24hrs - cannot be performed in private property

Answer 111

- the responsible clinician - the nearest relative but it can be overruled by a doctor - mental health review tribunal

Answer 112

- can be used following a section 3 or an unrestricted order - patient receives treatment in the community (who is discharged but then stops taking their medication) - allowed to be recalled back into hospital without a MHA assessment again

Answer 113

A progressive neurological disorder impacting cognition which causes functional impairment.

Answer 114

1. Alzheimer’s. 2. Vascular. 3. Lewy Body

Answer 115

1. Old age. 2. Depression. 3. Physical health problems e.g. DM, hypothyroid, vitamin deficiencies. 4. delirium

Answer 116

ACE-III screening tool

Answer 117

Attention. Memory. Fluency. Language. Visiospatial.

Answer 118

1. Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine, galantamine (mild to moderate dementia) 2. NMDA antagonist e.g. Memantine. (used for contraindications for AChE inhibitors + more severe dementia) 3. RF reduction in vascular dementia is important too

Answer 119

- Progress steadily - amyloid plaques and neurofibrillary tangles - main presentation = memory loss - >60 yrs old

Answer 120

CT head - brain looks smaller - atrophy in fronto-temporal regions

Answer 121

- 2nd MC RF: - MC in males - after stroke - hypertension presentation: - stepwise progress (period of stability, before acute decline progression) - main affects white matter areas - cognitive impairment = mood distrubances and disorders

Answer 122

>50 yrs old Presentation: - rapidly progresses, death MC in first 7 yrs - visual hallucinations - Parkinson like symptoms Cause: - Spherical Lewy body proteins deposited in the brain (also present in Parkinson's) Investigation: DaT scan

Answer 123

LBD - memory problems first or memory + movement within 12 months PDD - movement problems first with memory problems > 12 months later

Answer 124

Cognitive impairments secondary to a mental illness e.g. depression/anxiety.

Answer 125

Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.

Answer 126

- short history, rapid onset - patients with depression answer 'don't know' whereas Alzheimer's patients try to answer but incorrectly - global memory loss (dementia causes recent memory loss) - patient worried about poor memory - disappointed with test results - biological symptoms: weight loss, sleep disturbances

Answer 127

Delirium is an acute confusional state often with changes in consciousness. It is a medical emergency but is often reversible.

Answer 128

1. Infection e.g. UTI. 2. Dehydration. 3. Iatrogenic e.g. medication changes or surgery. 4. Constipation. 5. Urinary retention.

Answer 129

1. Hyperactive - restless, anxious, rapid mood swings, resist care 2. Hypoactive - inactive, drowsy, dazed, don't interact with family or friends 3. Mixed - may switch between being sluggish and restless

Answer 130

Patients with dementia - bidirectional relationship.

Answer 131

- Bloods = FBC, U+Es, LFTs, clotting factors - glucose level - urine dipctick - check medications - check if constipated - check for urinary retention, bladder scan - check for hyper/hypocalcaemia - CT head

Answer 132

Treat the underlying cause and consider environmental support. Antipsychotics can be used in extreme cases if the patient is suffering from hallucinations.

Answer 133

Delirium - acute onset - reversible - worse at night, less orientated - impacted attention Dementia - gradual decline - affect mainly memory - anatomical change - aggression, sexual inhibition, confusion, agitation

Answer 134

Can develop following exposure to an extremely threatening/horrific event/s - impaired memory consolidation of experiences too traumatic to be processed normally -> lead to chronic hyperarousal of fear circuits Need symptoms for 1 month

Answer 135

- Hyperarousal = persistently heightened perception of current threat (may include enhanced startle reaction) - Avoidance of situations/activities = reminiscent of the events, or of thoughts/memories of the events -Re-experiencing = the traumatic events (vivid intrusive memories, flashbacks, or nightmares). - Distress: strong/overwhelming fear and physical sensations when re-experiencing

Answer 136

1. Trauma-focused CBT 2. Eye-Movement Desensitization and Reprocessing (EMDR) therapy 3. Pharmacological: SSRI (sertraline) or SNRI venlafaxine/duloxetine (possible adjunctive antipsychotic) 4. Plus psychoeducation/sleep hygiene/ relaxation etc.

Answer 137

Abnormal state anxiety evoked only/predominantly by a specific external situation/object which is not currently dangerous

Answer 138

- Avoidance of situation - anticipatory anxiety - somatic symptoms e.g. palpitations, sweating, trembling, dyspnoea, cheat pain

Answer 139

- Agoraphobia (crowds, public places, leaving home) - Social phobia (associated with low self-esteem and fear of criticism) - Specific phobias (e.g. claustrophobia, animal phobias, etc.)

Answer 140

Symptoms thought not to be physical in origin - functional disorders

Answer 141

- Stress - abuse - mental conditions e.g. depression, anxiety

Answer 142

IBS, fibromyalgia - muscular or joint ache - headaches - fatigue - dizziness - chest pain - palpitations - GI symptoms - Neurological = seizures, weakness, paralysis, numbness multiple, recurring and frequently changing complaints for at least 2 years

Answer 143

- patient education around the diagnosis and management of stress - CBT, psychotherapy - anti-depressants = due to co-morbid depression

Answer 144

1. Abnormal reciprocal social interaction 2. Communication and language impairment 3. Repetitive repertoire of interests and activities

Answer 145

- Abnormal social interactions: impaired non-verbal behaviour, poor eye contact, failure to develop peer relationships - Abnormal communication or play: delay or lack of spoken language, difficulty in initiating or sustaining conversation - Restricted interests or activities: Encompassing preoccupations and interests, adherence to non-functional routines or rituals, resistance to change

Answer 146

For simple phobias - Treatment is only needed if symptoms are frequent, intrusive, or prevent necessary activities. Exposure therapy is effective. For social and agoraphobia - drug therapy SSRIs, and TCAs eg Clomipramine Psychological therapies CBT (cognitive restructuring) +/- exposure

Answer 147

Seizures Motor tics Increase head circumference Abnormal gaze monitoring Increased ambidexterity

Answer 148

- Intense sensory responsiveness - Absence of typical response to pain or injury - Abnormal temperature regulation

Answer 149

- Autism behaviour checklist - Child autism rating scales - Autism diagnosis observation schedule

Answer 150

Long-lasting, rigid patterns of thought and behaviour. Behaviour that differs from ‘normal’. Isn't developmentally appropriate Present in a range of situations and causes considerable distress. Associated with distress and functional impairment stable over time (2 years or more) Tends to begin in adolescence.

Answer 151

1. Impairments in self and interpersonal functioning. 2. Impairments in personality functioning. 3. Impairments are relatively stable across time and consistent across situations.

Answer 152

1. Forming/maintaining friendships and work relationships. 2. Struggle to control feelings and behaviours. 3. Struggle to trust others.

Answer 153

Emotionally unstable personality disorder.

Answer 154

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

Answer 155

Relieve psychic pain. Express anger. Reduce anxiety. Feel in control. Feel something when numb. Communicate how they feel.

Answer 156

1. Psychological therapies - dialectical behavioural therapy. (helps develop skills to regulate emotions, interpersonal difficulties and prevent future self-harming) 2. Structured clinical management. Medication is not mainstay.

Answer 157

1. certainty (held with absolute conviction) 2. incorrigibility (not changeable by compelling counterargument or proof to the contrary) 3. impossibility or falsity of content (implausible, bizarre, or patently untrue)

Answer 158

- Mood congruent vs mood incongruent - themed: persecutory (someone is trying to harm them), grandiose (they think super highly of themselves), erotomania (someone is in love with them), jealousy (partner having a affair), poverty, somatic (have a illness), nihilistic (body isn't working) - Specific e.g. delusion of reference = insignificant remarks, events, or objects in one's environment that have personal meaning or significance

Answer 159

delusions - no one else believes - erratic + fluctuating - not thinking logically - acting differently in other areas of life Religion - long held constant belief

Answer 160

- anorexia - bulimia - disordered eating = may still be normal weight but are very restrictive with eating - ARFID = avoidant restrictive food intake disorder (autism) - Binge eating = usually overweight

Answer 161

D Dieting Denial Dread of gaining weight Disturbed beliefs about weight Doesn't want help Dual effect = dieting + over exercise/diuretics, laxatives and self induced vomiting Disinterested/ socially withdrawn Decline in weight = rapid (below 85% of predicted BMI <17.5)

Answer 162

- Dry skin - Hypercarotenemia = yellowing skin - Lanugo body hair = hair that covers a newborns body - Acrocyanosis = discoloured extremities - Breast atrophy - Swelling of the parotid and submandibular glands - Thinning hair (irritable, aggressive)

Answer 163

C's and GH Cortisol beta -Carotene GH Cholesterol body compensates well so blood tests can be normal even if severely unwell (don't just rely on blood results)

Answer 164

- significant weight loss = % median BMI <70% - rest bradycardia <50 bpm - postural tachycardia >35 bpm - postural drop in systolic BP >20 - hypothermia <35.5 degrees - severe abdominal pain - escalating parental concern

Answer 165

% median BMI = patients BMI / 50th centile BMI for age X100

Answer 166

BMi = weight /height 2

Answer 167

1. DEXA = if underweight for a year (or 2 yrs if adult) > osteoporosis 2. ECG - slow heart rate - heart becomes very small, due to breakdown of heart muscle and struggles to pump due to no energy

Answer 168

- Bradycardia - prolonged QT (of severe anorexia) - T wave changes (hypokalaemia) low potassium, magnesium and phosphate

Answer 169

1. 3 week admission model - rest - monitor - feed = meal plan start with low calories 2. refeeding bloods daily for 5 days 3. refeeding supplements - phosphate sandoz - thiamine

Answer 170

1. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) 2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) 3. specialist supportive clinical management (SSCM).

Answer 171

Can occur when someone has been malnourished or starved begins feeding again. And if done too quickly can causes electrolyte imbalances that can have severe complications. - causes glucose to be released - glucose is a big molecule so everything else follows it - low potassium, magnesium, phosphate, thiamine

Answer 172

- osteoporosis and increased risk of fractures - growth stunting and pubertal delay (don't have oestrogen, so may not have periods) - reduced fertility - neurocognitive

Answer 173

binge eating followed by intentional vomiting or other putative behaviours such as the use of laxatives or diuretics or exercising

Answer 174

- 1st degree heart block - tall P-waves - flattened T waves changes caused by vomiting: - metabolic alkalosis - hypokalaemia

Answer 175

- recurrent binge eating - lack of control during episode - recurrent compensatory behaviour (vomiting, - misuse of laxatives, diuretics, fasting, excessive exercise) - once a week for 3 months self-evaluation is unduly influenced by body shape and weight (may be normal or high BMI compared to anorexia)

Answer 176

Results from an excess of serotonin in the CNS, often precipitated by the use of serotoneric drugs (often 2 or more) e.g. SSRIs, SNRIs, MAOIs, TCAs

Answer 177

Cognitive: headaches, agitation, hallucinations, coma Autonomic: sweating, shivering, tachycardia, hypertension, nausea, diarrhoea. Somatic: myoclonus, hyperreflexia (clonus), tremor.

Answer 178

1. removing causative agent 2. provide supportive care (cooling measures, fluids, benzodiazepine) 3. If symptoms persist = Cyproheptadine (serotonin antagonist )

Answer 179

Life threatening neurologic emergency associated with the use of antipsychotics (neuroleptic) agents and characterised by a distinctive clinical syndrome of mental status change dopamine depletion

Answer 180

CNS: - fluctuating consciousness - stupor Autonomic - hyperrefelxia - unstable BP - bradycardia - excessive sweating - salivation - urinary incontinence Motor - muscular rigidity (due to muscles breaking down) - dysphasia - dyspnoea agitation, confusion

Answer 181

- raised WBC - raised CPK

Answer 182

1. Stop drug 2. Maintain fluid balance 3. Diazepam for muscle rigidity 4. Dantrolene for malignant hyperthermia 5. Bromocriptine to get rid of dopamine blockade

Answer 183

SS - abrupt onset - Rapidly resolving - myoclonus + tremor - increased reflexes - pupils = mydriasis NMS - gradual onset - prolonged - Diffuse rigidity - decreased reflexes - normal pupils

Answer 184

Help with meaningful activity Social prescribing Health coaching Benefits support Care packages Housing support Support with social integration

Answer 185

- caused by typical antipsychotics

Answer 186

Extremely painful contraction in the: * eyes - oculogyric crisis * neck - antero/latero/retro/torticollis * Jaw - Arm held in dystonic posture, neck spasm to side, mouth open, upward eye gaze, pain and distress

Answer 187

IM procyclidine 5-10mg - anticholinergic medication that functions by blocking muscarinic receptors

Answer 188

- polyuria/ incontinence/ nausea - Drowsy, confusion, blackouts, faints, blurred vision * Shaking / muscle twitches, spasms in face, tongue & neck * TOXICCC - coarse tremor, oliguric renal failure, ataxia, inc reflexes, convulsions, dec consciousness, coma

Answer 189

- U&Es - LFTs - Lithium levels

Answer 190

medical emergency - stop lithium - high fluid + IV NaCl - haemodialysis if severe

Answer 191

Inhibit the reuptake of serotonin from presynaptic serotonin pumps

Answer 192

- depression, anxiety, OCD, bulimia, nervosa - fluoxetine for under 18s - once started com back to Dr 1 week later

Answer 193

Hyponatraemia highest = citalopram lowest risk = duloxetine

Answer 194

presynaptic blockade of both noradrenaline and serotonin reuptake pumps (in high doses also blocks dopamine receptors)

Answer 195

Tricyclic antidepressants - blockade of both noradrenaline and serotonin reuptake pumps (also dopamine to a small extent)

Answer 196

1. Presenting - problem patient comes with 2. Predisposing - biological, environmental or social things that increase their risk e.g. FH, attachment style, poverty 3. Precipitating - an event or something that happened e.g. medical illness, alcohol/drugs, grief, loss, 4. Perpetuating - something that stops you from moving on e.g. chronic illness, medication difficulties, substance use, denial, poor relationships, poor finances 5. Positive/protective factors - things that help the patient e.g. good physical health, positive relationships, religious beliefs, insight split into biological, psychological and social factors for each P

Answer 197

- acute onset - loss of neurological function - no investigation findings manifestation of psychological distress in physical symptoms

Answer 198

- psychological talking therapies = triggered by stressful event - physio if loss of function - psycho education = very common, genuine problem, normalise it

Answer 199

A serious mental health disorder in which a person appears sick or produces physical or mental illness

Answer 200

a depressive episode within the first twelve months postpartum, - peak incidence is 2 months after birth Triad of: Low mood Anhedonia (lack of pleasure in activities) Low energy Symptoms last at least two weeks before postnatal depression is diagnosed.

Answer 201

Manifesting psychological distress in physical symptoms unintentionally - not just neurological presentation e.g. pain, gastro, visual, hearing changes

Answer 202

1. Self-help strategies and non-directive counselling (‘listening visits’ by a health visitor). 2. Moderate to severe depression usually requires treatment with antidepressant medication and/or psychotherapy (CBT). 3. Breast-feeding is not a contraindication for antidepressant treatment, but drugs with low excretion in breastmilk, such as sertraline, are preferred. (High levels of Fluoxetine can transfer in breast milk)

Answer 203

Depression mania psychosis rapid mood changes restless unable to concentrate and sleep

Answer 204

Admission to the mother and baby unit Cognitive behavioural therapy Medications Electroconvulsive therapy (ECT)

Answer 205

Can lead to neonatal abstinence syndrome (also known as neonatal adaptation syndrome). It presents in the first few days after birth with symptoms such as irritability and poor feeding.

Answer 206

- Fear/anxiety about falling asleep - Change of environment (adjustment disorder) - Inadequate sleep hygiene - Idiopathic insomnia (rare, lifelong inability to sleep) - Behavioural insomnia of childhood

Answer 207

Sleep-related breathing disorder e.g. sleep apnoea Circadian rhythm disorders Shift work REM behavioural disorder e.g. Lewy body dementia, PD Medication conditions causing pain -> awake Psychiatric disorders - depression (early morning waking), anxiety (early/middle insomnia) Drugs/alcohol - steroids, antidepressants, stimulants

Answer 208

Non-pharmacological - good sleep routine - remove noise, light and distractions - wind down before bed - avoid caffeine - prevent naps Pharmacological - Z drugs 1L - zopiclone, zolpidem, zapeplon - Sedating antidepressants - mirtazepine - Melatonin

Answer 209

psychotic illness characterized by delusions and hallucinations, - without changes in affect (although there may be reactive anxiety), a form of thought, or personality. it’s the most common form of psychosis in old age - aka late-onset schizophrenia

Answer 210

- no evidence of dementia w/ later onset cases - delusions, hallucinations - paranoid - misidentification - partition delusion

Answer 211

- relive isolation + sensory deficits - low dose atypical antipsychotics (preferred as elderly are very sensitive to SE, but non- complicate secondary to lack of insight is often an issue) -

Answer 212

Minor problems w/ cognition - mental abilities: memory, thinking Not severe enough to interfere w/ everyday life Mild cognitive impairment = pre-dementia condition in some people

Answer 213

Depression, anxiety, stress Sleep apnoea and other sleep disorders Physical illness (constipation, infection) Poor eyesight/hearing Vitamin/thyroid deficiencies e.g. Vit B12 SE of medication: CCBs, anticholinergics, benzodiazepines Drug/alcohol abuse Uncontrolled health conditions like high BP, high cholesterol, diabetes, obesity

Answer 214

- history - review of medications - input from family/ collateral history - bloods/urine if suspect infection/clinical cause

Answer 215

prophylaxis of Sx: - poorly controlled heart condition/diabetes/stroke medication management

Answer 216

- IQ less than 70 - Significant impairment in social and adaptive functioning - Present since birth

Answer 217

- Learning difficulty in specific area - Overall IQ in normal range - E.g. dyslexia, dyspraxia

Answer 218

1. understand the information 2. retain 3. weigh up the risks 4. communicate a decision

Answer 219

Risk to self - may be unaware of surrounding or not have concept of risks Risk to others - may not regulate emotions well and lash out Risk from others - more vulnerable to abuse - could be taken advantage of

Answer 220

Biological: - Medical unwell, check no physical cause to trigger this e.g. infection, pain, constipation, dental, menstrual pain, seizures, change to medication e.g. SSRIs can increase irritability - If she is eating and drinking normally - Normal bowel and urine Social: - Not used to respite care, changes at respite care with staff - Recent loss - Something has changed at home Psychological: - Anxiety, depression, psychosis - Scared of something, trauma - Loud noises, bright lights, textures or smells - Boredom, need a routine

Answer 221

Anti-psychotics = off-license, sedative, low dose e.g. risperidone

Answer 222

often done to help regulate their sensory needs - sensory assessment performed by psychologist - naltrexone - benzos

Answer 223

Increase serotonin First line antidepressant 4-6 weeks to work e.g. sertraline, fluoxetine, citalopram

Answer 224

Nausea, headaches, bowel changes, palpitations, anxiety, insomnia, weight changes, sexual dysfunction citalopram = QT prolongation Paroxetine = significant withdrawal effects (short half life - electric shock sensation + anxiety)

Answer 225

Increase serotonin and noradrenaline - help in the morning with waking up due to noradrenergic effect e.g. duloxetine (help with pain), venlafaxine

Answer 226

Sweating dose dependent increased BP (due to noradrenaline)

Answer 227

Cardiotoxicity - wide QRS - sinus tachycardia - dominant R wave in avR Anticholinergic effect = blurred vision, urinary retention, constipation, dry mouth, confusion, agitation

Answer 228

Increase serotonin + noradrenaline Decrease histamine and acetylcholine e.g. amitriptyline (help with sleep due to antihistamine), imipramine

Answer 229

Increase serotonin, noradrenaline and dopamine - very strong and rarely used e.g. selegline, phenelzine, moclobemide

Answer 230

Hypertensive crisis from tyramine reaction (dietary restrictions e.g. cheese, beer, red wine)

Answer 231

1st generation 'typical' - dopamine antagonist = neurological SE e.g. chlorpromazine, levomepromazine, 2nd generation 'atypical' - work on dopamine and serotonin = metabolic SE e.g. risperidone, aripiprazole (less SE), olanzipine + quetiapine (both 1st line), clozapine (very effective), amisulphride

Answer 232

- Bipolar - rapid tranquillisation depression - personality disorder - eating disorder - delirium - nausea e.g. safe in pregnancy - huntington's chorea - Tic disorders - intractable hiccup

Answer 233

- acute dystonia (abnormal tone, muscle contraction held = hours) - akathisia (restlessness - days) - akinesia (Parkinsonism - weeks) - tardive dyskinesia (peri-oral muscle movement, chewing movement - may be irreversible) - neuroleptic malignant syndrome (dopamine depletion)

Answer 234

Oculogyric crisis is a dystonic reaction that occurs shortly after initiation of anti-psychotics, most commonly with the older typical anti-psychotics. - staring blankly - upward deviation of both eyes.

Answer 235

- hyperprolactinaemia - hyper salivation - sexual side effects - anticholinergic SE - impaired glucose tolerance

Answer 236

Better antipsychotic Used for: - treatment resistant schizophrenia SE - agranulocytosis (now monitored closely - drop in WBCs) - constipation - myocarditis - smoking reduces concentration, caffeine increase concentration - less likely to cause EPSEs 48 hr rule = if you stop for 48hrs you need to start from a low dose again and re-titrate up

Answer 237

1. Lithium - proven to reduce suicide 2. Anti-epileptics - valproic acid (teratogenic) - lamotrigine (help with bipolar depression more - SE Steven Johnson syndrome) 3. Antipsychotics - usually 2nd generation - help with bipolar mania

Answer 238

Cummulative effect on an individual taking on one or more medications with anticholinergic activity anticholinergic effects = stops rest and digest - constipation - urinary retention - dry eyes - confusion - increase cognitive impairment, falls, mortality in older adults

Answer 239

- Restlessness - Trouble sleeping - Unsteadiness - Sweating - Stomach problems - Depressed - Electric shock in your head - Changes to mood Come on within 5 days of stopping and can last 1-2 weeks (most significant with paroxetine)

Answer 240

- Happens due to dissociation - dissociation = feeling cut off or disconnected from your surroundings or from your own body e.g. people can hear but not speak - switching off process in the brain that happens unconsciously

Answer 241

= caused by sudden, often random experience of 'dissociation' - sometimes by stress - can happen when relaxed = easier to go into trance state

Answer 242

- worrying about the seizures - fear of being injured during seizure - fear of being embarrassed in public - fear of losing control - feeling that no one knows what's wrong with you - fear of not being believed

Answer 243

- psychoeducation = understanding the diagnosis - stopping anti-epileptic drugs - speaking to a psychiatrist - learn the warning symptoms - stop driving

Answer 244

- Feeling very worried about people abandoning you, and like you'd try very hard to stop that happening - Having intense emotions that last from a few hours to a few days and can change quickly (such as feeling very happy and confident to suddenly feeling low and sad) - Feeling insecure about who you are, with your sense of self changing significantly depending on who you're with - Ustable relationships, - Acting impulsively - Using self-harm to manage your feelings or feeling suicidal - Experiencing paranoia or dissociation in moments of extreme stress

Answer 245

ACEs Abuse - physical - emotional - sexual Neglect - physical - emotional Household - mental illness, - incarcerated relative - household substance abuse - parental divorce - mother treated violently

Answer 246

As the number of ACEs increase, so the does the risk for negative health outcomes

Answer 247

1. pre-attachment 2. Indiscriminate 3. Discriminate - attachment to one specific caregiver 4. Multiple - growing bonds with other caregivers

Answer 248

- secure - anxious - dismissive - fearful attachment styles develop into personality disorders

Answer 249

- overly clingy - anxious when the person leaves Becomes EUPD

Answer 250

- Avoidant - Never formed an attachment with a caregiver

Answer 251

Lifelong, persistent, deeply ingrained maladaptive behaviour that: - characterizes an individual - deviates markedly from culturally expected or accepted ‘normal’ range - Onset in late childhood or early adolescence

Answer 252

Pattern manifests in 2 or more areas: 1. Cognition = the ways of perceiving and interpreting self, other people and events 2. Affectivity = the range, intensity, + appropriateness of the patients emotional response 3. Interpersonal functioning 4. Impulse control

Answer 253

- unclear - genetic - poor parenting - disrupted/arrested psychic development

Answer 254

Cluster A: Odd or eccentric e.g. paranoid, schizoid,, schizotypal Cluster B: Dramatic, emotional, erratic e.g. antisocial, borderline, histrionic, narcissistic Cluster C: Anxious or fearful e.g. obsessive, dependent, avoidant

Answer 255

social isolation and avoidance of activities due to a fear of embarrassment, criticism, and fear of others.

Answer 256

- is associated with impulsivity, aggressiveness, and irritability. - People often fight and have a lack of remorse. - They are irresponsible and find it difficult to maintain a job.

Answer 257

(aka emotionally unstable EUPD) reflects a mixture of feelings involving: - impulsivity in self-damaging acts, - instability in relationships, depression, - self-harm - worries about abandonment. - recurrent suicidal behaviour - difficulty controlling temper

Answer 258

- Grandiose sense of self importance - Preoccupation with fantasies of unlimited success, power, or beauty - Sense of entitlement - Taking advantage of others to achieve own needs - Lack of empathy - Excessive need for admiration - Chronic envy - Arrogant and haughty attitude

Answer 259

- Difficulty making everyday decisions without excessive reassurance from others - Need for others to assume responsibility for major areas of their life - Difficulty in expressing disagreement with others due to fears of losing support - Lack of initiative

Answer 260

- inappropriate sexuality. - suggestibility, - self-dramatisation, - inappropriate sexual seduction.

Answer 261

- preference of being alone with few interests, - few friends - a lack of desire for companionship.

Answer 262

- Hypersensitivity and an unforgiving attitude when insulted - Unwarranted tendency to questions the loyalty of friends - Reluctance to confide in others - Preoccupation with conspirational beliefs and hidden meaning - Unwarranted tendency to perceive attacks on their character

Answer 263

- Ideas of reference (differ from delusions in that some insight is retained) - Odd beliefs and magical thinking - Unusual perceptual disturbances - Paranoid ideation and suspiciousness - Odd, eccentric behaviour - Lack of close friends other than family members - Inappropriate affect - Odd speech without being incoherent

Answer 264

Emotional sensitivity + Invalidating environment = pervasive emotion dysregulation

Answer 265

- Psychiatric history + MSE - Personality diagnostic questionnaire (PDQ-IV) - Minnesota multiphasic personality inventory - MRI/CT head Diagnosis typically made >18yrs when personality has developed

Answer 266

Biological 1. antipsychotics (reduce all thoughts) 2. Monoamine oxidase inhibitors 3. Mood stabilisers: carbamazepine + lithium (useful in EUPD + antisocial) 4. sedatives = short term crisis e.g. benzo Psychological 1. dialectical behaviour therapy (DBT) 2. CBT Social - crisis team - link up with support group - support with sleeping, eating, home situation

Answer 267

1. Psychodynamic psychotherapy - unconscious transference from the past - defence mechanisms - dream analysis 2. CBT - challenging set beliefs - helpful for cognitive error/ set beliefs 3. Interpersonal therapy - looking into relationships 4. Group psychotherapy - cheaper 5. Dialectical behaviour therapy (DBT) - 1st line treatment for EUPD - help a patient feel grounded, esp. in crisis and self-harming

Answer 268

OCD - a mental illness marked by recurrent intrusive, unwanted thoughts and repetitive behaviours - People feel anxiety or distress - symptoms fluctuate with anxiety - obsessions + compulsions OCPD - personality disorder - disorder in which someone always wants to be in control - signs include: strict orderliness, perfectionism - OCDP traits tend to be persistent over time - behaviours not driven by compulsions or obsessions

Answer 269

Electroconvulsive therapy - induced a grand mal type seizure with electrical currents - needs to high electrical current to have therapeutic benefit - patient under GA and given muscle relaxant

Answer 270

- Depression not responsive to medications and psychotherapy - Depression with psychotic features - Severe psychomotor depression – e.g. refusal to eat, severe personal neglect - catatonic patient It may also be used in: - Schizophrenia with severe depressive symptoms - Schizophrenia with Clouding of consciousness - Mania when drug treatments (both neuroleptics and lithium) have been ineffective

Answer 271

- mania - confusional state = last about 30 mins - memory loss * increased risk if bilateral shock, >12 treatments, >3 times a week

Answer 272

Mental - low mood - lack of motivation or concentration - no enjoyment - agitation - loss of confidence - suicidal thoughts - hopelessness Biological - poor sleep - loss of appetite - low libido Social - social isolation - socially withdrawing

Answer 273

- 3rd person auditory hallucinations - delusions of thought (interruption, content, possession, speed) - delusions of control (thoughts of being controlled by someone else) - delusional perception (ideas of being watched, monitored, persecuted, sense of grandiose, infatuation)

Answer 274

1. Thought insertion – Do you think people are putting ideas in your head? 2. Thought broadcasting – Do you feel like others can hear what you’re thinking? 3. Thought withdrawal – Does it feel like people have removed thoughts from your head?

Answer 275

Defense - Denial = refusal to accept reality - Distortion = a gross reshaping of reality to meet internal needs - Splitting = intolerance of ambiguity leading to self/others being perceived as wholly good or bad

Answer 276

Projection = attributing uncomfortable thoughts or feelings to others Acting out = acting on thoughts or emotions forbidden by the superego Projective identification = the object of projection invokes in that person precisely the thoughts, feelings or behaviours projected

Answer 277

Displacement = Redirection of impulses onto a different target to the one who caused the emotion Reaction formation = Acting in the opposite way to the thought or feeling Repression = Process of involuntarily keeping unwanted emotions or thoughts outside conscious awareness Intellectualization = Focusing on details in an effort to avoid painful thoughts or emotions Dissociation = Temporary drastic modification of one's personal identity or character to avoid emotional distress Isolation = The disconnection of an event from the emotion attached to it Regression = Reverting back to an earlier stage of development when faced with an unpleasant thought or emotion Rationalization = The creation of false but credible justifications Undoing = An attempt to take back an unpleasant thought or emotion

Answer 278

Altruism = Lessening negative feelings by providing constructive service/generosity to others Sublimation = Redirecting negative thoughts or feelings into a more positive form Suppression = Process of consciously avoiding thinking about something for example by distracting oneself Humour = Using ideas and feelings that are pleasurable to others to alleviate a challenging situation Identification = The unconscious modelling of one's self upon another person's character and behaviour

Answer 279

Delusion that a close friend/relative/pet has been replaced by an identical imposter

Answer 280

Delusion that a stranger is someone they know in disguise

Answer 281

Nihilistic delusion that body parts are missing/person is dead/parts are rotting

Answer 282

Erotomania (beliefs of another person being in love with the patient)

Answer 283

GP referral to adult services when aged 17 or 18 GP referral to GIDs (gender identity developmental services) if younger than this

Answer 284

masculinising hormone therapy = testosterone - IM - transdermal - monitoring of serum testosterone - blockers sometimes required for maximum suppression of female 2* sexual characteristics

Answer 285

likely Increased risk: - polycythemia - weight gain - acne - androgen balding - sleep apnoea - emotional instability possible - altered lipid profile - liver dysfunction increased risk with presence of additional risk factors - T2DM HTN - mania and psychosis in patients with pre-existing disorders - CVD

Answer 286

FBC, U+Es, LFTs, TFTs, prolactin, glucose, HbA1c, lipids serum oestradiol, serum testosterone (FSH + LH if oestradiol not supressed) + BMI & BP Desired level 8-12nmol/L for injectables and 14-20 nmol/L for gels Blood tests: 4-6h after gel; trough for injectables Every 3 months/every 6 months/every year

Answer 287

Feminising hormone therapy - oestrogen - transdermal patches or gels - oral tablets - monitoring of serum estradiol - blockers usually required for maximum suppression of sexual characteristics - anti-androgens sometimes also required

Answer 288

Likely - VTE (greater with oral than transdermal) - gallstones - elevated liver enzymes - weight gain - hypertriglyceridemia - emotional instability cardiovascular disease T2DM breast cancer

Answer 289

FBC, U+Es, LFTs, TFTs, prolactin (risk of hyperplasia of subclinical microadenoma), glucose, HbA1c, lipids serum oestradiol, serum testosterone (FSH + LH if testosterone not supressed) + BMI & BP Desired level 350pmol/L – 750pmol/L Blood tests: 4-6h after gel; 24h after tablet; 48h after patch Every 3 months/every 6 months/every year

Answer 290

- focus on system around young person = family, school - interview the family together - interview young person on own as well - obtain permission from young person and family before contacting school

Answer 291

Developmental Disorders Conduct Disorders Emotional Disorders Eating Disorders Psychoses

Answer 292

Able to internally self regulate the emotional neural systems and response to environment From about 5 years upwards - trusting lasting relationships - good self-esteem

Answer 293

Maintaining attachment with a caregiver who is unpredictable Clingy

Answer 294

Alternate clinging with excessive submissiveness to no trust Role reversal – parent cared for by child Dysregulation of fear and anger

Answer 295

Child tries to minimise need for attachment to avoid rebuff Remains in distant contact with the caregiver When severe can ‘freeze’ when reunited with parent

Answer 296

High premature mortality than the general population

Answer 297

- less likely to seek help - effects of lifestyle = exercise alcohol, drugs - effects of prescribed medication - effects of lifestyle - effects of the healthcare system

Answer 298

1. Preservation - refers to persistent repetition of a specific word, phrase or behaviour 2. Echolalia - involved automatic repetition of words or phrases spoken by others 3. Incoherence - manifests as disjointed or unclear speech 4. blocking - sudden and temporary disruptions in speech flow, where a person experiences a momentary inability to recall a word or continue a thought 5. Neologism - creation of new or invented words that may not have a recognised meaning 6. circumstantiality + tangentiality - involves excessive and unnecessary detail when expressing thoughts or explaining concepts 7. Alogia - poverty of thought - brief, unelaborated responses to questions