Psychiatry Flashcards
1
Q
what are factors of Mental State Examination
A
● Appearance and behaviour
● Speech - rate, tone, volume, quantity, flow
● Emotion (Mood and Affect)
● Perception
● Thoughts - form, content, possession
● Insight
● Cognition (Orientation to time, place, person)
2
Q
What is depression
A
a disorder that causes persistent feelings of low mood, low energy and reduced enjoyment of activities.
3
Q
What is the pathophysiology of depression
A
not fully understood
appears to involve a disturbance in neurotransmitter activity in the central nervous system, particularly serotonin, also called 5-hydroxytryptamine (5-HT)
4
Q
What causes depression
A
- may be triggered by life event
- can occur without any apparent trigger
- genetic, psychological, biological and environmental factors
- affected relative is a significant RF
5
Q
What can trigger or exacerbate depression
A
Physical health conditions eg stroke, myocardial infarction, multiple sclerosis and Parkinson’s disease.
6
Q
What are the 2 core symptoms of depression
A
- Low mood
- Anhedonia (a lack of pleasure or interest in activities)
7
Q
What are the emotional symptoms of depression
A
Anxiety
Irritability
Low self-esteem
Guilt
Hopelessness about the future
8
Q
What are the cognitive symptoms of depression
A
Poor concentration
Slow thoughts
Poor memory
9
Q
What are the physical symptoms of depression
A
Low energy (tired all the time)
weight gain/loss
Slow movements
10
Q
What are DDx for depression
A
Hypothyroidism
Neuro disorders (parkinson’s, MS, dementia)
adverse drug effects
Substance misuse
grief reaction
anxiety disorder
BPD
PMDD
11
Q
How soon after starting SSRI should patient be followed up
A
2 weeks
one week if under 25 and inc risk of suicide
12
Q
what is mechanism of SRRI
A
inhibit the reuptake of serotonin from
presynaptic serotonin pumps
13
Q
what are SSRI discontinuation symptoms
A
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia
- electric shock sensation
14
Q
what are SE of SSRI
A
GI upset
anxiety/agitation
insomnia
sweating
anorgasmia
GI bleeding
associated with increased suicidality
hyponatraemia
cytochrome-mediated interactions (fluoxetine)
prolonged QT (Citalopram)
15
Q
what are examples of SSRI
A
sertraline, fluoxetine, paroxetine, citalopram,
escitalopram
15
Q
what should be prescribed with SSRI and NSAID/Aspirin
A
PPI
16
Q
what are SNRI examples
A
venlafaxine, duloxetine
17
Q
when are SSRI indicated for use
A
depression, anxiety, OCD, bulimia nervosa
18
Q
what are SE of SNRI
A
dizziness, dry mouth, constipation, hot flushes
19
Q
when are SNRI indicated
A
depression, anxiety
20
Q
what is the mechanism of SNRI action
A
presynaptic blockade of both noradrenaline and serotonin reuptake pumps (in high doses also blocks dopamine reuptake);
low effects on muscarinic,
histaminergic and alpha-adrenergic receptors.
21
Q
what is NaSSAs
A
Noradrenergic and Specific Serotonergic Antidepressants
eg Mirtazapine
22
Q
when is NASSA indicated
A
depression, anxiety (off license)
23
Q
what are SE of NaSSa
A
- sedation and weight gain (blocking histamine)
- headache
- postural hypotension
- dizziness
- tremor
24
what is mechanism for action for NaSSAs
presynaptic alpha2 blockage -> increased noradrenaline and
serotonin from presynaptic neurons; histamine antagonist
25
when are TCA indicated
depression, anxiety, OCD, chronic pain (much lower dose),
nocturnal enuresis
26
what are MAOIS
inhibit enzyme Monoamine oxidase A & B
27
what are examples of MAOIs
phenelzine, Rasagiline, and selegiline
28
when are TCA CI
IHD, arrhythmias, severe liver disease, overdose risk!!
29
what are SE of TCAs
Triple A
- Anticholinergic effects (muscarinic receptor block): dry mouth, constipation, blurred vision, urinary retention
- Antiadrenergic effects: postural hypotension (dizziness and syncope)
- Antihistaminergic effects: sedation and weight gain
- Also cardiac effects: prolonged QT, heart block, arrhythmias, palpitations
30
What are investigations for depression
- Bloods: FBC, U&E, LFT, TFT, Ca2+, B12/folate, glucose, CRP/ESR
- Other tests: urine toxicology, thyroid antibodies,24hr urinary free cortisol
31
What environmental factors may contribute to depression
Potential triggers
Home environment
Relationships with family, friends, partners, colleagues and others
Work
Financial difficulties
Safeguarding issues
32
What are essential factors to explore when taking depression history
Caring responsibilities (e.g., children or vulnerable adults)
Social support
Drug use
Alcohol use
Forensic history (e.g., violence or abuse)
33
What risk assessment factors are included in every depression history encounter
Self-neglect
Self-harm
Harm to others (including neglect)
Suicide
34
Name 2 questionnaires used to assess the severity of depression
- PHQ-9 Questionnaire (Patient Health Questionnaire
- Hospital Anxiety and Depression (HAD) scale
35
What time frame is assessed in phq9
how often the patient is experiencing symptoms in the past two weeks
36
What does a score < 16 on the PHQ-9 indicate
less severe depression
37
What does a score of ≥ 16 on the PHQ-9 indicate
severe depression
38
How do the updated NICE guideline categorise depression
less severe or more severe depression.
39
What score is PHQ9 out of
27
9qs 3pts each
40
How many points is Hospital Anxiety and Depression (HAD) scale out of
42
14 qs: 7 for anxiety and 7 for depression
3pts each
41
What are treatment options for less severe depression
guided self help, IPT, group-based low intensity CBT
42
What are treatment options for more severe depression
high intensity CBT + SSRI or SNRI
43
Are antidepressants offered as first-line treatment for less severe depression
no unless patients preference
44
What is the first line medication for depression
selective serotonin reuptake inhibitors
45
What is the minimum period for which a patient should remain on SSRI for
6 months after remission of symptoms to decrease risk of relapse
46
Which SSRI does not allow a direct switch to another SSRI
fluoxetine
withdraw and leave gap of 4-7 days
47
How is SSRI switched to TCA
cross-tapering
48
Name a serotonin-norepinephrine reuptake inhibitor (SNRI)
duloxetine
49
What food should someone on monoamine oxidase inhibitors (MAOIs) avoid
cheese
50
What is Mirtazapine
antidepressant
NaSSa
block alpha2-adrenergic receptors
SE: increase appetite & sedation --> good for older ppl
51
What is Serotonin Syndrome
Caused by excessive serotonin activity.
It usually occurs with higher doses of antidepressants and when multiple antidepressants are used together
52
What are symptoms of Serotonin Syndrome
- Altered mental state (e.g., confusion, anxiety and agitation)
- Autonomic nervous system hyperactivity (e.g., tachycardia, hypertension and hyperthermia)
- Neuromuscular hyperactivity (e.g., hyperreflexia, tremor and rigidity)
agitation, hypertension, twitching muscles, and dilated pupils.
53
What are severe complications of Serotonin Syndromel
confusion, seizures, severe hyperthermia (over 40°C) and respiratory failure.
54
What are therapy options of depression
cognitive behavioural therapy, counselling or psychotherapy
guided self help
IPT
group based low intensity CBT
55
What is the management of Serotonin Syndrome
supportive care (e.g., sedation with benzodiazepines, IV fluids) and withdrawal of the causative medications
56
What can interact with SSRI and cause serotonin syndrome
St john wort & TCA
MAOIs
57
What lifestyle factors can be modified for depression management
exercise, diet, stress and alcohol
58
When is medication NOT indicated first line for depression
patients with less severe depression (defined as less than 16 on the PHQ-9) unless they have a preference for taking antidepressants.
59
When is admisson required for depression
high risk of self-harm, suicide or self-neglect or where there may be an immediate safeguarding issue.
60
What additional specialist treatment is used for unresponsive or severe depression
Antipsychotic medications (e.g., olanzapine or quetiapine)
Lithium
Electroconvulsive therapy
61
What service is offered for intensive support and tx for patients having mental health crisis WITHOUT being admitted to hospital
crisis resolution and home treatment team
62
what is Electroconvulsive Therapy for
severe, medication-resistant and psychotic depression.
63
How is Electroconvulsive Therapy provided
Under general anaesthesia, electrodes are placed on the patient’s head, and a brief electrical current is administered, which triggers a short generalised seizure lasting around 30 seconds
64
What are side effects of Electroconvulsive Therapy
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
muscle aches
65
What should happen with Antidepressant medication when a patient is about to commence ECT treatment
should be reduced but not stopped
66
What are symptoms of Psychosis
Delusions
Hallucinations
Thought disorder
67
what are delusions
beliefs that are strongly held and clearly untrue
68
what are hallucinations
hearing or seeing things that are not real
69
what is thought disorder
disorganised thoughts causing abnormal communication and behaviour
70
Name 2 antipsychotic drugs
olanzapine or quetiapine
71
How many women are affected by baby blues
seen in the majority of women
72
How many women are affected by Postnatal depression
one in ten women
73
How many women are affected by puerperal psychosis
one in a thousand women
74
What are symptoms of baby blues
mood swings, low mood, anxiety, irritability and tearfulness
75
When does baby blues symptoms start
in the first week or so after birth
76
How long do baby blues last
last only a few days and resolve within two weeks of delivery. No treatment is required.
77
What causes baby blues
* hormonal changes
* recovery from birth
* sleep deprivation
* increased responsibility
* difficulty with feeding
78
What are symptoms of postnatal depression
classic triad of low mood, anhedonia (lack of pleasure in activities) and low energy
79
When are women affected by postnatal depression
typically, women are affected around three months after birth
80
How long are symptoms required to last for postnatal depression disgnois
at least two weeks
81
When is onset of puerperal psychosis
two to three weeks after delivery
82
What are symptoms of puerperal psychosis
psychosis, such as delusions, hallucinations, depression, mania, confusion and thought disorder.
83
What questionaire is used to mothers for postnatal depression
Edinburgh postnatal depression scale
84
a score of 10+ on Edinburgh postnatal depression scale indicates what
suggests postnatal depression.
85
What is self harm
intentional self-injury without suicidal intent.
86
what is the mc method of self harm and who is it mc in
Cutting
more common in females and those aged under 25
87
What is self harm a response to
response to emotional distress and acts as a way for the person to cope with their emotions.
88
What is suicide
involves a person causing their own death.
89
what group is suicide mc in
more common in men and most common around the age of 50 years. It also increases in older age.
90
What is the cycle of self harm (6 steps)
Emotional suffering
Emotional overload
Panic
Self-harming
Temporary relief
Shame and guilt
91
What presenting features increase risk of suicide
Previous suicidal attempts
Escalating self-harm
Impulsiveness
Hopelessness
Feelings of being a burden
Making plans
Writing a suicide note
92
What background factors increase the risk of suicide
Mental health conditions
Physical health conditions
History of abuse or trauma
Family history of suicide
Financial difficulties or unemployment
Criminal problems (prisoners have a high rate of suicide)
Lack of social support (e.g., living alone)
Alcohol and drug use
Access to means (e.g., firearms)
93
What protective factors help reduce the risk of suicide
Social support and community
Sense of responsibility to others (e.g., children or family)
Resilience, coping and problem-solving skills
Access to mental health support
94
What 3 aspects are important aspects of suicide management
Safety-netting, a safety plan and follow-up
95
What are management considerations for self harm
Empathy, supportive communication and building rapport
Identifying triggers for episodes
Separating the means of self-harm
Discussing strategies for avoiding further episodes
Providing details for support services in a crisis
Treating underlying mental health conditions
96
What is first step when a patient present with overdose
check TOXBASE for recommendations about treating an overdose of almost any substance
97
When must activated charcoal be given
within one hour of overdose
98
how is paracetamol OD treated
Acetylcysteine
99
how is opioids OD treated
Naloxone
100
how is Benzodiazepines OD treated
Flumazenil
101
What medication can activated charcoal be used to reduce the absorption of
aspirin, SSRIs, tricyclic antidepressants, antipsychotic drugs, benzodiazepines and quinine
102
how is Beta blockers OD treated
Glucagon for heart failure or cardiogenic shock
Atropine for symptomatic bradycardia
103
how is Calcium channel blockers OD treated
Calcium chloride or calcium gluconate
104
how is Cocaine OD treated
Diazepam
105
What is bipolar disorder
recurrent episodes of depression and mania or hypomania
Diagnosis requires at least 1 episode of mania or hypomania.
106
What are manic episodes
excessively elevated mood and energy, significantly impacting their normal functions (e.g., caring and work responsibilities).
+/- psychosis -> key differentiation
>1 week
107
what are hypomanic episodes
milder symptoms of mania without having a significant impact on their function.
~4 days
108
What are Mixed episodes in bipolar
involve a mix of symptoms or rapid cycling between mania and depression.
109
What are features of manic episode
- Abnormally elevated mood
- Significant irritability
- Increased energy
- Decreased sleep
- Grandiosity, ambitious plans, excessive spending and risk-taking behaviours
- Disinhibition and sexually inappropriate behaviour
- Flight of ideas (rapidly generating and jumping between ideas)
- Pressured speech (rapid and unrelenting speech)
- Psychosis (delusions and hallucinations)
110
what is bipolar diagnosis based on
Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
111
What does bipolar I involve
at least one episode of mania.
112
What does bipolar II involve
at least one episode of major depression and at least one episode of hypomania.
113
what is the the key differentiation between mania and hypomania
psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania
114
What does cyclothymia involve
recurrent depressive and hypomanic states
lasting >2yrs
The symptoms are not severe enough to significantly impair their function.
115
What does unipolar depression involve
person only has episodes of depression, without hypomania or mania.
116
What is the pharmacological management options of an acute bipolar manic episode
- Antipsychotic medications (e.g., olanzapine, quetiapine, risperidone or haloperidol) are first-line
- Other options are lithium and sodium valproate (mood stabilizer)
- ** Existing antidepressants are tapered and stopped **
Acute mania: quetiapine + lithium + benzodiazepines
117
What are non pharmacological management options for bipolar
- Psychoeducation
- Psychotherapy - IPT (Interpersonal psychotherapy), CBT
- Social support eg family, support groups
118
what are the management options for an acute depressive episode bipolar
Olanzapine plus fluoxetine
Antipsychotic medications (e.g., olanzapine or quetiapine)
Lamotrigine
119
What is the long term management for bipolar
lithium - antimanic mood stabilizer
120
What is the target range for lithium
0.6–0.8 mmol/L - nhs websites
0.4-1.0 mmol/L - passmed
narrow therapeutic index
121
what investigations should be done before starting lithium
FBC, U&E, Ca2+, PO4*3-, thyroid, ECG, pregnancy
122
when should lithium levels be checked
12 hours post-dose
123
How often after lithium levels checked after starting
a week later after starting and weekly until the levels are stable.
124
once established when should lithium blood level 'normally' be checked
every 3 months
125
why no antipsychotics in depression
worsen symptoms
126
What are adverse effects of lithium
- Fine tremor
- Weight gain
- Sedation/lethargy
- Chronic kidney disease
- Hypothyroidism and goitre (it inhibits the production of thyroid hormones)
- Hyperparathyroidism and hypercalcaemia
- benign leukocytosis - high WCC
- Nephrogenic diabetes insipidus (polyuria, polydipsia)
127
What are features of lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
N+V
ECG changes - QT
128
how is lithium toxicity managed
stop lithium, high fluid + IV NaCl, haemodialysis if severe
129
Who should lithium be avoided in and why
women child bearing age - teratogenic
causes Ebstein’s anomaly (congenital malformation of tricuspid valve)
130
Name two alternatives to lithium for long term bipolar treatment
sodium valproate and olanzapine.
carbamazepine
131
Who should sodium valproate be avoided in
females with childbearing potential - teratogenic
132
what are SE of sodium valproate
weight gain, dizziness, hair loss, n+v, tremor, deranged LFTs
133
What is Generalised anxiety disorder
excessive and disproportional anxiety and worry that negatively impacts the person’s everyday activity.
134
what are the requirements for GAD diagnosis
persistent, occurring most days for at least six months, and not caused by substance use or another condition.
135
What is panic disorder
recurrent and unexpected panic attacks (sudden episodes of intense fear or discomfort)
136
What are secondary causes of anxiety
Substance use (e.g., caffeine, stimulants, bronchodilators and cocaine)
Substance withdrawal (e.g., alcohol or benzodiazepine withdrawal)
Hyperthyroidism
Phaeochromocytoma
Cushing’s disease
137
Emotional and cognitive symptoms of GAD
Excessive worrying
Unable to control the worrying
Restlessness
Difficulty relaxing
Easily tired
Difficulty concentrating
138
physical symptoms of GAD
Muscle tension
Palpitations (e.g., a feeling of their heart racing)
Sweating
Tremor
Gastrointestinal symptoms (e.g., abdominal pain and diarrhoea)
Headaches
Sleep disturbance
139
How does anxiety cause physical symptoms
overactivity of the sympathetic nervous system
140
What are physical symptoms of panic attacks
tension, palpitations, tremors, sweating, dry mouth, chest pain, shortness of breath, dizziness and nausea
141
What are emotional symptoms of panic attacks
panic, fear, danger, depersonalisation (feeling separated or detached) and loss of control.
142
What is phobia
extreme fear of certain situations or things, causing symptoms of anxiety and panic
143
What questionnaire is used to assess anxiety
Generalised Anxiety Disorder Questionnaire (GAD-7)
144
What does a score of 5-7 on Generalised Anxiety Disorder Questionnaire (GAD-7) indicate
mild anxiety
145
What does a score of 10-14 on Generalised Anxiety Disorder Questionnaire (GAD-7) indicate
moderate anxiety
146
What does a score of 15-21 on Generalised Anxiety Disorder Questionnaire (GAD-7) indicate
severe anxiety
147
How is mild anxiety managed
managed with active monitoring and advice about self-help strategies (e.g., meditation), sleep, diet, exercise and avoiding alcohol, caffeine and drugs.
148
How is moderate to severe anxiety managed
Cognitive behavioural therapy
Medication
149
What is 1st line medication for GAD and panic disorder
SSRIs (particularly sertraline)
or citalopram
150
What medication is used to treat the physical symptoms of anxiety
Propranolol - non-selective beta-blocker
reduce sympathetic nervous system overactivity
151
when is Propranolol contraindicated
asthma (it can cause bronchoconstriction in asthmatic patients).
152
What medication is recommended for short duration during crisis for anxiety
Benzodiazepines (e.g., diazepam) - stimulating GABA receptors
153
when are Benzodiazepines indicated
anxiety (short term in extreme cases only), mania, psychosis,
alcohol withdrawal, insomnia, acute agitation/aggression, epilepsy, acute back pain
154
What are side effects of Benzodiazepines
prolonged use causes down-regulation of GABA receptors, leading to tolerance and dependence
155
Name 3 benzodiazepines
lorazepam (short acting)
diazepam (longer acting)
midazolam
chlordiazepoxide
156
what are cautions of taking benzodiazepines
can be addictive if taken long term, resp and CNS depressant effects (so check if other CNS depressants being taken eg xs alcohol or antipsychotics)
157
when are benzodiazepines avoided
neuro disease, severe resp disease
158
what is mechanism of zopiclone
stimulate GABA receptor
159
What is PTSD
Post-Traumatic Stress Disorder
resulting from traumatic experiences, with ongoing distressing symptoms and impaired function
160
What are examples of events that can cause PTSD
Violence (e.g., sexual assault, domestic violence, abuse or physical attacks)
Major car accidents
Major health events (e.g., traumatic childbirth, serious illness or death of a loved one)
Natural disasters
Military, combat and war zone events
161
How does PTSD present
**hyperarousal**: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
**avoidance**: avoiding people, situations or circumstances resembling or associated with the event
**re-experiencing**: flashbacks, nightmares, repetitive and distressing intrusive images
**emotional numbing** - lack of ability to experience feelings, feeling detached
hare
162
What screening tool is used to screen for PTSD
Trauma Screening Questionnaire (TSQ)
163
What criteria is PTSD diagnosis based on
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
International Classification of Diseases (ICD-11)
164
What does management for PTSD include
Psychological therapy (e.g., trauma-focused CBT)
Eye movement desensitisation and reprocessing (EMDR)
Medication (e.g., SSRIs, venlafaxine or antipsychotics)
165
What medication is used for PTSD
SSRIs, venlafaxine or antipsychotics
166
What is difference between acute stress and PTSD
Acute stress disorder is defined as an acute stress reaction that occurs in the 4 weeks after a traumatic event
PTSD is diagnosed after 4 weeks
167
how is acute stress managed
trauma focused CBT
168
What is Eye movement desensitisation and reprocessing (EMDR)
processing traumatic memories while performing specific eye movements.
The theory is that the improperly stored traumatic memories are reprocessed and stored again in a more normal way so that they no longer cause as much negative emotion and distress
169
What is Obsessive compulsive disorder
**obsessions** (recurrent unpleasant intrusive thoughts/images)
+ **compulsions** (an action to alleviate the anxiety)
170
What are obsessions
unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore
eg fear of contamination
171
what are complusions
repetitive behaviours or mental acts the person feels they must do, generating anxiety if they are not done
way for the person to handle their obsessions.
172
what is the OCD cycle
Obsessions
Anxiety
Compulsion
Temporary relief
173
what are common obsessions
Contamination fears
Harm-related obsessions
Unwanted sexual thoughts
Religious/moral obsession
Perfectionism/symmetry
174
what are common compulsions
Cleaning/washing
Checking rituals
Counting/repeating rituals
Ordering/arranging behaviours
Mental neutralizing strategies
175
OCD diagnosis is based on what crieria
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
International Classification of Diseases (ICD-11)
176
What classification is used to assess OCD severity
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
177
How is mild OCD managed
education and self-help resources.
178
How is moderate to severe OCD managed
Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP)
SSRIs
or Clomipramine (alt to SSRI, a tricyclic antidepressant)
179
give an example of a tricyclic antidepressant
Clomipramine
180
what are side effects of TCA
Dry mouth (anticholinergic) and weight gain (antihistaminic)
181
What is exposure and response prevention
gradually facing the obsessive thoughts and anxiety without completing the compulsions.
182
What are Personality disorders
covers a variety of maladaptive personality traits that cause significant psychosocial distress and interfere with functioning.
183
How are Personality disorders characterised
thought, behaviour and emotion that differ from what is normally expected.
inflexible and pervasive across situations and present in adolescence/early adulthood.
184
What are risk factors for personality disorders
Socioeconomic status
positive family history
poor parenting,
attachment issues in childhood
childhood abuse/neglect/deprivation.
185
what are possible symptoms of borderline personality disorder
Strong and intense emotions (e.g., anger)
Emotional instability (rapidly changing emotions)
Difficulty managing emotions
Difficulty maintaining relationships
Poor sense of identity
Feelings of emptiness
Fear of abandonment
Impulsive and risky behaviour
Recurrent self-harm
Recurrent suicidal behaviours
186
What three categories do personality disorders fall in based on DSM-5
Cluster A – Suspicious / eccentric/odd
Cluster B – Emotional or impulsive
Cluster C – Anxious
187
What are the cluster A/suspicious personality disorders
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
188
What is Paranoid personality disorder
difficulty in trusting or revealing personal information to others.
sensitive suspicious unforgiving of others
189
What is Schizoid personality disorder
a lack of interest or desire to form relationships with others and feelings that this is of no benefit to them
emotionally cold detached affect lack of interest in others
190
what is Schizotypal personality disorder
unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.
191
What are Cluster B/Emotional and Impulsive Personality Disorders
Antisocial personality disorder
Borderline (emotionally unstable) personality disorder
Histrionic personality disorder
Narcissistic personality disorder
192
What is Antisocial personality disorder
features reckless and harmful behaviour, with a lack of concern for the consequences or the impact of their behaviour on other people. It often involves criminal misconduct.
193
What is emotionally unstable impulsive type personality disorder
violent impulsive and poor response to criticism
194
What is emotionally unstable borderline type personality disorder
self imagine and chronic feelings of emptiness, intense unstable relationships self harm and suicidal attempts profound
195
What is histrionic personality disorder
the need to be the centre of attention and performing for others to maintain that attention
196
What is narcissistic personality disorder
features feelings that they are special and need others to recognise this, or else they get upset. They put themselves first.
197
What are cluster C/anxious personality disorders
Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder
198
How are personality disorders investigated
- Psychiatric history + MSE
- Personality diagnostic questionnaire (PDQ-IV)
- Minnesota multiphasic personality inventory
199
What is Avoidant personality disorder
features severe anxiety about rejection or disapproval and avoidance of social situations or relationships.
200
What is dependent personality disorder
features a heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach.
201
What is Obsessive-compulsive personality disorder
NOT SAME AS OCD
unrealistic expectations of how things should be done by themselves and others and catastrophising about what will happen if these expectations are not met.
preoccupation with orderliness and control
202
How are personality disorders managed
No specific pharmacological Tx - can treat depression/anxiety, and use mood stabilisers/antipsychotics
patterns of thinking and behaviours are deeply ingrained and are difficult to change
Psychotherapies eg CBT, DBT, MBT, psychodynamic therapy
Risk management
Supportive care in crisis
203
What is the main treatment for personality disorders
Psychological treatment e.g., cognitive behavioural therapy or dialectical behaviour therapy or Mentalisation-based therapy (MBT)
204
What medication can be used short term in personality disorder crisis
Sedative medications (e.g., sedative antihistamines
205
What is Schizophrenia
severe, long-term mental health disorder characterised by psychosis
impairment of perception and thinking
most often presents between ages 15 and 30 and earlier in men than women
206
How long must symptoms must be present for Schizophrenia diagnosis
6 months
207
What is Schizoaffective disorder
combines the symptoms of schizophrenia with bipolar disorder. Patients have psychosis and symptoms of depression and mania.
208
what is Schizophreniform disorder
presents with the same features as schizophrenia but lasts less than six months.
209
What often occurs before full symptoms of psychosis and what are the features
prodrome phase
* poor memory
* reduced concentration
* mood swings
* suspicion of others
* loss of appetite
* difficulty sleeping
* social withdrawal
* decreased motivation
210
What are risk factors for schizophrenia
FHx, traumatic childhood events, childhood cannabis use, birth trauma,
maternal poor health, urban living, emigrating to more developed country
211
What are indications of better prognosis for schizophrenia
high IQ, sudden onset, strong support network, obvious precipitating factor eg
traumatic life event, +ve Sx predominate.
212
What are DDx for psychosis
Mania
Psychotic depression
Drugs (e.g., hallucinogens and cannabis)
Stroke
Brain tumours
Cushing’s syndrome (e.g., patients taking systemic steroids)
Hyperthyroidism
Huntington’s disease
213
What is the central feature of schizophrenia and what are they called
Psychosis - Positive Symptoms
- Delusions (beliefs that are strongly held and clearly untrue)
- Auditory Hallucinations (perceiving things that are not real)
- Thought disorder (disorganised thoughts causing abnormal speech and behaviour)
- Passivity phenomenon
214
What are the negative symptoms of schizophrenia
Affective flattening
Alogia
Anhedonia
Avolition
Apathy
Attentional impairment
215
What does negative symptoms mean in schizophrenia
decrease or absence of normal function
216
what is Affective flattening
minimal emotional reaction to emotive subjects or events
217
what is Alogia
“poverty of speech” – reduced speech
lack of spontaneous speech
218
what is Anhedonia
lack of interest in activities
219
what is Avolition
lack of motivation in working towards goals or completing tasks
220
What is lack of insight
lack awareness that the delusions and hallucinations are not based in reality.
221
What is Auditory hallucinations
hearing voices, particularly a voice narrating the patient’s actions
222
What is somatic passivity
believing that an external entity is controlling their sensations and actions
223
What is thought insertion and thought withdrawl
believing that an external entity is inserting or removing their thoughts
224
what is thought broadcasting
believing that others are overhearing their thoughts
225
what is pressured speech
increased production of spontaneous speech
speaking much faster than usual, often without pausing and with irregularities in rhythm and loudness
226
what is Circumstantiality
moves onto diff topics w a followable train of thought, but eventually returns to original topic
long winded reply
227
what is derailment
conversation moves randomly from one topic to another
228
what is thought blocking
suddenly halts in thought process can/cannot continue
229
what is flight of ideas
stream of accelerated thoughts jumping rapidly topic to topic
have discernible links between them
230
what is Persecutory delusions
believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence
231
what is Ideas of reference
a false belief that unconnected events or details in the world directly relate to them
232
what is delusional perception
occurs when the patient experiences an ordinary and unremarkable perception (e.g., a cat crossing the road) that triggers a sudden, often self-related delusion (e.g., “and I knew I would be meeting the aliens on behalf of humanity”).
233
what are examples of reduced level of functioning in Schizophrenic patients
Social engagement
Productivity and achievement at work or school
Self-care
234
what is catatonia
someone is awake but does not seem to respond to other people and their environment
Stopping of voluntary movement or staying still in an unusual position
235
What is difference between normal and abnormal grief reaction
abnormal grief reactions are usually partially defined as being present 6+ months following the bereavement
Pseudohallucinations can be a frightening and confusing part of the grief reaction, but are considered non-pathological.
patient aware they r not real
236
What are typpes of patterns of Schizophrenia symptoms
Continuous
Episodic (relapsing and remitting)
A single episode only
237
what factors indicate poor prognosis for schizophrenia
FHx, abuse Hx, substance misuse, teenage onset, low IQ, male, slow onset
238
what factors indicate good prognosis for schizophrenia
high IQ, sudden onset, strong support network, obvious precipitating factor eg
traumatic life event, +ve Sx predominate.
239
What criteria is used for schizophrenia diagnosis
DSM-5 criteria.
240
What time frame is required for schizophrenia diagnosis
prodrome phase = 6 months
+
active phase = 1 month
241
What specialist psychiatry services are used to manage patients with schizophrenia
- Early intervention in psychosis services are available for the first episodes of psychosis
- Crisis resolution and home treatment teams provide urgent support for patients in a crisis
- Acute hospital admission (under the Mental Health Act when required)
- Community mental health team for ongoing monitoring and management
242
How is schizophrenia treated
Antipsychotic medications - atypical trialled first
Cognitive behavioural therapy
243
name two key associations with schizophrenia and antipsychotic drugs
metabolic syndrome & parkinsonian Sx & cardiovascular disease
244
What antipsychotic has least SE
Aripiprazole
245
What ibs the method of action for typical antipsychotic medication
inhibiting dopamine receptors, specifically antagonise D2 receptors in mesolimbic, mesocortical, substantia nigra
246
what symptoms in schizophrenia stem for mesolimbic
delusions and hallucinations
247
what symptoms in schizophrenia stem for mesocortical
negative symptoms
248
what symptoms in schizophrenia stem for substantia nigra
movement symptoms
blocking -> extrapyramidal side
effects
249
what symptoms in schizophrenia stem from tuberoinfundibular
prolactin secretion -> sexual
function and libido
250
What is the method of action for atypical antipsychotic medication
block 5HT2 receptor ->
metabolic side effects (eg weight gain,
impaired glycaemic control, lipid elevation)
251
Name two typical first gen Oral antipsychotics
Chlorpromazine
Haloperidol
flupentixol
252
Name two atypical second gen Oral antipsychotics
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
d
CORQA
253
Name two depot antipsychotics
Aripiprazole
Flupentixol
Paliperidone
Risperidone
254
What is key complication of Clozapine
** Agranulocytosis, with a severely low neutrophil count (predisposing to severe infections)
regular blood tests require
Myocarditis or cardiomyopathy, which can be fatal
**Constipation**
Seizures
Excessive salivation
255
What medication is used for treatment resistant schizophrenia
Clozapine
256
When is Dose adjustment of clozapine necessary
if smoking is started or stopped during treatment.
257
what is treatment resistant schizophrenia
the persistence of symptoms despite ≥2 trials of antipsychotic medications of adequate dose and duration with documented adherence
258
What are Monitoring requirements before starting and during antipsychotic treatment
Weight and waist circumference
Blood pressure and pulse rate
Bloods, including HbA1c, lipid profile and prolactin
ECG
259
What are side effects associated with antipsychotic drugs
Weight gain
drowsiness
constipation
dry mouth
sexual dysfunction
Raised prolactin
Extrapyramidal symptoms
260
What are side effects of typical antipsychotic drugs
Extrapyramidal side-effects and hyperprolactinaemia common
261
What are side effects of atypical antipsychotic drugs
Extrapyramidal side-effects and hyperprolactinaemia less common
Metabolic effects
262
What are Extrapyramidal symptoms
- Akathisia
- Dystonia
- Pseudo-parkinsonism
- Tardive dyskinesia
______________________
shaking
trembling
muscle twitches
muscle spasms
263
What is Akathisia
psychomotor restlessness, with an inability to stay still
264
What is Dystonia
sustained muscle contraction
abnormal muscle tone
265
What is pseudo-parkinsonism
resting tremor, rigidity, bradykinesia
266
What is Tardive dyskinesia
abnormal involuntary movements, particularly affecting the face/mouth
267
What is a complication of antipsychotic treatment.
Neuroleptic Malignant Syndrome
268
what is Neuroleptic Malignant Syndrome
Adverse reaction to antipsychotics (dopamine receptor agonist) or abrupt dopaminergic withdrawal (levodopa)
269
What are key features of Neuroleptic malignant syndrome
* Muscle rigidity
* Hyperthermia (raised body temperature)
* Altered mental state
* Autonomic dysfunction (e.g., fluctuating blood pressure and tachycardia)
**pyrexia, muscle stiffness**
270
how is Neuroleptic malignant syndrome investigated
bloods, CT/MRI head, infection screen
271
What are key blood test findings for Neuroleptic malignant syndrome
Raised creatine kinase
Raised white cell count (leukocytosis)
272
how is Neuroleptic malignant syndrome managed
medical emergency
stopping the causative medications and supportive care (e.g., IV fluids and sedation with benzodiazepines
Severe cases may require treatment with bromocriptine (a dopamine agonist) or dantrolene (a muscle relaxant).
273
what are the complications of neuroleptic malignany syndrome
PE, Renal Failure, Shock
274
What is Acute Dystonic Syndrome
Caused by typical antipsychotics - EPSEs
275
What are symptoms of Acute Dystonic Syndrome
extremely painful contraction in the
- eyes - oculogyric crisis
- neck - antero/latero/retro/torticollis
- jaw
Arm held in dystonic posture, neck spasm to side, mouth open, upward eye gaze, pain and distress
276
What is the management of Acute Dystonic Syndrome
IM Procyclidine 5-10mg
277
What are other SE to typical antipsychotics
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin
impaired glucose tolerance
Lower seizure threshold
prolonged QT
278
What is the mental health act 1983
provides a legal framework for keeping patients in hospital against their wish for assessment and treatment of a mental health disorder.
279
What is an informal admission
a patient with capacity agrees to be admitted to hospital voluntarily
does not involve detention under the Mental Health Act
280
When can a pateint be detained under MHA
They have a mental disorder that poses significant risk to themselves or others, and treatment in the community is not possible because of this
281
What people are involved in an admission under the Mental Health Act
Approved Mental Health Professional (AMHP)
Section 12 doctor
Responsible Clinician
Nearest Relative
Independent Mental Health Advocate (IMHA)
282
what is a section 12 doctor
qualified and approved doctor (usually a psychiatrist) who can undertake Mental Health Act assessments
283
What a Mental Health Act assessment
detailed evaluation to determine whether to detain someone under the Mental Health Act.
284
who is the primary person making application and organising the admission under MHA
Approved Mental Health Professional (AMHP)
specially qualified professional (e.g., social worker or mental health nurse)
285
What 2 doctors are needed to recommend a patient under MHA
A Section 12 doctor
Another doctor (e.g., their GP)
286
What sections can result in compulsory admission under MHA
Section 2 or Section 3.
287
What is section 2
28 days; for assessment (can treat)
It cannot be renewed. It ends in either discharge or further detention under Section 3.
2 doctors (1 S12 approved) + 1 AMHP
288
what evidence is needed for section 2
1. Mental disorder present
2. For patient’s safety or
protection of others
289
What is section 3
6 months; for treatment
can be renewed
2 doctors (1 S12 approved) + 1 AMHP
290
what evidence is needed for section 3
1. Mental disorder present
2. Treatment in best interest
3. Treatment is available
291
what is section 4
detain patients for up to 72 hours in urgent scenarios where other procedures cannot be arranged in time
an AMHP and one doctor.
It is followed by a Mental Health Act assessment.
292
what evidence is needed for section 4
1. Mental disorder present
2. For patient’s safety or protection of others
3. Not enough time for 2nd doctor to attend
293
What is a section 5(2)
can stop a patient leaving any ward up to 72hrs to allow for MHA to be organised
requires only one doctor.
294
what evidence is needed for section 5(2)
-to wait if S2 or S3 are needed
-FY2 and above
295
what is a section 5(4)
can stop psychiatric patient leaving a ward up to 6hrs to allow for MHA by a doctor
requires only one nurse.
296
what evidence is needed for section 5(4)
-to wait for medical assessment
297
What is a section 136
police power
to take an individual to a place of safety - from a public place
It lasts up to 24 hours.
It is followed by a Mental Health Act assessment.
298
what evidence is needed for section 136
person suspected to have a mental disorder in a public place
299
what is a section 135
to enter someone’s property and take them to a place of safety needs magistrate approval
36 hours
300
what evidence is needed for section 135
needs court order to access pt’s home and remove them to a place of safety
301
What is drug addiction
the compulsive use of substances, often leading to harmful physical, psychological and social consequences.
302
what is tolerance
a loss of effect when taking the same dose
303
what is dependence
a physiological and psychological need to keep using a drug.
304
Name 2 factors that contribute to dependence
Physiological changes
Psychological factors
305
what are Psychological factors of dependence
cravings and compulsions to use the drug
306
How do benzodiazepines cause withdrawl
- Benzodiazepines work by stimulating GABA receptors.
- GABA is an inhibitory neurotransmitter that has a relaxing effect.
- Long-term use of benzodiazepines results in the body reducing its natural production of GABA to balance the stimulating effects of the drug.
- When the drug is withdrawn, there is under-activity of the GABA system, causing withdrawal symptoms
307
name benzodiazepines withdrawl symptoms
anxiety, irritability, tremors, insomnia and even seizures.
308
What is the reward pathway in brain called
mesolimbic pathway
309
what is the primary neurotransmitter involved in the reward pathway in brain
dopamine
310
What are key structure in mesolimbic pathway
ventral tegmental area, nucleus accumbens, amygdala, and prefrontal cortex
311
What structure has trigger for substance or behaviour embedded into
amygdala
People, events, places or objects can act as cues, triggering cravings
312
What area of brain is responsible for executive function
prefrontal cortex
eg decision-making, assessing risk, and controlling impulses.
313
what is the basic mechanism of action of opioids
Stimulates opioid receptors
314
what is the basic mechanism of action of cocaine
blocks reuptake of dopamine by the presynaptic membrane
315
what is the basic mechanism of action of MDMA
stimulates the release of serotonin and blocks its reuptake
316
what is the basic mechanism of action of meth
stimulates the release of dopamine and blocks its reuptake
317
what is the basic mechanism of action of depressants (alcohol/benzos)
Stimulates gamma-aminobutyric acid (GABA) receptors
318
what is the basic mechanism of action of hallucinogens (LSD)
Stimulate serotonin receptors, particularly 5-HT2A receptors
319
what is the basic mechanism of action of cannabinoids
Stimulates cannabinoid receptors (CB1 and CB2)
320
what is the basic mechanism of action of anticonvulsants (pregabalin/gabapentin)
Blocks voltage-gated calcium channels in the presynaptic membrane, reducing the release of excretory neurotransmitters
321
what is the basic mechanism of action of nicotine
Stimulates nicotinic acetylcholine receptors
322
What management is involved in addiction Tx
Detoxification (may be coordinated at home or as an inpatient)
Medication to help maintain abstinence
Psychological and behavioural therapies (e.g., cognitive behavioural therapy)
Ongoing support (e.g., a recovery coordinator and support groups)
323
What medication is used to opioid dependence
Methadone (Opiate receptor agonist)
Buprenorphine (Partial opiate receptor agonist)
Naltrexone (reduce cravings)
324
What medication is used for nicotine dependence
Nicotine replacement therapy (e.g., patches, gum or lozenges)
Bupropion (reduce pleasure)
Varenicline (reduce cravings)
325
What is alcohol dependence
craves alcohol and is unable to control their drinking
* daily consumption
* cravings
* difficulty controlling consumption
* tolerance to the effects
* withdrawal symptoms
326
What is alcohol mode of action
depressant
stimulates GABA receptors, which have a relaxing effect on the brain.
It also inhibits glutamate receptors (also known as NMDA receptors), causing a further relaxing effect on the electrical activity of the brain (glutamate is an excitatory neurotransmitter).
327
What happens to neurotransmitters in long term alcohol use
the GABA system becoming down-regulated and the glutamate system becoming up-regulated to balance the effects of alcohol.
-> cessation causes CNS-hyperexcitability
328
What is the equation of calculating alcohol units
Volume (ml) x Alcohol Content (%) ÷ 1000 = Units of Alcohol
329
How many units in a shot of vodka
For a 25 ml shot of 40% vodka: 25 x 40 / 1000= 1 unit
330
How many units in a pint
2-3
For 500 mls of 5.2% lager: 500 x 5.2 / 1000 = 2.6 units
331
What is the recommended alcohol consumption
Not more than 14 units per week
Spread evenly over 3 or more days
Not more than 5 units in a single day
332
How is binge drinking defined
6 or more units for women
8 or more units for men
333
What can alcohol in early pregnancy lead to
Miscarriage
Small for dates
Preterm delivery
Fetal alcohol syndrome
334
Name 5 complications of alcohol excess
Alcohol-related liver disease
Cirrhosis
Alcohol dependence and withdrawal
Wernicke-Korsakoff syndrome (WKS)
Pancreatitis
Alcoholic cardiomyopathy
Increased risk of cardiovascular disease
Increased risk of cancer, particularly breast, mouth and throat cancer
335
what are complications of cirrhosis
oesophageal varices, ascites and hepatocellular carcinoma
336
What questionnaire is used to screen for harmful alcohol use and what score indicates harmful use
Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organisation
A score of 8 or more indicates harmful use.
337
What are the CAGE questions
C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
338
What findings would you see on examination for excess alcohol use
Smelling of alcohol
Slurred speech
Ataxia
Bloodshot eyes
Dilated capillaries on the face (telangiectasia)
Tremor
339
What would blood test results show for alcohol excess
- Raised mean corpuscular volume (MCV)
- Raised ALT and AST
- AST:ALT ratio above 1.5
- Raised gamma-GT
340
What is a serious complication of alcohol withdrawl
delirium tremens
341
What withdrawal symptoms occur after 6-12 hours after alcohol consumption ceases
tremor, sweating, headache, craving and anxiety
342
What withdrawal symptoms occur after 12-24 hours after alcohol consumption ceases
hallucinations
343
What withdrawal symptoms occur after 24-48 hours after alcohol consumption ceases
seizures peak incidence 36 hrs
344
What withdrawal symptoms occur after 72 hours after alcohol consumption ceases
delirium tremens
345
What is delirium tremens
a medical emergency associated with alcohol withdrawal. Untreated, the mortality rate is 35%.
346
How does delirium tremens present
* coarse tremor
* confusion
* delusions
* auditory and visual hallucinations
* fever
* tachycardia
347
How is delirium tremen managed
IV Pabrinex + Chlordiazepoxide
348
What tool scores a patients alcohol withdrawl symptoms
CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised)
349
What medication is most commonly used to manage alcohol withdrawl
first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam
(e.g., 10 – 40 mg every 1 – 4 hours). The dose is reduced over 5-7 days.
+ IV thiamine/pabrinex
350
What medication is an alternative to Chlordiazepoxide
Diazepam
Lorazepam -> hepatic failure
351
What intervention is used in the long term management of alcohol dependence
Specialist alcohol service involvement
Alcohol detoxification programme
Oral thiamine to prevent Wernicke-Korsakoff syndrome
Psychological therapy (e.g., cognitive behavioural therapy)
Acamprosate, naltrexone or disulfiram are medications used to help maintain abstinence
Informing the DVLA (their driving licence will be revoked until an extended period of abstinence)
352
What is Wernicke-Korsakoff Syndrome
Alcohol excess leads to thiamine (vitamin B1) deficiency. Thiamine is poorly absorbed in the presence of alcohol.
Thiamine deficiency leads to Wernicke’s encephalopathy and Korsakoff syndrome
353
What medication is given to prevent Wernicke-Korsakoff syndrome.
High-dose B vitamins (Pabrinex) are given intramuscularly or intravenously, followed by long-term oral thiamine.
354
What is Wernicke-Korsakoff syndrome.
Alcohol excess leads to thiamine (vitamin B1) deficiency.
Thiamine is poorly absorbed in the presence of alcohol.
Alcoholics often have poor diets and get many of their calories from alcohol.
355
What are feature of Wernicke’s encephalopathy
* oculomotor dysfunction
* nystagmus
* ophthalmoplegia
* ataxia
* confusion, disorientation, indifference, and inattentiveness
* peripheral sensory neuropathy
356
What are feature of Korsakoff syndrome
anterograde amnesia: inability to acquire new memories
retrograde amnesia
confabulation
357
what is prognosis of Wernicke’s encephalopathy
medical emergency with a high mortality rate
358
what is prognosis of Korsakoff syndrome
often irreversible and results in patients requiring full-time institutional care.
359
what medication can be used to maintain alcohol sobriety
- disulifram (makes u throw up if have alcohol)
- naltrezone (dec pleasure)
- acamprosate (anti craving tablet)
360
What is autistim spectrum disorder
impairments in social interaction, communication and behaviour.
as well as repetitive stereotyped behaviour, interests, and activities
361
What causes autism
complex & multifactorial
- Genetic
- FHx
- Advanced parental age
- Environmental
362
What genetic diagnoses are associated with autism
Tuberous sclerosis complex
Fragile X syndrome
Chromosome 15q11-13 duplication syndrome
Angelman syndrome
Rett's syndrome
Down syndrome
363
How is autism severity assessed
Level 1 (requiring support)
Level 2 (requiring substantial support), and
Level 3 (requiring very substantial support).
364
What previously recognised diagnoses does autistic spectrum disorder group
Asperger’s syndrome, autistic disorder and pervasive developmental disorder
365
What is the mild end of Autistic spectrum disorder
patients have normal intelligence and the ability to function in everyday life but display difficulties with reading emotions and responding to others
previously known as Asperger’s disorder
366
What is the severe end of Autistic spectrum disorder
patients can be severely affected and unable to function in typical environments.
367
What 3 categories does ASD deficit fall under
social interaction, communication and behaviour
368
Before what age are features of autism typically observable
3 years
369
What features are included in deficits in social interaction
Lack of eye contact
Delay in smiling
Avoiding physical contact
Unable to read non-verbal cues
Difficulty establishing friendships
Not displaying a desire to share attention (e.g., not playing with others)
370
What features are included in deficits in social interaction
* Delay, absence or regression in language development
* Lack of appropriate non-verbal communication (e.g., smiling, eye contact, responding to others and sharing interest)
* Difficulty with imaginative or imitative behaviour
* Repetitive use of words or phrases
371
What features are included in deficits in behavious in autism
* Greater interest in objects, numbers or patterns than people
* Stereotypical repetitive movements (e.g., self-stimulating movements, such as hand-flapping or rocking)
* Intense and deep interests that are persistent and rigid
* Repetitive behaviour and fixed routines
* Anxiety and distress with experiences outside their regular routine
* Extremely restricted food preferences
372
How is an autism diagnosis mande
An autism specialist should make the diagnosis.
Diagnosis usually involves assessment by psychiatrists and clinical psychologists.
It involves a detailed evaluation of the patient’s current and historical behaviour and communication.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
373
What people might be involved in MDT to manage autism
Child and adolescent mental health services (CAMHS)
Psychologists
Speech and language specialists
Dieticians
Paediatricians
Social workers
Specially trained educators and special school environments
Charity organisations (e.g., National Autistic Society)
374
What is Attention deficit hyperactivity disorder
neurodevelopment disorder featuring the core features of difficulty maintaining attention, excessive energy and activity, and impulsivity.
375
What factors are thought to contribute to ADHD
Genetic (there is significant heritability)
Pregnancy-related factors (e.g., maternal smoking, premature birth and low birth weight)
Environmental factors
376
When and how do symptoms present for ADHD
start in childhood and should be consistent across settings.
When a person displays symptoms only at work or school but is calm and focused at home, this is suggestive of an environmental effect rather than an underlying diagnosis.
377
What are features of ADHD
Short attention span
Easily distracted
Quickly moving from one activity to another
Quickly losing interest in a task
Inability to persist with and complete tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive behaviour
Difficulty managing time
378
Features of ADHD can be part of a normal spectrum of behaviour, when is ADHD considered
When many of these features are present, and they are adversely affecting the person
379
What screening test is used for ADHD
Adult ADHD Self-Report Scale (ASRS)
380
What managing strategies for parents are relevant for ADHD children
A positive approach
Structured routines
Clear boundaries
Plenty of physical activity
A healthy diet (certain foods may exacerbate the symptoms)
381
What self management strategies are relevant for adults
organisation techniques, a healthy diet, exercise, and a sleep routine.
Reasonable adjustments to the workplace may be helpful.
382
When is medication considered for ADHD
after conservative management has failed, or in severe cases
383
Name two examples of medication for ADHD
Methylphenidate - 1st line
Lisdexamfetamine
Dexamfetamine
Atomoxetine
384
What is the mode of action for ADHD medication
central nervous system stimulants.
reuptake of dopamine and noradrenaline
385
What are the monitoring requirements for ADHD medication
heart rate, blood pressure, weight and mood changes.
386
Name 4 ways to assess risk of suicide
- Risk assessment tools eg DRAM, FACE
- Clinical Assessment - psychiatric history + MSE
- Static risk factors - do not change
- Dynamic risk factors - may change
387
Name 4 static risk factors of suicide
* History of self-harm/ overdoses
* Seriousness of previous suicidality
* Previous hospitalisation
* History of mental disorder
* History of substance use disorder
(overdose or suicide)
* Personality disorder/traits
* Childhood adversity
* Family history of suicide
* Age, gender and marital status
388
Name 4 dynamic risk factors of suicide
* Suicidal ideation, communication,
and intent
* Hopelessness
* Psych Sx – ?command hallucinations
* Treatment adherence
* Substance use
* Psychiatric admission and discharge -
risk when discharged
* Psychosocial stress
* Problem-solving deficits
389
What is Somatisation disorder
multiple chronic physical complaints that persist for at least two years and are accompanied by refusal to accept reassurance following negative investigations.
390
what are results of long-term lithium use
hyperparathyroidism and resultant hypercalcaemia
391
what is Functional neurological disorder
typically involves loss of motor or sensory function present after peroid of stress -
hoover test positive
392
what can SSRI use in 1st and 3rd trimester cause
3rd trimester = persistent pulmonary hypertension
1st trimester= small increased chance of congenital heart defects
393
how long does it take for SSRI to ellicte response in depression and OCD
depression = 2-4 weeks
OCD = 12 weeks
394
what is Brief psychotic disorder
episode of psychosis lasting less than a month with a subsequent return to baseline functioning.
395
what are SE of antipsychotics in the elderly
VTE
396
how should people be taken off SSRIs
dose should be gradually reduced over a 4 week period
397
how is Tardive dyskinesia managed
tetrabenazine
398
how is Akathisia managed
propranolol
399
what SE are SNRI associated with
development of hypertension
400
