Psychiatry Flashcards

Question

Describe neuroleptic malignant syndrome

Answer 1

- Rare but life-threatening condition seen if patients on antipsychotics, from a single dose or if they are increased/switched (also other dopaminergic drugs for Parkinson's if these are stopped/reduced) - Clinical features: pyrexia, muscle rigidity, altered mental state, autonomic dysfunction (tachycardia, fluctuating blood pressure, excessive swelling/saliva) - Management: stop antipsychotic, IV fluids, dantrolene (muscle relaxant), bromocriptine (dopamine agonist), benzodiazepine - Complications: rhabdomyolysis, shock, kidney failure, seizures, DIC, PE

Answer 2

- FBCs, U&Es, LFTs: before initiation then annually, clozapine needs white blood cell monitoring weekly for 18 weeks then fortnightly up to 1 year, then monthly - Fasting blood glucose: at baseline, at 4-6 months, then annually, clozapine and olanzapine also at 1 month - Lipids: baseline, 3 months, annually - ECG: before initiating if cardiovascular risk factors, monitoring advised for haloperidol - Blood pressure: before initiation, and frequently during dose titration - Prolactin: baseline, 6 months, annually - Weight/BMI: baseline, then frequently for 3 months, then annually

Answer 3

SSRIs (selective serotonin reuptake inhibitors) - fluoxetine - sertraline - citalopram SNRIs (serotonin noradrenaline reuptake inhibitors) - duloxetine - venlafaxine TCAs (tricyclic antidepressants) - clomipramine - amitriptyline - nortriptyline NASSAs (noradrenaline and specific serotoninergic antidepressants) - mirtazapine MAOIs (monoamine oxidase inhibitors) - phenelzine - isocarboxazid

Answer 4

- SSRIs: first line for mild/moderate depression, also used in generalised anxiety disorder, panic disorders, PTSD, OCD, safer in overdoses - SNRIs: may have a better effect in more severe depression, also used in anxiety disorders, social phobia, chronic nerve pain, migraine prevention, ADHD - TCAs: older with more side effects and dangerous in overdose, may be used in severe depression, OCD, chronic nerve pain - MAOIs: used as last line for depression as serious side effects - NASSAs: useful in treating depression alongside anxiety disorders or insomnia, cause less sexual dysfunction, used if weight gain would be beneficial

Answer 5

- Nausea and vomiting - Weight loss or weight gain - Diarrhoea or constipation - Increased anxiety - Loss of libido/sexual dysfunction - Dizziness - Headaches - Palpitations - Excessive sweating - Drowsiness or insomnia - Increased suicide risk (rare, most likely in under 25s) - Hyponatraemia (in elderly particularly with SSRIs) - Serotonin syndrome (rare) - Reduced seizure threshold or prolonged seizures - Induction of manic episode if history of mania

Answer 6

- Dry mouth - Blurred vision - Constipation - Urinary retention - Drowsiness - Weight gain - Excessive sweating - Postural hypotension - Cardiac arrhythmias and toxicity in overdose

Answer 7

- Postural hypotension - Drowsiness or insomnia - Nausea - Weight gain - Muscle pain and myoclonus - Paraesthesia - Sexual dysfunction - Hypertensive crisis due to dietary interaction of high-tyramine foods - Serotonin syndrome (2 week wash out period if starting new antidepressant)

Answer 8

- Nausea or vomiting - Dizziness/postural hypotension - Drowsiness - Increased appetite and weight gain - Dry mouth - Constipation or diarrhoea - Tremor - Anxiety or abnormal dreams - Serotonin syndrome

Answer 9

- SSRIs: mania (unless with mood stabiliser), on NSAIDs (without PPI), on heparin/warfarin - SNRIs: mania, cardiac arrhythmias, uncontrolled hypertension - NASSAs: pregnancy/breast feeding, glaucoma, psychoses, history of seizures - TCAs: recent MI, cardiac arrhythmias (QT prolongation), mania, agranulocytosis - MAOIs: acute confusional states

Answer 10

- Rare but life threatening complication of increased serotonin, usually rapidly occurring within minutes of taking the medication - Cause: most commonly SSRIs, but also MAOIs, TCAs, lithium. and cocaine - Clinical features: cognitive effects (headache, agitation, confusion, hallucinations, hypomania, coma), autonomic effects (shivering, sweating, hyperthermia, hypertension, tachycardia), neuromuscular effects (myoclonus, hyperreflexia, tremor) - Management: stop offending drug, supportive measures

Answer 11

Benzodiazepines: - lorazepam (short acting), diazepam (long acting) Azapirones: - buspirone, gepirone, tandospirone Sedative antihistamines: - hydroxyzine Beta-blockers: - propranolol, atenolol

Answer 12

- Relieves acute anxiety (short-term management) - Used in panic disorders, sleep disorders, acute behavioural disturbance, muscle spasm, and premeditation and sedation for procedures

Answer 13

- Bind selectively to GABA receptors to improve the binding of GABA to increased the opening of chloride ion channels - Higher levels of intracellular chloride makes depolarization more difficult so reduces the excitability of nerve cells to slow the nervous system down

Answer 14

- Drowsiness and over sedation - Light headedness - Memory impairment (particularly in elderly) - Ataxia - Slurred speech - Psychomotor effects - Paradoxical effects (aggression, anxiety, psychosis) - Dependence - Respiratory depression

Answer 15

- Generalised anxiety disorder (safer for longer term use as doesn't cause dependence like benzodiazepines) - Mild antidepressant, used alongside SSRIs - Not as effective for panic disorders or phobias - Mechanism of action: 5-HT1A receptor agonists (some are also agonists to D2 and 5-HT2A receptors so have antipsychotic effects)

Answer 16

- Used for insomnia, relief of anxiety, and as premedication prior to procedures - Also used to treat pruritis and nausea - Mechanism of action: potent H1 receptor blocker responsible for sedative effects

Answer 17

- To alleviate physical symptoms (fast heart rate, shaking, sweating, dizziness) of anxiety, panic disorders, and phobias - Beta-adrenergic receptors antagonists to slow down sympathetic nervous system and reduce 'fight or flight'

Answer 18

- Bipolar disorder - Mania or hypomania - Recurrent severe depression - Schizoaffective disorder (bipolar type)

Answer 19

- Lithium (first line) - Antiepileptics: carbamazepine, valproate, lamotrigine - Antipsychotics: haloperidol, olanzapine, risperidone

Answer 20

- Lithium: unknown mechanism, but decreases intracellular sodium in nerve and muscle cells, increases serotonin, and decreases norepinephrine and dopamine - Antiepileptics: unknown mechanism, but effects sodium/potassium exchange, and enhancing GABA system - Antipsychotics: increase activity of serotonin, and decreases activity of norepinephrine, and dopamine transmission

Answer 21

- Lethargy - Muscle weakness - Fine tremor - Hypothyroidism - GI side effects (nausea, vomiting, diarrhoea) - Polydipsia and polyuria (nephrogenic diabetes insipidus) - Impaired renal function - Leucocytosis - Memory problems - Oedema - Weight gain - Serotonin syndrome - Teratogenic effects

Answer 22

Mild (1.5-2.0 mmol/L): - nausea and vomiting - coarse tremor - ataxia - muscle weakness - apathy Severe (>2.0 mmol/L): - nystagmus - dysarthria - hyperreflexia - oliguria - hypotension - seizures - coma

Answer 23

- Before initiation: U&Es (avoid in renal failure), TFTs (contraindicated in untreated hypothyroidism), pregnancy test, ECG (for QT prolongation) - Lithium levels: 12 hours after first dose, weekly until therapeutic level (0.4-1.0 mmol/L) stable for 4 weeks, then every 3 months - Regular: U&Es every 6 months, TFTs every 12 months

Answer 24

- GI side effects (nausea and vomiting) - Dizziness - Drowsiness and fatigue - Ataxia - Aggression - Weight gain - Rash/dermatitis - Tremor - Teratogenic affects - Impaired liver function - Agranulocytosis (carbamazepine) - Thrombocytopaenia

Answer 25

A fixed false belief that is outside the person's social, cultural, or religious norms

Answer 26

- Delusions of grandeur: false belief in one's superiority of power, wealth, intelligence, talents, or other traits - Persecutory delusions: false belief that harm will come, or other intend to harm the individual - Delusional jealousy: false belief that a partner is being unfaithful which can lead to violent behaviour - Nihilistic delusions: false belief of already being dead, that their body is rotting, or that parts of the body no longer exist - Delusions of reference: false belief that un-related occurrences in the external world have special personal significance - Somatic delusion: false belief that one or more organs/body parts and injured, diseased, or not functioning - Delusional perception: a true perception to which a patient attributes a false meaning

Answer 27

- Unfounded or exaggerated doubting or mistrusting other people - Paranoia may be temporary and soothed by opposing evidence - Persecutory delusions and stronger and irrational paranoid beliefs that don't change with contradiction

Answer 28

- Knight's move thinking: sequence of unrelated or remotely related ideas - Tangential thinking: diverts from original train of thought and doesn't return - Circumstantiality: slow thought processing with unnecessary details or digressions before returning to original point - Word salad: speech reduces to senseless repetition of sounds or phrases - Neologisms: words/phrases devised by the patient, or a new meaning to an existing word - Perseveration: uncontrollable and inappropriate repetition of a response

Answer 29

- Hallucinations: perception in the absence of external stimulus (any of 5 senses) - Illusion: false mental image produced by misinterpretation of an external stimulus - Depersonalisation: feeling detached from normal sense of self - Derealisation: feeling of unreality in which the environment or people are experience as unreal

Answer 30

An abnormal mental state involving signification problems with reality testing and impaired higher brain functions, typically presenting with... - delusions - hallucinations - thought disorder

Answer 31

- Delirium - Dementia - Endocrine disturbance (e.g. Cushing's syndrome) - Metabolic disorders (e.g. vitamin B12 deficiency) - Huntington's disease - Syphilis - Complex epilepsy - Iatrogenic - Drug-induced (alcohol, cocaine, amphetamines)

Answer 32

- Schizophrenia - Schizotypal disorder - Schizoaffective disorder - Acute psychotic episode - Mood disorders with psychosis - Drug-induced psychosis - Delusional disorder - Puerperal (post-partum) psychosis

Answer 33

Most common psychotic condition characterised by disturbance in thinking, emotion, and behaviour in the absence of organic cause, persistent for more than 1 month, with typical onset between late teens and early 30s

Answer 34

- Genetics: high concordance in monozygotic twin studies, increased incidence with family history - Adverse life events - Substance misuse (cannabis or stimulants) - Neurodevelopmental: premature birth, obstetric complications, fetal brain injury - Childhood abuse - Low socioeconomic status

Answer 35

- Delusions (particularly delusional perception) - Hallucinations (particularly third person, running commentary, or hearing own thoughts aloud) - Thought interference (insertion, withdrawal, broadcasting) - Passivity (actions, feelings or emotions controlled by an external force) * these are 'positive' symptoms

Answer 36

- Antisocial behaviour - Poverty of speech - Anhedonia - Blunted affect - Attention deficits - Avolition (reduced motivation)

Answer 37

- Appearance: normal, or poor self-care (negative) - Behaviour: preoccupied, restless, suspicious (positive), or withdrawn, poor eye contact, apathy (negative) - Speech: reflects underlying thought disorder (loosening associations, pressured and distractable), poor flow of thought (blocking), poverty of speech (negative) - Mood: incongruity of affect, irritability, labile mood, flattened affect (negative) - Thought: delusions, possession of thoughts, formal thought disorder (positive) - Perception: hallucination (particularly 3rd person, auditory) (positive) - Cognition: normal orientation, impaired concentration - Insight: poor

Answer 38

Biological: - antipsychotics - adjuvants (benzos, antidepressants) - ECT (if resistant, or catatonic) Psychological: - CBT - Family intervention and psychoeducation Social: - support groups - social skills training - supported employment

Answer 39

- Gradual/insidious onset - Longer prodromal/untreated period - Negative symptoms - Family history - Male sex - Low IQ - Low socioeconomic status - Significant psychiatric history - Continued substance misuse

Answer 40

A psychotic episode presenting similarly to schizophrenia, but of sudden onset and short duration (<1 month)

Answer 41

- Schizoaffective disorder: symptoms of schizophrenia and a mood disorder (depression or mania) in the same episode of illness - Mood disorder with psychosis: psychosis occurring secondary to depression or mania

Answer 42

Development of a single or set of delusions (often persecutory, grandiose, or hypochondrial) as the only or most prominent symptom with other areas of thinking and functioning being preserved

Answer 43

A group of disorders involving pervasive and inflexible patterns of inner experiences and behaviour that deviates markedly from expectations in the individual's culture, with usual onset in adolescence or early adulthood

Answer 44

- Social: low socioeconomic status, social reinforcement of abnormal behaviour - Genetic: higher concordance in monozygotic twin studies, higher incidence with family history - Dysfunctional family: poor parenting or parental deprivation - Abuse during childhood: physical, emotional, sexual (particularly EUPD), and neglect

Answer 45

Paranoid: - pervasive and unwarranted suspicious and distrusting of others - hypersensitivity (easily offended, readiness to counterattack) - restricted emotions (cold affect, no humour) Schizoid: - detached or flattened affect with emotional coldness - absence of close friends and reduced sexual drive - little pleasure in activities and works alone - indifferent to praise or criticism Schizotypal: - odd or eccentric beliefs and behaviour - suspiciousness or paranoia - speech or thought disorder - lack of close friends - inappropriate affect

Answer 46

Emotionally unstable (borderline): - longstanding instability in mood and chronic emptiness - intense but unstable relationships with fear of abandonment - self-damaging behaviour (self harm, fights, gambling, substance misuse) Dissocial (antisocial): - pervasive disposition to disregard and violate others - impulsive and reckless disregard of safety - deceitful and quick to blame other - lacks remorse and empathy Histrionic: - long term self-dramatization and need for attention - egocentric and exaggerated emotions - provocative behaviour and concern for physical attractiveness - influenced by other easily Narcissist: - grandiose sense if self importance - sense of entitlement - taking advantage of others - lack of empathy - excessive need for admiration - chronic envy

Answer 47

Dependent: - long term pattern of needing others to take responsibility - requires reassurance and fear of abandonment - lack of self confidence and self dependence Anxious (avoidant): - hypersensitivity to rejection and criticism - withdrawal and restriction of lifestyle to maintain security - low self esteem and feelings of inadequacy Anankastic (obsessional): - excessive perfectionism reducing ability to complete tasks - workaholic at the expense of leisure - stubborn, inflexible, and rigid - meticulous attention to detail

Answer 48

Biological: - mood stabilisers (for instability and aggression e.g. in EUPD) - atypical antipsychotics (for short term transient psychotic episodes e.g. in paranoid PD) - small role for antidepressants Psychological: - cognitive behavioural therapy - psychodynamic therapy - dialectical behavioural therapy (emphasis on coping strategies to improve impulse control) Social: - support groups - assistance with housing, finance, employment - access to education, voluntary work, meaningful occupation

Answer 49

A chronic episodic mood disorder categorised as... - bipolar I: periods of severe mood episodes from mania to depression - bipolar II: milder form of mood elevation (hypomania) that alternate with periods of severe depression

Answer 50

- Genetics: high concordance monozygotic twin studies, strong family history - Adverse life events (exams, post-partum, bereavement) - Age: early 20s - Anxiety disorders

Answer 51

- Elevated mood - Increased energy - Irritability - Disinhibition (sexual, social, spending) - Grandiose delusions - Flight of ideas and pressure of speech - Sleep decreased - Distractibility and reduced concentration - Impaired insight

Answer 52

- Hypomania: mildly elevated or irritable mood for >4 days, with symptoms present to a lesser extent, mild disruption to work and social life, partial insight - Mania: symptoms present for >1 week, complete disruption of work and social activities, grandiose ideas and disinhibition, reduced sleep leading to exhaustion - Mania with psychosis: severely elevated or suspicious mood, with additional grandiose/persecutory delusions and hallucinations, may show aggression

Answer 53

A mood disturbance that fluctuates usually between manic and depressive symptoms over a short period, with 4 or more episodes in 12 months * treated with lithium + valproate

Answer 54

A pattern of alcohol use above that of the recommended intake (14 units/week) that persists despite consequences of physical, psychological, and/or social harm

Answer 55

A pattern of repeated or compulsive use of alcohol despite significant behavioural and psychosocial problems, which may include cravings, tolerance, and withdrawal symptoms if stopped

Answer 56

- Alcohols affects on GABA causes anxiolytic and sedative effects - The dopaminergic pathway mediates the pleasurable and stimulant effects, and repeated intake sensitises this pathway, leading to dependence - Long-term exposure causes adaptative changes to several neurotransmitters, including down-regulation of inhibitory neuronal GABA receptors and up-regulation of excitatory glutamate receptors - When alcohol is withdrawn it results in central nervous system hyper-excitability

Answer 57

- Males - Younger adults - Genetics (high concordance in monozygotic twins, strong family history) - Antisocial behaviour - Lack of facial flushing - Life stressors (financial, marital, work)

Answer 58

- Compulsions to drink - Narrowed repertoire - Withdrawal symptoms - Increased tolerance - Drink-seeking behaviour predominating other behaviour - Reinstatement of drinking after attempted abstinence - Avoidance/relief of withdrawal symptoms by further drinking - Stereotyped drinking pattern (fixed times)

Answer 59

- C: have you ever felt you should Cut down your drinking? - A: have people Annoyed you by criticising your drinking? - G: have you ever felt Guilty about your drinking? - E: do you ever need a drink early in the morning to calm your nerves or relieve a hangover (Eye-opener)?

Answer 60

Symptoms occurring at 6-12 hours after abstinence: - malaise - tremor - nausea - insomnia - depression/anxiety - transient hallucinations - autonomic hyperactivity - seizures (peaks at 36 hours) - delirium tremens (severe end of scale)

Answer 61

Biological: - fatty liver, hepatitis, cirrhosis, cancer - peptic ulcers, pancreatitis, oesophageal cancer - hypertension, cardiomyopathy, arrhythmias - anaemia, thrombocytopaenia - seizures, peripheral neuropathy, Wernicke's encephalopathy, head injuries - fetal alcohol syndrome Psychological: - morbid jealousy - self harm and suicide - mood and anxiety disorders - alcohol related hallucinations/delirium Social: - employment and financial difficulties - homelessness - relationship problems - drink driving - domestic violence

Answer 62

- Develops between 24 hours and one week after alcohol cessation (peak at 72 hours) - Treatment: large doses of benzodiazepine (e.g. chlordiazepoxide), haloperidol for psychosis, IV pabrinex (thiamine) Clinical features: - cognitive impairment - vivid perceptual abnormalities - paranoid delusions - marked tremor - autonomic arousal (tachycardia, fever, sweating, dilated pupils) - electrolyte disturbances

Answer 63

- Acute encephalopathy due to thiamine (vitamin B1) deficiency, presenting with delirium, nystagmus, ophthalmoplegia, hypothermia and ataxia, needing urgent treatment with parenteral thiamine (pabrinex) - Korsakoff's psychosis is a late presentation of untreated thiamine deficiency, characterised by profound irreversible short-term memory loss, confabulation (filling gaps of memory with imaginary events), hallucinations, disorientation

Answer 64

- Detoxification regime offers controlled withdrawal - High dose benzodiazepines (commonly chlordiazepoxide), tapered down over 5-9 days - Also given thiamine (oral or IV) to prevent Wernicke's encephalopathy - Can be in community or inpatient (recommended in more severe cases, risk or suicide, poor social support, history of severe withdrawal reactions)

Answer 65

Biological: - disulfiram (causes build-up of acetaldehyde when consuming alcohol to cause unpleasant symptoms (e.g. anxiety, headaches, flushing) - acamprosate (reduces cravings by enhancing GABA transmission) - naltrexone (blocks opioid receptors to reduce pleasurable effects of alcohol) Psychological: - motivational interviewing (most effective in pre-contemplation and contemplation stages) - CBT Social: - support groups (alcoholics anonymous) - support with finances, housing, employment

Answer 66

- Opiates (e.g. morphine, diamorphine/heroin, codeine, methadone) - Cannabinoids (e.g. cannabis) - Sedatives/hypnotics (e.g. benzodiazepines, barbiturates) - Stimulants (e.g. cocaine, crack cocaine, ecstasy, amphetamine) - Hallucinogens (e.g. LSD, magic mushrooms) - Volatile solvents (e.g. aerosols, paint, glue) - Anabolic steroids (e.g. testosterone)

Answer 67

- Acute intoxication: acute and transient effects of the substance - Harmful use: recurrent misuse despite physical, psychological, and social problems - Dependence: prolonged compulsive use leading to addiction and tolerance - Withdrawal state: physical and/or psychosocial effects of cessation after prolonged, repeated or high level or use

Answer 68

Biological: - infection (HIV, hepatitis, staph aureus, etc.) - endocarditis - DVT or PE - death Psychological: - craving - anxiety - cognitive disturbance - drug induced psychosis Social: - crime and imprisonment - homelessness - relationship problems - financial problems

Answer 69

Biological: - methadone (or buprenorphine) for detoxification and maintenance - naltrexone (for former opioid dependence to continue abstinence) - IV naloxone as an antidote for opioid overdose - hepatitis B immunisation for those at high risk Psychological: - motivational interviewing - CBT (for comorbid anxiety and depression) - contingency management (incentives for positive behaviour) Social: - support groups - help with housing, finance, employment

Answer 70

An acute, transient global organic disorder of central nervous system functioning resulting in impaired consciousness and attention with a fluctuating course

Answer 71

- Hypoactive: most common, lethargy, decreased motor activity, apathy, confused with depression - Hyperactive: agitation, restlessness, aggression, hallucinations, delusions, confused with psychosis - Mixed: signs of both hypo and hyperactive delirium

Answer 72

HE IS NOT MAAD - Hypoxia (Respiratory failure, MI, cardiac failure, PE) - Endocrine (hypo/hyperthyroid, hypo/hyperglycaemia, Cushing's) - Infection (UTI, pneumonia, encephilitis, meningitis) - Stroke and other intracranial events (space-occupying lesion, epilepsy, head trauma, intracranial bleed) - Nutritional (low thiamine, low vitamin B12) - Others (pain, sensory deprivation, changing environment, sleep deprivation) - Theatre (post-operative complications, anaesthetics, opiate analgesics) - Metabolic (high/low sodium, high/low calcium, low magnesium) - Abdominal (constipation, urinary retention, catheterisation, malnutrition) - Alcohol (intoxication, withdrawal) - Drugs (benzodiazepines, opioids, anticholinergics, steroids, anti-parkinsonism)

Answer 73

- Older age (>65) - Male sex - Physical frailty - Multiple comorbidities - Sensory impairment - Dementia - Renal impairment - Previous episodes - Recent surgery

Answer 74

DELIRIUM - Disordered thinking (slowed, irrational, incoherent) - Emotional changes (euphoric, fearful, depressed, angry) - Language impaired (rambling speech, repetitive, disruptive) - Illusions, delusions, hallucinations (often visual) - Reversal of sleep-wake cycle - Inattention (lack f focus, clouding of consciousness) - Unaware/disorientated (to time pace and person) - Memory deficits + abnormal psychomotor activity

Answer 75

- Urinalysis (UTI) - FBC (infection - U&Es (electrolyte disturbances) - LFTs (liver disease, alcoholism) - Calcium (low or high) - CRP (inflammation/infection) - TFTs (high or low) - B12, folate, ferritin (nutritional deficiencies) - Blood cultures (sepsis) - ECG (acute coronary syndrome, cardiac abnormalities) - CXR (infection) - ABG (hypoxia) - CT head (trauma, intracranial bleed, CVA) - EEG (epilepsy) - Cognitive testing (MMSE, AMT)

Answer 76

- Treat underlying cause (antibiotics, electrolyte disturbance, laxative, catheter, analgesia, stop any causing drugs) - Reassurance (reduce anxiety, regular reminder of time, place and day) - Appropriate environment (quiet, well-lit, consistency in care/staff, presence of family/friend, optimise sensory acuity) - Manage abnormal behaviours (verbal/non-verbal de-escalation), low-dose haloperidol or olanzapine, (avoid benzodiazepines)

Answer 77

Refers to a patient's sustained and experienced emotional state over a period of time, reported subjectively or objectively (as dysthymic, euthymic, or elated)

Answer 78

Refers to the immediate expression and transient flow of emotion to a particular stimulus

Answer 79

Primary (does not result from other condition): - unipolar (depressive disorder, dysthymia) - bipolar (bipolar affective disorder, cyclothymia) Secondary (results from another condition) - physical disorder (anaemia, hypothyroid, malignancy, Cushing's syndrome, MS, parkinsonism) - psychiatric disorder (schizophrenia, alcoholism, dementia, personality disorder) - drug induced (corticosteroids, antiepileptics, beta-blockers, antidepressants can induce mania)

Answer 80

An affective mood disorder characterised by persistent low mood, loss of pleasure (anhedonia), and lack of energy, accompanied by emotional, cognitive, and/or biological symptoms

Answer 81

- Female sex - Genetics (high monozygotic twin concordance, family history) - Physical or mental co-morbidities - Past history - Social stressors (unemployment, poverty, divorce, financial struggles, bereavement, post natal period) - Alcohol and substance misuse - Lack of social support - Low socioeconomic status - Over activity of HPA axis

Answer 82

Core symptoms: - low mood (for at least 2 weeks) - anhedonia - lack of energy Cognitive symptoms: - lack of concentration - negative thoughts (about self, world, future) - excessive guilt - suicidal ideation Biological symptoms: - diurnal variation in mood - early morning wakening - loss of libido - psychomotor retardation - changes to appetite and weight Psychotic symptoms: - hallucinations (often 2nd person auditory) - delusions (often guilt, nihilistic, hypochondrial, persecutory)

Answer 83

- Appearance: self-neglect, unkempt, decreased facial expression, tearful - Behaviour: poor eye contact, psychomotor retardation, slow responses - Speech: may be slow, reduced volume and tone - Emotion: low and dysthymic (subjectively and objectively) - Thought: pessimistic, worthlessness, helpless, suicidal, delusions (if psychotic) - Perception: 2nd person auditory hallucinations - Cognition: impaired concentration - Insight: usually good

Answer 84

Biological: - antidepressants (not usually first line for mild depression, unless lasting a long time, past history of moderate-severe, failure of other interventions, or other physical conditions are compromised) - adjuvants (e.g. antipsychotics) - ECT (for severe life-threatening depression, if rapid response is required, failure of other treatments, psychotic features present) Psychological: - psychotherapies (CBT, IPT, counselling, psychodynamic) - self help programs - physical activity program Social: - support groups - engaging with community activities - help with housing, finances, work

Answer 85

- Recurrent depressive disorder: depressive episodes after their first episode - Seasonal affective disorder: depressive episodes recurring annually at the same time each year (often winter months) - Dysthymia: lasting for at least 2 years, but not meeting the criteria for mild/moderate/severe depression, and is not the result of partially-treated depressive illness - Cyclothymia: chronic mood fluctuation over as least 2 years with episodes of depression and elation that are insufficient to meet the criteria for hypomanic or depressive disorder - Postnatal depression: affects approx. 10%, often starting within a month and peaking at 3 months, similar clinical features as other circumstances

Answer 86

- Severe life stressors - Drug or alcohol abuse - Age under 35 - Chronic physical health problems - Psychiatric illness (e.g. depression, psychosis) - Socioeconomic disadvantage - Domestic violence - Childhood maltreatment - Divorces, or single, or living alone

Answer 87

- What were their intentions before and after the act (e.g. relief from problems, punishment, seeking attention, suicidal intent) - Does the patient now wish to die? Do they regret their actions? - Psychiatric history, previous self-harm? - Collateral history from relatives/friends - Risk assessment - Assess for complications (e.g. nerve/tendon damage, liver damage, intracranial damage)

Answer 88

- History of deliberate self-harm or attempted suicide - Psychiatric illness - Family history of suicide/attempts - Medical illness (e.g. disabling, painful, terminal) - Male - Unemployed - Low socioeconomic status - Occupations (vets, doctors, nurses, farmers) - Access to lethal means (firearms, hanging, suffocation) - Lack of social support (e.g. living alone) - Institutionalised (e.g. prisoners) - Recent life crisis - Childhood abuse

Answer 89

- Violent method - Planned attempt of suicide - Attempts to avoid discovery - Not seeking help afterwards - Final acts (e.g. sorting out finances, writing will) - Leaving note

Answer 90

- Explore suicidal ideation: hope for future, life worth living, thoughts about ending own life - Explore suicidal intent: degree of premeditation, method, plans to avoid discovery, seeking help, regretfullness, feelings about being found/receiving help - Explore risk factors: recent life stressors, previous attempts, psychiatric and medical history, family history - Explore protective factors: what would stop them, social support - Explore risk to other and from others: any children/dependents, thoughts of harming others, threatened by others - Mental state examination

Answer 91

Biological: - treatment of overdoses, suturing wounds - medication for underlying psychiatric illness Psychological: - CBT for underlying depression - other forms of psychotherapies - inpatient admission if high suicide risk Social: - helps with finances, housing etc. - referral to drug/alcohol services - improve social network

Answer 92

A collective term for psychiatric disorders characterised by significant anxiety or other distressing emotional symptoms, in the absence of hallucinations, delusions, or personality disorders

Answer 93

Paroxysmal... - situation dependent: phobic disorders (e.g. specific phobia, social phobia) - situation independent: panic disorders Continuous... - generalised anxiety disorder

Answer 94

A syndrome of ongoing, uncontrollable, and widespread worry about many events of thoughts, recognised as excessive and inappropriate, present for over 6 months

Answer 95

Biological... - genetic: higher concordance in monozygotic twins, family history - neurophysiological: dysfunction of autonomic nervous system, alteration in GABA, serotonin and noradrenaline Environmental... - stressful life events: difficulties in childhood upbringing, problems with relationships, employment, finances, personal illness - substance dependence

Answer 96

- Difficulty breathing or chest pain/discomfort - Tremor/shaking - Palpitations - Sweating - Dry mouth - Abdominal pain or nausea - Dizziness - Fear of loosing control or dying - Depersonalisation or derealisation - Headache - Numbness or tingling - Hot/cold flushes - Muscle tension, aches or pains - Restlessness or feeling on edge - Easily startled - Concentration difficulties - Irritability - Sleep problems

Answer 97

Biological: - SSRI (sertraline) - SNRI (venlafaxine) - pregabalin - benzodiazepines (only for short-term during crises) Psychological: - psychoeducation - CBT - applied relaxation Social: - self help - support groups - exercise

Answer 98

- Phobia = intense irrational fear of an object, situation, place, or person that is recognised as excessive/unreasonable - Agoraphobia = fear of being in open or unfamiliar spaces, resulting in avoidance of public situations from which escape may be difficult (often accompanied by panic disorder) - Social phobia = fear of social situations which may lead to humiliation, criticism, or embarrassment - Specific phobia = fear restricted to a specific object or situation

Answer 99

- Aversive experiences (prior negative experiences with specific objects/situations) - Stress and negative life events - Other anxiety disorders - Mood disorders - Substance misuse - Family history

Answer 100

Biological: - autonomic response (most often tachycardia) - other symptoms of anxiety - in phobias of blood/needles/injury can have vasovagal response and syncope - in social phobia fear of vomiting, urgency or fear of micturition/defecation Psychological: - anticipatory anxiety - inability to relax - urge to avoid feared situation

Answer 101

- Psychotherapies are first line (CBT with graduated exposure or desensitisation) - Medications: SSRIs for agoraphobia or social phobia or SNRIs, benzodiazepines for short term management of specific phobia (e.g. needing a CT scan if claustrophobic)

Answer 102

Recurrent, episodic, severe panic attacks, which are unpredictable and not restricted to any particular situations or circumstances

Answer 103

- Discrete episode of intense fear or discomfort - Starting abruptly, peaking within a few minuets, and lasting less than 1 hour - Autonomic arousal (palpitations, shaking, sweating, dry mouth) - Other symptoms of anxiety

Answer 104

- Recognition and identifying co-morbidities (depression, substance misuse) - Psychological therapy: CBT - Self-help: education, support groups, exercise, avoid caffeine - Medications: SSRI, or if no effect after 12 weeks TCA (clomipramine)

Answer 105

An intense, prolonged, delayed reaction following exposure to a traumatic event (e.g. assault, natural disaster, RTA, involvement in war, unexpected/violent death of family member/friend), occurring within 6 months of the event

Answer 106

- Professions at risk (armed forces, emergency services, doctors) - Groups at risk (refugees, asylum seekers) - Previous trauma (childhood abuse) - History of mental illness - Low socioeconomic background - Perceived threat to life - Concurrent life stressors - Absence of social support - Adverse emotional reaction during or immediately after the event

Answer 107

- Re-living the situation (persistent, intrusive, involuntary): flashbacks, vivid memories, nightmares, distress around similar circumstances - Avoidance: to avoid reminders trauma, inability to recall aspects of the trauma - Hyperarousal: irritability, outbursts, difficulty concentrating, difficulty sleeping, hypervigilance, exaggerated startle response - Emotional numbing: negative thoughts about self, difficulty experiencing emotions, feeling detached from others, anhedonia

Answer 108

Exposure to exceptional physical or mental stressor followed by an immediate onset (within 1 hour) of symptoms (including those of anxiety, narrowing of attention, disorientation, uncontrollable/excessive grief, anger/aggression), which diminish with 8/48 hours (for transient/continued stressors)

Answer 109

Biological: - short term treatment for sleep disturbance (e.g. zopiclone) - antidepressants (if no benefit from psychological therapies, or comorbid depression) e.g. paroxetine, venlafaxine, mirtazapine Psychological: - trauma focused CBT - eye movement desensitisation and reprocessing (EMDR) Social: - support groups - help with housing, finances, employment, and meaningful occupation

Answer 110

Recurrent obsessional thoughts (unwanted intrusive thoughts or urges that repeatedly enter the individual's mind despite trying to resist them) and/or compulsions (repetitive ritual behaviours or mental acts that a person feels driven to perform)

Answer 111

Obsessions: - contamination (e.g. from dirt, germs, bodily fluids) - fear of harm (e.g. door locks not safe) - excessive concern with order or symmetry - doubts about performing actions (e.g. not turned off oven) Compulsions: - checking things (e.g. taps, doors, appliances) - cleaning, washing, decontamination - repeating actions (e.g. counting, arranging objects) - mental compulsions (e.g. special phrases repeated in set manner) - hoarding

Answer 112

Biological: - SSRIs (escitalopram, fluoxetine, etc.) - Can add clomipramine (TCA) in severe cases Psychological: - CBT with exposure and response prevention (ERP) - psychoeducation Social: - support groups - self-help

Answer 113

A group of disorders marked by physical illness or a specific medical condition, in the absence of physiological evidence

Answer 114

A type of somatoform disorder involving at least 2 years of multiple physical symptoms that cannot be explained by any detectable physical disorder, where preoccupation with symptoms causing distress, repeated seeking of medical attention, and refusal to accept reassurance

Answer 115

A type of somatoform disorder characterised by persistent prolonged pain that cannot be fully explained by a physical disorder, often resulting from psychosocial stressors, and that significantly interferes with a person's ability to function

Answer 116

A type of somatoform disorder characterised by preoccupation with the fear or belief that one has a serious physical disease based on the incorrect and unrealistic interpretation of bodily symptoms

Answer 117

A group of disorders characterised by a sudden or gradual disruption in normal consciousness, memory, or perception of the environment, associated in time with psychosocial stressors, categorised as dissociative amnesia, fugue, trance, motor disorder, convulsions etc.

Answer 118

Also known as functional neurological disorder, a type of somatoform disorder characterised by one or more neurological deficit in the absence of physiological evidence, including symptoms like paralysis, loss of voice, blindness, seizures, loss of sensation, which are not intentionally produced or under voluntary control

Answer 119

- Childhood abuse - Reinforcement of illness behaviours - Anxiety disorders - Mood disorders - Personality disorders - Social stressors

Answer 120

- Malingering disorder: symptoms are intentionally produced (faked) or exaggerated to seek advantageous consequences for personal gain (e.g. avoiding criminal persecution, receive benefits), associated with antisocial/dissociative/borderline personality disorders, substance use disorders) - Factitious (Munchausen) disorder: mental health disorder involving intentionally produced or exaggerated symptoms, with no obvious motivation or reward, other than internal emotional gain/adopting the 'sick role'

Answer 121

Biological: - antidepressants for any underlying mood disorder - promote physical health (e.g. exercise) Psychological: - CBT - developing coping strategies Social: - stress-relieving activities - family support

Answer 122

A pervasive developmental disorder characterised by impaired social interaction, deficits in communication, and restricted/repetitive interests and behaviours, which typically occur during preschool years

Answer 123

Prenatal: - genetics (complex relationship with multiple chromosomes e.g. 7, and genetic conditions such as fragile X syndrome) - parental age (higher risk with over 40s) - drugs (intrauterine exposure e.g. sodium valproate) - infection (e.g. rubella) Antenatal: - hypoxia during childbirth - preterm birth - low birthweight Postnatal: - toxin exposure (e.g. lead, mercury) - pesticide exposure (may affect those genetically predisposed) - NOT MMR VACCINE

Answer 124

Asocial: - lack of eye contact, response to name - lack of emotional expression - unstained relationships - unawareness of social rules - few social gestures (e.g. waving, nodding) Behaviour: - restricted, repetitive and stereotyped behaviours (e.g. rocking, swaying) - upset by change in routine - preferring same food, clothes, games etc. - obsessively pursued interests - fascination with sensory aspects on environment Communication: - distorted and delayed speech - echolalia (repetition of words) - other speech anomalies (e.g. perseveration, monosyllabic/monotonic, louder/quieter, etc.) Other features: - intellectual disability - problems with temper - impulsivity - cognitive impairment

Answer 125

Biological: - management of co-existing disorders (e.g. ADHD, depression, physical health) - for sleep problems (e.g. melatonin) - antipsychotics for severely challenging behaviours Psychological: - support for families - CBT (depending on verbal and cognitive ability) Social: - modification of environmental factors - intervention for life skills and communication - specialist education - self help groups

Answer 126

Attention deficit hyperactivity disorder, characterised by and early onset (before age 7) of persistent pattern of inattention, hyperactivity and impulsivity, which impair social, academic, or occupational functioning

Answer 127

- Genetic: high concordance in monozygotic twins, linked with certain genes - Abnormalities in dopaminergic pathways - Neurodevelopmental abnormalities in pre-frontal cortex - Social factors: deprivation, family conflict, parental cannabis and alcohol

Answer 128

Biological: - methylphenidate (only over age of 5, switched if not effective after 6 weeks, needs baseline ECG and cardiovascular assessment) Psychological: - psychoeducation and parent-training - CBT Social: - support groups - social skills training

Answer 129

A state of arrested or incomplete development of the mind, characterised by a low intellectual performance (IQ<70) and a wide range of functional impairment (including social and adaptive skills e.g. ADLs)

Answer 130

- Genetic: Down's syndrome, fragile X syndrome, Prader-Willi, hydrocephaly - Antenatal: congenital infections (rubella, CMV), intoxication, physical damage, nutritional deficiencies - Postnatal: infection (meningitis, encephalitis), metabolic (hypothyroidism, hypernatraemia), cerebral palsy - Environmental: neglect, injury, malnutrition, socioeconomic deprivation

Answer 131

- Multidisciplinary approach (psychiatrists, SALT, specialist nurses, OT, social worker, teachers, GP) - Treatment of co-morbid medical conditions - Behavioural techniques e.g. positive behaviour support, CBT - Family education and support - Antipsychotics for severely challenging behaviour

Answer 132

An eating disorder characterised by deliberate weight loss, an intense fear of fatness, distorted body image, and endocrine disturbances

Answer 133

- Genetics (high concordance in monozygotic twin studies for anorexia nervosa) - Family history - Female - Adolescence and puberty - Early onset of puberty/menarche - Anxiety or depressive symptoms - Perfectionism, or anankastic personality - Occupational/recreational pressure (e.g. dancers, athletes, models) - Bullying/criticism about eating, body shape or weight - Stressful life events - Physical or sexual abuse

Answer 134

- Low body weight (>15% below expected, or BMI<17.5) - Restricted eating patterns or dieting - Deliberate weight loss (e.g. over exercise) - Distorted body image - Dread of gaining weight - Social withdrawal - Fatigue - Fainting and dizziness - Delay in secondary sexual development - Amenorrhoea - GI symptoms: constipation, pain, fullness after meals - Physical signs: hypothermia, bradycardia, hypotension, peripheral oedema, sings of anaemia, lanugo hair, proximal muscle weakness (sit up, squat, stand test)

Answer 135

- FBC (low hb, platelets, leukocytes) - U&Es (raised urea and creatinine, low potassium, phosphate, magnesium, chloride) - TFTs (low T3/4) - LFTs (low albumin) - High cortisol - Low sex hormones - Low glucose - DEXA scan (rue out osteoporosis) - ECG (arrhythmias e.g. bradycardia, prolonged QT)

Answer 136

Biological: - treatment of complications (e.g. electrolyte imbalances) - refeeding (with caution of refeeding syndrome) - SSRIs for co-morbid depression or OCD Psychological: - CBT (eating disorder focused) - Family therapy - Psycho-education Social: - self help groups - reduced isolation

Answer 137

- Severe electrolyte imbalance - Severe malnutrition or dehydration - Cardiac arrhythmias - BMI below 13 - Rapid weight loss (more than 1kg a week) - Significant suicide risk

Answer 138

- Potentially life threatening syndrome resulting from food intake after prolonged starvation or malnourishment - Insulin surge causes increased uptake of phosphate, potassium, and magnesium into cells, and the depletion of phosphate causes reduction in cardiac muscle activity leading to failure - Management: low calorie diet that is slowly increased, electrolyte monitoring and replacement

Answer 139

An eating disorder characterised by repeated episodes of uncontrolled binge eating followed compensatory weight loss behaviours

Answer 140

- Binge eating (cravings with sense of compulsion and loss of control) - Compensatory weight loss behaviours (vomiting, laxatives, diuretics, fasting,, excessive exercise) - Preoccupation with weight, body shape and body image - Depression, low self-esteem, anxiety - Usually normal weight (any loss is counteracted by gain from binging) - Irregular periods - GI symptoms: bloating, heartburn, abdominal pain - Physical signs: low blood pressure, dehydration, enlarged salivary glands, oedema, abrasions on back of hands, dental erosions

Answer 141

- Bloods are often normal: except low potassium - VBG: metabolic alkalosis - ECG: ventricular arrhythmias (due to hypokalaemia), prolonged PR interval,

Answer 142

Biological: - treat medical complications (e.g. potassium replacement) - treat co-morbid conditions (e.g. depression, anxiety) - antidepressant (fluoxetine) in combination with other treatments Psychological: - psychoeducation about nutrition - CBT for bulimia nervosa Social: - food diary - techniques to avoid binging (distractions, company, small regular meals) - self help

Answer 143

- Electroconvulsive therapy is an electric current applied via electrodes to the skull to induce a seizure (for at least 30 seconds) - General anaesthesia and muscle relaxant are used to limit the motor effects - Can be bilateral (most effective) or unilateral (if previous cognitive side effects) - Indicated in prolonged/severe mania, catatonia, severe depression (treatment resistant, life-threatening, risk to self/others) - Needs written informed consent, or a second opinion if lacking under MHA - Contraindicated in recent MI or stroke, major unstable fracture, raised ICP, severe anaesthetic risk, cerebral aneurysm

Answer 144

- Confusion - Short term memory impairment - Anaesthesia risks - Muscle aches - Dental/oral trauma - Cardiac arrhythmias - Peripheral nerve palsies - Long term anterograde and retrograde amnesia - Status epilepticus

Answer 145

- Admission for assessment, followed by necessary treatment for mental illness - For up to 28 days (can't be renewed) - Can appeal within the first 14 days, and apply to hospital manager for discharge at any time

Answer 146

- Admission for treatment of mental illness - For up to 6 months - Can be renewed for another 6 months, then annually - Can appeal once in each period, can apply to hospital manager for discharge at any time - Nearest relative can object and prevent detention

Answer 147

- Used when there is an urgent necessity for detention under S2 - Only need 1 medical recommendation - Lasts 72 hours until 2nd doctor is sought

Answer 148

- Urgent detention of inpatient by one doctor on any ward (except A&E), pending a MHA assessment - Lasts up to 72 hours - No right to appeal

Answer 149

- Urgent detention of inpatient by a nurse on any ward (except A&E), pending a MHA assessment or arrival of a doctor - Must be registered mental health or learning disability nurse - Lasts up to 72 hours - No right to appeal

Answer 150

- Allows a police officer to enter a person's premises, who is suspected of suffering from a mental disorder - Patient is removed to place of safety (including being kept at home) - Lasts for 24 hours

Answer 151

- Allows a police officer to remove an individual from a public space, who appears to be suffering from a mental disorder - Patient is removed to place of safety - Lasts for 24 hours

Answer 152

- s17: allows responsible clinician to give detained patients leave from hospital under certain conditions - s35/37: used by the court to remand criminals to hospital for psychiatric assessment - s41/47/49: used by ministry of justice to order transfers/leave/return to prison - s117: legal duty of social services and health authorities to provide free aftercare for patients discharged from s3 (and others) - CTO: community treatment order allows patients on s3 to be treated at home if well enough, to be recalled if they do not comply

Answer 153

- Indications: mild-moderate depression, eating disorders, anxiety disorders, substance misuse disorders, schizophrenia, chronic medical conditions - Rationale: the disorder is not caused by life events but by the way the patient views the events - Aim: help patients identify and challenge negative thoughts, maladaptive behaviour, and modify underlying beliefs

Answer 154

- Relaxation training: useful in stress-related and anxiety disorders, uses muscle relaxation and relaxing situations (e.g. walking) - Systemic desensitisation: used for phobic anxiety disorders, gradual exposure to a hierarchy of anxiety-producing situations - Exposure and response prevention: used for OCD and phobias, repeated exposure to anxiety-producing situations and prevented from preforming compulsive actions to reduce anxiety

Answer 155

- Indications: dissociative/somatoform disorders, personality disorders, recurrent depression, psychosexual disorders - Rationale: childhood experiences, past unresolved conflicts, previous relationships significantly influence current situations - Aim: conflicts and defence mechanisms are explored, patient develops insight to change maladaptive behaviours

Answer 156

- Delivers information about the nature of their illness, likely causes, what help is available (from services, or themselves) - Can be individually or in groups

Answer 157

- Indication: depression, eating disorders - Focus on problems such as bereavement, relationship difficulties, or interpersonal deficits, and how these impact the individual - Some overlap with CBT and psychodynamic therapy, but focuses on problems which may cause difficulty initiating or maintaining relationships

Answer 158

- Helps patients access and process traumatic memories with the aim to resolve them emotionally, using and eternal stimulus to direct the patients eye movement - Effective treatment for PTSD

Answer 159

- Used for EUPD - Uses components of CBT and provides group skills training, and alternative coping strategies during emotional instability

Answer 160

- Decisions made on behalf of the patient must be in their best interests - People must be given appropriate help to make decisions (e.g. interpreters, multiple attempts), before concluding a lack of capacity - Capacity is determine by the ability to make decisions, not the decision itself (unwise decisions are allowed) - The least restrictive intervention should be used - Capacity is assumed to be present until proven otherwise

Answer 161

Schizophrenia/psychosis: - delusional belief of physical health - paranoia about healthcare staff or treatments - thought disorder leading to challenging engagement - negative symptoms of social withdrawal, amotivation Depression: - lack of motivation - apathy - negative thinking (worthlessness/hopelessness/guilt) Anxiety: - social anxiety (not leaving home) - healthcare anxiety Dementia: - cognitive impairment - lack of concordance with medication

Answer 162

- Metabolic syndrome (central obesity, hypertension, dyslipidaemia, glucose intolerance) - Type 2 diabetes - Cardiovascular disease - Bone mineral density loss - Renal disease - Thyroid disease

Answer 163

- Social deprivation (poverty, homelessness, crime, financial difficulties) - Isolation (reduced contact with healthcare)

Answer 164

- Smoking - Poor diet - Lack of exercise - Drug and alcohol use * due to amotivation, isolation, cognitive dysfunction, stigma * leading to direct illness (liver disease, accidental overdose, brain damage), or related illnesses (VTE, HIV, hepatitis)

Answer 165

- Division of healthcare system into psychiatry and physical health (de-skilling, poor communication, etc.) - Diagnostic overshadowing (assumption that behaviour is due to mental illness without ruling out physical causes)