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3A Flashcards > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Autism spectrum disorder definition

A

A full range of people affected by deficits in social interaction, communication and flexible behavior

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2
Q

ASD social interaction presentation features

A

Lack of eye contact
Delayed smiling
Avoids physical contact
Cannot read non verbal clues
Difficulty establishing friendships

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3
Q

ASD development/behaviour presentation features

A

Delay absence or regression in language development
Lack of nom verbal communication
Difficulty with imaginative behaviour
Repetitive use of words/phrases

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4
Q

ASD behavioural presentation features

A

Greater interest in objects, numbers or patterns
Stereotypical repetitive movements eg stimming
Persistent rigid interests
Repetitive behaviour and fixed routines
Restrictive food preferences

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5
Q

Teams/healthcare professionals involved in management of childhood autism

A

CAMS
Speach and language specialist
Dietician
Social workers
Specially trained educators

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6
Q

Illusion definition

A

An incorrect perception based on a real stimulus

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7
Q

Hallucination definition

A

A perception without a stimulus

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8
Q

Causes of hallucinations

A

schizophrenia/bipolar
drugs/alcohol
Parkinson’s

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9
Q

Pseudo-hallucination definition

A

A vivid unwanted sensory experience that is real enough to be regarded as a hallucination, but the patient knows it is not real

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10
Q

Causes of pseudohallucination

A

bipolar/extreme emotional stress

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11
Q

Somatic Passivity definition

A

Experiencing thought/actions/sensations exposed by an external entity

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12
Q

Overvalued idea definition

A

An unreasonable sustained belief that is not fixed eg patient acknowledges it may be incorrect

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13
Q

Delusion definition

A

An unreasonable sustained belief that is fixed

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14
Q

What conditions cause delusions

A

psychotic disorders eg schizophrenia, schizo-effective disorder or Bi-polar

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15
Q

Which conditions are overvalued ideas in?

A

anorexia nervosa and Paranoia

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16
Q

Delusional perception definition

A

Patient attributes false meaning to real stimulus eg. traffic lights turning red = martians coming

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17
Q

what conditions cause delusional perception

A

Psychotic disorders eg. schizophrenia/schizo-affective disorder/bipolar

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18
Q

Concrete thinking definition

A

Rigid thought pattern based entirely on what is seen, heard and felt eg. looking at garden tools and saying the similarity is ‘all the handles are wood’ and not ‘all used in the garden’

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19
Q

Loosening of association definition

A

disorganised speech caused by a lack of connection between ideas due to a thought processing disorder

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20
Q

Confabulation definition

A

Patient creates false memories without the intention of deceit

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21
Q

What conditions may have Confabulation

A

schizophrenia/bipolar
Alzheimer’s Dementia
Stroke/traumatic brain injury

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22
Q

Circumstantiality (speech) definition

A

Patient includes too many details eg. about surrounding unrelated to the actual question, but does circle back

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23
Q

Tangentiality (speech) definition and what condition

A

Patient speach moves in unrelated direction, changing train of thought and does not return to the question

Mania

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24
Q

Pressured speech definition and condition

A

Patients speech is fast and without pauses, with unusual volume and rhythm

Mania/hypomania or bipolar

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25
Q

Preservation of speech definition

A

Patient is unable to shift response and uses same answer for all questions.
Continuation of one idea to an extreme degree

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26
Q

Anhedonia definition and condition

A

loss of pleasure in doing things - depression

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27
Q

Incongruity of affect definition

A

Expressing emotion that does not match the situation eg. appearing happy talking about sad things

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28
Q

What condition does incongruity of affect occur in

A

schizophrenia

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29
Q

Poverty of speach definition and condition

A

slow, few words and unvaried - severe depression

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30
Q

Blunting of affect definition

A

difficulty expressing emotions/fewer facial expressions

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31
Q

what conditions have blunting of affect

A

ASD
schizophrenia
Parkinsonism

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32
Q

what is la belle indifference

A

the absence of distress despite having serious psychological symptoms

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33
Q

depersonalisation definition

A

a state in which a patients thoughts or actions feel to not belong to them

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34
Q

derealisation definition

A

A state in which the world feels unreal, distant or falsified

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35
Q

what conditions cause depersonalisation

A

dissociative identity disorder, dissociative amnesia, depersonalisation derealisation disorder

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36
Q

what is thought alienation

A

A symptoms of psychosis in which a patient feels their thoughts are no longer their own

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37
Q

what condition does thought alienation occur in (what type of symptom is is)

A

Schneiderian first rank symptom of schizophrenia

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38
Q

What are the types of thought alienation

A

Thought insertion
thought withdrawal
thought broadcast

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39
Q

thought insertion definition

A

patient feels thoughts are being implanted from an external entity

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40
Q

thought withdrawal definition

A

thoughts have been taken away by an external entity

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41
Q

thought broadcast definition

A

thoughts are known to everyone via media or telepathy

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42
Q

what is a thought echo

A

a form of auditory hallucination where a patient hears their thoughts after they have had them

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43
Q

what is thought block, what does it look like and what condition?

A

patients mind becomes suddenly empty of thoughts, indicated by a sudden silence - schizophrenia

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44
Q

Akathisia definition

A

a state of restlessness/inability to stay still

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45
Q

Causes of akathisia

A

antipsychotic medication
drugs/alcohol
Parkinson’s

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46
Q

Mannerism definition

A

an unusual behaviour/ way of doing an action (eating, walking or speaking) as a product of the individuals upbringing/environment

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47
Q

Clouding of consciousness definition

A

A state where the patient has difficulty thinking, understanding or perceiving eg. Brainfog

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48
Q

Causes of clouding of consciousness

A

anaemia, menopause, pain, severe anxiety ect

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49
Q

Delirium definition

A

a temporary state characterised by confusion, anxiety, incoherent speach and hallucinations

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50
Q

Clouding of consciousness vs delirium

A

delirium is more severe

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51
Q

Causes of delirium

A

fever/uti
intoxication
lack of sleep
hypoglycaemia

People with dementia more susceptible

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52
Q

what is catatonia

A

a state where patients are awake but not responding to people or the environment. can affect movement speach and behaviour. Stupor = symptom

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53
Q

Stupor definition

A

Stupor is an alteration of consciousness marked by decreased responsiveness to environmental stimuli and absence of spontaneous movement

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54
Q

psychomotor retardation definition

A

sluggish or diminished movements, sometimes with slowed cognition

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55
Q

conditions that cause psychomotor retardation

A

Bipolar disorder/severe depressive episodes

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56
Q

flight of ideas definition

A

a continuous stream of superficially connected ideas manifesting in hurried tangential speach

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57
Q

formal thought disorder definition and causes

A

an impaired capacity to sustain coherent discourse in either written or spoken language. due to flight of ideas or cognitive impairment

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58
Q

obsession definition

A

repeated unwanted thoughts that cause anxiety

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59
Q

compulsion definition

A

repetitive behaviours done to reduce the anxiety of an obsession

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60
Q

What is schizophrenia

A

a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions

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61
Q

First rank symptoms of schizoprenia

A

Auditory hallucinations eg. commentary/narration, thought’s heard out loud
Somatic hallucination
Delusional perception
Thought insertion, withdrawal or broadcasting
Somatic passivity (feeling thoughts or body is controlled by external agents)

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62
Q

Negative symptoms of schizophrenia

A

Flat affect, poverty of speech, poverty of movement, Loss of interests

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63
Q

treatment of schizophrenia

A

Anti psychotics
1. Olanzipine (atypical)
2. Haliperidol (typical)
3. Clozipine (Atypical - for treatment resistant schizophrenia)

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64
Q

Side effects of typical antipsychotics

A

metabolic - weight gain and increased risk of T2DM
Extra pyramidal - Parkinsonism/akathesia (inability to remain still
Anti-cholinergic - blurred vision/tachycardia
Neurological - seizures

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65
Q

Side effect of atypical antipsychotics

A

Metabolic - weight gain/increased risk of T2DM
Anti-cholinergic - tachycardia/blurred vision

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66
Q

what is Bipolar disorder

A

A mood disorder that causes swings from one extreme to another

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67
Q

Symptoms of Mania

A

D- distractibility
I - impulsiveness
G - grandiosity (delusions
F - Flight of ideas
A - activity increase
S - lack of sleep
T - talkativeness

68
Q

How long must the symptoms of mania last before it is considered mania

A

7 days

69
Q

What are the two types of bipolar

A

type 1 - has experienced mania
type 2 - has never experienced mania

70
Q

Characteristics of hypomania

A

decreased need for sleep WITHOUT negative effects on functioning
NO hallucinations or delusions
Persistent mild mood elevation
increased energy
increased sociability

71
Q

Bipolar management: Immediate management of Mania

A

Stop antidepressants
start haloperidol
benzodiazepine’s for sleep

72
Q

Bipolar management: Management of depression

A

fluoxetine and olanzipine
OR
Olanzipine alone
OR
lamotrigene alone

73
Q

What medication is used for long term mood stabilization

A

Lithium

74
Q

Risk factors for Bipolar

A

Cannabis use
Postpartum period
Genetics
childhood trauma

75
Q

what is schizoaffective disorder

A

When there is an equal mix of bipolar and schizophrenia features

76
Q

Name two types of mood disorder

A

Bipolar, depression

77
Q

What two categories can mental illness be divided into

A

Organic - due to a know physical cause
Functional - no physical abnormality found

78
Q

Give an example of an organic disorder applied to mental illness

A

Carcinoma
Endocrine (Thyroid)
Delirium

79
Q

What substances might cause an organic mental illness

A

Alcohol/illicit drugs

80
Q

what is the definition of ‘psychoses’ and give two examples

A

Psychoses is a loss of contact with reality
schizophrenia/mood disorders eg bipolar

81
Q

Neuroses’ are classed as functional mental health disorders. Give 2 examples of conditions which can be considered as ‘neuroses’.

A

OCD, Phobia, Depression, anxiety,

82
Q

What is the definition of Neuroses

A

a mild functional disorder without loss of contact with reality

83
Q

affect definition

A

Pattern of observable behaviours
Variable over time
In response to changing emotional state

84
Q

Screening questions for depression

A

Have you been feeling down depressed or hopeless within the last month?
Have you felt reduced interest in things you used to enjoy in the last month?

85
Q

Symptoms of depression (DEAD SWAMP)

A

Depressed mood
Energy loss/fatigue
Anhedonia
Death thoughts/suicide

Sleep disturbances (+/-)
Worthlessness/guilt
Appetite loss
More difficulty concentrating
Psychomotor adgitation

86
Q

How long do symptoms have to be present to diagnose depression

A

2 weeks

87
Q

3 Core depression symptoms

A

Low mood
Anhedonia
Fatigue/energy loss

88
Q

A patient presents with 5 symptoms of depression plus mild functional impairment. How might you describe this clinically?

A

Mild depression

89
Q

What is required for a diagnosis of severe depression

A

most symptoms having a major effect on day to day activities (maybe psychosis)

90
Q

what are the two main methods of assessing depression

A

HAD scale
Hospital Anxiety and Depression Scale (out of 21)

PHQ-9
Patient Health Questionnaire

91
Q

what is the physiological mechanism of depression

A

Decreased 5-HT -> Decreased Noradrenaline -> Decreased Dopamine

92
Q

What is the first line treatment for depression

A

Mild = CBT
Moderate/severe = SSRI eg Fluoxetine/sertraline + CBT

93
Q

First line pharmacological treatment for depression?
What if the patient has Cardiovascular disease

A

SSRI eg Fluoxetine (without CVD)

Sertraline or Citalopram if CVD

94
Q

Side effects of SSRI’s

A

Increased suicidality/depression
Nausea diarrhoea Vomiting
serotonin syndrome
loss of Libido

95
Q

when are SSRI’s contraindicated

A

in epilepsy - increased risk of seizures

96
Q

3 examples of tricyclic depressants

A

amitriptyline, imipramine, lofepramine

97
Q

Side effects of Tricyclic antidepressants and contraindications

A

side effect is arrhythmias
Avoid in heart disease

98
Q

Give an example of a MAO-I. When might an MAO-I be used?

A

Phenelzine

Used in resistant depression

99
Q

What are important points to remember when prescribing Phenelzine for depression?

What class of drug is Phenelzine?

A

Increased risk of hypertensive crisis
Avoid tyramine-containing foods (cheese, red wine, broad beans)

Monoamine oxidase inhibitor

100
Q

Give an example of a SNRI (Serotonin Noradrenaline Reuptake Inhibitors).

A

Duloxetine

101
Q

give 4 substances which cause serotonin syndrome

A

MAO-I
SSRIs
Ecstasy
Amphetamines

102
Q

What is the acronym to remember the diagnosis for Serotonin Syndrome?

A

‘CAN’
Cognitive changes: agitation, confusion, euphoria, hallucinations

Autonomic changes: Tachycardia, HTN, Fever, Arrythmias,

Neuromuscular changes: Tremor, Hyperreflexia, Clonus, Ataxia, Incoordination, Seizures

103
Q

What are the 3 fundamental components of Serotonin Syndrome?

A

Cognitive state changes
Autonomic hyperactivity
Neuromuscular abnormality

104
Q

What is the treatment for Serotonin Syndrome?

A

Stop taking causative substance then support with symptoms

105
Q

How might a bipolar patient appear / behave (eg. during a mental state exam)?

A

May behave manic (DIGFAST)
Distractible, impulsive, delusions of grandeur, flight of ideas, activity increase, sleep defecit, talkativeness

Many also be depressed

106
Q

How may a bipolar patient speak compared to a normal patient?

A

Increased pressure of speech
Increased rate and amount
Difficult to interrupt.

107
Q

Causes of mania

A

Bipolar, amphetamines, cocaine ?schizophrenia

108
Q

differentials for bipolar

A

amphetamine use/cocaine use

109
Q

How is bipolar managed/treated (non pharmacological

A

coordinated care from MDT
Rapid crisis action and ?hospitalization under section
Medication
annual reviews

110
Q

Pharmacological management of bipolar disorder

A

Mood stabilisers

Lithium
Anticonvulsants (Sodium Valproate, Carbamazepine, Lamotrigine)
Anti-psychotics (conventional, atypical) -> used in acute mania

111
Q

What are the 2 most important tests we need to carry out in patients on Lithium (for bipolar)?

A

Renal function (U+E)
TFTs -> check for hypothyroidism

112
Q

What are the side effects of Lithium?

  • lithium is used as a treatment for bipolar disorder
A

Leukocytosis
Insipidus (diabetic)
Tremors
Hypothyroidism
Increased urine
Mums beware (teratogenic)

113
Q

List some effects of Lithium toxicity

A

blurred vision
coarse tremor
seizures
muscle weakness
Coma
Nausea and vomiting

114
Q

Give the WHO definition for Schizophrenia.

A

‘A severe mental disorder, characterised by profound disruptions in thinking, affecting language, perception, and the sense of self.’

115
Q

how long must symptoms of schizophrenia last before a diagnosis is made?

A

1 month

116
Q

Organic differential for schizophrenia

A

brain disease - brain injury/CNS infection
Metabolic - hypernatremia
Endocrine - hyperthyroid
Substance induced - alcohol/stimulants

117
Q

3 examples of typical/conventional antipsychotics

A

Haliperidol, Chlorpromazine, Flupentixol

118
Q

3 examples of an atypical antipsychotic

A

olanzapine
Risperidone
Clozapine

119
Q

List 3 side effects of atypical anti-psychotics.

A

Weight gain, tachycardia, blurred vision

120
Q

Give 2 side effects of Olanzepine. What class of antipsychotic is Olanzepine?

A

Side effects: weight gain, tachycardia

Atypical

121
Q

When might Clozapine be used as an antipsychotic?

A

in treatment resistant schizophrenia - 3rd antipsychotic tried

122
Q

Main side effect of clozapine

A

agranulocytosis

123
Q

symptoms of parkinsons

A

Stooped posture
Shuffling gait
Rigidity
Bradykinesia
Tremors at rest
Pill-rolling motion of the hand.

124
Q

what is pseudoparkinsonism

A

a reaction to a medication that mimics parkinsons disease

125
Q

describe acute dystonia (symptoms)

A

Facial grimacing
Involuntary upward eye movement
Muscle spasms of the tongue, face, neck and back
> back muscle spasms cause the trunk to arch forward)
Laryngeal spasms

126
Q

describe akathisia

A

a state of restlessness/inability to stay still/Paces the floor/rocking back and forth

127
Q

Describe tardive dyskinesia

A

Protrusion and rolling of the tongue.
Sucking and smacking movements of the lips
Chewing motion
Facial dyskinesia
Involuntary movements of the body and extremities

128
Q

What is ‘Neuroleptic Malignant Syndrome’ (NMS)?

A

NMS is a reaction that occurs following starting an antipsychotic / increased dose.

129
Q

What are the signs and symptoms of Neuroleptic Malignant Syndrome?

A

Fever, muscle pain, breathlessness, Seizures/coma increased creatinine kinase

130
Q

What investigations should you order if you suspect Neuroleptic Malignant Syndrome?

A

ABG: Metabolic Acidosis
Increased Creatinine Kinase
FBC - Leucocytosis (high WBC)
ECG: Prolonged QT

131
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A

Stop antipsychotic
Supportive: IV fluids
Benzodiazepines

132
Q

For Serotonin syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils

A

For Serotonin syndrome, describe the:
Onset: abrupt
Course: rapidly evolving
Neuromuscular findings: myoclonus/tremor
Reflexes: hyperreflexia
Pupils: dilated/Mydriasis

133
Q

For Neuroleptic Malignant Syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils

A

For Neuroleptic Malignant Syndrome, describe the:
Onset: gradual
Course: prolonged
Neuromuscular findings: rigidity
Reflexes: decreased
Pupils: normal

134
Q

List 5 anxiety disorders.

A

generalised Anxiety
panic disorder
OCD
PTSD
Phobias

135
Q

Describe Generalised Anxiety Disorder.

A

Feel anxious on most days
Can’t remember last time they felt relaxed - can’t calm themselves down
Worried about many things
As soon as one anxious thought is resolved, another may appear about a different issue.

136
Q

Generalised anxiety disorder risk factors

A

Risk factors:
Genetics
Past trauma
Chronic physical health condition eg arthritis
Substance missuse eg alcoholism

137
Q

Generalised anxiety disorder treatment

A

CBT + SSRIs (sertraline/paroxetine)
maybe Benzo eg (diazepam/lorazepam)

138
Q

SSRI side effects

A

Nausea vomiting diarrhoea
difficulty achieving orgasm/erectile dysfunction
dry mouth/blurred vision
increase in suicidal ideation/nightmares

139
Q

List the symptoms of a panic attack

A

racing heart rate/palpatations
hyperventilation
Intense fear + dread
Sense of impending doom

140
Q

Describe panic attacks in relation to Panic Disorder.

A

Attacks last 5 - 20 mins
Triggered by stressors or manifest unexpectedly
Pts show avoidance behaviour / become reclusive
Can be very debilitating and disruptive to life.

141
Q

What is the treatment for panic disorder

A

CBT + SSRI (eg fluoxetine/sertraline)

142
Q

Describe ‘obsessions’ as related to OCD.

A

repeated unwanted thoughts that are uncontrollable and distressing

143
Q

Describe ‘compulsions’ as related to OCD.

A

a ritualistic action taken to alleviate the distress of an obsession

144
Q

Describe a typical OCD patient.

A

Can’t control his/her thoughts or behaviours, even when these are recognised as excessive.
Doesn’t get pleasure when performing the behaviours or rituals, but may feel brief relief from the anxiety the thoughts cause
Experience significant problems in their daily life

145
Q

treatment for OCD

A

CBT + SSRI (eg fluoxetine/sertraline)

146
Q

What is a ‘phobia’?

A

an irrational debilitating fear of a specific non-dangerous thing that causes avoidance

147
Q

What is the treatment for a phobia?

A

CBT

148
Q

What is the lifetime prevalence of PTSD?

A

10% of women; 4% of men

149
Q

What is the most likely event to cause PTSD?

A

sexual assault

150
Q

What are the risk factors for PTSD?

A

Previous Mental Health problems
Past trauma (esp. childhood abuse)
Lack of support
Victim-blaming by the environment

151
Q

List some symptoms of PTSD.

A

Intrusive thoughts recalling the traumatic event
Nightmares / flashbacks
Feeling detached / unable to connect with loved ones.
Irritability / angry outbursts
avoiding reminders of trauma

152
Q

Treatment for PTSD

A

Management of PTSD includes:

Trauma-focused CBT
Eye-Movement Desensitization and Reprocessing (EMDR) therapy
Pharmacological: SSRI

153
Q

define personality disorder

A

A group of disorders characterised by rigid, maladaptive traits that cause great distress or an inability to get along with others.

154
Q

Which disorders comprise Cluster A of ‘Personality Disorders’?

A

Cluster A: a group of disorders characterised by odd / eccentric behaviours:

Paranoid personality disorder
Schizoid personality disorder
Schizotypal Personality Disorder

155
Q

What is the defintion of Cluster A ‘Personality Disorders’?

A

a group of disorders characterised by odd / eccentric behaviours: eg.
Paranoid personality disorder
Schizoid personality disorder
Schizotypal Personality Disorder

156
Q

Which disorders comprise Cluster B of ‘Personality Disorders’?

A

Cluster B: a group of disorders characterised by dramatic, emotional or erratic behaviours:

Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder

157
Q

what is the definition of cluster B ‘Personality disorders’

A

Cluster B: a group of disorders characterised by dramatic, emotional or erratic behaviours:

Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder

158
Q

Which disorders comprise Cluster C of ‘Personality Disorders’?

A

Cluster C: a group of disorders characterised by anxious or fearful behaviours:

Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder

159
Q

what is the definition of Cluster C ‘personality disorders’

A

Cluster C: a group of disorders characterised by anxious or fearful behaviours:

Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder

160
Q

What acronym can be used to help remember the components of a suicide risk assessment?

A

‘SAD PERSONS score’

Sex: Male
Age: <19, >45
Depression: present?
Previous suicide attempt
Ethanol (or other substance abuse)?
Rational thinking loss (eg. psychosis, psychotic depression)
Single or separated
Organised (attempt wasn’t an impulse, but well thought through)
No social support
Sickness (eg. Chronic Illness)

161
Q

What must somome do in order to have capacity (according to the Mental Capacity Act 2005)?

A

A person has capacity if they are able to:

Understand info
Retain info
Weigh up info
Communicate their decision

162
Q

What does Section 2 of the Mental Health Act (1983) permit?

A

Admission for assessment
Up to 28 days
Can’t be renewed
Signed by 2 doctors / 1 doctor and 1 AMHP
Treatment can be administered, if needed.

163
Q

What does Section 3 of the Mental Health Act (1983) state?

A

Admission for treatment
6 months; can be renewed
Signed by 2 doctors / 1 doctor and 1 AMHP
Can give you treatment + perform investigations etc.

164
Q

What does Section 4 of the Mental Health Act (1983) state?

A

Can be signed by 1 AMHP Doctor
Used in emergency when you’re unsafe to go home but only 1 AMPH available
Can hold you in hospital until another Dr / AMHP arrives, until you can be sectioned under 2 or 3.
Up to 72 hrs
Can’t treat you, can only keep you in hospital.

165
Q

What does Section 5 of the Mental Health Act (1983) state?

A

Detention of a patient already in hospital by a doctor or nurse.
Can stop you from physically leaving until you can be reviewed and Sectioned under Section 2 or 3.

3A Flashcards (9 decks)

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