Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a Emily > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Define: ADHD

A

Attention Deficit Hyperactivity Disorder (ADHD)
- affects the person’s ability to carry out everyday tasks, develop normal skills and perform well in school

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentation: ADHD

A

Very short attention span
Quickly moving from one activity to another
Quickly losing interest in a task and not being able to persist with challenging tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive or rule breaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 types of ADHD?

A
  1. predominantly inattentive type
  2. predominantly hyperactive-impulsive type
  3. combined type
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management: ADHD

A
  1. detailed assessment by specialist
  2. establish healthy diet and exercise
  3. Medication (central nervous system stimulants)
    - Methylphenidate ‘Ritalin’ (CNS stimulant)
    - Dexamfetamine (stimulant)
    - Atomoxetine (SNRI, increase norepinephrine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 core behaviours of ADHD?

A
  1. Hyperactivity.
  2. Inattention.
  3. Impulsivity.
    (HII)

These symptoms occur in every child from time to time but when they are persistent and impact on daily functions, more investigation is needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ADHD core behaviours: give 3 signs of impulsivity.

A
  1. Blurts out answers.
  2. Interrupts.
  3. Difficulty waiting turns.
  4. When older, pregnancy and drug use.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the sections of a mental state examination?

A

ASEPTIC

  1. Appearance
    (clothing, evidence of self harm or neglect)
  2. Behaviour
    (eye contact, calm, agitated, body language, rapport)
  3. Speech = tone, rate + volume
  4. Emotion: Mood + affect = subjective (how patient describes it), objective (how you would describe their mood)
  5. Thoughts: form + content + possession
  6. Perception
    (hallucinations, delusions)
  7. Cognition
    (orientated to person, place and time)
  8. Insight
    (do they know they have a mental illness)

RISK
- self-harm
- plans to end life
- plans/thoughts to harm others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give some life factors that make you more susceptible to depression.

A

Genetic susceptibility
Life factors –i.e. social situation – e.g. single mums
Alcohol/drug dependence
Abuse (sexual or not) – particularly in childhood
Unemployed
Previous psychiatric diagnosis
Chronic disease
Lack of a confiding relationship
Urban population
Post natal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What medications can cause depression?

A

beta-blockers,
opioids,
antidepressants,
CCBs,
Benzos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ADHD core behaviours: give 3 signs of inattention.

A
  1. Easily distracted.
  2. Not listening.
  3. Mind wandering.
  4. Struggling at school.
  5. Forgetful.
  6. Organisational problems.
  7. Does not appear to be listening when spoken to directly
  8. Makes careless mistakes
  9. Looses important items
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give 3 treatment/management strategies for depression.

A
  1. Antidepressants e.g. SSRI’s.
  2. Talking therapies.
  3. Social inclusion and community support.
  4. ECT.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does depression present in older adults?

A

Under-recognised and under-diagnosed
“Depression without sadness”
Biological symptoms thought of as physical illness
Less likely to seek help
Vague presentations

Relationship with physical health
Bidirectional relationship
Higher physical morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the diagnostic criteria for ADHD? According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

A

ADHD definition <17 Years

6/9 inattentive symptoms and 6/9 hyperactivity/impulsivity.

Present before 12 years
Developmentally inappropriate
Several symptoms in 2 or more settings
Clear evidence symptoms interfere/reduce the quality of social/academic/occupational function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of depression often responds poorly to antidepressants?

A

Vascular depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you classify the severity of the depression?

A

The ICD-10 system:
*Depressed Mood
*Anhedonia
*Fatigability/Loss of energy
Disturbed sleep
Lack of concentration/indecisiveness
Low self confidence
Increased/decreased appetite
Suicidal thoughts or actions
Slowing of movement or speech
Feelings of guilt, worthlessness or self-reproach

Mild depression: 4 symptoms

Moderate depression = 5-6 symptoms

Severe = 7 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some medications for ADHD?

A
  • Methylphenidate ‘Ritalin’
  • Dexamfetamine
  • Atomoxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the NICE guidelines for treatment of mild/moderate depression?

A
  1. low intensity psychological interventions
    - individual guided CBT
    - structured group activity programme
  2. High intensity psychological intervention and/or antidepressant medication
  3. Consider different AD therapy or escalation to psychiatry services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some side effects of ADHD medication?

A
  • headache, insomnia, loss of appetite, stomach ache, dry mouth, nausea
  • Can stunt growth
  • Need to Monitor weight, height and BP
  • Methyphenidate is Not recommended to take during pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the different types of anti-depressants?

A

Selective serotonin re-uptake inhibitor
e.g. sertraline, citalopram, fluoxetine

Serotonin-norepinephrine uptake inhibitor
e.g. venlafaxine, duloxetine

Tricyclic TCA
e.g. amitriptyline

Monoamine oxidase inhibitors
e.g. phenelzine, moclobemide

Atypicals
e.g. Mirtazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Outline some social interaction issues often seen in those with ASD

A
  • NO DESIRE TO INTERACT WITH OTHERS
  • BEING INTERESTED IN OTHERS TO HAVE NEEDS MET
  • LACK OF MOTIVATION TO PLEASE OTHERS
  • AFFECTIONATE ON OWN TERMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define: generalised anxiety disorder GAD

A

A mental health condition that causes excessive and disproportional anxiety and worry that negatively impacts the persons everyday activity

Symptoms are present on a daily basis for months at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Explain the Yerkes-Dodson curve about anxiety

A
  • As anxiety increase, so does performance, attention and focus
  • But if anxiety becomes too high performance is then impaired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the criteria to diagnose generalised anxiety disorder?

A

Diagnosis
requires at least three of these to be present:

Restlessness
Fatigue
Irritability
Poor concentration
Sleep disturbance
Muscle tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the differentials to GAD?

A
  • Depression
  • OCD – anxiety forms part of this condition
  • Can include any psychotic illness

Physical symptoms of anxiety may be mimicked by:
- Hyperthyroidism
- Alcohol / drug abuse
- Drug withdrawal
- Episodes of hypoglycaemia
- Diet related
- Diabetes treatment related
- Tachyarrythmias – e.g. SVT
- Vitamin B12 deficiency
- Heavy metal toxicity
- Phaeochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the physiological reactions to anxiety?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management: GAD

A
  • psychoeducation
  • avoid exacerbating lifestyle factors
  • advise regular exercise
  • stress reduction techniques
  • CBT
  • pharmacological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Outline some communication issues often seen in those with ASD

A
  • pedantic language
  • repetitive use of words
  • delay, absence in language development
  • lack of appropriate non-verbal communication such as smiling, eye contact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some suicide warning signs?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How to manage people who exhibit suicidal ideation?

A

High risk of imminent suicide attempt:
consider inpatient treatment

Medium risk:
consider home crisis plan & provide details of crisis team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the difference between suicide and NSSI behaviour?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some risk factors for suicide?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How to assess a patient after suicide attempt or in crisis?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Management: suicide attempt

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What 4 questions should be considered in a mental capacity assessment?

A
  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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the symptoms for Generalised anxiety disorder?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What assessment is used for generalised anxiety disorder?

A

GAD-7 anxiety questionnaire

helps establish the severity of the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the diagnosis criteria for GAD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management: Generalised anxiety disorder

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Define: hypochrondriasis

A

Anxiety related to health issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Define: OCD

A

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’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the screening questions for OCD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are features of OCD?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Management: obsessive-compulsive disorder

A

depends on functioning level
1. mild (can still work + socialise)
- CBT + ERP (exposure response) OR group CBT
- SSRI added if unable to engage

  1. Moderate (late to work + sees friends less)
    - high intensity CBT + ERP
    - pt can choose to have SSRI instead of therapy
  2. Severe (lost job + stays in)
    - high intensity CBT + ERP
    - SSRI always given in combo

first line = SSRI
second line = TCA e.g. clomipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the differences between GAD, OCD and PTSD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Define: panic disorder

A
  • frequent panic attacks
  • fear apprehension
  • dyspnoea –> tachycardia, palpitations, sweating, tremor, nausea, chest pain, derealisation, fear of impending death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Define: psychosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Name 3 types of psychoses.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the causes/risk factors of psychosis?

A
  • stress
  • trauma
  • severe depression
  • mania
  • drugs
  • personality disorders
  • PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Presentation: Psychosis

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Give 3 positive signs/symptoms in psychosis.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Give 3 negative signs/symptoms in psychosis.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Management: Psychosis

A
  • Assess the person’s risk of unintentional harm to themselves
  • Assess risk of harm to others
  • refer to psychosis service
  • CBT
  • anti-psychotic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the different types of hallucinations?

A
  • auditory
  • visual
  • tactile
  • olfactory
  • gustatory (taste)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Define: schizophrenia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is ICD-10 criteria for schizophrenia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Give 3 second rank symptoms of schizophrenia.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When is the onset of schizophrenia most typical?

A

In the 2nd or 3rd decade.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is concrete thinking?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the cause of schizophrenia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are pathophysiology theories of schizophrenia?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the subtypes of schizophrenia?

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is paranoid schizophrenia?

A
  • most common
  • characterised by paranoid delusions and auditory hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is Hebephrenic schizophrenia?

A
  • diagnosed in adolescents and young adults
  • characterised by mood changes, unpredictable behaviour, shallow effects and fragmentary hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is simple schizophrenia?

A

Characterised by negative symptoms
- patients have never experience positive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is catatonic schizophrenia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is undifferentiated schizophrenia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is residual schizophrenia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the risks factors for schizophrenia?

A
  • family history
  • malnutrition + viral infections in pregnancies
  • drug abuse esp. cannabis
  • stressful life experiences
  • afrocarribean men most affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Investigations: schizophrenia

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Management: Schizophrenia

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are examples of ‘typical’ antipsychotic medication?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are examples of ‘atypical’ antipsychotics?

A

More selective in their dopamine blockade + block serotonin 5-HT2 receptors

  • olanzapine
  • Risperidone
  • Amisulpride
  • Quetiapine
  • Clozapine (used when atypical and typical meds are ineffective)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the effects of clozapine?

A

Need regular blood tests to check neutrophil levels
- can trigger agranulocytosis
(low levels of WBC neutrophils)

Myocarditis

Chronic severe constipation (spontaneous bowel perforation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Define: schizoaffective disorder

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the different types of mood disorders?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Define: bipolar

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the risk factors for bipolar disorder?

A
  • genetic factors = single nucleotide polymorphisms
  • prenatal exposure to Toxoplasmosis
  • Premature birth <32 weeks
  • childhood maltreatment
  • postpartum period
  • cannabis use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the different types of bipolar disorders?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the features of mania?

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are features of hypomania?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is mood congruent and incongruent mean?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

How would a bipolar patient appear in a mental state examination?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What medications can trigger mania?

A
  • corticosteroids
  • SSRI
  • levodopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Investigations: Bipolar

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is the diagnosis criteria for bipolar?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the differential diagnosis for bipolar?

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are some general risks in a bipolar patient?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Investigations: Bipolar

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Acute Management: Bipolar

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Long term management: bipolar

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the side effects of lithium?

A

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

  • nephrotoxic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What can cause lithium toxicity?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

How should lithium be monitored?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the complications of bipolar disorder?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Define: substance misuse disorder

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are requirements for substance dependence?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the pathophysiology of addiction?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the difference between hazardous drinking, harmful drinking and alcohol dependence?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the CAGE questions for alcohol dependence?

A
  • 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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the alcohol units equation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What are the clinical features of alcohol misuse?

A

short term:
- alcohol poisoning
- accidents

long term
- liver cirrhosis
- bleeding oesophageal varices
- hepatic failure
- stigmata of liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are the neurochemical changes occurring in alcohol withdrawal?

A

Decreased inhibitory GABA and increased NMDA glutamate transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

● What are the potential risks or complications if you suddenly stop drinking?

A
  • restlessness
  • anxiety
  • sweating
  • insomnia
  • nausea/ vomiting
  • Delirium tremens
  • Wernicke’s encephalopathy
  • autonomic arousal = tachycardia, pupillary dilation, sweating
  • seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are delirium tremens? And the treatment?

A

Medical emergency
- characterised by agitation, confusion, paranoia, and visual and auditory hallucinations

Treatment:
1. Oral lorazepam
2. Vitamin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is Wernicke’s triad?

A

ACE
1. Ataxia

  1. Confusion
  2. Eyes
    - ophthalmoplegia
    - nystagmus

all affect cerebellar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Investigations: alcohol misuse

A
  • FBC = raised MCV, raised platelets, anaemia
  • LFTs = increased GGT, AST:ALT >2:1
  • haematinics B12/folate (alcohol can cause folate deficiency)
  • thyroid function tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Management: assisted alcohol withdrawal

A
  1. Long-acting benzodiazepine
    - chlordiazepoxide hydrochloride
    - diazepam

Fixed dose reducing regimens are used

  1. 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Management: alcohol dependence and relapse prevention

A
  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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Define + treatment: Wernicke’s encephalopathy

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Define: Korsakoff’s syndrome

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Management: Korsakoff syndrome

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the clinical features of opioid misuse?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is the diagnostic criteria for substance abuse?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Investigations: opioid misuse

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Management: opioid misuse detoxification

A

Methadone reduction
or
Buprenorphine reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is prescribed for opioid withdrawal symptom relief?

A

Lofexidine
- alpha-adrenergic agonist

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Management: opiate overdose

A
  1. ABCDE
  2. Naloxone IV (if come or resp depression)
  3. oral activated charcoal if have ingested a load
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is prescribed for opioid relapse prevention?

A

Naltrexone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Management: paracetamol overdose

A
  1. Acetylcysteine (NAC)
  2. psychiatric referral
  3. Bloods - check paracetamol level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is included in the Mental Health Act 2007/1983?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the purpose of the mental health act?

A
  • protect vulnerable people
  • gives patients human rights
  • protect staff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Who is included under the Mental Health Act?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

How does the MHA define mental health?

A

Any disorder or disability of the mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Define AMPH.

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What are the steps in a MHA assessment?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the role of a nearest relative under MHA?

A

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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is the guideline for the Nearest relative in MHA?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is included in section 131 of MHA?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is stated in section 2 of MHA?

A

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.

  1. 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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is stated in section 3 of MHA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Describe Section 4 of the MHA - purpose, duration, professionals involved.

A
  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)

132
Q

Define Section 135

A

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

133
Q

Define Section 135 (2)

A

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

134
Q

Define Section 136

A

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
135
Q

How to remove a patient from a section?

A
  • the responsible clinician
  • the nearest relative but it can be overruled by a doctor
  • mental health review tribunal
136
Q

What is a community treatment order?

A
  • 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
137
Q

What is dementia?

A

A progressive neurological disorder impacting cognition which causes functional impairment.

138
Q

Name 3 types of Dementia.

A
  1. Alzheimer’s.
  2. Vascular.
  3. Lewy Body
139
Q

Give 3 differential diagnoses for dementia.

A
  1. Old age.
  2. Depression.
  3. Physical health problems e.g. DM, hypothyroid, vitamin deficiencies.
  4. delirium
140
Q

What is the main investigative screening tool used for dementia?

A

ACE-III screening tool

141
Q

Dementia: what 5 cognitive domains does the ACE-III screening tool assess?

A

Attention.
Memory.
Fluency.
Language.
Visiospatial.

142
Q

What drugs can be used in the treatment of dementia?

A
  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
143
Q

What are the features of Alzheimer’s dementia?

A
  • Progress steadily
  • amyloid plaques and neurofibrillary tangles
  • main presentation = memory loss
  • > 60 yrs old
144
Q

Investigations: alzheimer’s

A

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

145
Q

What are the features of vascular dementia?

A
  • 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

146
Q

What are the features and causes of Lewy body dementia?

A

> 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

147
Q

What are the different presentations of Lewy body dementia and Parkinsons disease dementia?

A

LBD
- memory problems first or memory + movement within 12 months

PDD
- movement problems first with memory problems > 12 months later

148
Q

What is pseudo-dementia?

A

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

149
Q

Give one way that you could distinguish between pseudo-dementia and dementia.

A

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

150
Q

What factors support old age depression instead of dementia?

A
  • 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
151
Q

What is delirium?

A

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

152
Q

Give 3 causes of delirium.

A
  1. Infection e.g. UTI.
  2. Dehydration.
  3. Iatrogenic e.g. medication changes or surgery.
  4. Constipation.
  5. Urinary retention.
153
Q

What are the different types of delirium?

A
  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
154
Q

Patients with what psychiatric disorder may be more prone to delirium?

A

Patients with dementia - bidirectional relationship.

155
Q

Investigations: Delirium

A
  • 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
156
Q

How can you treat delirium?

A

Treat the underlying cause and consider environmental support.

Antipsychotics can be used in extreme cases if the patient is suffering from hallucinations.

157
Q

What are the differences between delirium and dementia?

A

Delirium
- acute onset
- reversible
- worse at night, less orientated
- impacted attention

Dementia
- gradual decline
- affect mainly memory
- anatomical change
- aggression, sexual inhibition, confusion, agitation

158
Q

Define: Post traumatic stress disorder PTSD

A

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

159
Q

What are some features of PTSD?

A
  • 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
160
Q

Management: PTSD

A
  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.
161
Q

Define: Phobic anxiety disorder

A

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

162
Q

What are some features of Phobias?

A
  • Avoidance of situation
  • anticipatory anxiety
  • somatic symptoms e.g. palpitations, sweating, trembling, dyspnoea, cheat pain
163
Q

What are some types of phobias?

A
  • 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.)
164
Q

Define: somatisation disorder

A

Symptoms thought not to be physical in origin
- functional disorders

165
Q

What are the risk factors for somatisation disorder?

A
  • Stress
  • abuse
  • mental conditions e.g. depression, anxiety
166
Q

What are the main symptoms of a somatisation disorder?

A

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

167
Q

Management: somatisation disorders

A
  • patient education around the diagnosis and management of stress
  • CBT, psychotherapy
  • anti-depressants = due to co-morbid depression
168
Q

What are the triad of symptoms that characterise autism?

A
  1. Abnormal reciprocal social interaction
  2. Communication and language impairment
  3. Repetitive repertoire of interests and activities
169
Q

What are the clinical features of autism?

A
  • 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
170
Q

What are the general treatments for phobias?

A

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

171
Q

What are some neurological features of autism?

A

Seizures
Motor tics
Increase head circumference
Abnormal gaze monitoring
Increased ambidexterity

172
Q

What are some physiological features of autism?

A
  • Intense sensory responsiveness
  • Absence of typical response to pain or injury
  • Abnormal temperature regulation
173
Q

What are the rating scales for autism?

A
  • Autism behaviour checklist
  • Child autism rating scales
  • Autism diagnosis observation schedule
174
Q

Define: personality disorder

A

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.

175
Q

What are the essential diagnostic features of a personality disorder?

A
  1. Impairments in self and interpersonal functioning.
  2. Impairments in personality functioning.
  3. Impairments are relatively stable across time and consistent across situations.
176
Q

What daily life tasks might someone with a personality disorder struggle with?

A
  1. Forming/maintaining friendships and work relationships.
  2. Struggle to control feelings and behaviours.
  3. Struggle to trust others.
177
Q

What is the main type of personality disorder?

A

Emotionally unstable personality disorder.

178
Q

Give 3 symptoms of a borderline type personality disorder.

A
  1. Emotional instability.
  2. Difficult, intense relationships.
  3. Feelings of emptiness.
  4. Impulsive.
  5. Self injurious behaviour.
  6. Fear of abandonment/rejection.
179
Q

Why might someone with a borderline personality disorder self-harm?

A

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

180
Q

How would you treat/manage someone with a personality disorder?

A
  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.

181
Q

What is the criteria for a delusion?

A
  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)
182
Q

What are the different types of delusions?

A
  • 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
183
Q

How might you differentiate religious beliefs from ill mental health?

A

delusions
- no one else believes
- erratic + fluctuating
- not thinking logically
- acting differently in other areas of life

Religion
- long held constant belief

184
Q

What are the different types of eating disorders?

A
  • 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
185
Q

What are some features of anorexia nervosa?

A

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)

186
Q

What are physical signs of anorexia nervosa?

A
  • 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)
187
Q

Which bloods would increase in anorexia nervosa?

A

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)

188
Q

What is the criteria for medical admission of someone with anorexia?

A
  • 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
189
Q

How do you calculate %median BMI?

A

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

189
Q

How do you calculate BMI?

A

BMi = weight /height 2

190
Q

What 2 tests need to be considered after bloods?

A
  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
191
Q

What ECG findings would there be in anorexia nervosa?

A
  • Bradycardia
  • prolonged QT (of severe anorexia)
  • T wave changes (hypokalaemia)

low potassium, magnesium and phosphate

192
Q

What treatment is given to adolescents with anorexia in hospital?

A
  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
193
Q
A
194
Q

What treatment is given to adults with anorexia?

A
  1. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  3. specialist supportive clinical management (SSCM).
195
Q

What is refeeding syndrome ?

A

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
196
Q
A
197
Q

what are the long term complications of anorexia?

A
  • osteoporosis and increased risk of fractures
  • growth stunting and pubertal delay (don’t have oestrogen, so may not have periods)
  • reduced fertility
  • neurocognitive
198
Q

Define: Bulimia Nervosa

A

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

199
Q

What ECG findings are in bullimia nervosa?

A
  • 1st degree heart block
  • tall P-waves
  • flattened T waves
    changes caused by vomiting:
  • metabolic alkalosis
  • hypokalaemia
200
Q

What are the features of Bulimia Nervosa?

A
  • 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)

201
Q

Define: serotonin syndrome

A

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

202
Q

Presentation: serotonin syndrome

A

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

203
Q

Management: serotonin syndrome

A
  1. removing causative agent
  2. provide supportive care (cooling measures, fluids, benzodiazepine)
  3. If symptoms persist = Cyproheptadine (serotonin antagonist )
204
Q

Define: neuroleptic malignant syndrome

A

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

205
Q

Presentation: neuroleptic malignant syndrome

A

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

206
Q

What are the blood test results for neuroleptic malignant syndrome?

A
  • raised WBC
  • raised CPK
207
Q

Management: neuroleptic malignant syndrome

A
  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
208
Q

What is the difference in symptoms between serotonin syndrome and neuroleptic malignant syndrome?

A

SS
- abrupt onset
- Rapidly resolving
- myoclonus + tremor
- increased reflexes
- pupils = mydriasis

NMS
- gradual onset
- prolonged
- Diffuse rigidity
- decreased reflexes
- normal pupils

209
Q

Name 3 things to improve the social determinants of health?

A

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

210
Q

What is acute dystonic syndrome?

A
  • caused by typical antipsychotics
211
Q

Presentation: acute dystonic syndrome

A

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

212
Q

Management: acute dystonic syndrome

A

IM procyclidine 5-10mg

  • anticholinergic medication that functions by blocking muscarinic receptors
213
Q

What are the featuresf of lithium toxicity?

A
  • 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
214
Q

Investigations: lithium toxicity

A
  • U&Es
  • LFTs
  • Lithium levels
215
Q

Management: lithium toxicity

A

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

216
Q

What is the mechanism of SSRIs?

A

Inhibit the reuptake of serotonin from presynaptic serotonin pumps

217
Q

Indications and protocol for use of SSRIs?

A
  • depression, anxiety, OCD, bulimia, nervosa
  • fluoxetine for under 18s
  • once started com back to Dr 1 week later
218
Q

What is a key side effect of antidepressants?

A

Hyponatraemia

highest = citalopram
lowest risk = duloxetine

219
Q

What is the mechanism of SNRIs?

A

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

220
Q

What is the mechanism of TCAs?

A

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

221
Q

What are the 5P’s in in biopsychosocial formulation?

A
  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

222
Q

Define: Functional Neurological disorder

A
  • acute onset
  • loss of neurological function
  • no investigation findings

manifestation of psychological distress in physical symptoms

223
Q

Management: functional neurological disorder

A
  • psychological talking therapies = triggered by stressful event
  • physio if loss of function
  • psycho education = very common, genuine problem, normalise it
224
Q

Define: factitious disorder

A

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

225
Q

What is seen in Postnatal depression? How long must symptoms be going on before a diagnosis can be made?

A

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.

226
Q

Define: somatoform disorder

A

Manifesting psychological distress in physical symptoms unintentionally

  • not just neurological presentation e.g. pain, gastro, visual, hearing changes
227
Q

What is some of the treatment for post natal depression? What would be the medication of choice

A
  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)

228
Q
A
229
Q

What is seen in postpartum psychosis?

A

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

230
Q

What is the treatment of puerperal psychosis?

A

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

231
Q

What is the problem with SSRIs in pregnancy?

A

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.

232
Q

What are some primary causes of insomia?

A
  • Fear/anxiety about falling asleep
  • Change of environment (adjustment disorder)
  • Inadequate sleep hygiene
  • Idiopathic insomnia (rare, lifelong inability to sleep)
  • Behavioural insomnia of childhood
233
Q

What are some secondary causes of insomia?

A

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

234
Q

Management: insomnia

A

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
235
Q

What is paraphrenia?

A

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

236
Q

What are some things you’d see in paraphrenia?

A
  • no evidence of dementia w/ later onset cases
  • delusions, hallucinations
  • paranoid
  • misidentification
  • partition delusion
237
Q

Management: paraphrenia

A
  • 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)
    -
238
Q

What is seen in a cognitive impairment?

A

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

239
Q

What are some causes of a cognitive decline, particulary in the elderly?

A

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

240
Q

Investigations: cognitive impairment

A
  • history
  • review of medications
  • input from family/ collateral history
  • bloods/urine if suspect infection/clinical cause
241
Q

Management: cognitive impairment

A

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

medication management

242
Q

What is the criteria for a learning disability?

A
  • IQ less than 70
  • Significant impairment in social and adaptive functioning
  • Present since birth
243
Q

What is a learning difficulty?

A
  • Learning difficulty in specific area
  • Overall IQ in normal range
  • E.g. dyslexia, dyspraxia
244
Q

What are the 4 areas assessed in capacity?

A
  1. understand the information
  2. retain
  3. weigh up the risks
  4. communicate a decision
245
Q

What ethical concerns are related to people with learning disabilities?

A

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

246
Q

What could be the cause of change in behaviour in a person with LD?

A

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

247
Q

What medication is given for difficult behaviour in LD people?

A

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

248
Q

How to regulate self-injurious behaviour in people with LD?

A

often done to help regulate their sensory needs

  • sensory assessment performed by psychologist
  • naltrexone
  • benzos
249
Q

What is the mechanism of SSRIs and examples?

A

Increase serotonin
First line antidepressant
4-6 weeks to work

e.g. sertraline, fluoxetine, citalopram

250
Q

What are the side effects of SSRIs?

A

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)

251
Q

What is the mechanism of SNRIs and examples?

A

Increase serotonin and noradrenaline
- help in the morning with waking up due to noradrenergic effect

e.g. duloxetine (help with pain), venlafaxine

252
Q

What are the SE of SNRIs?

A

Sweating
dose dependent increased BP

(due to noradrenaline)

253
Q

What are the SE of TCAs?

A

Cardiotoxicity
- wide QRS
- sinus tachycardia
- dominant R wave in avR

Anticholinergic effect = blurred vision, urinary retention, constipation, dry mouth, confusion, agitation

254
Q

What is the mechanism of TCAs and examples?

A

Increase serotonin + noradrenaline
Decrease histamine and acetylcholine

e.g. amitriptyline (help with sleep due to antihistamine), imipramine

255
Q

What is the mechanism of MAOIs and examples?

A

Increase serotonin, noradrenaline and dopamine
- very strong and rarely used

e.g. selegline, phenelzine, moclobemide

256
Q

What are the SE of MAOIs?

A

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

257
Q

What are the types of antipsychotics?

A

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

258
Q

What are antipsychotics used for?

A
  • Bipolar
  • rapid tranquillisation
    depression
  • personality disorder
  • eating disorder
  • delirium
  • nausea e.g. safe in pregnancy
  • huntington’s chorea
  • Tic disorders
  • intractable hiccup
259
Q

What are the extrapyramidal SE of antipsychotics?

A
  • 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)
260
Q

What is oculogyric crisis?

A

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.

261
Q

What are the other SE of antipsychotics?

A
  • hyperprolactinaemia
  • hyper salivation
  • sexual side effects
  • anticholinergic SE
  • impaired glucose tolerance
262
Q

What is the role and side effects of clozapine?

A

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

263
Q

What are the types of mood stabilisers?

A
  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
264
Q

What is anticholinergic burden?

A

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

265
Q

What are the side effects of stopping antidepressants?

A
  • 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)

266
Q

Define: dissociative seizures

A
  • 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
267
Q

What causes dissociative seizures?

A

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

268
Q

What can worsen dissociative seizures?

A
  • 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
269
Q

What is the treatment for dissociative seizures?

A
  • psychoeducation = understanding the diagnosis
  • stopping anti-epileptic drugs
  • speaking to a psychiatrist
  • learn the warning symptoms
  • stop driving
270
Q

What are the features of borderline personality disorder?

A
  • 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
271
Q

What are the different types of trauma?

A

ACEs

Abuse
- physical
- emotional
- sexual

Neglect
- physical
- emotional

Household
- mental illness,
- incarcerated relative
- household substance abuse
- parental divorce
- mother treated violently

272
Q

How do ACEs relate to health outcomes?

A

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

273
Q

What are the stages of attachment?

A
  1. pre-attachment
  2. Indiscriminate
  3. Discriminate - attachment to one specific caregiver
  4. Multiple - growing bonds with other caregivers
274
Q

What are the types of attachment style?

A
  • secure
  • anxious
  • dismissive
  • fearful

attachment styles develop into personality disorders

275
Q

Define: reative attachement disroder

A
  • overly clingy
  • anxious when the person leaves

Becomes EUPD

276
Q

Define: Social disinhibited disengagement disorder

A
  • Avoidant
  • Never formed an attachment with a caregiver
277
Q

Define: personality disorder

A

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

278
Q

What are the 4 areas a personality disorder can manifest in?

A

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
279
Q

Aetiology: personality disorder

A
  • unclear
  • genetic
  • poor parenting
  • disrupted/arrested psychic development
280
Q

What are the 3 clusters of personality disorders?

A

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

281
Q

What are the features of an avoidant personality disorder?

A

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

282
Q

What are the features of an antisocial personality disorder?

A
  • 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.
283
Q

What are the features of a borderline personality disorder?

A

(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

284
Q

What are the features of a narcissistic personality disorder?

A
  • 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
285
Q

What are the features of a dependent personality disorder?

A
  • 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
286
Q

What are the features of a histrionic personality disorder?

A
  • inappropriate sexuality.
  • suggestibility,
  • self-dramatisation,
  • inappropriate sexual seduction.
287
Q

What are the features of a schizoid personality disorder?

A
  • preference of being alone with few interests,
  • few friends
  • a lack of desire for companionship.
288
Q

What are the features of a paranoid personality disorder?

A
  • 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
289
Q

What are the features of a schizotypal personality disorder?

A
  • 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
290
Q

What is the aetiology of personality disorders shown through the biosocial model?

A

Emotional sensitivity
+
Invalidating environment
=
pervasive emotion dysregulation

291
Q

Investigations: personality disorders

A
  • Psychiatric history + MSE
  • Personality diagnostic questionnaire (PDQ-IV)
  • Minnesota multiphasic personality inventory
  • MRI/CT head

Diagnosis typically made >18yrs when personality has developed

292
Q

Management: personality disorders

A

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

293
Q

What are the different types of psychological therapies?

A
  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
294
Q

What are the key differences between OCD and OCPD?

A

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

295
Q

What is ECT?

A

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
296
Q

What are the indications for ECT?

A
  • 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

297
Q

What are the side effects of ECT?

A
  • mania
  • confusional state = last about 30 mins
  • memory loss
  • increased risk if bilateral shock, >12 treatments, >3 times a week
298
Q

What are mental, biological and social symptoms of depression?

A

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

299
Q

What are the first rank symptoms of schizophrenia?

A
  • 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)
300
Q

What are the 3 different types of thought possession?

A
  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?
301
Q

What are the different types of ego ‘psychotic’ defences?

A

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

302
Q

What are the types of ‘immature’ ego defences?

A

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

303
Q

What are the types of ‘neurotic’ ego defences?

A

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

304
Q

What are the types of ‘mature’ ego defences?

A

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

305
Q

Define: capgras syndrome

A

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

306
Q

Define: Fregoli syndrome

A

Delusion that a stranger is someone they know in disguise

307
Q

Define: Cotard syndrome

A

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

308
Q

Define: De Clerambault’s syndrome

A

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

309
Q

how to access gender clinics?

A

GP referral to adult services when aged 17 or 18

GP referral to GIDs (gender identity developmental services) if younger than this

310
Q

What hormone therapy is given at gender clinics for becoming male?

A

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

311
Q

What are the risks of taking testosterone?

A

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

312
Q

What monitoring is provided for testosterone therapy?

A

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

313
Q

What hormone therapy is provided to become female?

A

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
314
Q

What are the risks of taking oestrogen?

A

Likely
- VTE (greater with oral than transdermal)
- gallstones
- elevated liver enzymes
- weight gain
- hypertriglyceridemia
- emotional instability

cardiovascular disease
T2DM
breast cancer

315
Q

How to monitor estradiol therapy?

A

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

316
Q

How paediatric mental health is very different from adults?

A
  • 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
317
Q

What are the 5 main common mental health problems in young people?

A

Developmental Disorders
Conduct Disorders
Emotional Disorders
Eating Disorders
Psychoses

318
Q

What is secure attachment?

A

Able to internally self regulate the emotional neural systems and response to environment From about 5 years upwards

  • trusting lasting relationships
  • good self-esteem
319
Q

What is anxious attachment?

A

Maintaining attachment with a caregiver who is unpredictable
Clingy

320
Q

What is ambivalent attachment?

A

Alternate clinging with excessive submissiveness to no trust

Role reversal – parent cared for by child

Dysregulation of fear and anger

321
Q

What is avoidant attachment?

A

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

322
Q

What is the effect of Severe Mental illness (SMI) on physical health?

A

High premature mortality than the general population

323
Q

Why does severe mental health have a big effect on physical health?

A
  • less likely to seek help
  • effects of lifestyle = exercise alcohol, drugs
  • effects of prescribed medication
  • effects of lifestyle
  • effects of the healthcare system
324
Q

What are the different types of thought disorder?

A
  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
325
Q
A

Phase 3a Emily (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions