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Psychiatry Flashcards

1
Q

What is the Mental Health Act?

A
  • 1983 and updated 2007
  • legal framework for informal and compulsory care and treatment
  • keeping pt in hospital against their wishes
  • for people diagnosed with a mental disorder
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2
Q

What is an informal admission?

A
  • patient with capacity
  • agrees to be admitted voluntarily
  • does not involve the MHA
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3
Q

Who is involved in the MHA?

A
  • Approved mental health professional
  • section 12 doctor
  • responsible clinician
  • nearest relative
  • independent mental health advocate
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4
Q

What is an approved mental health professional?

A
  • social worker
  • MH nurse
  • occupational therapist
  • psychiatrist
  • helps to organise and contribute to assessments
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5
Q

What is a mental disorder?

A
  • mental illness:
  • personality disorder
  • learning disability (associated w aggressive behaviour/irresponsible conduct)
  • disorders of sexual preference
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6
Q

What is section 2?

A
  • compulsory detention for assessment
  • max period 28 days, can’t be renewed
  • ends in section 3 or discharge
  • admission by AMHP/ nearest relative and TWO doctors (1 is section 12 approved)
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7
Q

What are the 2 criteria needed for section 2?

A
  • person suffers from a mental disorder that warrants detention
  • person ought to be detained in interests of their own health and safety or protection of others
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8
Q

What is section 3?

A
  • compulsory admission for treatment
  • max period 6 months can be renewed
  • requires MHA assessment
  • well-known pts can be detained straight from community
  • application by AMHP/relative and TWO doctors (1 is section 12)
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9
Q

What are the 3 criteria for section 3?

A
  • person suffers from a mental disorder requiring hospital treatment
  • necessary for health of pt and protection of others
  • appropriate medical treatment available
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10
Q

What is section 4?

A
  • admission in emergency
  • detain patients for up to 72hrs > section 2
  • requires AMHP/relative and 1 doctor
  • primarily used in outpatient
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11
Q

What is section 5(2)?

A
  • used in emergency
  • detain patients already in hosp voluntarily
  • changes status from informal to formal
  • lasts up to 72hrs
  • requires 1 doctor
  • followed by MHA assessment
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12
Q

What is section 5(4)?

A
  • used in emergency when clinican not present
  • detain pt already in hosp voluntarily
  • requires 1 nurse
  • lasts up to 6hrs
  • followed by MHA assessment
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13
Q

What is section 136?

A
  • used by police
  • remove someone who appears to have mental health disorder from public
  • take to safe place for assessment
  • lasts up to 24h
  • followed by MHA assessment
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14
Q

What is section 135?

A
  • requires magistrates warrant
  • allows police to enter private property
  • accompanied by AMHP and doctor
  • remove to a place of safety
  • assessment at home or in safe place
  • lasts up to 24hrs (can be extended up to 12h)
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15
Q

What are the criteria for section 135?

A
  • have a mental disorder
  • being ill-treated or neglected
  • or unable to look after themselves
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16
Q

What is section 135(2)?

A
  • allows entry to private property
  • return a person previously detained in hospital who left without permission
  • subject to a CTO or guardianship but non-compliant
  • application by AMHP/doctor
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17
Q

What is section 131?

A
  • voluntary informal admission
  • admitted w/out formal restrictions
  • free to leave at any time
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18
Q

What are the 3 criteria for section 131?

A
  • must have capacity
  • must consent to admission
  • must not resist admission
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19
Q

What is the pathophysiology of depression?

A
  • disturbance in neurotransmitter activity in the CNS
  • particularly in serotonin (5-HT)
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20
Q

What are the 3 core symptoms of depression?

A
  • anhedonia
  • low mood
  • anergia/fatigue
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21
Q

What are some emotional symptoms of depression?

A
  • anxiety
  • irritability
  • low self-esteem
  • guilt
  • hopelessness
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22
Q

What are some cognitive symptoms of depression?

A
  • poor concentration
  • slow thoughts
  • poor memory
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23
Q

What are some physical symptoms of depression?

A
  • low energy
  • abnormal sleep
  • poor appetite/overeating
  • slow movements
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24
Q

How do SSRIs work?

A
  • block reuptake of serotonin by presynaptic membrane
  • results in more serotonin in synapses in CNS
  • boosts communication between neurones
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25
Q

What are some examples of SSRIs?

A
  • sertraline
  • citalopram
  • fluoxetine
  • paroxetine
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26
Q

What is the risk of citalopram?

A
  • prolong QT interval
  • leading to torsades de pointes
  • least safe SSRI
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27
Q

What are the contraindications to SSRIs?

A
  • omitted in mania
  • caution in children and adolescents
  • avoided in warfarin
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28
Q

What is serotonin syndrome?

A
  • drug induced
  • excess serotonin in CNS due to SSRI
  • onset within hours
  • supportive management
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29
Q

What is the triad seen in serotonin syndrome?

A
  • altered mental state: anxiety, delirium
  • autonomic hyperactivity : hyperthermia, tachycardia
  • neuromuscular abnormalities: tremor, clonus, rigidity
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30
Q

What is the management of serotonin syndrome?

A
  • bloods
  • benzodiazepines
  • cyproheptadine
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31
Q

What are side effects of SSRIs?

A
  • GI symptoms
  • headaches
  • sexual dysfunction
  • insomnia
  • increased risk of bleeding esp with anticoags or NSAIDs
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32
Q

How do SNRIs work?

A
  • block reuptake of serotonin and noradrenaline
  • resulting in more in synapses in CNS
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33
Q

What are some examples of SNRIs?

A
  • duloxetine
  • venlafaxine
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34
Q

What psychiatric symptoms can occur when starting antidepressants?

A
  • worsened agitation
  • anxiety
  • suicidal thoughts or acts
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35
Q

When should patients be reviewed after starting antidepressants?

A
  • within two weeks
  • one week if aged 18-25/high suicide
  • noticeable response within 2-4 weeks
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36
Q

Can antidepressants be swapped?

A
  • SSRIs and SNRIs can be directly swapped
  • cross-tapered e.g. SSRI to mirtazapine > reduce existing drug and increase new one
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37
Q

What is the procedure for stopping antidepressants?

A
  • should be continued for at least 6mo after starting
  • dose reduced over 4 weeks to minimise discontinuation symptoms
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38
Q

What are discontinuation symptoms?

A
  • flu-like symptoms
  • electric shock like sensations
  • irritability
  • insomnia
  • vivid dreams
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39
Q

What are the key side effects of mirtazapine and when should it be taken?

A
  • sedation (more in low doses but take @ night)
  • increased appetite
  • weight gain
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40
Q

How do tricyclic antidepressants work?

A
  • block reuptake of serotonin and noradrenaline
  • block Ach and histamine
  • giving sedative side effects
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41
Q

What are some examples of tricyclic antidepressants?

A
  • amitriptyline
  • nortriptyline
  • imipramime
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42
Q

What are some cardiovascular effects of tricyclic antidepressants?

A
  • arrythmia
  • tachycardia
  • prolonged QT
  • bundle branch block
  • dangerous in overdose - so not used in suicide risk
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43
Q

What are some anticholinergic side effects of tricyclic antidepressants?

A
  • dry mouth
  • constipation
  • urinary retention
  • blurred vision
  • cognitive impairment
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44
Q

What is the mechanism of action of typical psychotics?

A
  • dopamine receptor antagonists
  • inhibit dopaminergic neurotransmission
  • noradrenergic, cholinergic, histaminergic blocking properties
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45
Q

What are some examples of typical antipsychotics?

A
  • haloperidol
  • chlorpromazine
  • flupentixol
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46
Q

What is the action of atypical antipsychotics?

A
  • dopamine and serotonin antagonists
  • block D2 dopamine receptors
  • block 5-HT2A serotonin receptors
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47
Q

What are atypical antipsychotics?

A
  • second generation
  • effective against positive and negative symptoms of schizophrenia
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48
Q

What are examples of atypical antipsychotics?

A
  • risperidone
  • quetiapine
  • olanzapine
  • clozapine
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49
Q

What are side effects of atypical antipsychotics?

A
  • weight gain
  • dyslipidaemia
  • seizures
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50
Q

When is clozapine used?

A
  • atypical antipsychotic
  • used in treatment resistant schizophrenia
  • after trial of 2 antipsychotic drugs
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51
Q

What is clozapine induced neutropenia?

A
  • can cause neutropenia (low neutrophils) or agranulocytosis (+low basophils and eosinophils)
  • FBC weekly for 18 weeks, then fortnightly until 1 year, after which monthly
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52
Q

How does neutropenia present?

A
  • fever (flu like symptoms)
  • rigors
  • hypotension
  • tachycardia
  • altered mental status
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53
Q

How do patients with clozapine induced myocarditis present?

A
  • tachycardia at rest
  • chest pain
  • abnormal rhythm
  • palpitations
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54
Q

How is myocarditis investigated?

A
  • ECG
  • cardiac exam
  • troponin
  • CRP
  • echocardiogram
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55
Q

How does clozapine affect the GI system?

A
  • impairs motility of GI system
  • constipation
  • intestinal obstruction
  • faecal impaction
  • paralytic ileus
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56
Q

What is bipolar disorder?

A
  • characterised by recurrent episodes of depression, mania or hypomania
  • symptoms start <25
  • high suicide rate
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57
Q

What are manic episodes?

A
  • excessively elevated mood and energy
  • persisting >7 days
  • significantly impacts normal functioning
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58
Q

What is hypomania?

A
  • increased/decreased function for >4 days without psychotic symptoms
  • milder
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59
Q

What is bipolar I disorder?

A
  • at least one episode of mania
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60
Q

What is bipolar II disorder?

A
  • at least one episode of major depression
  • at least 1 ep of hypomania
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61
Q

What is cyclothymia?

A
  • milder symptoms of hypomania and low mood
  • symptoms not severe enough to impact function
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62
Q

What is unipolar depression?

A
  • person only has episodes of depression
  • without mania or hypomania
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63
Q

What is the long term management of bipolar disorder?

A
  • lithium
  • alternatives: sodium valproate and olanzapine
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64
Q

What are side effects of lithium?

A
  • fine tremor
  • weight gain
  • seizures
  • CKD
  • hypothyroidism and goitre
  • hyperpth and hypercalcaemia
  • nephrogenic diabetes insipidus
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65
Q

What are the dangers of sodium valproate?

A
  • teratogenic: neural tube defects
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66
Q

What are the symptoms of mania?

A
  • abnormally elevated mood
  • irritability
  • increased energy
  • decreased sleep
  • grandiosity, excessive spending, risk-taking
  • disinhibition
  • flight of ideas
  • pressured speech
  • psychosis
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67
Q

How is an acute manic episode managed?

A
  • antipsychotic medications
  • existing antidepressants tapered and stopped
  • lithium and sodium valproate
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68
Q

How is an acute depressive episode in bipolar disorder managed?

A
  • olanzapine plus fluoxetine
  • antipsychotics
  • lamotrigine
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69
Q

What is the non-pharmacological management of bipolar disorder?

A
  • psychoeducation
  • IPT
  • CBT
  • social support
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70
Q

What is schizophrenia?

A
  • severe, long-term mental health disorder
  • characterised by psychosis
  • lasts 6+ months
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71
Q

When is schizophrenia most commonly diagnosed?

A
  • presents between 15-30 years old
  • diagnosed earlier in men than women
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72
Q

What is schizoaffective disorder?

A
  • combining the symptoms of schizophrenia with bipolar disorder
  • psychosis, depression and mania
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73
Q

What is schizophreniform disorder?

A
  • presents w/ same features as schizophrenia
  • lasts <6 months
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74
Q

What is the cause of schizophrenia?

A
  • genetic
  • environmental
  • affected family member is RF
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75
Q

What is a prodrome phase?

A
  • subtle symptoms
  • precedes full symptoms
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76
Q

What symptoms are experienced in a prodrome phase of schizophrenia?

A
  • poor memory
  • reduced concentration
  • mood swings
  • social withdrawal
  • suspicion of others
  • loss of appetite
  • difficulty sleeping
  • decreased motivation
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77
Q

What are the key features of psychosis?

A
  • delusions
  • hallucinations
  • thought disorder
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78
Q

What are delusions?

A
  • beliefs that are strongly held and clearly untrue
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79
Q

What are hallucinations?

A
  • perceiving things that aren’t real
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80
Q

What is a thought disorder?

A
  • disorganised thoughts causing abnormal speech and behaviour
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81
Q

What are key positive symptoms of schizophrenia?

A
  • auditory hallucinations
  • somatic passivity
  • thought disturbance: insertion, withdrawal, broadcasting
  • delusions: persecutory, delusional perceptions, ideas of reference
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82
Q

What are the specific characteristics of auditory hallucinations in schizophrenia?

A
  • thought echo
  • 2+ voices discussing the patient in 3rd person
  • voices commenting on the pts behaviour
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83
Q

What is thought broadcasting?

A

the belief that others are overhearing their thoughts

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84
Q

What is thought insertion/withdrawal?

A
  • the idea that an external entity is inserting or removing their thoughts
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85
Q

What are persecutory delusions?

A

false belief that a person or group is going to harm them

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86
Q

What is a delusional perception?

A
  • when an ordinary event triggers a sudden self-related delusion
  • e.g. seeing the cat > knew I was going to meet an alien
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87
Q

What is the ABCD mnemonic for positive symptoms of schizophrenia?

A
  • auditory hallucinations
  • broadcasting of thoughts
  • control issues
  • delusional perception
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88
Q

What are ideas of reference?

A
  • false belief that unconnected events or details in the world directly relate to them
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89
Q

What is somatic passivity?

A
  • believing an external entity is controlling their sensation and action
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90
Q

What are negative symptoms of schizophrenia?

A
  • affective flattening
  • alogia
  • anhedonia
  • avolition
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91
Q

What is affective flattening?

A
  • minimal emotional reaction to emotive subjects or events
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92
Q

What is alogia?

A
  • poverty of speech
  • reduced speech
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93
Q

What is avolition?

A
  • lack of motivation in completing tasks or working towards goals
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94
Q

What types of functioning are reduced in schizophrenia?

A
  • social engagement
  • productivity at work or school
  • self-care
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95
Q

What is the pattern of symptoms in schizophrenia?

A
  • continuous
  • episodic
  • a single episode
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96
Q

What does the DSM-5 criteria require for the diagnosis of schizophrenia?

A
  • prodrome phase for >6 months
  • active phase for > 1 month
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97
Q

How is schizophrenia treated?

A
  • antipsychotic medications
  • CBT
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98
Q

Which psychiatric teams manage patients with schizophrenia?

A
  • early intervention in psychosis
  • crisis resolution and home treatment teams
  • acute hospital admission
  • community mental health team
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99
Q

What medical conditions are associated with schizophrenia and antipsychotics?

A
  • metabolic syndrome
  • cardiovascular disease
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100
Q

What are side effects of antipsychotic drugs?

A
  • weight gain
  • diabetes
  • prolonged QT interval
  • raised prolactin
  • extrapyramidal symptoms
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101
Q

What are some extra pyramidal symptoms?

A
  • akathisia (restlessness)
  • dystonia (abnormal muscle tone)
  • pseudo-parkinsonism
  • tardive dyskinesia
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102
Q

What are depot antipsychotics?

A
  • IM injections
  • given every 2 weeks - 3 months
  • helpful with lack of adherence
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103
Q

What are examples of depot antipsychotics?

A
  • aripiprazole
  • flupentoxil
  • risperidone
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104
Q

What are the possible adverse effects of clozapine?

A
  • agranulocytosis
  • myocarditis
  • constipation
  • seizures
  • excess salivation
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105
Q

What must be monitored during antipsychotic treatment?

A
  • weight and waist circumference
  • blood pressure and pulse rate
  • bloods (HbA1c, lipids, prolactin)
  • ECG
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106
Q

What is a personality disorder?

A
  • maladaptive personality traits causing significant psychosocial stress
  • interfere with functioning
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107
Q

What are the Class A personality disorders?

A
  • suspicious type
  • paranoid
  • schizoid
  • schizotypal
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108
Q

What is paranoid personality disorder?

A
  • difficulty trusting people
  • difficulty revealing personal info
  • hypersensitive to criticism
  • believes others are plotting against them
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109
Q

What is a schizoid personality disorder?

A
  • lack of interest in relationships with others
  • emotional coldness
  • indifference to praise/criticism
  • preference for solitary activity
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110
Q

What is a schizotypal personality disorder?

A
  • magical thinking, odd beliefs and behaviour
  • ideas of reference
  • social anxiety + paranoid
  • similar to schizophrenia, absence of delusions
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111
Q

What are Class B personality disorders?

A
  • emotional or impulsive
  • antisocial
  • borderline
  • histrionic
  • narcissistic
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112
Q

What is antisocial personality disorder?

A
  • reckless and harmful behaviour
  • lack of concern for consequences
  • aggressive and unremorseful
  • criminal misconduct
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113
Q

What is borderline personality disorder?

A
  • fluctuating strong emotions
  • difficulties with identity
  • struggles to maintain healthy relationships
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114
Q

What is histrionic personality disorder?

A
  • need to be centre of attention
  • shallow, dramatic, emotional expressions
  • perceive relationships as being more intimate than they actually are
  • tendency towards inappropriate sexual behaviours
115
Q

What is narcissistic personality disorder?

A
  • feeling of entitlement and need for others to recognise this
  • pattern of grandiosity, need for admiration, lack of empathy
116
Q

What are Class C personality disorders?

A
  • anxious types
  • avoidant
  • dependent
  • obsessive-compulsive
117
Q

What is avoidant personality disorder?

A
  • severe anxiety about rejection or disapproval
  • avoidance of social situations and relationships
  • fear of criticism
118
Q

What is dependent personality disorder?

A
  • heavy reliance on others to make decisions, very passive
  • lack self-confidence and initiative
  • submissive and clinging behaviour
119
Q

What is obsessive-compulsive personality disorder?

A
  • unrealistic expectations of how things should be done
  • catastrophising about what will happen if expectations aren’t met
120
Q

How are personality disorders managed?

A
  • risk management by MDT
  • CBT
  • sedative antihistamine in crisis
121
Q

What are the symptoms of borderline personality disorder?

A
  • strong emotions
  • instability
  • difficulty with relationships
  • fear of abandonment
  • self-harm/suicidal
122
Q

What are obsessions?

A
  • unwanted and uncontrolled thoughts
  • intrusive images
  • difficult to ignore
123
Q

What are compulsions?

A
  • repetitive actions that must be done
  • generate anxiety if not done
  • way to handle obsessions
124
Q

What is the cycle in OCD?

A
  1. obsessions
  2. anxiety
  3. compulsion
  4. temporary relief
125
Q

How is OCD managed?

A
  • CBT
  • exposure and response prevention (ERP)
  • SSRis
  • clomipramime (tricyclic antidepressant)
126
Q

What is exposure and response prevention?

A
  • facing obsessive thoughts
  • without completing compulsions
127
Q

What is the mechanism of alcohol dependence on the brain?

A
  • depressant
  • stimulates GABA receptors causing relaxation
  • inhibits glutamate (excitatory) receptors causing further relaxation
128
Q

What effect does long-term alcohol use have on the brain?

A
  • GABA system is down-regulated
  • glutamate is upregulated
  • to balance the effects of alcohol
  • must keep drinking or withdrawal symptoms
129
Q

What is the recommended alcohol consumption?

A
  • under 14 units
  • spread evenly over 3+ days
  • <5 units in a single day
130
Q

How is binge drinking defined?

A
  • 6+ units for women
  • 8+ units for men
131
Q

What deficiency is caused by alcohol excess?

A
  • thiamine
  • vitamin B1
  • leads to Wernicke’s encephalopathy and Korsakoff syndrome
132
Q

What are symptoms of Wernicke’s encephalopathy? (CAN OPEN)

A
  • confusion
  • ataxia
  • nystagmus
  • ophthalmoplegia
  • peripheral neuropathy
133
Q

What are symptoms of Korsakoff syndrome?

A
  • memory impairment (retrograde and anterograde)
  • behavioural changes
  • confabulation
134
Q

What are complications of alcohol excess?

A
  • liver disease
  • cirrhosis
  • cardiomyopathy
  • myopathy
  • inc risk of CVD and cancer
135
Q

What are some examination features of excess alcohol?

A
  • smelling of alcohol
  • slurred speech
  • bloodshot eyes
  • telangiectasia
  • tremor
136
Q

What is delirium tremens?

A
  • medical emergency associated with alcohol withdrawal
  • extreme excitability due to altered nervous system
137
Q

How does delirium tremens present?

A
  • acute confusion
  • agitation
  • ataxia
  • tremor
  • tachycardia and arrhythmia
  • hypertension
  • delusions
138
Q

What symptoms occur 6-12hrs after alcohol withdrawal?

A
  • tremor
  • anxiety
  • craving
  • headache
  • sweating
139
Q

What are the time frames for withdrawal symptoms occurring from alcohol?

A
  • 12-24hrs: hallucinations
  • 24-48hrs: seizures
  • 48-72hrs: delirium tremens
140
Q

What medication can be given for alcohol withdrawal?

A
  • chlordiazepoxide: benzodiazepine
  • pabrinex: high dose vit B followed by long-term oral thiamine
141
Q

What bloods are seen in alcohol excess?

A
  • raised MCV
  • raised AST and ALT ratio 2:1
  • raised gamma-GT
142
Q

What is long-term management of alcohol-withdrawal?

A
  • specialist service/detox program
  • psychological therapy
  • acamprosate to maintain abstinence
  • inform DVLA
143
Q

What is CAGE?

A
  • C: cut down
  • A: annoyed at comments
  • G: guilty?
  • E: eye opener (drink in morning to help hangover or nerves)
144
Q

What is AUDIT?

A
  • Alcohol Use Disorders Identification Test
  • screens for harmful alcohol use
  • score of ≥8 indicates harmful use
145
Q

What is tolerance?

A
  • loss of effect when taking the same dose
  • dose inc to achieve same effect
  • occurs with most psychoactive substances
146
Q

What is dependence?

A
  • physiological or psychological need to keep using a drug
147
Q

Which medications are used for opioid dependence?

A
  • methadone
  • buprenorphine
  • naltrexone
148
Q

Which medications are used for nicotine dependence?

A
  • nicotine replacement therapy
  • bupropion
  • varenicline
149
Q

How is drug addiction managed?

A
  • detoxification
  • medication
  • psychological and CBT
  • ongoing support
150
Q

What is the brain’s reward pathway called?

A
  • mesolimbic pathway
151
Q

What is the primary neurotransmitter involved in the brain’s reward pathway?

152
Q

Which are the key structures involved in the mesolimbic pathway?

A
  • ventral tegmental area
  • nucleus accumbens
  • amygdala
  • prefrontal cortex
153
Q

How do addictive substances affect the mesolimbic pathway?

A
  • addictive substances release dopamine
  • repeated exposure reduces the number and sensitivity of receptors
  • response of dopamine to everyday activities reduces
  • person seeks out substance to stimulate reward pathway
154
Q

How is the prefrontal cortex related to drug addiction?

A
  • changes lead to impaired function
  • is responsible for decision-making, assessing risk and controlling impulses
155
Q

How is the amygdala related to drug addiction?

A
  • cues are embedded into the amygdala
  • events act as cues and trigger cravings
  • stress is a common trigger
156
Q

What is generalised anxiety disorder?

A
  • excessive and disproportionate anxiety and worry
  • negatively impacts person’s day
  • symptoms should occur most days for >6 months
  • not caused by substance use or another condition
157
Q

What are secondary causes of anxiety?

A
  • substance use/withdrawal
  • hyperthyroidism
  • phaeochromocytoma
  • Cushing’s
158
Q

What is panic disorder?

A
  • unexpected recurrent panic attacks
  • random and without trigger
  • leads to maladaptive behaviour
159
Q

What are emotional and cognitive symptoms of GAD?

A
  • excessive, uncontrolled worrying
  • restlessness
  • easily tired
  • difficulty concentrating
160
Q

What are physical symptoms of GAD?

A
  • muscle tension
  • palpitations
  • sweating
  • tremor
  • GI symptoms
  • headaches
  • sleep disturbance
161
Q

What causes physical symptoms of GAD?

A
  • overactivity of the sympathetic nervous system
162
Q

How is mild anxiety managed?

A
  • active monitoring and self-help advice
  • sleep, diet, exercise
  • avoid alcohol, caffeine, drugs
163
Q

How is moderate to severe anxiety managed?

A
  • CBT
  • medication: sertraline 1st line
164
Q

What medication is used for GAD?

A
  • 1st LINE: SSRIs: sertraline
  • SNRIs: venlafaxine
  • pregabalin
165
Q

How is propranolol used in GAD?

A
  • non-selective β blocker
  • used to treat physical symptoms
  • reduces SNS overactivity
166
Q

What is a phobia?

A
  • extreme fear or situations or things
  • causes symptoms of anxiety or panic
167
Q

What is the management of phobia?

A
  • CBT
  • systematic desensitisation
  • applied relaxation: to manage tension
168
Q

What are panic attacks?

A
  • sudden onset of intense physical and emotional symptoms
  • come on within mins and last <10 mins
169
Q

What are physical symptoms of a panic attack?

A
  • tension
  • palpitations
  • tremors
  • sweating
  • dry mouth
  • chest pain
  • SOB
  • dizziness
  • nausea
170
Q

What are emotional symptoms of a panic attack?

A
  • panic
  • fear
  • danger
  • depersonalisation
  • loss of control
171
Q

What is PTSD?

A
  • condition resulting from traumatic experiences
  • ongoing distressing symptoms
  • impaired function
  • symptoms must be present for > 1 month
172
Q

What does PTSD increase risk of?

A
  • depression
  • anxiety
  • substance misuse
  • suicide
173
Q

What does PTSD result from?

A
  • any traumatic event
  • car accident
  • health event
  • natural disasters
  • military events
174
Q

How does PTSD present?

A
  • re-experiencing: intrusive thoughts
  • hyperarousal
  • depersonalisation
  • derealisation
  • emotional numbing
175
Q

How is PTSD diagnosed?

A
  • Trauma screening questionnaire
  • DSM-5 or ICD-11
176
Q

How is PTSD managed?

A
  • psychological therapy
  • eye movement desensitisation and reprocessing
  • SSRIs, antipsychotics
177
Q

What is eye movement desensitisation and reprocessing?

A
  • processing traumatic memories while performing specific eye movements
  • improperly stored traumatic memories are reprocessed
178
Q

What is ADHD?

A
  • neurodevelopment disorder
  • difficulty maintaining attention
  • excessive energy
  • impulsivity
179
Q

Who does ADHD affect?

A
  • 2x more common in males
  • genetic
  • pregnancy related (smoking, prematurity, low weight)
  • environmental
180
Q

In what settings is ADHD seen?

A
  • consistent across settings
  • if only appearing at school - environmental effect
181
Q

What are some symptoms of ADHD?

A
  • short attention span
  • easily distracted
  • quickly moving from one task to another
  • impulsive and disruptive behaviour
182
Q

How is ADHD diagnosed?

A
  • detailed assessment
  • history dating back to childhood
183
Q

How is ADHD managed conservatively?

A
  • structured routines
  • clear boundaries
  • physical activity
  • healthy diet
184
Q

What medication is used for ADHD?

A
  • methylphenidate
  • dexamfetamine
  • atomoxetine
185
Q

What is autism spectrum disorder?

A
  • impairments in social interaction, communication and behaviour
186
Q

What social difficulties do patients with ASD have?

A
  • lack of eye contact
  • delay in smiling
  • unable to read non-verbal cues
  • difficulty with friendships
  • avoiding physical contact
187
Q

What communication difficulties do patients with ASD have?

A
  • delay in language development
  • difficulty with imaginative behaviour
  • repetitive use of words
188
Q

What behavioural deficits do patients with ASD have?

A
  • greater interest in numbers and patterns
  • stereotypical repetitive movement
  • anxiety/distress outside regular routine
189
Q

How is ASD managed in the MDT?

A
  • CAMHS
  • psychologist
  • SALT
  • dietician
  • special educators
190
Q

What is self-harm?

A
  • intentional self-injury without suicidal intention
  • response to emotional distress
191
Q

In which groups is suicide more common?

A
  • 3x MC in men
  • MC around 50y/o
192
Q

In what groups is self-harm most common?

A
  • females under 25
193
Q

What are the 6 steps in the cycle of self-harm?

A
  • emotional suffering
  • emotional overload
  • panic
  • self-harming
  • temporary relief
  • shame and guilt
194
Q

How is activated charcoal used in overdose?

A
  • reduces absorption of substances
  • aspirin, SSRIs, antidepressants and antipsychotics, paracetamol
  • use within 1hr
195
Q

What are presenting features of suicide risk?

A
  • previous attempts
  • escalating self-harm
  • impulsive
  • hopeless
  • making plans/writing a note
196
Q

What are protective factors reducing suicide risk?

A
  • social support
  • responsibility (children)
  • resilience
  • access to MH support
197
Q

What background factors inc suicide risk?

A
  • health conditions
  • Hx of trauma
  • financial difficulties
  • criminal problems
  • substance use
  • access to weapons
198
Q

What are the steps to managing self harm?

A
  • safety netting
  • safety plan
  • follow up
  • consider safeguarding issues
199
Q

What tools can be used to manage self harm?

A
  • identify triggers
  • provide details for support services
  • treat underlying conditions
  • CBT
  • separating means of harm - blades, meds
200
Q

How is mild suicide risk managed?

A
  • managed in primary care
  • support network
  • followup
201
Q

How is moderate suicide risk managed?

A
  • sent to A&E/admitted
  • reviewed by liason
202
Q

What is dementia?

A
  • a progressive and irreversible impairment
  • of memory, cognition, personality and communication
203
Q

What age classes early-onset dementia?

A

symptoms before age 65

204
Q

What is mild cognitive impairment?

A
  • deficit in cognition and memory
  • expected with age
  • not significant enough for dementia
205
Q

How is a paracetamol overdose treated?

A
  • acetylcysteine infused over 1hr
206
Q

How is benzodiazepine overdose managed?

A
  • flumazenil
207
Q

How is cocaine overdose managed?

208
Q

How is opioid overdose managed?

209
Q

What is thought echo?

A
  • hearing their own thoughts repeated back to them
  • as an auditory hallucination
210
Q

What is thought block?

A
  • Patient suddenly halting in their thought process and can’t continue
211
Q

What is flight of ideas?

A
  • rapid uncontrolled stream of thoughts
  • leaps from one topic to another
  • no clear focus
212
Q

What is pressure of speech?

A
  • increased vol and speed of speech
  • frequently observed in mania
213
Q

What is tangentiality?

A
  • veering off main topic of discussion without return
  • introducing unrelated or loosely connected thoughts
  • challenging to maintain coherent conversation
214
Q

What is perseveration?

A
  • repetition of words or ideas when the other person is attempting to change the topic
  • seem in autism, trauma, dementia
215
Q

What is poverty of speech?

A
  • lack of spontaneous speech
216
Q

What is thought alienation?

A
  • refers to thought insertion, withdrawal and broadcasting
  • all Scheiderian first-rank symptoms - highly indicative of schizophrenia
217
Q

What is confabulation?

A
  • unintentional creation of false memories
  • person believes info is genuine
  • often occurs with memory gaps
  • seen in Korsakoff syndrome, dementia
218
Q

What is anhedonia?

A
  • decreased interest or pleasure in most activities
219
Q

What is depersonalisation?

A
  • A feeling of detachment
  • observing thoughts, feelings or body from the outside
  • watching oneself from a distance
220
Q

What is derealisation?

A
  • sense that the external world feels unreal
  • environment seems distant, disconnected from surroundings
  • familiar things feel unfamiliar
221
Q

What is flattening of affect?

A
  • severe reduction in emotional expression
  • little facial expression, tone, body language
  • schizophrenia, depression
222
Q

What is incongruity of affect?

A
  • mismatch between emotional expression and situation or content of speech
  • e.g. laughing whilst describing something sad
223
Q

What is blunting of affect?

A
  • reduction in intensity or range of emotional expression
  • schizophrenia, depression
224
Q

What is belle indifference?

A
  • lack of concern or anxiety about serious physical symptoms or disabilities
225
Q

What is circumstantiality?

A
  • thought disorder
  • indirect and delayed communication of ideas
  • provides excess, unnecessary details before getting to the point
  • eventually returns to topic
226
Q

What is an illusion?

A
  • misperception of real external stimulus
  • without distortion of sensory processes
  • based on actual stimuli
227
Q

What is an overvalued idea?

A
  • false or exaggerated belief
  • sustained beyond reason
  • less rigid than delusion
  • persistent, influences behaviour
  • belief shared by others
228
Q

What is concrete thinking?

A
  • thought process
  • characterised by literal understanding of concepts
  • difficulty with abstract concepts and figurative language
229
Q

What is loosening of associations?

A
  • thought disorder characterised by a pattern of speech
  • lack of connections between ideas
  • rapid shift from one topic to another
230
Q

What are made acts and feelings?

A
  • actions and emotions controlled by an external force
  • first rank symptoms of schizophrenia
231
Q

What is delirium?

A
  • acute, fluctuating disturbance in attention and cognition
  • age, dementia
232
Q

What is conversion disorder?

A
  • functional neurological disorder
  • sensory and motor symptoms unexplained by neuro disease
  • caused by underlying psychosocial factors
  • history of stress or trauma
233
Q

What are symptoms of a functional neurological disorder?

A
  • weakness
  • gait disturbance
  • seizures
  • sensory loss
  • visual disturbance
234
Q

What is catatonia?

A
  • abnormal movement, communication and behaviour
  • unusual postures, odd actions
235
Q

What causes catatonia?

A
  • severe depression
  • bipolar disorder
  • psychosis
236
Q

What is stupor?

A
  • state of near-complete unresponsiveness to external stimuli
  • no movement, speech
237
Q

What is psychomotor retardation?

A
  • slowing or reduction of physical movements, speech, thought processes
238
Q

In which conditions is psychomotor retardation seen?

A
  • major depressive disorder
  • bipolar disorder
  • schizophrenia
  • Parkinson’s
239
Q

What are the 3 dissociative disorders?

A
  • dissociative amnesia
  • dissociative identity disorder
  • depersonalisation-derealisation disorder
240
Q

What is dissociative amnesia?

A
  • forgetting autobiographical info about oneself
  • following a traumatic experience
  • leads to memory gaps
241
Q

What is dissociative identity disorder?

A
  • multiple personality disorder
  • clear lack of identity
  • multiple separate identities with unique names, personalities, memories
  • associated with severe stress and trauma in childhood
242
Q

What is stereotypy?

A
  • repetitive, purposeless movements and vocalisations
  • e.g. hand flapping
243
Q

What are mannerisms?

A
  • peculiar voluntary gestures or behaviours
  • ritualistic with symbolic meaning
  • verbal or non-verbal
244
Q

Where is stereotypy seen?

A
  • ASD
  • intellectual disability
  • schizophrenia
  • tic disorders
245
Q

Where are mannerisms seen?

A
  • schizophrenia
  • personality disorders
  • obsessive compulsive disorders
246
Q

How is stereotypy/mannerisms treated?

A
  • treat underlying condition
  • behavioural intentions
  • antipsychotics
247
Q

What is poverty of thought?

A
  • reduction in quantity or quality of thought
  • manifested in speech
  • lack of supplementary info
  • concrete thinking
248
Q

What is phenomenology?

A
  • approach to mental disorders based on a patient’s experience
  • descriptive approach
  • not trying to categorise symptoms
249
Q

What is ECT?

A
  • electroconvulsive therapy
  • electrical energy is directed to brain and induces a brief, controlled seizure
250
Q

What is ECT used for?

A
  • severe depression
  • severe depressive disorder
  • catatonia
  • severe mania
251
Q

What are common side effects of ECT?

A
  • short-term memory loss
  • headache/muscle ache
  • drowsiness
252
Q

What is anorexia nervosa?

A
  • person feels they are overweight despite normal or low bodyweight
  • obsessively restricting calorie intake to lose weight
253
Q

What is the presentation of anorexia?

A
  • weight loss (15% below expected) or BMI <17.5
  • amenorrhoea
  • lanugo hair
  • hypotension
  • hypothermia
  • mood changes
  • low bone mineral density
254
Q

What are the cardiac complications of anorexia?

A
  • arrythmia
  • cardiac atrophy
  • sudden cardiac death
255
Q

Why does anorexia cause amenorrhoea?

A
  • disruption of HPG axis
  • lack of LH and FSH
  • leads to reduced activity of ovaries
256
Q

What is bulimia nervosa?

A
  • normal body weight that fluctuates
  • binge eating > purging by vomiting/laxatives
257
Q

How does bulimia present?

A
  • erosion of teeth
  • swollen salivary glands
  • mouth ulcers
  • GORD
  • Russell’s sign
258
Q

What is Russell’s sign?

A
  • calluses on knuckles where they have been scraped across teeth
  • seen in bulimia
259
Q

What is binge eating disorder?

A
  • episodes of excessive overeating
  • loss of control
  • pt likely to be overweight
260
Q

How does binge eating disorder present?

A
  • planned binge
  • eating quickly
  • unrelated to feelings of hunger
  • uncomfortably full
  • eating in dazed state
261
Q

What is seen on bloods in binge eating disorder?

A
  • anaemia
  • leucopenia
  • thrombocytopenia
  • hypokalaemia
262
Q

How are eating disorders managed?

A
  • self-help
  • psychological therapies/family therapy
  • addressing other psychosocial factors
  • admit to hospital
263
Q

What is refeeding syndrome?

A
  • occurs in extended severe nutritional deficit then resuming eating
  • risk of arrhythmia and heart failure
264
Q

What is the pathophysiology of refeeding syndrome?

A
  • intracellular K, PO4 and Mg are depleted
  • electrolytes move from cell > blood to maintain serum levels
  • cell metabolism reduces
265
Q

What occurs to chemicals during refeeding?

A
  • Mg, PO4, K shifted out of blood and Na into blood
  • carbs cause inc in insulin
  • glucose, PO4, K driven into cells
  • Na/K ATP pumps K into cells and Na out
  • insulin causes extra Na reabsorption
266
Q

What are the serum levels in refeeding syndrome?

A
  • low magnesium
  • low potassium
  • low phosphate
  • fluid overload
267
Q

How is refeeding syndrome avoided?

A
  • slowly reintroducing food
  • Mg, PO4, K, glucose monitoring
  • fluid balance monitoring
  • ECG monitoring
  • supplementation with electrolytes and vitamins
268
Q

What is seen biochemically in starvation?

A
  • loss of glycogen stores
  • low insulin
  • ketogenesis
  • normal serum electrolytes
  • severe intracellular depletion
269
Q

What are major risk factors for refeeding syndrome?

A
  • BMI <16
  • unintentional weight loss >15% within 3-6 mo
  • little/no intake for >10 days
  • low K, Mg, PO4 prior to feeding
270
Q

What are minor risks for refeeding syndrome?

A
  • BMI <18.5
  • unintentional weight loss >10% within 3-6mo
  • little/no intake for >5 days
  • history of alcohol excess or insulin, chemo, diuretics
271
Q

What are symptoms of hypophosphataemia?

A
  • lethargy
  • weakness
  • bone pain
  • altered mental state
  • neuro symptoms
  • ileus
  • rhabdomyolysis
  • arrhythmia
272
Q

What are symptoms of hypomagnesaemia?

A
  • neuromsk: tremor, seizure, weakness, confusion
  • cv: palpitations, chest pain, arrythmia
273
Q

What is neuroleptic malignant syndrome?

A
  • caused by anti-dopaminergic drugs such as antipsychotics
  • occurs within days
274
Q

What are the symptoms of neuroleptic malignant syndrome?

A
  • pyrexia
  • altered mental status
  • rigidity
  • autonomic instability
275
Q

How is neuroleptic malignant syndrome investigated?

A
  • elevated creatine kinase levels > may lead to rhabdomyolysis
  • leukocytosis
276
Q

How is neuroleptic malignant syndrome treated?

A
  • supportive
  • dantrolene and bromocriptine
  • begin antipsychotic challenge at 5 days
277
Q

What is cognitive behavioural therapy?

A
  • short-term, goal-oriented
  • changing negative thought patterns
  • improve emotional regulation and coping strategies
278
Q

What is dialectic behavioural therapy?

A
  • type of CBT
  • emphasis mindfulness, distress tolerance
  • used in borderline personality disorder
279
Q

What is psychoanalytic psychotherapy?

A
  • long-term
  • focuses on unconscious processes, improves relationships
  • used in depression, anxiety, personality disorders, trauma
280
Q

What are anxiolytics and what do they treat?

A
  • sedatives e.g. benzodiazepines
  • anxiety
  • insomnia
281
Q

What are some examples of anxiolytics?

A
  • diazepam
  • lorazepam
  • midazolam
282
Q

What is the mechanism of benzodiazepines?

A
  • enhance GABA
  • an inhibitory neurotransmitter
283
Q

What are the side effects of benzodiazepines?

A
  • drowsiness
  • confusion
  • hypoventilation
  • tolerance and dependence
  • ataxia in elderly
284
Q

What are stimulant drugs?

A
  • used to treat ADHD
  • methylphenidate
  • lisdexamfetamine

Osha 3a (15 decks)

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