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Phase 3a Jemima > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are signs of lithium toxicity

A

slurred speech and coarse tremor
nausea and vomiting
diarrhoea
dehydration
lethargy

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2
Q

what points towards a diagnosis of fronto-temporal dementia

A

impulsivity
change in personality/aggression
young age (relatively)
lack of movement abnormalities

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3
Q

what is echopraxia

A

it is when the patient involuntarily imitates another persons movements. It is a rare feature of schizophrenia

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3
Q

what section of the Mental Health Act 1983 can be used to detain patients for up to 28 days

A

section 2

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4
Q

what medication can be given to help improve the cognitive function in Alzheimers disease

A

Donepezil

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5
Q

what is the mode of action of donepezil

A

it is an acetylcholinesterase inhibitor - increase free levels of acetylcholine in the brain

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6
Q

what is systematic desensitization

A

this is when there is exposure to a phobia/phobic stimulus that builds gradually in stages. In each stage there are relaxation techniques

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7
Q

what is somatoform disorder

A

this is when there is presence of a physical symptom that cant be explained by a physical medical condition. It is an unconscious process. Often caused by stresses in patients life/underlying psychological condition.

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8
Q

what is conversion disorder

A

this is a psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause

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9
Q

what is malingering

A

this involves patients intentionally fabricating or inducing illness for secondary gain such as drug seeking, time off work, avoiding going to prison ect.

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10
Q

what is hypochondriasis

A

this is when patients have an excessive concern that they have a serious illness despite a lack of evidence.

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11
Q

what is the most appropriate management of a mother who has postpartum psychosis

A

Seen as an emergency and the patient would need admission to a mother and baby unit

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12
Q

what is a cotard delusion

A

a delusion that a patient is dead, non-existent or rotting

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13
Q

what is knights move thinking

A

this is when there is a lack of apparent connections between ideas - words remain in the form of sentences

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14
Q

what are Neologisms

A

these are new words coined by the patient - schizophrenia

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15
Q

what is Logoclonia

A

this is when a patient repeats the last syllable of a word or phrase

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16
Q

what is echopraxia

A

this is when a patient imitates another persons movements and is seen in severe schizophrenia

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17
Q

what is the SUSS test

A

this is the sit up squat stand test and assesses muscle wasting in patients with anorexia nervosa.
- sit up test the patient lies flat on a firm surface and attempts to sit up without using their hands
- squat test patient is asked to rise from a squatting position without using their hands

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18
Q

what do NICE guidelines recommend as first line treatment for mild to moderate dementia

A

donepezil
rivastigmine
galantamine

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19
Q

what is the first line treatment of autoimmune encephalitis

A

steroids and IV immunoglobulins

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20
Q

what is schizotypal personality disorder characterised by

A

unusual social behaviour, bizarre or magical thinking and distorted perceptions
- unlike in schizophrenia these patients are able to maintain a grasp on reality and do not hold their unusual beliefs with such unwavering certainty

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21
Q

what is the treatment for severe alzheimers disease

A

Memantine

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22
Q

what are side effects of memantine

A

feeling sleepy or dizzy, headaches, constipation and shortness of breath

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23
Q

what is the triad associated with lewy body dementia

A

REM sleep disorder
history of falls
hallucinations

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24
Q

what is akathisia

A

it is the feeling of inner restlessness and tension, an urge to constantly move parts of the body, especially the legs, and difficulty maintaining a posture for a few minutes

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25
Q

what drugs can cause akathisia

A

antipsychotics
- first generation such as haloperidol are more likely to cause it than second generation

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26
Q

what is conversion disorder

A

this is the presence to neurological symptoms without any underlying neurological causes
- often linked with emotional distress

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27
Q

how long must PTSD symptoms be present for it to be diagnosed

A

at least 1 month and must interfere with day to day activities

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28
Q

what is the most common side effect of clozapine

A

Constipation due to impairment of intestinal peristalsis

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29
Q

what is histrionic personality disorder

A

this is characterised by attention seeking behaviour, they are willing to be viewed as dependent on others and weak to gain attention. They use speech/dress to seek attention
- dont display self harm or suicidal behaviour

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30
Q

what is dependent personality disorder

A

this is characterised by fear of abandonment. They will have excessive reliance on caregivers and they may feel unable to make decisions when the caregiver is not around

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31
Q

What is Russells sign

A

this is scarring of the knuckles indicative of bulimia

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32
Q

what is tardive dyskinesia

A

this is repetitive movements often affecting the face and jaw. This is often due to antipsychotic medication

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33
Q

For what time period must symptoms be seen before a diagnosis of depression can be made?

A

Depression can be diagnosed if symptoms are present nearly every day for 2 weeks or longer

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34
Q

what is the ICD 10 diagnostic criteria for dementia

A

Disturbance of multiple higher cortical functions
- memory
- thinking
- orientation
- comprehension
- calculation
- learning capacity
- language
- judgement
- consciousness is not clouded

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35
Q

what is the ICD 10 diagnostic criteria for delirium

A

disturbances of
- consciousness
- attention
- perception
- thinking
- memory
- psychomotor behavior
- emotion
- sleep wake schedule
severity ranges from mild to severe

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36
Q

what is the ICD 10 diagnostic criteria for schizophrenia

A

Positive symptoms
- thought echo, insertion, withdrawal, broadcasting
- delusions of perception
- delusions of control
- over valued ideas
- auditory hallucinations with 3rd person voice
- catatonic behaviour

Negative symptoms
- blunted affect
- apathy, loss of drive
- social isolation
- poverty of speech
- poor self care

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37
Q

what is the ICD 10 diagnostic criteria for depression

A

symptoms for 2 weeks with sustained dysfunction
triad of: lowering of mood, anhedonia, reduction of energy
plus
- decreased concentration
- reduced self confidence and self esteem
- ideas of guilt and worthlessness
- poor sleep and early waking
- loss of appetite
- loss of weight
- loss of libido
- psychomotor retardation

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38
Q

what is the ICD 10 diagnostic criteria for mania

A

symptoms or features for 7 days with sustained dysfunction
- elevated mood
- distractable
- delusions of grandeur
- flight of ideas
- pressure of speech
- disinhibited ideas
- decreased need for sleep
- increased energy

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39
Q

what are features of panic disorder

A

recurrent panic attacks of severe anxiety
somatic symptoms - heart racing, sweating, cant breath etc
feeling of unreality - depersonalisation or derealisation
recurrent over one month

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40
Q

what are features of obsessive compulsive disorder

A

recurrent obsessional thoughts or compulsive acts
obsessional thoughts are: ideas, images, impulses
compulsive acts or rituals are stereotypes behaviours that are repeated to prevent some objectively unlikely event
anxiety worsens if compulsions are ignored

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41
Q

what are features of generalised anxiety disorder

A

anxiety that is general and consistent (not about one specific thin)
complaints of persistent nervousness, trembling, muscular tensions, sweating, light headedness, palpitations, dizziness

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42
Q

what are features of phobias

A

this is anxiety at particular events/situations/things
situations are avoided to prevent anxiety
secondary = fear of dying, losing control or going mad
phobic anxiety and depression often coexist

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43
Q

what are features of anorexia nervosa

A

deliberate and sustained weight loss induced and sustained by the patient
dread of fatness
under nutrition of varying severity with changed in body function
restrictive dietary choice including excessive exercise, induced vomiting and use of appetite suppressants and diuretics

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44
Q

what are features of bulimia nervosa

A

repeated bouts of overeating and preoccupation with the control of body weight
pattern of overeating followed by purging/vomiting
repeated vomiting is likely to give rise to disturbances of the body electrolytes and physical complications
can have bulimia without purging - controlled by excessive exercise or restrictive eating after

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45
Q

what is dependance syndrome

A

this is behavioural, cognitive and physiological phenomena that develops after repeated and sustained substance use
- strong desire to take the drug
- difficulties in controlling its use
- persistent use despite harmful consequences
- higher priority given to the drug than other activities and obligations

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46
Q

what are examples of cholinesterase inhibitors

A

donepezil
rivastigmine
galantamine

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47
Q

what are side effects of cholinesterase inhibitors

A

agitation
dizziness
fatigue
insomnia
headaches

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48
Q

what conditions do you have to take care with when prescribing cholinesterase inhibitors

A

cardiac problems
asthma
COPD
urinary retention

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49
Q

what are NMDA receptor antagonists used for

A

Alzheimer’s disease

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50
Q

what is an example of a NMDA receptor antagonist

A

memantine

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51
Q

what are side effects of NMDA receptor antagonists

A

constipation
dizziness
drowsiness

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52
Q

when would you avoid prescribing NMDA receptor antagonists

A

in hepatic impairment and if the patient is on antipsychotics

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53
Q

what are examples of SSRIs

A

citalopram
fluoxetine
paroxetine
sertraline

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54
Q

what are side effects of SSRIs

A

GI problems
diarrhoea
abdominal pain
insomnia
nausea
sexual dysfunction

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55
Q

what SSRI can cause QT prolongation

A

citalopram

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56
Q

what SSRI is used in children and adolescents

A

fluoxetine

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57
Q

what are examples of SNRIs

A

duloxetine
venlafaxine

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58
Q

what are side effects of SNRIs

A

GI problems
diarrhoea
nausea
abdominal pan
sexual dysfunction
drowsiness
palpitations
fatigue
anxiety
dry mouth
rhabdomyeitis
SIADH

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59
Q

what diseases should you be cautious of when prescribing SNRIs

A

cardiac disease
mania - can make worse
seizures

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60
Q

what are examples of tetracyclic antidepressants

A

mianserin
mirtazapine

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61
Q

what are the side effects of tetracyclic antidepressants

A

cardiac problems
diabetes mellitus
seizures

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62
Q

what are examples of tricyclic antidepressants

A

amitriptyline
clomipramine
imipramine

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63
Q

what are side effects of tricyclic antidepressants

A

fatigue
oedema
postural hypotension
abdominal problems
dry eyes

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64
Q

who should you not prescribe tricyclic antidepressants to

A

patients with risk of overdosing

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65
Q

what are examples of atypical antipsychotics

A

aripiprazole
clozapine
olanzapine
quetiapine

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66
Q

what are side effects to atypical antipsychotics

A

weight gain
hyperlipidaemia
hypercholesterolaemia
hypersalivation
sexual problems

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67
Q

what is the risk when on clozapine

A

risk of agranulocytosis and neutropenia

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68
Q

what are examples of mood stabilisers

A

lithium
valproic acid
carbamazepine
lamotrigine
atypicals

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69
Q

what are common side effects with mood stabilisers

A

GI problems
nausea

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70
Q

which mood stabiliser needs regular monitoring

A

lithium

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71
Q

which mood stabiliser should not be prescribed to people below 55, particularly women of child baring age

A

sodium valproate

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72
Q

what disorders is CBT used in

A

depression
anxiety disorders
mood disorders
eating disorders
psychotic disorders

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73
Q

what disorders is dialectic behavioural therapy used in

A

emotionally unstable personality disorder

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74
Q

how does dialectic behavioural therapy work

A

it refers to the way in which someone thinks, and helps people unlearn unhelpful ways of thinking
uses a mix of CBT and mindfulness and psychotherapy

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75
Q

what disorders in psychotherapy used in

A

complex clinical conditions - where the therapist spends time with the patient helping them to explore their thought, feelings, emotions etc

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76
Q

how is mental capacity assessed

A

assessed using 4 domains
1. can the patient understand what is being said to them - understand the nature of the treatment
2. retain that information
3. use that information to make an informed decision
4. relay their decision back to the medical practitioner

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77
Q

what are the 5 principles of the mental capacity act (2005)

A
  1. capacity is assumed
  2. practical steps are taken to help
  3. allow unwise decisions
  4. best interest
  5. least restrictive
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78
Q

what is a section 2 under the Mental health act 1983

A

assessment for up to 28 days

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79
Q

what is a section 3 under the mental health act 1983

A

treatment for up to 6 months

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80
Q

what is a section 4 under the mental health act 1983

A

emergency admission for 72 hours

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81
Q

what is a section 5(2) under the mental health act 1983

A

doctors holding power for 72 hours

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82
Q

what is a section 5(4) under the mental health act 1983

A

nurses holding power for 6 hours
- have to be a mental health nurse or learning disability nurse

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83
Q

what is section 135

A

it is the warrant the police can use to enter you home
- there is a type 1 and type 2

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84
Q

what is section 136

A

it is what the police can use to have someone assessed who is in a public place

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85
Q

what is section 17a

A

this is a community treatment order - normally after a section 3 when someone leaves hospital that allows them to be recalled without another MHA assessment

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86
Q

what are the clinical features of someone with emotionally unstable personality disorder

A

impulsive
angry
hedonistic
unstable
low self esteem
chronic emptiness
self harm
unstable relationships

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87
Q

what are the clinical features of someone with paranoid personality disorder

A

sensitive
bears grudges
suspicious
combative
fears of infidelity
self referential
preoccupied with conspiracies

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88
Q

what are the clinical features of anankastic (obsessive compulsive) personality disorder

A

perfectionist
stubborn
rigid
unable to delegate
pays undue attention to detail

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89
Q

what are clinical features of anxious personality disorder

A

worried
isolated
avoids social situations
inadequate
poor self image

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90
Q

what are the clinical features of dissocial/antisocial personality disorder

A

uncaring
callous
lacking remorse
manipulative
violent
blames others
amoral

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91
Q

what are clinical features of schizoid personality disorder

A

cold
aloof
detached
indifferent to praise/criticism
solitary
emotionally blunted

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92
Q

what are the clinical features of histrionic personality disorder

A

dramatic
vain
self obsessed
centre of attention
sexual
shallow
obsessed with appearance

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93
Q

what are the clinical features of narcissistic personality disorder

A

grandiose
views themselves as special
jealous
self centred
manipulative
prone to fantisies

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94
Q

what are the clinical features of schizotypal personality disorder

A

strange
odd behaviour
strange beliefs out of keeping with societal norms
not fully psychotic

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95
Q

what are clinical features of dependent personality disorder

A

needy
low self esteem
unable to make decisions
fears being alone

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96
Q

what are the three main developmental processes of personality disorders

A
  1. constitutional deposition - emotional instability, anxiousness, impulsiveness
  2. conditions during childhood - trauma, neglect, abuse, deprivation
  3. social context - opinions about themselves and the world
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97
Q

what are the three groups of personality disorders

A

eccentric/odd - group A
emotional/erratic - group B
anxious/fearful - group C

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98
Q

what are characteristics of a schizoid personality disorder

A

they show emotional coldness
they omit close friends and lack close friends
they are isolated and take pleasure in few activities
they have a restricted interest in sex
it is more common in men

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99
Q

what is the ICD10 criteria for a schizoid personality disorder diagnosis

A

4 of the following
- anhedonia
-emotional coldness
- lack of feelings towards others
- indifference to praise or criticism
- sexual indifference
- solitary habits
- no desire for close friends
- disregard for social norms

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100
Q

what are characteristics of schizotypal personality disorder

A

magical thinking and eccentric behaviours
they have paranoid ideation
they experience unusual perceptions and have unusual thinking
they lack friends
they are socially anxious

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101
Q

what is the ICD10 criteria for schizotypal personality disorder

A

need a minimum of 4 of these continuously or repeatedly over at least 2 years
- inappropriate affect
- odd, eccentric or peculiar behaviour
- poor rapport with others
off beliefs or magical thinking
- suspicious, paranoid
- unusual perceptual experiences
- vague circumstantial thinking with odd speech
- occasional quasipsychotic episodes

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102
Q

what are characteristics of someone with paranoid personality disorder

A

spouse suspected cheating
unforgiving and suspicious
perceives attacks from others and sees an enemy in everyone
confiding in others is feared
threats are seen in benign things

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103
Q

what is the ICD10 diagnostic criteria for paranoid personality disorder

A

must have at least 4 of
excessive sensitivity
tendency to bear grudges
suspicious and distorting of the facts
combative personality
recurrent suspicions of infidelity
self referential attitude
preoccupations with conspiracies

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104
Q

what are characteristics of dissocial personality disorder

A

cannot follow the law
obligations are ignored
remorselessness
recklessness
underhandedness
unable to plan
temper

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105
Q

what is the ICD10 diagnostic criteria for dissocial personality disorder

A

at least 3 of
unconcern for others
irresponsibility - disregard for social norms
lack of maintaining social relationships
violence: low tolerance to frustration
lack of guilt or remorse
prone to blaming others

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106
Q

what are characteristics of emotionally unstable personality disorder

A

paranoid ideas
relationship instability
angry outbursts and affective instability
impulsive behaviours
suicidal behaviour
emptiness

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107
Q

what is the ICD10 diagnostic criteria for emotionally unstable personality disorder

A

any three from (but * is a must!!)
impulsive actions
quarrelsome behaviour and conflict *
outbursts of anger
unstable mood
hedonism

plus two of the following
uncertain self image
unstable emotional relationships
recurrent threats of self harm
chronic feelings of emptiness

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108
Q

what are characteristics of someone with histrionic personality disorder

A

provocative seductive behaviour
relationships considered overly intimate
needs to be the centre of attention
influenced easily
emotionally liable and shallow
concern with physical appearance
exaggerated motion

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109
Q

what is the ICD10 diagnostic criteria for histrionic personality disorder

A

exaggerated expression of emotions
suggestibility
shallow and liable affect
continual excitement and being the centre of attention
inappropriate seductiveness
over concern with physical attractiveness

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110
Q

what are characteristics of narcissistic personality disorder

A

is easily jealous
lacks empathy
overreacts to criticism
views themselves as special and exaggerates own importance
manipulative of others
expectations are unrealistic

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111
Q

what is the ICD10 diagnostic criteria for narcissistic personality disorder

A

at least 5 from:
grandiose sense of self importance
preoccupation of fantasies of success
belief they are special and unique
need for excessive admiration
a sense of entitlement
exploitation of relationships
lack of empathy
envy or belief others are envious of them
arrogant behaviour

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112
Q

what are characteristics of avoidant personality disorder

A

avoids occupational activities
views self as socially inept
occupied with being rejected or criticised
inhibited in new situations
declines to get involved
embarrassed socially
refrains from intimacy

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113
Q

what is the ICD10 diagnostic criteria of avoidant personality disorder

A

persistent feelings of tension
belief one is socially inept
preoccupation with being rejected or criticised
avoidance of people
restrictions in lifestyle due to need for security
avoidance of social events

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114
Q

what are characteristics of dependent personality disorder

A

difficulty making decisions
go to excessive lengths to obtain help
preoccupied with fear of isolation
exaggerated fear of inability to cope
needs others to make decisions for them
difficulty disagreeing with others
ending relationships is difficult for them
noticeable difficulty in initiating things

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115
Q

what is the ICD10 diagnostic criteria for dependent personality disorder

A

allowing others to make their important choices
undue compliance with others wishes
unwillingness to make any demands
feeling uncomfortable alone
preoccupation with fears of being left alone
inability to make decisions

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116
Q

what are characteristics of obsessive compulsive personality disorder (anankastic)

A

loses point (due to preoccupation)
ability is compromised by perfectionism
unable to discard worthless objects - hording
friends are excluded
they are often inflexible and rigid in their way
reluctance to delegate
stubborn

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117
Q

what is the ICD10 diagnostic criteria for obsessive compulsive personality disorder

A

excessive doubt
reoccupation with rules, details, order
perfectionism interferes with tasks/job etc
preoccupation with productivity
excessive pedantry - the quality of being too interested in formal rules and small details that are not important
rigidity

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118
Q

what are negative symptoms of schizophrenia

A

Lack of emotion or small emotional range - Apathy
loss of energy - Anergia
lack of interest or low motivation - anhedonia
affective flattening - black blunted facial expression
difficulty, poverty or inability to speak
reduction difficulty or inability to initiate and persist in goal directed behaviour
autistic like features
absent minded, reduced concentration
activities of daily living are avoided

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119
Q

what are catatonic behaviours

A

marked decrease in reaction to the immediate surrounding environment sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures or aimless excess motor activity

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120
Q

what are examples of second generation antipsychotics

A

aripiprazole
clozapine
olanzapine
paliperidone
quetiapine
risperidone

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121
Q

what are examples of first generation antipsychotics

A

chlorpromazine
fluphenazine
haloperidol

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122
Q

what are complications of schizophrenia

A

suicide and self harm
anxiety and obsessive compulsive disorders
depression
abuse of alcohol and recreational drugs
inability to work or attend school
legal and financial issues
hopelessness
self isolation
health and medical problems
stigmatisation
aggressive behaviour

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123
Q

what are the side effects of typical (first generation) antipsychotics

A

shaking
trembling
muscle spasms
muscle twitches

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124
Q

what are side effects of both typical and atypical antipsychotics

A

drowsiness
weight gain
blurred vision
constipation
lack of sex drive
dry mouth

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125
Q

what are extrapyramidal effects of antipsychotic medications

A

tardive dyskinesia - persistent involuntary movement of the lips, jaw or face and extremities
pseudo parkinsonism
dystonia - irregular muscle contractions
akathisia - inability to sit still

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126
Q

what is neuroleptic malignant syndrome

A

it is a serious neurological disorder affecting the nervous system that usually develops rapidly over 24-72 hours and may occur during administration or withdrawal/change of antipsychotic medication

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127
Q

what are symptoms of neuroleptic malignant syndrome

A

sweating or fever with high temperature
tremour, rigidity or loss of movement
difficulty in speaking or swallowing
rapid heart beat, very rapid breathing and changes in blood pressure
changes in consciousness, from lethargy and confusion to stupor or coma

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128
Q

What ECG change may be seen in re-feeder syndrome

A

Prominent U waves due to the hypokalaemia

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129
Q

What is agnosia

A

the inability to recognise people, places or things that were once known to that person

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130
Q

What is normal pressure hydrocephalus

A

an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles (cavities). It occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way. This causes the ventricles to enlarge, putting pressure on the brain.

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131
Q

what are the symptoms of normal pressure hydrocephalus

A

Wet, wobbly, wacky
- urinary incontinence
- gait dysfunction
- dementia

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132
Q

what is the advice on taking lithium in pregnancy

A

lithium is known to increase the chances of developing Ebsteins abnormality (congenital abnormality), where the leaflets of the tricuspid valves are displaced

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133
Q

what is capgras syndrome

A

when someone believes that someone similar to them has been replaced by an exact clone (may or may not want to harm them)

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134
Q

what is Ekbom syndrome

A

In ekbom syndrome a patient experiences delusional beliefs that they are infested with insects/parasites and will complain of them crawling on their skin

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135
Q

what medication can be used to help curb the extrapyramidal side effects of antipsychotic medication

A

Procyclidine

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136
Q

what are side effects of valporate

A

vomiting
alopecia
liver toxicity
pancreatitis/pancytopenia
retention of fats (weight gain)
oedema
anorexia
tremor
enzyme inhibition

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137
Q

what questions as asked in CAGE alcohol questionnaire

A

Have you every wanted to cut down on your drinking
Are people every annoyed at your drinking
do you ever feel guilty by your drinking
do you need a drink first think in the morning (eye opener)

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138
Q

What questions are asked in an AUDIT C questionnaire

A

How often do you drink (0-4)
How many units do you drink per week (0-4)
How often have you had over 6 units if female and over 8 units in male in the last year (>3 times = bad)

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139
Q

what questions should be asked when asking about substance intake

A

origin
pattern
quantification
behaviours
abstinence
ask about dependence and the impact on life

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140
Q

what is harmful drinking

A

it is a pattern of drinking that causes health problems, includes psychological

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141
Q

what is dependence drinking

A

chronic disease in which a person craves alcoholic drinks and is unable to control this
- require greater amounts of alcohol and have withdrawal

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142
Q

what are consequences of long term alcohol use

A

increased risk of mouth, throat and breast cancer
stroke
heart disease
liver disease: cirrhosis, alcoholic liver disease
brain damage/damage to nervous system
depression
dementia
self harm

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143
Q

what are symptoms of acute alcohol withdrawal

A

mood change, insomnia, tremor, nausea and vomiting, confusion, hallucinations, seizures
in severe cases Wernickes

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144
Q

what is given for the acute management of alcohol withdrawal

A

benzodiazepines
IV thiamine

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145
Q

what are symptoms of Wernickes

A

change in mental state, ocular abnormalities, ataxia, hypotension, tachycardia, seizures, hallucinations, hypo/perthermia, spasticity

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146
Q

what are long term risks of heroin use

A

significant development of tolerance and dependence
insomnia
infections o the heart lining and valves
abscesses
chronic chest infections
chronic and severe constipation
depression
antisocial personality
sexual dysfunction and increased risk of STI
irregular menstrual cycle
increased risk of HIV and Hepatitis

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147
Q

when is clozapine used in psychiatry

A

it is used in treatment resistant schizophrenia
- someone who has not responded to or has not tolerated two previous antipsychotic medications (in which one has to be an atypical medication)

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148
Q

what happens if someone hasnt taken their clozapine for 48 hours

A

after 48 hours their healthcare provider must be contacted and the patient has to be started back down at the lowest dose as they will have a loss of tolerance

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149
Q

what is the relationship between smoking and clozapine

A

smoking causes clozapine to be metabolised quicker, and therefore someone may need a higher dose to get the same effect

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150
Q

what therapeutic window does lithium need to be kept between

A

0.4-1mmol/L measured 12 hours post dose given

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151
Q

what are side effects of lithium

A

nephrogenic diabetes
tremors
dry mouth
diarrhoea
GI upset
increased weight
underactive thyroid
in pregnant women - Ebsteins phenomina

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152
Q

what things are important to check before starting lithium

A

BMI
cardiac function
heart function
thyroid function
renal function

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153
Q

how do you treat lithium toxicity

A

IV fluids
stop and review medications
may need haemodialysis

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154
Q

why might someone get a lithium overdose

A

overdose on the medication
interactions - diuretics
dehydration - vomiting and diarrhoea
low sodium diet
reduced renal function
change in lithium brand

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155
Q

what are side effects of valproate

A

gastro pain
drowsiness
tremor ataxia
hair loss
sedation
increased appetite
weight gain
blood dysstasias (decreased WCC, liver damage)

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156
Q

what is the main side effects of lamotrigine

A

skin rashes
steven johnson syndrome

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157
Q

what monitoring is done for those on lithium

A

every six months monitor thyroid, calcium, renal function

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158
Q

what monitoring is done for valproate

A

liver function testing every 6 months

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159
Q

what is serotonin syndrome

A

it is when there is too much serotonin in the body causing neuromuscular hyperactivity, autonomic dysfunction and altered mental state

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160
Q

what are the symptoms of serotonin syndrome

A

agitation, anxiety, restlessness, disorientation, diaphoresis
hyperthermia
tachycardia
nausea, vomiting
tremor
muscle rigidity
hyperreflexia
myoclonus
dilated pupils
ocular clonus
dry mucous membranes
flushed skin
increased bowel sounds
a bilateral Babinski sign.

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161
Q

what are general symptoms of anxiety

A

dizziness
nausea
restlessness
headache
tachycardia
sweating
insomnia
panic attacks
feeling tense
dread
low mood
depersonalization and disconnect

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162
Q

what are the symptoms of a panic attack

A

struggling to breathe
dissociation
loss of control
fainting symptoms
chest pain

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163
Q

what is the treatment for anxiety (general)

A

self help - relaxation techniques
talking therapies CBT
medication - SSRI, pregabalin, beta blockers

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164
Q

what are causes of delirium

A

constipation
hypoxia
infection
metabolic disturbance
pain
sleeplessness
prescriptions
hypo or hyperthermia
organ dysfunction
nutrition
environmental changes
drugs
(CHIMPS PHONED)

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165
Q

what is delirium

A

it is an acute, transient and reversible state of confusion, usually as a result of a biological process
- cognition is highly fluctuant

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166
Q

what is dementia

A

it is an irreversible, progressive decline and impairment of more than one aspect of higher brain function (concentration, memory, language, personality, emotion)

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167
Q

what is mild cognitive impairment

A

people with memory problems or higher critical thinking issues which is not severe enough to interfere with their everyday life
- 10-15% will go onto develop dementia

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168
Q

how do you assess capacity

A
  1. does the person understand the information relevant to the decision
  2. can the person retain the information for long enough to make a decision
  3. can the person weigh up the information and use it to make a decision
  4. can the person communicate their decision in any way back to the practitioner
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169
Q

what are signs you would look for in someone with suspected eating disorder

A

malnourished
slow pulse
delayed capillary refill
postural tachycardia
low blood pressure
muscle weakness
back and bone pain
less than 75% weight for height

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170
Q

what are important things to ask in an eating disorder history

A

changes in eating
what do they think about food
what was eaten yesterday
do they vomit after eating
how much exercise do they do
ask about body checking
do they use diet pills/laxatives
how much water do they drink
do they smoke

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171
Q

what changes may you see on an ECG in someone who has an eating disorder

A

arrhythmias
prolonged QT
signs of electrolyte disturbance
sinus bradycardia

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172
Q

what might the bone profile of someone with an eating disorder show

A

low calcium, magnesium and phosphate

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173
Q

what might U+E of someone with an eating disorder show

A

hyponatraemia
hypokalaemia
dehydration
electrolyte disturbance

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174
Q

what is the treatment for anorexia

A

combination of talking therapy and supervised weight gain
- up to 40 weeks CBT
- MANTRA (understanding ED)
- specialist supportive clinical management
- focal psychodynamic therapy
- nutritional support

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175
Q

what is the treatment for bulimia

A

guided help
- CBT 20 sessions over 20 weeks
- self care

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176
Q

what is the treatment for binge eating disorder

A

guided self help
- CBT 20 sessions over 20 weeks

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177
Q

what is refeeding syndrome

A

it can happen when someone has been malnourished begins feeding again
it is due to metabolising nutrients again as the body tries to do normal carbohydrate metabolism but due to low macronutrients it is unable to

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178
Q

what are symptoms of refeeding syndrome

A

confusions and disorientation
seizures
cardiomyopathy
nausea and vomiting
hypotension
double vision
swallowing issues
trouble breathing
kidney dysfunction
muscle weakness

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179
Q

what is a learning disability

A

it is a condition which has an effect on a persons IQ and affects all aspects of learning and areas of life not just education
- Downs syndrome, Williams syndrome, Aspergers syndrome

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180
Q

what is a learning difficulty

A

it doesnt affect a persons IQ/general intelligence, and will affect areas of learning but not other areas of life
- dyslexia, dyspraxia, dyscalcula, dysgraphia

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181
Q

what support can be given to those with learning disabilities

A

education services
support and training for family careers
choice of housing
housing planning
annual health check
liaison workers
reasonable adjustments
specialist health and social care
early years services
help with personal budget

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182
Q

what is the link between traumatic stress and its affect on the brain

A

traumatic stress increases amygdala function and reduces hippocampal volumes. It increases cortisol and noradrenaline responses to stress. It also reduces the connections between the prefrontal cortex and the limbic system

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183
Q

what is attachment theory

A

that young children need to develop a relationship with at least one primary care giver for normal social and emotional development

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184
Q

what are the types of attachment in adults

A

secure
anxious preoccupied
dismissive avoidant
fearful avoidant

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185
Q

what is the affect of trauma on development

A

difficulty in identifying, expressing and managing emotions
internalise or externalise stress reactions
depression, anxiety or anger
aggressive behavious
behaviour regression

186
Q

what are questions you should ask when someone has self harmed

A

before the harm
- what happened before
- was the self harm planned or impulsive
- have they harmed before
During
- were they alone
- what did they use to harm themselves
- was the intent to end their lives
- did they want to be found
After
- did they seek help
- what is the patients current mood

187
Q

what questions are important to ask when someone has overdosed (self harm)

A

what was taken
how much was taken
where did you get it from
how long have they been thinking about the overdose
was it taken with alcohol

188
Q

what questions are important to ask when someone cuts themselves

A

where are the cuts
how many cuts do they have
how does it make them feel when they do it
is it done with the intent to kill themselves
how deep are the cuts

189
Q

what do you assess in an assessment of suicidal behaviour

A

the level of intent/hopelessness
the level of lethality (how much do they want to die)
do they live alone
their level of lack of sleep or agitation
their age, sex
have they had mental health issues previously
do they have absent rational thinking
do they have any protecting factors

190
Q

what is a hallucination

A

it is a false perception of objects or events involving your senses: sight, sounds, smell, touch

191
Q

what is a delusion

A

it is a false belief or judgement about external reality, occurring especially in mental conditions

192
Q

what are different types of hallucinations

A

auditory
smell
hearing
tactile
somatic
gustatory

193
Q

how long must symptoms be present for someone to be diagnosed with schizophrenia

A

symptoms must be present for one month and supported by indications of social dysfunction at work/school/interpersonal relationships for at least 6 months

194
Q

what can be triggers for a schizophrenic episode

A

stress
bereavement
loss of job or home
divorce
end of relationship
abuse - drug, physical, emotional, sexual

195
Q

what is substance dependence characterised by

A

impaired control over the substance
increasing priority over other aspects of life
psychological features such as neuroadaption

196
Q

what is the upper limit for alcohol consumption

A

14 units per weeks spread over 3 or more days

197
Q

what will happen within 6-12 hours of alcohol withdrawal

A

tremors
autonomic arousal - tachycardia, fever, pupillary dilation, increased sweating

198
Q

what can happen within 12-48 hours of alcohol withdrawal

A

alcohol hallucination
seizures at 36 hours

199
Q

what can happen within 72-96 hours of alcohol withdrawal

A

delirium tremens
altered mental status
hallucinations

200
Q

what medications can be given to help someone through alcohol withdrawal

A

benzodiazepines
Naltrexone: opiate blocker, makes alcohol less enjoyable
acamprosate: increases GABA to reduce cravings
Disulfiram: inhibits acetaldehyde dehydrogenase

201
Q

how long should someone with severe alcoholism be on thiamine for once they stop drinking

A

two years

202
Q

what are the symptoms of opioid withdrawal

A

rhinorrhoea
lacrimation
diarrhoea
pupillary dilation
piloerection
tachycardia
hot flushes
nausea and vomiting

203
Q

what are the effects of benzodiazepines (when not taken medically)

A

altered mental status
slurred speech
ataxia
respiratory distress
hypothermia
euphoria
disinhibition
aggression
anterograde amnesia
labile mood

204
Q

what are effects of benzodiazipine withdrawal

A

tremor
nausea and vomiting
tachycardia
postural hypotension
agitation
malaise
hallucinations
seizures

205
Q

what are examples of CNS stimulants

A

adderall
methamphetamines
cocaine

206
Q

what are the effects of CNS stimulants on the body

A

tachycardia, hypertension, mydriasis, tactile hallucinations, chest pain

207
Q

what are withdrawal side effects from CNS stimulants

A

dysphoria
lethargy
psychomotor agitation ]craving
increased appetite
insomnia

208
Q

what are examples of hallucinogens

A

LSD, marijuana, ecstasy, PCP

209
Q

what do components of addiction comprise of

A

salience - when something becomes important
mood modification
tolerance
withdrawal
relapse

210
Q

what are features of ADHD

A

short attention span
quickly loosing interest
constant fidgeting
impulsive behaviour
disruptive
poor organisation
acting without thinking

211
Q

what are risk factors for developing ADHD

A

prematurity
low birth weight
low paternal education
prenatal smoking
maternal depression

212
Q

how is a diagnosis of ADHD made

A

made my specialist
in adults use the - Diagnostic interview for ADHD in adults questionnaire
use the DSM-5 criteria looking at inattention and symptoms of hyperactivity and impulsivity
- children up to 16 have to have 6 or more symptoms across both categories
- over 17 only need 5 ore more symptoms

213
Q

how long must symptoms be present for for ADHD to be considered

A

present for at least 6 months and be present in multiple settings

214
Q

how is ADHD managed

A

initially watch and wait period for up to 10 weeks including encouraged self care and behavioural management
medication: methylphenidate

215
Q

what needs to be monitored when someone is on methylphenidate

A

blood pressure
heart rate - measured every 6 months

216
Q

what are complications of ADHD

A

lower educational and employment attainment
poor self esteem
relationship issues
sleep disturbance
substance abuse
self harm

217
Q

what is trait anxiety

A

Trait anxiety is when worry and fear permeate your experiences on a regular basis—not just in response to a stressful situation and is influenced by
- stable characteristics from genetics and environment
- adaptive responses to treat during childhood
experienced calibrate the CNS response to a threat in adulthood

218
Q

what is state anxiety

A

it is the state of feeling anxious - in the disorder these symptoms become more severe and persistant

219
Q

what are some psychological symptoms of anxiety

A

suspense
recurrent thoughts of negative outcomes
reduced concentration
hyper vigilance

220
Q

what is the neurobiology of anxiety

A

there is a reduced functional connectivity between the prefrontal cortex and the limbic system
variations in 5-HT transporter resulting in reduced 5-HT signalling
dysregulation of the hypothalamic-pituitary-adrenal axis

221
Q

what are features of anxiety disorder

A

Avoidance
Attention and cognitive bias
anxious rumination
low self worth
poor sleep

222
Q

what is autism spectrum disorder

A

it is a neurodevelopmental disorder which is characterised by abnormal social interaction, communication and restricted and repetitive behaviours

223
Q

what is Asperger’s syndrome

A

a condition forming part of the autistic spectrum, characterized chiefly by repetitive patterns of behaviour, preoccupation with restricted interests, and difficulties with social interaction, without intellectual impairment or significant problems with verbal communication.

224
Q

what medical conditions can predispose someone to developing autism

A

infantile spasms
congenital rubella
tuberous sclerosis
fragile X syndrome

225
Q

what are risk factors for autism

A

male sex
family history
genetic variants such as PTEN, MeCP
chromosomal abnormalities

226
Q

what are clinical features of autism

A

social interaction: lack of emotional response, unable to interpret cues, inability to form social attachment
communication: delayed or minimally expressive speech, impairment of make believe, lack of social gestures, one way conversation
restricted, repetitive behaviour: resist change, preoccupied with specific interests, inability to adapt to new environments

227
Q

what investigations are done for autism

A

a clinical assessment which shows deficits across all three domains (discussed in clinical features card)
- features must be observable in all environments and present from early childhood

228
Q

how is autism diagnosed

A

diagnostic interview for social and communication disorders
autism diagnostic observation schedule

229
Q

how is autism managed non pharmacologically

A

non pharmacological: specialist education, occupational therapy, speech therapy, clinical psychology, sleep hygiene, care agencies

230
Q

how is autism managed pharmacologically

A

SSRI if the patient has anxiety or depression
children with sleep issues may benefit from the use of melatonin

231
Q

what is bipolar disorder

A

it is a mood disorder characterised by episodes of mania or hypomania and depression

232
Q

what are the genetic factors can influence bipolar disorder development

A

1st degree relatives of a person with bipolar disorder are at an increased risk of developing bipolar, unipolar and schizophrenia
- 60% chance with identical twins
- polygenic inheritance

233
Q

what environmental factors can influence development of bipolar disorder

A

negative life events can precipitate depressive or manic episodes

234
Q

what neurobiological factors can influence development of bipolar disorder

A

increased dopamine activity in the brain may be important in the development of mania
disturbances in the hypothalamic - pituitary- adrenal axis can result in increased cortisol secretion

235
Q

what are risk factors for developing bipolar disorder

A

genetic factors
prenatal exposure to toxoplasma gondii
premature birth
childhood maltreatment
postpartum period issues
cannabis use

236
Q

what is Bipolar I

A

the person has experienced at least one episode of mania

237
Q

what is bipolar II

A

the person has experienced at least 1 episode of hypomania but never an episode of mania, they must have also experienced at least one episode of major depression

238
Q

what is cyclothymia

A

this is cycling between hypomania and depression for at least 2 years

239
Q

what are symptoms of mania

A

elevated mood
increased activity level
grandiose delusions
energy increase
pressure of speech
decreased need for sleep
inability to maintain attention
inflated self esteem
loss of normal social inhibitions
risky sexual activity

240
Q

what criteria needs to be met for something to be diagnosed as a manic episode

A

needs to last for at least 7 days and have a significant negative functional effect

241
Q

what are symptoms of hypomania

A

persistent elation in mood (less than in mania)
increased energy and activity
increased sociability
talkativeness
over familiarity
increased sexual energy
decreased need for sleep
irritability

242
Q

what investigations should be done when someone presents with mania

A

baseline bloods - FBC, U+E, LFT, TFT, CRP, B12, folate, vitamin D, ferritin
HIV testing
toxicology
physical exam
CT head

243
Q

what is required for a diagnosis of bipolar disorder

A

at least 7 days of mania
or
at least 4 days of hypomania
depression

244
Q

how is bipolar disorder managed acutely

A

acute: oral antipsychotics for mania (olanzapine, risperidone, etc.)
if patient on antipsychotic this should be tapered off and discontinued

benzodiazepines can be used in short term to manage symptoms or increased activity and allow better sleep

if patient depressed need to be careful with what is given due to mania risk
- fluoxetine+olanzapine, quetiapine alone, olanzapine alone, lamotrigine alone

245
Q

how is bipolar managed long term

A

mood stabilisers: lithium (if not effective valproate
psychotherapies: CBT, interpersonal or family focused therapies

246
Q

what are complications of bipolar disorder

A

increased risk of death by suicide
increased risk of death by general medical conditions
side effects of antipsychotics
socioeconomic effects

247
Q

how are lithium levels monitored

A

12 hour bloods weekly initially until stable
once stable do 3 monthly bloods
then do bloods every 6 months

248
Q

what are the brain changes associated with alzheimers disease

A

amyloid plaques and neurofibrillary fibers (tau)
have a medial temporal lobe atrophy

249
Q

what are risk factors for developing vascular dementia

A

hypertension
smoking
diabetes mellitus
hyperlipidaemia
obesity

250
Q

what are clinical features of vascular dementia

A

cognitive impairment
mood disturbance
psychosis
delusions
paranoia

251
Q

what are the brain changes associated with lewy body dementia

A

spherical lewy body proteins (alpha synuclein) are deposited within the brain

252
Q

what are clinical features of lewy body dementia

A

visual hallucinations
parkinson like symptoms
cognitive ddecline
problems multitasking and performing complex tasks
sleep disorders - often will present first
fluctuation in cognitive ability

253
Q

what are the brain changes seen in fronto-temporal dementia

A

neuronal damage and cell death in the frontal and temporal lobes - atrophy occurs due the deposition of abnormal proteins (often tau)

254
Q

what are the clinical features of fronto-temporal dementia

A

altered mood
apathy
disinhibition
increased impulsivity
progressive decline in interpersonal skills
decline in understanding words or speech
difficulty in name retrieval
not knowing the meaning of common words
breakdown of language
speech no longer fluent
speech apraxia

255
Q

what can increase the chance of a child developing a learning disability

A

family history
abuse, neglect
trauma
toxins
genetic conditions
fetal alcohol syndrome
maternal chicken pox
prematurity
meningitis
autism
epilepsy

256
Q

what are the different types of delirium you can get

A

hyperactive
hypoactive

257
Q

how do you treat delirium

A

identify and treat underlying cause
calm/consistent
aids they may need
independence
orientate the patient
involve family/carers in management
haloperidol if antipsychotic required - 0.5mg

258
Q

what are signs of opioid overdose

A

decreased level of consciousness
respiratory depression
pin point pupils

259
Q

what are symptoms of an opioid overdose

A

nausea
vomiting
confusion
drowsiness

260
Q

how do you manage an opioid overdose

A

ABCDE
Naloxone - initially 400 micrograms, of no response then give 800 for up to two doses at one minute intervals (subcut/IM)
oxygen- non-rebreathe mask 15L
assess consciousness - AVPU scale

261
Q

how is paracetamol metabolised by the body

A

mostly via glucuronidation and sulphation. 5% is metabolised by cytochrome p450 into N-acetyl-p-benzoquinone imine (NAPQI)
this binds to glutathione to become non toxic and is secreted in the urine

262
Q

what are the three types of paracetamol overdose

A

acute: excess amounts ingested quickly
staggered: excess amounts ingested over longer than 1 hour
therapeutic: excess ingested with the intent to treat pain/fever without self harm intent

263
Q

what are the risk factors of paracetamol overdose

A

history of self harm
history of frequent or repeated pain medication use
low body weight
cytochrome p450 inducers (phenytoin, rifampicin)
glutathione deficiency - ED, alcoholism

264
Q

what are the early signs of paracetamol overdose (<12 hours)

A

nausea and vomiting
mild to moderate abdominal pain/tenderness

265
Q

what are late signs of paracetamol overdose (12-48 hours)

A

moderate to severe abdominal pain
metabolic acidosis
jaundice
AKI
hepatic encephalopathy
coma
bruising/systemic haemorrhage

266
Q

what investigations should be done with suspected paracetamol overdose

A

paracetamol concentration
LFTs
INR
U+E
plasma bicarbonate
plasma glucose
FBC
lactate

267
Q

how is paracetamol overdose managed

A

if less than 8 hours after overdose: take bloods and start on acetylcysteine if paracetamol high
if over 8 hours after overdose: bloods and if paracetamol is over 150mg/kg or the person is symptomatic start acetylcysteine immediately
- if someone has taken a staggered overdose start acetylcysteine immediately regardless of level

268
Q

what is the acetylcysteine regime for paracetamol overdose

A

1) standard 21 hour - 150mg/kg over 1 hour then 50mg/kg over 4 hours then 100mg/kg over 16 hours
2) modified 12 hour (SNAP) : 100mg/kg over 2 hours then 200 mg/kg over 10 hours

269
Q

what can be given if someone has overdosed on benzodiazepines

A

flumazenil - not always recommended as long term use can cause withdrawal seizures

270
Q

what are signs of benzodiazepine overdose

A

agitation
euphoria
blurred vision
slurred speech
ataxia

271
Q

what is severe aspirin overdose

A

over 500mg/kg

272
Q

what are signs of aspirin overdose

A

mild: tinnitus, lethargy, dizziness, N+V
severe: dehydration, sweating, bounding pulse, deafness, breathlessness, confusion

273
Q

what investigations should be done for suspected aspirin overdose

A

salicylate concentration measured
U+E
glucose
potassium
urine pH
ABG

274
Q

how do you treat aspirin overdose

A

activated charcoal within one hour of ingestion
aggressive rehydration
sodium bicarb if aspirin levels v.high
haemodialysis in severe cases

275
Q

what is the treatment for cocaine/amphetamine overdose

A

benzodiazepines

275
Q

what psychiatric conditions could ECT be used in

A

severe resistant depression
severe depressive disorder causing harm to patient
catatonia
severe or ongoing mania

276
Q

what does the ECT regime comprise of

A

6-12 sessions occurring twice weekly
patient reassessed after each session and may stop before the end of the course/continue depending on the clinical presentation

277
Q

what is given before ECT to prevent physical affects of the therapy

A

a muscle relaxant - suxamethonium

278
Q

what are side effects of ECT

A

short term memory loss
retrograde amnesia
post ECT headache
post ECT muscle aches
brief confusion or drowsiness

279
Q

what are risks of ECT

A

risks of anaesthesia - airway issues, dental damage
risk of prolonged seizure

280
Q

what are contraindications for ECT

A

recent MI/stroke
increased intercranial pressure
active bleeding
retinal detachment

281
Q

what is a hypnotic

A

it can sedate when given during the day

282
Q

what is an anxiolytic

A

it helps to induce sleep at night

283
Q

what are hypnotics used in

A

used in disorders relating to sleep and anxiety

284
Q

what are the most common types of hypnotics/anxiolytics

A

benzodiazepines

285
Q

what are examples of Noradrenaline and specific serotonergic antidepressants (NASSAs)

A

Mirtazapine

286
Q

what are examples of TCA antidepressants

A

amitriptyline
imipramine

287
Q

what are examples of serotonin antagonist and reuptake inhibitors (SARIs)

A

trazodone

288
Q

what are examples of MAOI antidepressants

A

tranylcypromine
phenelzine
isocarboxazid

289
Q

what are side effects of TCA antidepressants

A

dry mouth
blurred vision
constipation
drowsiness
dizziness
weight gain
sweating
arrhythmia
impotence

290
Q

what do you need to be aware of in elderly people on antidepressants

A

risk of hyponatraemia
- nausea
- headache
- muscle pain
- loss of appetite
- confusion
- tired
- disorientated

291
Q

what is the depot injection

A

this is a long acting antipsychotic which is given every two to four weeks

292
Q

what are examples of depot injections

A

flupentixol deconate
zuclopenthixol deconate
aripiprazole

293
Q

what blood tests are required when on clozapine

A

weekly bloods for the first 18 weeks
they bloods every other week up to 1 year
after that blood tests are monthly

294
Q

what are the different types of stimulant medications for ADHD

A

short acting - lasts up to 4 hours, get crash after
long acting - take one a day and lasts from 6-8 hours. fewer ups and downs during the day

295
Q

what features would you see in mild learning disability

A

IQ between 50-69
some difficulties in acquisition and comprehension of complex language and academic skills
most can manage basic self care, domestic and practical skills
can live and work independently

296
Q

what features would you see in moderate learning disability

A

IQ 35-49
basic language and academic skills
some will manage basic self care, domestic and practical skills
consistent support to live alone

297
Q

what features do you see in severe learning disability

A

IQ 20-34
very limited language and academic skills
may have motor impairments
require daily support

298
Q

what features do you see in someone with a profound learning disability

A

IQ <20
very limited communication skills
may have some basic concrete skills
may have motor and sensory impairment
will need daily support

299
Q

what are risk factors for learning disability

A

chromosomal/genetic abnormalities
congenital malformations
prenatal exposures - alcohol, sodium valproate, rubella, zika virus
birth complications and premature birth
childhood illness - meningitis, encephalitis, measles, epilepsy
childhood brain injury
childhood neglect

300
Q

what environmental factors can impact on a childs development of learning disabilities

A

care environment with little opportunity for social interaction
excessive sensory stimulation
care environments which are crowded, unresponsive or unpredictable
abuse and neglect
developmentally inappropriate care environments
illness
care environment where disrespectful social relationships and poor communication is typical

301
Q

what is section 135(2)

A

this is when someone already in hospital goes AWOL and you need the police to bring them back in

302
Q

what year did the mental health act come out

A

1983

303
Q

what is a second opinion appointed doctor (SOAD)

A

this is a service which appoints a second opinion doctor which safeguards the rights of the patient subject to the mental health act

304
Q

under what conditions can you be sectioned

A

being assessed or treated for a mental health condition
if you are at risk of getting worse without treatment
if your safety or someone elses safety is at risk if you dont get treatment

305
Q

what is nearest relative in mental health

A

different to next of kin, it is something the patient doesnt have a say in
- hierarchy of blood relatives
- preference is given to age
- preference is given to those who live with the patient

306
Q

what are predisposing factors for depression

A

family history
age
female
personality traits
childhood trauma
lack of social support
marital status

307
Q

what are precipitating factors for depression

A

substance abuse
physical health
traumatic life events
low self esteem
lack of social support
poor socioeconomic status

308
Q

what are perpetuating factors for depression

A

substance abuse
physical health
failure to cope with loss
ongoing loss
lack of support

309
Q

what are protective factors for depression

A

current employment
good social support
being in a relationship

310
Q

what are biological risk factors for developing depression

A

genetics
personality
physical illness
serotonin imbalance
neuroendocrine issues
substance misuse

311
Q

what physiological risk factors can predispose someone to depression

A

traumatic life events
low self esteem
lack of education

312
Q

what are biological symptoms of depression

A

anhedonia
loss of emotions
diurnal changes
early morning waking
agitation
appetite and weight change
delusions
hallucinationa

313
Q

what is the diagnostic criteria for mild, moderate and severe depression

A

Mild: two typical core and two other symptoms
Moderate: two typical core and at least 3 other symptoms
Severe: all three typical core symptoms and at least 4 other symptoms

314
Q

how do you manage depression

A

mild: self help, guided CBT, mindfulness, interpersonal psychotherapy, SSRIs, counselling
moderate: CBT and SSRIs, individual CBT and behavioral therapy, psychotherapy
Severe: consider antipsychotics and ECT. same management as above. Need regular risk assessments.

315
Q

what are complications of depression

A

suicide
self harm
substance misuse
recurrence of depression
reduced quality of life
antidepressant side effects

316
Q

what are obsessions (in OCD)

A

unwanted and uncontrolled thoughts and intrusive images which are hard to ignore

317
Q

what are compulsions (in OCD)

A

these are repetitive actions the person feels they must do, anxiety generating, often a way to control obsessive throughs

318
Q

what are different types of obsessive compulsive disorder

A

OCD - obsessive type, compulsive type, mixed
body dysmorphic disorder
body focused repetitive behaviour disorder
hypochondriasis
hoarding disorder

319
Q

how is OCD managed

A

combination of SSRIs and psychological therapy
- exposure and response prevention therapy
- clomipramine (TCA)
- adjunctive antipsychotics if required

320
Q

what is delusional disorder

A

this is one or more firmly held false beliefs that are persistent for at least 1 month.
- no other psychotic symptoms

321
Q

what are different types of delusions

A

persecutory
referential
grandiose
erotomanic
nihilistic
somatic
jealous

322
Q

what are non bizarre delusions

A

these are situations that could occur in real life

323
Q

what are bizarre delusions

A

these are implausible. they reflect beliefs that would be physically impossible

324
Q

what are diagnostic criteria for delusional disorder

A
  • presence of one of more delusion for >1 month
  • diagnostic criteria for schizophrenia not met
  • patients function not markedly impaired, behaviour not obviously bizarre or odd
  • disturbance is not better explained by another mental disorder
325
Q

what are phobias

A

extreme anxiety triggered by particular situations or objects

326
Q

when does fear become a phobia

A

when the fear is out of proportion to the danger
when it lasts for more than 6 months
when it has significant impact on day to day life

327
Q

what are examples of phobias

A

animals
natural environment - heights, water, dark, germs
body based phobias
sexual phobias
food phobias

328
Q

what is social phobia

A

it is the sense of intense fear when in social situations
- may struggle with talking in groups, starting conversations, public speaking, speaking on the phone, meeting new people, working, talking to authority figures

329
Q

what is agoraphobia

A

extreme or irrational fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is difficult.
- may struggle out the house, being in big open space, being in crowds, traveling by car/bus/plane

330
Q

what are symptoms someone may experience with phobias

A

dizziness
lightheadedness
chest pain
shortness of breath
numbness
dissociation

331
Q

what can be causes of phobias

A

trauma
learned responses from childhood
experiencing long term stress
genetic factors

332
Q

how are phobias managed

A

CBT
exposure therapy
hypnotherapy
antidepressants (SSRI)
benzodiazepines for severe anxiety
beta blockers for symptoms control

333
Q

what are baby blues

A

these are mood changes typically in the first week or so after birth characterised by mood swings, low mood, anxiety, irritability and tearfulness.
- thought to be due to significant hormone fluctuation, recovery from birth and responsibility of caring for a neonate

334
Q

what is postnatal depression

A

this is a triad of low mood, anhedonia and low energy typically presenting around 3 months after birth lasting at least 2 weeks

335
Q

how is postnatal depression treated

A

mild: additional support, self help, follow up
moderate: antidepressants (SSRI) and CBT
severe: specialist psychiatric help and rarely impatient help on the mother and baby unit

336
Q

what is the Edinburgh postnatal depression scale

A

this is used to assess how the mother has felt over the past week as a screening tool
- 10 questions with total score of 30, a score of 10 or more suggest postnatal depression

337
Q

what is puerperal psychosis

A

it is a rare but severe condition characterised by delusions, hallucinations, depression and mania presenting typically between two to three weeks post delivery

338
Q

what can SSRIs taken in pregnancy lead to after birth

A

neonatal abstinence syndrome - first few days after birth baby may be irritable and have poor feeding

339
Q

what is delirium tremens

A

it is life threatening alcohol withdrawal caused when someone with moderate to severe alcohol intake suddenly stops drinking.
needs immediate medical care

340
Q

what are symptoms of delirium tremens

A

tremors
shakes
confusion
agitation and anxiety
psychosis
sensory disruption
disorientation
bouts of heavy sweating
hyperthermia
headaches
nausea and vomiting
hallucinations

341
Q

how do you treat delirium tremens

A

(not fully curable)
supportive therapy
benzodiazepines
IV fluids
thiamine, folate, vitamins, electrolytes

342
Q

what causes Wernicke’s encephalopathy

A

it is caused by thiamine deficiency in alcoholism

343
Q

what occurs if Wernickes goes untreated

A

the patient can develop korsakoff syndrome
- memory impairment
- behavioural changes
- hallucinations

344
Q

how is Wernickes treated

A

IV thiamine (pabrinex)

345
Q

what issues can lithium cause when it is in its therapeutic dose

A

polyuria/polydipsia
weight gain
cognitive problems
tremor
sedation
GI distress
T wave change and wide QRS
issues with renal function and hypothyroidism long term

346
Q

what is acute dystonia

A

it is involuntary muscle contractions, eye spasms/blinking, twisting head or protruding tongue
- can cause painful muscle contractions

347
Q

what is tardive dystonia

A

involves twisting of the torso and the neck - severe

348
Q

what are risk factors for developing neuroleptic malignant syndrome

A

dehydration
rapid antipsychotic dose increase or initiation
withdrawal of antiparkinsonian medication
predisposing drugs

349
Q

how do you treat neuroleptic malignant syndrome

A

Benzodiazepines
stop any causative agents
supportive measures: oxygen, IV fluids, decrease temp with cooling blankets
allow two+ weeks before restarting medication
if rhabdomyolysis occurs then you need vigorous hydration and IV sodium bicarbonate

350
Q

how do you treat serotonin syndrome

A

mild: stop medication, maybe add in a serotonin blocker
moderate: observed in hospital for at least 24 hours
severe: ICU
give benzodiazepines for symptoms
iv fluids and oxygen
cyproheptadine - serotonin blocking agent

351
Q

what is catatonia

A

it is a state in which someone is awake but doesnt seem to respond to other people or the environment around them
- can affect movement, speech and behaviour

352
Q

what are signs of catatonia

A

sitting and staring into space
holding unusual postures
holding arms and legs in whatever position someone moves them into
repetitive movements
repeating the same phrase over and over
repeating words and phrases they hear
holding strange faces
not eating or drinking
sudden agitation

353
Q

what are causes of catatonia

A

schizophrenia
depression
mood disorders
OCD
PTSD
psychosis
infections
brain injury
drug and alcohol use
metabolic disorders
autoimmune disorders

354
Q

how do you treat catatonia

A

treat the underlying cause if physical
lorazepam single dose challenge - symptoms tend to improve
ECT
monitor nutrition and hydration

355
Q

what can untreated catatonia lead to

A

AKI
dehydration
malnutrition
pressure ulcers
infections
blood clots
death

356
Q

what is the DSM-5 criteria for delirium

A
  1. disturbance in awareness and attention
  2. acute onset
  3. disturbance in cognition
  4. not explained by pre existing conditions
  5. evidence of organic cause
357
Q

when does clozapine induced neutropenia typically occur

A

in the first 18 weeks of treatment

358
Q

what are symptoms of clozapine induced agranulocytosis

A

fever
mouth ulcer
sore throat

359
Q

how do you threat clozapine induced neutropenia

A

treatment is often supportive until neutrophil count is back up
stop clozapine
can use granulocyte colony stimulating factor to reduce agranulocytosis time

360
Q

what effects can clozapine have on the heart

A

increased risk of myocarditis (inflammation of the heart), possibly due to IgE hypersensitivity
can cause cardiomyopathy

361
Q

when does clozapine induced myocarditis typically present

A

1-2 months after starting the medication

362
Q

what are symptoms of myocarditis

A

tachycardia
fever
flu like symptoms
chest pain
breathlessness

363
Q

when does clozapine induced cardiomyopathy present

A

about 9 months after starting the treatment

364
Q

what affect does clozapine have on the gut

A

gut hypomobility

365
Q

why does clozapine cause gut hypomobility

A

thought that clozapine causes anticholinergic inhibition of the GI smooth muscle contraction and peristalsis
pus it compounds the issue from serotonin receptor antagonism as serotonin plays a role in gut motility

366
Q

what are symptoms of gut hypomobility

A

bloating
low stool frequency
distension
discomfort
constipation
ileus (paralytic)
ischaemia
necrosis

367
Q

how do you prevent clozapine induced gut hypomobility

A

stool charts
fiber in diet
drinking plenty of fluid
have a low threshold for reporting and gut issues !!!
prescribe laxatives/stool softeners to help prevent long term constipation

368
Q

what are the signs that someone is constipated

A

change in bowel habit
straining
stomach aches
feeling sick
smelly wind
hard stool

369
Q

when should you refer someone under suspicion of gut hypomobility

A

abdominal pain or discomfort for over an hour
swollen or distended stomach
overflow diarrhoea
sickness or vomiting
absent bowel sounds
sepsis symptoms

370
Q

what is psychosis

A

it is when the mind has lost contact with reality, resulting in disrupted thoughts and perceptions and have difficulty determining what is real and what is not

371
Q

what are symptoms of psychosis

A

delusions and hallucinations
incoherent speech and behaviour
suspicions and paranoia
trouble thinking clearly
withdrawing socially
overly intense or unusual ideas
lack of feelings
decline in self care
disruption of sleep
difficulty telling reality from fantasy
emotional disruption
harming themself or others

372
Q

what are causes of psychosis

A

complex combination of factors
- genetics
- exposure to stress/trauma
- mental illness
- physical illness
- disease of older age
- drugs and alcohol
- sleep deprivation

373
Q

how do you treat psychosis

A

antipsychotics
specialty care
recovery orientated team approach
therapy if trauma involved

374
Q

what is PTSD

A

it occurs after a traumatic event characterised by feeling numb, having trouble sleeping, and reliving the traumatic event, with the symptoms lasting over one month

375
Q

what are the different types of PTSD

A

delayed onset - symptoms emerge over 6 months after the event
complex - trauma at an early age/lasted a long time
birth trauma - traumatic childbirth

376
Q

what is secondary trauma

A

It is when you experience some PTSD symptoms while supporting someone close to you who has experienced trauma

377
Q

what are symptoms of PTSD

A

reliving the experience
nightmares
intense distress
alertness/feeling on edge
panicking
upset or angry easily
hypervigilance
lack of sleep
irritability
avoidance of feelings or memories
avoiding certain places
emotionally numb
difficult feelings/beliefs - unable to trust

378
Q

what symptoms might someone with complex PTSD experience

A

difficulty controlling emotions
distrustful
feelings of emptiness or loneliness
avoiding friendships or relationships
dissociation
suicidal ideation

379
Q

what is the treatment for PTSD

A

if the symptoms are for less than 1 month the GP may suggest watchful waiting to see sx progression
talking therapy: trauma focused CBT, eye movement desensitisation and reprocessing
medication may be offered to patients who are experiencing depression, sleep issues or didnt respond to talk therapy

380
Q

what is schizoaffective disorder

A

it is psychosis as well as mood disorder symptoms

381
Q

what are symptoms of schizoaffective disorder

A

psychosis: hallucinations, delusions, disorientation, confusion, feeling disconnected, difficulty with concentration, lack of motivation
mood: excited, irritated, lack of sleep, sad, low, little connection with others

382
Q

what are types of schizoaffective disorder

A

bipolar type - manic episodes along with psychosis
depressive type - depressive episodes with psychosis

383
Q

what is the diagnostic criteria for schizoaffective disorder

A

symptoms need to last for 1 month or longer
you have psychosis and mood symptoms at the same time
you have had mood symptoms for most of the time you have been unwell
you have had a period of time (over 2 weeks) with psychosis without mood symptoms

384
Q

what are causes of schizoaffective disorder

A

traumatic life events
childhood trauma
genetic predisposition

385
Q

how is schizoaffective disorder managed

A

talking therapies - CBT, mindfulness, psychodynamic therapies
art therapy
medication: antipsychotics, mood stabilisers, antidepressants (need to be careful with these as they increase the likelihood of a manic episode)

386
Q

what is schizophrenia

A

it is a mental disorder which affects thinking, perception and affect

387
Q

what are risk factors for developing schizophrenia

A

family history and genetics
malnutrition
viral infection during pregnancy
drug abuse
social and environmental - trauma, socioeconomic class

388
Q

how do you diagnose schizophrenia

A

rule out biological cause first
- bloods, urine, drug screen, syphilis/HIV screen, CT head
- then use the ICD 11 criteria: at least two symptoms for most of the time for at least 1 month, with one of the symptoms being a core symptom of schizophrenia

389
Q

what is DBT

A

dialect behavioural therapy
- designed for people that feel emotions very deeply, helps people understand their feelings, manage them and make changes

390
Q

what is somatisation disorder

A

it is when mental factors cause physical symptoms
affected people tend to be emotional about their symptoms and can affect day to day life
unknown cause
can persist a long time

391
Q

what are examples of somatisation disorder

A

chest pains
dizziness
tiredness
back pain
GI upset

392
Q

what is a functional disorder

A

it is when something is wrong but there is no known/diagnosable cause

393
Q

what are types of somatoform disorder

A

somatisation disorder
hypochondriasis
conversion disorder
body dysmorphic disorder
pain disorder

394
Q

what is hypochondriasis

A

it is when people fear minor symptoms may be due to a serious disease
- fear, lots of time thinking about symptoms
- people may accept that their symptoms are minor
- reassurance often doesnt help

395
Q

what is conversion disorder

A

person has symptoms which suggests a disease of the brain or nerves, but due to mental factors
- loss of vision, deafness, weakness, paralysis

396
Q

what is pain disorder

A

it is when a person experiences persistent pain that cant be attributed to a physical condition or biological cause

397
Q

what is fictitious disorder

A

it is when someone fakes illnesses (physical or mental) which they may or may not benefit from
- can also create illness or injury in another person

398
Q

what can be given to treat insomnia

A

zopiclone

399
Q

what can be given to treat narcolepsy

A

Modafinil (CNS stimulant)
sleep hygiene

400
Q

what HLA type is narcolepsy associated with

A

HLA BDQ B1 0602

401
Q

what symptoms must be present for someone to be diagnosed with gender dysphoria

A

at least two of the following for at least 6 months
- incongruent mental and physical appearance
- strong desire for opposite gender genitalia
- strong desire to be opposite gender
- strong desire to be treated like the other gender
- mentally feels like the opposite gender
- doesnt like to look at/wants to remove own genitals or secondary sexual characteristics

402
Q

what are symptoms of SSRI discontinuation syndrome

A

Dizziness
electric shock sensations
anxiety
restlessness

403
Q

what SSRIs can cause SSRI discontinuation syndrome

A

paroxetine

404
Q

what atypical antipsychotic has the most tolerable side effect profile

A

aripiprazole

405
Q

when should patients under 25 who have been started on SSRIs be reviewed

A

after 1 week

406
Q

when should patients over 25 who have been started on SSRIs be reviewed

A

after 2 weeks

407
Q

what is a characteristic side effect of mirtazapine

A

increased appetite
sedation

408
Q

what antidepressants can cause the tyramine cheese reaction

A

MAOI = such as phenelzine
this can occur when a patient eats cheese, causing a hypertensive crisis

409
Q

what can long term lithium use lead to

A

hyperparathyroidism - resultant hypercalcaemia leading to symptoms of ‘stones, bones, abdominal moans and psychologic moans’

410
Q

what are the 5p’s of formulation surrounding mental health disorders

A

predisposing
precipitation
presenting
perpetuating
protective

411
Q

what is the biopsychosocial model of risk factors and treatment of mental health illnesses

A

bio - genetics, birth complications, past medical history, drug history
psych - trauma, abuse, self esteem, mood and personality
social - relationships, finances, stress, culture

412
Q

what is delusional perception

A

thinking ‘ if A happens then B will happen’
- pathognomonic for schizophrenia

413
Q

what is the difference between depersonalisation and derealisation

A

depersonalisation - thinks they are not real
derealisation - thinks the world around them isnt real

414
Q

what is fregoli delusion

A

where they believe everyone in the world is actually just one single person all wearing masks

415
Q

what is orthello delusion

A

where they believe their partner to be unfaithful

416
Q

what is De cleraumbalt delusion

A

they believe that a high status person is in love with them (erotomania)

417
Q

which antidepressant causes QTc prolongation

A

citalopram

418
Q

when do antidepressants need monitoring

A

have a baseline monitor
then weekly for 4 weeks
then after 2 weekly

419
Q

what are drug interactions with SSRIs

A

triptans decrease efficacy of SSRIs
if someone is taking SSRI and NSAID you need to co-prescribe a PPI

420
Q

what can taking SSRIs in pregnancy cause

A

in first trimester - CHD and cleft palate
third trimester - Persistent pulmonary hypertension of the newborn

421
Q

what are signs of a TCA overdose

A

confusion
hot dry skin
increase Ach symptoms - cramps, increased salivation, lacrimation, muscular weakness, paralysis, muscular fasciculation, diarrhea, and blurry vision

422
Q

what will be seen on ECG in TCA overdose

A

a wide QRS >100ms and QT prolongation >480ms

423
Q

what is the treatment for TCA overdose

A

IV bicarb

424
Q

what are side effects of mirtazapine

A

weight gain and sedation

425
Q

what is the correct way to stop antipsychotics

A

slowly reduce and then stop over 3 months to prevent a relapse

426
Q

what bloods are needed every 12 months when someone is on antipsychotics

A

FBC, U+E, HbA1C, LFT, prolactin
also need to do a BMI measurement

427
Q

what are side effects of typical antipsychotics

A

acute dystonic reaction
akathisia
parkinsonism
tardive dyskinesia

428
Q

what can treat acute dystonic reaction

A

IM/IV procyclidine

429
Q

what can treat akathisia

A

po propranolol

430
Q

what can treat tardive dyskinesia

A

PO tetrabenazine

431
Q

what are complications of neuroleptic malignant syndrome

A

rhabdomyolysis
AKI

432
Q

what drug interactions does lithium have

A

NSAIDs - AKI
diuretics - increase dehydration
ACEi
- can precipitate lithium toxicity

433
Q

when are the uses of couple therapy

A

to promote communication strength
to reduce emotional avoidance
to modify dysfunctional behaviour

434
Q

what are atypical presentations of depression

A

increased appetite
increased seep
mood may seem okay on good occasions
catatonia
very sensitive

435
Q

what is dysthymia

A

it is subclinical depression for 2 or more years

436
Q

what are risk factors for self harm

A

female
EUPD
depression
bereavement
trauma or abuse
LGBTQ

437
Q

what increases the risk of suicide recurrence in someone

A

if they made a conscious effort to not be found
if they left a note
if they planned the death
if they have no regret after the attempt

438
Q

what are the different referrals to CMHT for mania and hypomania

A

mania requires an urgent referral
hypomania requires a routine referral

439
Q

which lobe is affected in schizophrenia

A

the temporal lobe

440
Q

what are schniders first rank symptoms of schizophrenia

A

delusional perceptions
thought alienation - insertion, withdrawal, broadcast, word salad
third person auditory hallucinations
passivity

441
Q

what are second rank symptoms of schizophrenia

A

non auditory hallucinations
catatonia
delusions
reduced insight

442
Q

what are risk factors for developing anxiety

A

bio- genetics, stimulants, palpitations, increased T4, withdrawal
psych - mental health history, trauma, abuse
social - stress, life events

443
Q

what is panic disorder

A

over 1 month of at least 4 weekly spells of 10-30minutes of panic attacks

444
Q

what are the dependence terms/symptoms for addiction

A

withdrawal symptoms - use of substance to avoid
tolerance
narrow repertoire
craving
loss of control
rapid reinforcement - quick return to old level after stopping
primacy - takes precedence over physiological need
continued use despite harm

445
Q

what is the ICD 10 definition of alcohol dependence

A

it is 12 months of over three of the dependence symptoms/terms

446
Q

when is disulfiram contraindicated

A

in pregnancy and when the person is still drinking alcohol

447
Q

how do you treat opioid addiction in the long term

A

use of methadone/Buprenorphine and naltrexone

448
Q

what are the symptoms of LSD

A

psychosis, impaired judgement, panic attack, dilated pupils, hyperreflexia

449
Q

what are rise effects of cocaine use

A

seizures
coronary artery vasospasm
ischaemic colitis
hyperthermia
QRS widening

450
Q

what is a screening tool that is used for anorexia

A

SCOFF
- make self sick after food
- loss of control of food
- one stone in last 3 months lost
- food dominates life
- fat perception

451
Q

what bloods do you expect to see in someone with anorexia

A

everything will be reduced except growth hormone and cortisol which will be raised

452
Q

what are complications of anorexia

A

refeeding syndrome
infertility
amenorrhoea
osteoporosis

453
Q

what are type A personality disorders

A

eccentric/odd
- paranoid
- schizotypal
- schizoid

454
Q

what are type B personality disorders

A

erratic/wild
- narcissistic
- histrionic
- EUPD
- antisocial

455
Q

what are type C personality disorders

A

anxious
- anankastic - OCPD
- avoidant
- dependent

456
Q

what are psychological emergencies

A

neuroleptic malignant syndrome
serotonin syndrome
lithium toxicity
alcohol overuse

457
Q

what is it important to monitor when a child is taking methylphenidate

A

their growth charts as it can cause slow growth - 6 monthly
also need to do baseline ECG as there is a risk of right bundle branch block

458
Q

what are tics associated with

A

ASD
ADHD
PANDAs

459
Q

what are simple tics

A

non-goal oriented movement

460
Q

what are complex tics

A

echolalia
coprolalia - verbal swearing
copropraxia - middle finger

461
Q

what is PANDAs

A

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections - can cause OCD or tics after a strep infection

462
Q

what should be done if a patient is on antidepressant medication before ECT is performed

A

should be reduced but not stopped

Phase 3a Jemima (16 decks)

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