Psychiatry Flashcards
1
Q
Autism spectrum disorder definition
A
A full range of people affected by deficits in social interaction, communication and flexible behavior
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
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
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
5
Q
Teams/healthcare professionals involved in management of childhood autism
A
CAMS
Speach and language specialist
Dietician
Social workers
Specially trained educators
6
Q
Illusion definition
A
An incorrect perception based on a real stimulus
7
Q
Hallucination definition
A
A perception without a stimulus
8
Q
Causes of hallucinations
A
schizophrenia/bipolar
drugs/alcohol
Parkinson’s
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
10
Q
Causes of pseudohallucination
A
bipolar/extreme emotional stress
11
Q
Somatic Passivity definition
A
Experiencing thought/actions/sensations exposed by an external entity
12
Q
Overvalued idea definition
A
An unreasonable sustained belief that is not fixed eg patient acknowledges it may be incorrect
13
Q
Delusion definition
A
An unreasonable sustained belief that is fixed
14
Q
What conditions cause delusions
A
psychotic disorders eg schizophrenia, schizo-effective disorder or Bi-polar
15
Q
Which conditions are overvalued ideas in?
A
anorexia nervosa and Paranoia
16
Q
Delusional perception definition
A
Patient attributes false meaning to real stimulus eg. traffic lights turning red = martians coming
17
Q
what conditions cause delusional perception
A
Psychotic disorders eg. schizophrenia/schizo-affective disorder/bipolar
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’
19
Q
Loosening of association definition
A
disorganised speech caused by a lack of connection between ideas due to a thought processing disorder
20
Q
Confabulation definition
A
Patient creates false memories without the intention of deceit
21
Q
What conditions may have Confabulation
A
schizophrenia/bipolar
Alzheimer’s Dementia
Stroke/traumatic brain injury
22
Q
Circumstantiality (speech) definition
A
Patient includes too many details eg. about surrounding unrelated to the actual question, but does circle back
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
24
Q
Pressured speech definition and condition
A
Patients speech is fast and without pauses, with unusual volume and rhythm
Mania/hypomania or bipolar
25
Preservation of speech definition
Patient is unable to shift response and uses same answer for all questions.
Continuation of one idea to an extreme degree
26
Anhedonia definition and condition
loss of pleasure in doing things - depression
27
Incongruity of affect definition
Expressing emotion that does not match the situation eg. appearing happy talking about sad things
28
What condition does incongruity of affect occur in
schizophrenia
29
Poverty of speach definition and condition
slow, few words and unvaried - severe depression
30
Blunting of affect definition
difficulty expressing emotions/fewer facial expressions
31
what conditions have blunting of affect
ASD
schizophrenia
Parkinsonism
32
what is la belle indifference
the absence of distress despite having serious psychological symptoms
33
depersonalisation definition
a state in which a patients thoughts or actions feel to not belong to them
34
derealisation definition
A state in which the world feels unreal, distant or falsified
35
what conditions cause depersonalisation
dissociative identity disorder, dissociative amnesia, depersonalisation derealisation disorder
36
what is thought alienation
A symptoms of psychosis in which a patient feels their thoughts are no longer their own
37
what condition does thought alienation occur in (what type of symptom is is)
Schneiderian first rank symptom of schizophrenia
38
What are the types of thought alienation
Thought insertion
thought withdrawal
thought broadcast
39
thought insertion definition
patient feels thoughts are being implanted from an external entity
40
thought withdrawal definition
thoughts have been taken away by an external entity
41
thought broadcast definition
thoughts are known to everyone via media or telepathy
42
what is a thought echo
a form of auditory hallucination where a patient hears their thoughts after they have had them
43
what is thought block, what does it look like and what condition?
patients mind becomes suddenly empty of thoughts, indicated by a sudden silence - schizophrenia
44
Akathisia definition
a state of restlessness/inability to stay still
45
Causes of akathisia
antipsychotic medication
drugs/alcohol
Parkinson's
46
Mannerism definition
an unusual behaviour/ way of doing an action (eating, walking or speaking) as a product of the individuals upbringing/environment
47
Clouding of consciousness definition
A state where the patient has difficulty thinking, understanding or perceiving eg. Brainfog
48
Causes of clouding of consciousness
anaemia, menopause, pain, severe anxiety ect
49
Delirium definition
a temporary state characterised by confusion, anxiety, incoherent speach and hallucinations
50
Clouding of consciousness vs delirium
delirium is more severe
51
Causes of delirium
fever/uti
intoxication
lack of sleep
hypoglycaemia
People with dementia more susceptible
52
what is catatonia
a state where patients are awake but not responding to people or the environment. can affect movement speach and behaviour. Stupor = symptom
53
Stupor definition
Stupor is an alteration of consciousness marked by decreased responsiveness to environmental stimuli and absence of spontaneous movement
54
psychomotor retardation definition
sluggish or diminished movements, sometimes with slowed cognition
55
conditions that cause psychomotor retardation
Bipolar disorder/severe depressive episodes
56
flight of ideas definition
a continuous stream of superficially connected ideas manifesting in hurried tangential speach
57
formal thought disorder definition and causes
an impaired capacity to sustain coherent discourse in either written or spoken language. due to flight of ideas or cognitive impairment
58
obsession definition
repeated unwanted thoughts that cause anxiety
59
compulsion definition
repetitive behaviours done to reduce the anxiety of an obsession
60
What is schizophrenia
a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions
61
First rank symptoms of schizoprenia
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)
62
Negative symptoms of schizophrenia
Flat affect, poverty of speech, poverty of movement, Loss of interests
63
treatment of schizophrenia
Anti psychotics
1. Olanzipine (atypical)
2. Haliperidol (typical)
3. Clozipine (Atypical - for treatment resistant schizophrenia)
64
Side effects of typical antipsychotics
metabolic - weight gain and increased risk of T2DM
Extra pyramidal - Parkinsonism/akathesia (inability to remain still
Anti-cholinergic - blurred vision/tachycardia
Neurological - seizures
65
Side effect of atypical antipsychotics
Metabolic - weight gain/increased risk of T2DM
Anti-cholinergic - tachycardia/blurred vision
66
what is Bipolar disorder
A mood disorder that causes swings from one extreme to another
67
Symptoms of Mania
D- distractibility
I - impulsiveness
G - grandiosity (delusions
F - Flight of ideas
A - activity increase
S - lack of sleep
T - talkativeness
68
How long must the symptoms of mania last before it is considered mania
7 days
69
What are the two types of bipolar
type 1 - has experienced mania
type 2 - has never experienced mania
70
Characteristics of hypomania
decreased need for sleep WITHOUT negative effects on functioning
NO hallucinations or delusions
Persistent mild mood elevation
increased energy
increased sociability
71
Bipolar management: Immediate management of Mania
Stop antidepressants
start haloperidol
benzodiazepine's for sleep
72
Bipolar management: Management of depression
fluoxetine and olanzipine
OR
Olanzipine alone
OR
lamotrigene alone
73
What medication is used for long term mood stabilization
Lithium
74
Risk factors for Bipolar
Cannabis use
Postpartum period
Genetics
childhood trauma
75
what is schizoaffective disorder
When there is an equal mix of bipolar and schizophrenia features
76
Name two types of mood disorder
Bipolar, depression
77
What two categories can mental illness be divided into
Organic - due to a know physical cause
Functional - no physical abnormality found
78
Give an example of an organic disorder applied to mental illness
Carcinoma
Endocrine (Thyroid)
Delirium
79
What substances might cause an organic mental illness
Alcohol/illicit drugs
80
what is the definition of 'psychoses' and give two examples
Psychoses is a loss of contact with reality
schizophrenia/mood disorders eg bipolar
81
Neuroses’ are classed as functional mental health disorders. Give 2 examples of conditions which can be considered as ‘neuroses’.
OCD, Phobia, Depression, anxiety,
82
What is the definition of Neuroses
a mild functional disorder without loss of contact with reality
83
affect definition
Pattern of observable behaviours
Variable over time
In response to changing emotional state
84
Screening questions for depression
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
Symptoms of depression (DEAD SWAMP)
Depressed mood
Energy loss/fatigue
Anhedonia
Death thoughts/suicide
Sleep disturbances (+/-)
Worthlessness/guilt
Appetite loss
More difficulty concentrating
Psychomotor adgitation
86
How long do symptoms have to be present to diagnose depression
2 weeks
87
3 Core depression symptoms
Low mood
Anhedonia
Fatigue/energy loss
88
A patient presents with 5 symptoms of depression plus mild functional impairment. How might you describe this clinically?
Mild depression
89
What is required for a diagnosis of severe depression
most symptoms having a major effect on day to day activities (maybe psychosis)
90
what are the two main methods of assessing depression
HAD scale
Hospital Anxiety and Depression Scale (out of 21)
PHQ-9
Patient Health Questionnaire
91
what is the physiological mechanism of depression
Decreased 5-HT -> Decreased Noradrenaline -> Decreased Dopamine
92
What is the first line treatment for depression
Mild = CBT
Moderate/severe = SSRI eg Fluoxetine/sertraline + CBT
93
First line pharmacological treatment for depression?
What if the patient has Cardiovascular disease
SSRI eg Fluoxetine (without CVD)
Sertraline or Citalopram if CVD
94
Side effects of SSRI's
Increased suicidality/depression
Nausea diarrhoea Vomiting
serotonin syndrome
loss of Libido
95
when are SSRI's contraindicated
in epilepsy - increased risk of seizures
96
3 examples of tricyclic depressants
amitriptyline, imipramine, lofepramine
97
Side effects of Tricyclic antidepressants and contraindications
side effect is arrhythmias
Avoid in heart disease
98
Give an example of a MAO-I. When might an MAO-I be used?
Phenelzine
Used in resistant depression
99
What are important points to remember when prescribing Phenelzine for depression?
What class of drug is Phenelzine?
Increased risk of hypertensive crisis
Avoid tyramine-containing foods (cheese, red wine, broad beans)
Monoamine oxidase inhibitor
100
Give an example of a SNRI (Serotonin Noradrenaline Reuptake Inhibitors).
Duloxetine
101
give 4 substances which cause serotonin syndrome
MAO-I
SSRIs
Ecstasy
Amphetamines
102
What is the acronym to remember the diagnosis for Serotonin Syndrome?
‘CAN’
Cognitive changes: agitation, confusion, euphoria, hallucinations
Autonomic changes: Tachycardia, HTN, Fever, Arrythmias,
Neuromuscular changes: Tremor, Hyperreflexia, Clonus, Ataxia, Incoordination, Seizures
103
What are the 3 fundamental components of Serotonin Syndrome?
Cognitive state changes
Autonomic hyperactivity
Neuromuscular abnormality
104
What is the treatment for Serotonin Syndrome?
Stop taking causative substance then support with symptoms
105
How might a bipolar patient appear / behave (eg. during a mental state exam)?
May behave manic (DIGFAST)
Distractible, impulsive, delusions of grandeur, flight of ideas, activity increase, sleep defecit, talkativeness
Many also be depressed
106
How may a bipolar patient speak compared to a normal patient?
Increased pressure of speech
Increased rate and amount
Difficult to interrupt.
107
Causes of mania
Bipolar, amphetamines, cocaine ?schizophrenia
108
differentials for bipolar
amphetamine use/cocaine use
109
How is bipolar managed/treated (non pharmacological
coordinated care from MDT
Rapid crisis action and ?hospitalization under section
Medication
annual reviews
110
Pharmacological management of bipolar disorder
Mood stabilisers
Lithium
Anticonvulsants (Sodium Valproate, Carbamazepine, Lamotrigine)
Anti-psychotics (conventional, atypical) -> used in acute mania
111
What are the 2 most important tests we need to carry out in patients on Lithium (for bipolar)?
Renal function (U+E)
TFTs -> check for hypothyroidism
112
What are the side effects of Lithium?
* lithium is used as a treatment for bipolar disorder
Leukocytosis
Insipidus (diabetic)
Tremors
Hypothyroidism
Increased urine
Mums beware (teratogenic)
113
List some effects of Lithium toxicity
blurred vision
coarse tremor
seizures
muscle weakness
Coma
Nausea and vomiting
114
Give the WHO definition for Schizophrenia.
‘A severe mental disorder, characterised by profound disruptions in thinking, affecting language, perception, and the sense of self.’
115
how long must symptoms of schizophrenia last before a diagnosis is made?
1 month
116
Organic differential for schizophrenia
brain disease - brain injury/CNS infection
Metabolic - hypernatremia
Endocrine - hyperthyroid
Substance induced - alcohol/stimulants
117
3 examples of typical/conventional antipsychotics
Haliperidol, Chlorpromazine, Flupentixol
118
3 examples of an atypical antipsychotic
olanzapine
Risperidone
Clozapine
119
List 3 side effects of atypical anti-psychotics.
Weight gain, tachycardia, blurred vision
120
Give 2 side effects of Olanzepine. What class of antipsychotic is Olanzepine?
Side effects: weight gain, tachycardia
Atypical
121
When might Clozapine be used as an antipsychotic?
in treatment resistant schizophrenia - 3rd antipsychotic tried
122
Main side effect of clozapine
agranulocytosis
123
symptoms of parkinsons
Stooped posture
Shuffling gait
Rigidity
Bradykinesia
Tremors at rest
Pill-rolling motion of the hand.
124
what is pseudoparkinsonism
a reaction to a medication that mimics parkinsons disease
125
describe acute dystonia (symptoms)
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
describe akathisia
a state of restlessness/inability to stay still/Paces the floor/rocking back and forth
127
Describe tardive dyskinesia
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
What is ‘Neuroleptic Malignant Syndrome’ (NMS)?
NMS is a reaction that occurs following starting an antipsychotic / increased dose.
129
What are the signs and symptoms of Neuroleptic Malignant Syndrome?
Fever, muscle pain, breathlessness, Seizures/coma increased creatinine kinase
130
What investigations should you order if you suspect Neuroleptic Malignant Syndrome?
ABG: Metabolic Acidosis
Increased Creatinine Kinase
FBC - Leucocytosis (high WBC)
ECG: Prolonged QT
131
What is the treatment for Neuroleptic Malignant Syndrome?
Stop antipsychotic
Supportive: IV fluids
Benzodiazepines
132
For Serotonin syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils
For Serotonin syndrome, describe the:
Onset: abrupt
Course: rapidly evolving
Neuromuscular findings: myoclonus/tremor
Reflexes: hyperreflexia
Pupils: dilated/Mydriasis
133
For Neuroleptic Malignant Syndrome, describe the:
Onset
Course
Neuromuscular findings
Reflexes
Pupils
For Neuroleptic Malignant Syndrome, describe the:
Onset: gradual
Course: prolonged
Neuromuscular findings: rigidity
Reflexes: decreased
Pupils: normal
134
List 5 anxiety disorders.
generalised Anxiety
panic disorder
OCD
PTSD
Phobias
135
Describe Generalised Anxiety Disorder.
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
Generalised anxiety disorder risk factors
Risk factors:
Genetics
Past trauma
Chronic physical health condition eg arthritis
Substance missuse eg alcoholism
137
Generalised anxiety disorder treatment
CBT + SSRIs (sertraline/paroxetine)
maybe Benzo eg (diazepam/lorazepam)
138
SSRI side effects
Nausea vomiting diarrhoea
difficulty achieving orgasm/erectile dysfunction
dry mouth/blurred vision
increase in suicidal ideation/nightmares
139
List the symptoms of a panic attack
racing heart rate/palpatations
hyperventilation
Intense fear + dread
Sense of impending doom
140
Describe panic attacks in relation to Panic Disorder.
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
What is the treatment for panic disorder
CBT + SSRI (eg fluoxetine/sertraline)
142
Describe ‘obsessions’ as related to OCD.
repeated unwanted thoughts that are uncontrollable and distressing
143
Describe ‘compulsions’ as related to OCD.
a ritualistic action taken to alleviate the distress of an obsession
144
Describe a typical OCD patient.
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
treatment for OCD
CBT + SSRI (eg fluoxetine/sertraline)
146
What is a ‘phobia’?
an irrational debilitating fear of a specific non-dangerous thing that causes avoidance
147
What is the treatment for a phobia?
CBT
148
What is the lifetime prevalence of PTSD?
10% of women; 4% of men
149
What is the most likely event to cause PTSD?
sexual assault
150
What are the risk factors for PTSD?
Previous Mental Health problems
Past trauma (esp. childhood abuse)
Lack of support
Victim-blaming by the environment
151
List some symptoms of PTSD.
Intrusive thoughts recalling the traumatic event
Nightmares / flashbacks
Feeling detached / unable to connect with loved ones.
Irritability / angry outbursts
avoiding reminders of trauma
152
Treatment for PTSD
Management of PTSD includes:
Trauma-focused CBT
Eye-Movement Desensitization and Reprocessing (EMDR) therapy
Pharmacological: SSRI
153
define personality disorder
A group of disorders characterised by rigid, maladaptive traits that cause great distress or an inability to get along with others.
154
Which disorders comprise Cluster A of ‘Personality Disorders’?
Cluster A: a group of disorders characterised by odd / eccentric behaviours:
Paranoid personality disorder
Schizoid personality disorder
Schizotypal Personality Disorder
155
What is the defintion of Cluster A ‘Personality Disorders’?
a group of disorders characterised by odd / eccentric behaviours: eg.
Paranoid personality disorder
Schizoid personality disorder
Schizotypal Personality Disorder
156
Which disorders comprise Cluster B of ‘Personality Disorders’?
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
what is the definition of cluster B 'Personality disorders'
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
Which disorders comprise Cluster C of ‘Personality Disorders’?
Cluster C: a group of disorders characterised by anxious or fearful behaviours:
Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder
159
what is the definition of Cluster C 'personality disorders'
Cluster C: a group of disorders characterised by anxious or fearful behaviours:
Avoidant personality disorder
Dependent personality disorder
Obsessive-Compulsive personality disorder
160
What acronym can be used to help remember the components of a suicide risk assessment?
‘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
What must somome do in order to have capacity (according to the Mental Capacity Act 2005)?
A person has capacity if they are able to:
Understand info
Retain info
Weigh up info
Communicate their decision
162
What does Section 2 of the Mental Health Act (1983) permit?
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
What does Section 3 of the Mental Health Act (1983) state?
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
What does Section 4 of the Mental Health Act (1983) state?
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
What does Section 5 of the Mental Health Act (1983) state?
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.
