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
2
Q
What is an informal admission?
A
- patient with capacity
- agrees to be admitted voluntarily
- does not involve the MHA
3
Q
Who is involved in the MHA?
A
- Approved mental health professional
- section 12 doctor
- responsible clinician
- nearest relative
- independent mental health advocate
4
Q
What is an approved mental health professional?
A
- social worker
- MH nurse
- occupational therapist
- psychiatrist
- helps to organise and contribute to assessments
5
Q
What is a mental disorder?
A
- mental illness:
- personality disorder
- learning disability (associated w aggressive behaviour/irresponsible conduct)
- disorders of sexual preference
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)
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
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)
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
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
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
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
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
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)
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
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
17
Q
What is section 131?
A
- voluntary informal admission
- admitted w/out formal restrictions
- free to leave at any time
18
Q
What are the 3 criteria for section 131?
A
- must have capacity
- must consent to admission
- must not resist admission
19
Q
What is the pathophysiology of depression?
A
- disturbance in neurotransmitter activity in the CNS
- particularly in serotonin (5-HT)
20
Q
What are the 3 core symptoms of depression?
A
- anhedonia
- low mood
- anergia/fatigue
21
Q
What are some emotional symptoms of depression?
A
- anxiety
- irritability
- low self-esteem
- guilt
- hopelessness
22
Q
What are some cognitive symptoms of depression?
A
- poor concentration
- slow thoughts
- poor memory
23
Q
What are some physical symptoms of depression?
A
- low energy
- abnormal sleep
- poor appetite/overeating
- slow movements
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
25
What are some examples of SSRIs?
- sertraline
- citalopram
- fluoxetine
- paroxetine
26
What is the risk of citalopram?
- prolong QT interval
- leading to torsades de pointes
- least safe SSRI
27
What are the contraindications to SSRIs?
- omitted in mania
- caution in children and adolescents
- avoided in warfarin
28
What is serotonin syndrome?
- drug induced
- excess serotonin in CNS due to SSRI
- onset within hours
- supportive management
29
What is the triad seen in serotonin syndrome?
- altered mental state: anxiety, delirium
- autonomic hyperactivity : hyperthermia, tachycardia
- neuromuscular abnormalities: tremor, clonus, rigidity
30
What is the management of serotonin syndrome?
- bloods
- benzodiazepines
- cyproheptadine
31
What are side effects of SSRIs?
- GI symptoms
- headaches
- sexual dysfunction
- insomnia
- increased risk of bleeding esp with anticoags or NSAIDs
32
How do SNRIs work?
- block reuptake of serotonin and noradrenaline
- resulting in more in synapses in CNS
33
What are some examples of SNRIs?
- duloxetine
- venlafaxine
34
What psychiatric symptoms can occur when starting antidepressants?
- worsened agitation
- anxiety
- suicidal thoughts or acts
35
When should patients be reviewed after starting antidepressants?
- within two weeks
- one week if aged 18-25/high suicide
- noticeable response within 2-4 weeks
36
Can antidepressants be swapped?
- SSRIs and SNRIs can be directly swapped
- cross-tapered e.g. SSRI to mirtazapine > reduce existing drug and increase new one
37
What is the procedure for stopping antidepressants?
- should be continued for at least 6mo after starting
- dose reduced over 4 weeks to minimise discontinuation symptoms
38
What are discontinuation symptoms?
- flu-like symptoms
- electric shock like sensations
- irritability
- insomnia
- vivid dreams
39
What are the key side effects of mirtazapine and when should it be taken?
- sedation (more in low doses but take @ night)
- increased appetite
- weight gain
40
How do tricyclic antidepressants work?
- block reuptake of serotonin and noradrenaline
- block Ach and histamine
- giving sedative side effects
41
What are some examples of tricyclic antidepressants?
- amitriptyline
- nortriptyline
- imipramime
42
What are some cardiovascular effects of tricyclic antidepressants?
- arrythmia
- tachycardia
- prolonged QT
- bundle branch block
- dangerous in overdose - so not used in suicide risk
43
What are some anticholinergic side effects of tricyclic antidepressants?
- dry mouth
- constipation
- urinary retention
- blurred vision
- cognitive impairment
44
What is the mechanism of action of typical psychotics?
- dopamine receptor antagonists
- inhibit dopaminergic neurotransmission
- noradrenergic, cholinergic, histaminergic blocking properties
45
What are some examples of typical antipsychotics?
- haloperidol
- chlorpromazine
- flupentixol
46
What is the action of atypical antipsychotics?
- dopamine and serotonin antagonists
- block D2 dopamine receptors
- block 5-HT2A serotonin receptors
47
What are atypical antipsychotics?
- second generation
- effective against positive and negative symptoms of schizophrenia
48
What are examples of atypical antipsychotics?
- risperidone
- quetiapine
- olanzapine
- clozapine
49
What are side effects of atypical antipsychotics?
- weight gain
- dyslipidaemia
- seizures
50
When is clozapine used?
- atypical antipsychotic
- used in treatment resistant schizophrenia
- after trial of 2 antipsychotic drugs
51
What is clozapine induced neutropenia?
- can cause neutropenia (low neutrophils) or agranulocytosis (+low basophils and eosinophils)
- FBC weekly for 18 weeks, then fortnightly until 1 year, after which monthly
52
How does neutropenia present?
- fever (flu like symptoms)
- rigors
- hypotension
- tachycardia
- altered mental status
53
How do patients with clozapine induced myocarditis present?
- tachycardia at rest
- chest pain
- abnormal rhythm
- palpitations
54
How is myocarditis investigated?
- ECG
- cardiac exam
- troponin
- CRP
- echocardiogram
55
How does clozapine affect the GI system?
- impairs motility of GI system
- constipation
- intestinal obstruction
- faecal impaction
- paralytic ileus
56
What is bipolar disorder?
- characterised by recurrent episodes of depression, mania or hypomania
- symptoms start <25
- high suicide rate
57
What are manic episodes?
- excessively elevated mood and energy
- persisting >7 days
- significantly impacts normal functioning
58
What is hypomania?
- increased/decreased function for >4 days without psychotic symptoms
- milder
59
What is bipolar I disorder?
- at least one episode of mania
60
What is bipolar II disorder?
- at least one episode of major depression
- at least 1 ep of hypomania
61
What is cyclothymia?
- milder symptoms of hypomania and low mood
- symptoms not severe enough to impact function
62
What is unipolar depression?
- person only has episodes of depression
- without mania or hypomania
63
What is the long term management of bipolar disorder?
- lithium
- alternatives: sodium valproate and olanzapine
64
What are side effects of lithium?
- fine tremor
- weight gain
- seizures
- CKD
- hypothyroidism and goitre
- hyperpth and hypercalcaemia
- nephrogenic diabetes insipidus
65
What are the dangers of sodium valproate?
- teratogenic: neural tube defects
66
What are the symptoms of mania?
- abnormally elevated mood
- irritability
- increased energy
- decreased sleep
- grandiosity, excessive spending, risk-taking
- disinhibition
- flight of ideas
- pressured speech
- psychosis
67
How is an acute manic episode managed?
- antipsychotic medications
- existing antidepressants tapered and stopped
- lithium and sodium valproate
68
How is an acute depressive episode in bipolar disorder managed?
- olanzapine plus fluoxetine
- antipsychotics
- lamotrigine
69
What is the non-pharmacological management of bipolar disorder?
- psychoeducation
- IPT
- CBT
- social support
70
What is schizophrenia?
- severe, long-term mental health disorder
- characterised by psychosis
- lasts 6+ months
71
When is schizophrenia most commonly diagnosed?
- presents between 15-30 years old
- diagnosed earlier in men than women
72
What is schizoaffective disorder?
- combining the symptoms of schizophrenia with bipolar disorder
- psychosis, depression and mania
73
What is schizophreniform disorder?
- presents w/ same features as schizophrenia
- lasts <6 months
74
What is the cause of schizophrenia?
- genetic
- environmental
- affected family member is RF
75
What is a prodrome phase?
- subtle symptoms
- precedes full symptoms
76
What symptoms are experienced in a prodrome phase of schizophrenia?
- poor memory
- reduced concentration
- mood swings
- social withdrawal
- suspicion of others
- loss of appetite
- difficulty sleeping
- decreased motivation
77
What are the key features of psychosis?
- delusions
- hallucinations
- thought disorder
78
What are delusions?
- beliefs that are strongly held and clearly untrue
79
What are hallucinations?
- perceiving things that aren't real
80
What is a thought disorder?
- disorganised thoughts causing abnormal speech and behaviour
81
What are key positive symptoms of schizophrenia?
- auditory hallucinations
- somatic passivity
- thought disturbance: insertion, withdrawal, broadcasting
- delusions: persecutory, delusional perceptions, ideas of reference
82
What are the specific characteristics of auditory hallucinations in schizophrenia?
- thought echo
- 2+ voices discussing the patient in 3rd person
- voices commenting on the pts behaviour
83
What is thought broadcasting?
the belief that others are overhearing their thoughts
84
What is thought insertion/withdrawal?
- the idea that an external entity is inserting or removing their thoughts
85
What are persecutory delusions?
false belief that a person or group is going to harm them
86
What is a delusional perception?
- when an ordinary event triggers a sudden self-related delusion
- e.g. seeing the cat > knew I was going to meet an alien
87
What is the ABCD mnemonic for positive symptoms of schizophrenia?
- auditory hallucinations
- broadcasting of thoughts
- control issues
- delusional perception
88
What are ideas of reference?
- false belief that unconnected events or details in the world directly relate to them
89
What is somatic passivity?
- believing an external entity is controlling their sensation and action
90
What are negative symptoms of schizophrenia?
- affective flattening
- alogia
- anhedonia
- avolition
91
What is affective flattening?
- minimal emotional reaction to emotive subjects or events
92
What is alogia?
- poverty of speech
- reduced speech
93
What is avolition?
- lack of motivation in completing tasks or working towards goals
94
What types of functioning are reduced in schizophrenia?
- social engagement
- productivity at work or school
- self-care
95
What is the pattern of symptoms in schizophrenia?
- continuous
- episodic
- a single episode
96
What does the DSM-5 criteria require for the diagnosis of schizophrenia?
- prodrome phase for >6 months
- active phase for > 1 month
97
How is schizophrenia treated?
- antipsychotic medications
- CBT
98
Which psychiatric teams manage patients with schizophrenia?
- early intervention in psychosis
- crisis resolution and home treatment teams
- acute hospital admission
- community mental health team
99
What medical conditions are associated with schizophrenia and antipsychotics?
- metabolic syndrome
- cardiovascular disease
100
What are side effects of antipsychotic drugs?
- weight gain
- diabetes
- prolonged QT interval
- raised prolactin
- extrapyramidal symptoms
101
What are some extra pyramidal symptoms?
- akathisia (restlessness)
- dystonia (abnormal muscle tone)
- pseudo-parkinsonism
- tardive dyskinesia
102
What are depot antipsychotics?
- IM injections
- given every 2 weeks - 3 months
- helpful with lack of adherence
103
What are examples of depot antipsychotics?
- aripiprazole
- flupentoxil
- risperidone
104
What are the possible adverse effects of clozapine?
- agranulocytosis
- myocarditis
- constipation
- seizures
- excess salivation
105
What must be monitored during antipsychotic treatment?
- weight and waist circumference
- blood pressure and pulse rate
- bloods (HbA1c, lipids, prolactin)
- ECG
106
What is a personality disorder?
- maladaptive personality traits causing significant psychosocial stress
- interfere with functioning
107
What are the Class A personality disorders?
- suspicious type
- paranoid
- schizoid
- schizotypal
108
What is paranoid personality disorder?
- difficulty trusting people
- difficulty revealing personal info
- hypersensitive to criticism
- believes others are plotting against them
109
What is a schizoid personality disorder?
- lack of interest in relationships with others
- emotional coldness
- indifference to praise/criticism
- preference for solitary activity
110
What is a schizotypal personality disorder?
- magical thinking, odd beliefs and behaviour
- ideas of reference
- social anxiety + paranoid
- similar to schizophrenia, absence of delusions
111
What are Class B personality disorders?
- emotional or impulsive
- antisocial
- borderline
- histrionic
- narcissistic
112
What is antisocial personality disorder?
- reckless and harmful behaviour
- lack of concern for consequences
- aggressive and unremorseful
- criminal misconduct
113
What is borderline personality disorder?
- fluctuating strong emotions
- difficulties with identity
- struggles to maintain healthy relationships
114
What is histrionic personality disorder?
- 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
What is narcissistic personality disorder?
- feeling of entitlement and need for others to recognise this
- pattern of grandiosity, need for admiration, lack of empathy
116
What are Class C personality disorders?
- anxious types
- avoidant
- dependent
- obsessive-compulsive
117
What is avoidant personality disorder?
- severe anxiety about rejection or disapproval
- avoidance of social situations and relationships
- fear of criticism
118
What is dependent personality disorder?
- heavy reliance on others to make decisions, very passive
- lack self-confidence and initiative
- submissive and clinging behaviour
119
What is obsessive-compulsive personality disorder?
- unrealistic expectations of how things should be done
- catastrophising about what will happen if expectations aren't met
120
How are personality disorders managed?
- risk management by MDT
- CBT
- sedative antihistamine in crisis
121
What are the symptoms of borderline personality disorder?
- strong emotions
- instability
- difficulty with relationships
- fear of abandonment
- self-harm/suicidal
122
What are obsessions?
- unwanted and uncontrolled thoughts
- intrusive images
- difficult to ignore
123
What are compulsions?
- repetitive actions that must be done
- generate anxiety if not done
- way to handle obsessions
124
What is the cycle in OCD?
1. obsessions
2. anxiety
3. compulsion
4. temporary relief
125
How is OCD managed?
- CBT
- exposure and response prevention (ERP)
- SSRis
- clomipramime (tricyclic antidepressant)
126
What is exposure and response prevention?
- facing obsessive thoughts
- without completing compulsions
127
What is the mechanism of alcohol dependence on the brain?
- depressant
- stimulates GABA receptors causing relaxation
- inhibits glutamate (excitatory) receptors causing further relaxation
128
What effect does long-term alcohol use have on the brain?
- GABA system is down-regulated
- glutamate is upregulated
- to balance the effects of alcohol
- must keep drinking or withdrawal symptoms
129
What is the recommended alcohol consumption?
- under 14 units
- spread evenly over 3+ days
- <5 units in a single day
130
How is binge drinking defined?
- 6+ units for women
- 8+ units for men
131
What deficiency is caused by alcohol excess?
- thiamine
- vitamin B1
- leads to Wernicke's encephalopathy and Korsakoff syndrome
132
What are symptoms of Wernicke's encephalopathy? (CAN OPEN)
- confusion
- ataxia
- nystagmus
- ophthalmoplegia
- peripheral neuropathy
133
What are symptoms of Korsakoff syndrome?
- memory impairment (retrograde and anterograde)
- behavioural changes
- confabulation
134
What are complications of alcohol excess?
- liver disease
- cirrhosis
- cardiomyopathy
- myopathy
- inc risk of CVD and cancer
135
What are some examination features of excess alcohol?
- smelling of alcohol
- slurred speech
- bloodshot eyes
- telangiectasia
- tremor
136
What is delirium tremens?
- medical emergency associated with alcohol withdrawal
- extreme excitability due to altered nervous system
137
How does delirium tremens present?
- acute confusion
- agitation
- ataxia
- tremor
- tachycardia and arrhythmia
- hypertension
- delusions
138
What symptoms occur 6-12hrs after alcohol withdrawal?
- tremor
- anxiety
- craving
- headache
- sweating
139
What are the time frames for withdrawal symptoms occurring from alcohol?
- 12-24hrs: hallucinations
- 24-48hrs: seizures
- 48-72hrs: delirium tremens
140
What medication can be given for alcohol withdrawal?
- chlordiazepoxide: benzodiazepine
- pabrinex: high dose vit B followed by long-term oral thiamine
141
What bloods are seen in alcohol excess?
- raised MCV
- raised AST and ALT ratio 2:1
- raised gamma-GT
142
What is long-term management of alcohol-withdrawal?
- specialist service/detox program
- psychological therapy
- acamprosate to maintain abstinence
- inform DVLA
143
What is CAGE?
- C: cut down
- A: annoyed at comments
- G: guilty?
- E: eye opener (drink in morning to help hangover or nerves)
144
What is AUDIT?
- Alcohol Use Disorders Identification Test
- screens for harmful alcohol use
- score of ≥8 indicates harmful use
145
What is tolerance?
- loss of effect when taking the same dose
- dose inc to achieve same effect
- occurs with most psychoactive substances
146
What is dependence?
- physiological or psychological need to keep using a drug
147
Which medications are used for opioid dependence?
- methadone
- buprenorphine
- naltrexone
148
Which medications are used for nicotine dependence?
- nicotine replacement therapy
- bupropion
- varenicline
149
How is drug addiction managed?
- detoxification
- medication
- psychological and CBT
- ongoing support
150
What is the brain's reward pathway called?
- mesolimbic pathway
151
What is the primary neurotransmitter involved in the brain's reward pathway?
- dopamine
152
Which are the key structures involved in the mesolimbic pathway?
- ventral tegmental area
- nucleus accumbens
- amygdala
- prefrontal cortex
153
How do addictive substances affect the mesolimbic pathway?
- 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
How is the prefrontal cortex related to drug addiction?
- changes lead to impaired function
- is responsible for decision-making, assessing risk and controlling impulses
155
How is the amygdala related to drug addiction?
- cues are embedded into the amygdala
- events act as cues and trigger cravings
- stress is a common trigger
156
What is generalised anxiety disorder?
- 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
What are secondary causes of anxiety?
- substance use/withdrawal
- hyperthyroidism
- phaeochromocytoma
- Cushing's
158
What is panic disorder?
- unexpected recurrent panic attacks
- random and without trigger
- leads to maladaptive behaviour
159
What are emotional and cognitive symptoms of GAD?
- excessive, uncontrolled worrying
- restlessness
- easily tired
- difficulty concentrating
160
What are physical symptoms of GAD?
- muscle tension
- palpitations
- sweating
- tremor
- GI symptoms
- headaches
- sleep disturbance
161
What causes physical symptoms of GAD?
- overactivity of the sympathetic nervous system
162
How is mild anxiety managed?
- active monitoring and self-help advice
- sleep, diet, exercise
- avoid alcohol, caffeine, drugs
163
How is moderate to severe anxiety managed?
- CBT
- medication: sertraline 1st line
164
What medication is used for GAD?
- 1st LINE: SSRIs: sertraline
- SNRIs: venlafaxine
- pregabalin
165
How is propranolol used in GAD?
- non-selective β blocker
- used to treat physical symptoms
- reduces SNS overactivity
166
What is a phobia?
- extreme fear or situations or things
- causes symptoms of anxiety or panic
167
What is the management of phobia?
- CBT
- systematic desensitisation
- applied relaxation: to manage tension
168
What are panic attacks?
- sudden onset of intense physical and emotional symptoms
- come on within mins and last <10 mins
169
What are physical symptoms of a panic attack?
- tension
- palpitations
- tremors
- sweating
- dry mouth
- chest pain
- SOB
- dizziness
- nausea
170
What are emotional symptoms of a panic attack?
- panic
- fear
- danger
- depersonalisation
- loss of control
171
What is PTSD?
- condition resulting from traumatic experiences
- ongoing distressing symptoms
- impaired function
- symptoms must be present for > 1 month
172
What does PTSD increase risk of?
- depression
- anxiety
- substance misuse
- suicide
173
What does PTSD result from?
- any traumatic event
- car accident
- health event
- natural disasters
- military events
174
How does PTSD present?
- re-experiencing: intrusive thoughts
- hyperarousal
- depersonalisation
- derealisation
- emotional numbing
175
How is PTSD diagnosed?
- Trauma screening questionnaire
- DSM-5 or ICD-11
176
How is PTSD managed?
- psychological therapy
- eye movement desensitisation and reprocessing
- SSRIs, antipsychotics
177
What is eye movement desensitisation and reprocessing?
- processing traumatic memories while performing specific eye movements
- improperly stored traumatic memories are reprocessed
178
What is ADHD?
- neurodevelopment disorder
- difficulty maintaining attention
- excessive energy
- impulsivity
179
Who does ADHD affect?
- 2x more common in males
- genetic
- pregnancy related (smoking, prematurity, low weight)
- environmental
180
In what settings is ADHD seen?
- consistent across settings
- if only appearing at school - environmental effect
181
What are some symptoms of ADHD?
- short attention span
- easily distracted
- quickly moving from one task to another
- impulsive and disruptive behaviour
182
How is ADHD diagnosed?
- detailed assessment
- history dating back to childhood
183
How is ADHD managed conservatively?
- structured routines
- clear boundaries
- physical activity
- healthy diet
184
What medication is used for ADHD?
- methylphenidate
- dexamfetamine
- atomoxetine
185
What is autism spectrum disorder?
- impairments in social interaction, communication and behaviour
186
What social difficulties do patients with ASD have?
- lack of eye contact
- delay in smiling
- unable to read non-verbal cues
- difficulty with friendships
- avoiding physical contact
187
What communication difficulties do patients with ASD have?
- delay in language development
- difficulty with imaginative behaviour
- repetitive use of words
188
What behavioural deficits do patients with ASD have?
- greater interest in numbers and patterns
- stereotypical repetitive movement
- anxiety/distress outside regular routine
189
How is ASD managed in the MDT?
- CAMHS
- psychologist
- SALT
- dietician
- special educators
190
What is self-harm?
- intentional self-injury without suicidal intention
- response to emotional distress
191
In which groups is suicide more common?
- 3x MC in men
- MC around 50y/o
192
In what groups is self-harm most common?
- females under 25
193
What are the 6 steps in the cycle of self-harm?
- emotional suffering
- emotional overload
- panic
- self-harming
- temporary relief
- shame and guilt
194
How is activated charcoal used in overdose?
- reduces absorption of substances
- aspirin, SSRIs, antidepressants and antipsychotics, paracetamol
- use within 1hr
195
What are presenting features of suicide risk?
- previous attempts
- escalating self-harm
- impulsive
- hopeless
- making plans/writing a note
196
What are protective factors reducing suicide risk?
- social support
- responsibility (children)
- resilience
- access to MH support
197
What background factors inc suicide risk?
- health conditions
- Hx of trauma
- financial difficulties
- criminal problems
- substance use
- access to weapons
198
What are the steps to managing self harm?
- safety netting
- safety plan
- follow up
- consider safeguarding issues
199
What tools can be used to manage self harm?
- identify triggers
- provide details for support services
- treat underlying conditions
- CBT
- separating means of harm - blades, meds
200
How is mild suicide risk managed?
- managed in primary care
- support network
- followup
201
How is moderate suicide risk managed?
- sent to A&E/admitted
- reviewed by liason
202
What is dementia?
- a progressive and irreversible impairment
- of memory, cognition, personality and communication
203
What age classes early-onset dementia?
symptoms before age 65
204
What is mild cognitive impairment?
- deficit in cognition and memory
- expected with age
- not significant enough for dementia
205
How is a paracetamol overdose treated?
- acetylcysteine infused over 1hr
206
How is benzodiazepine overdose managed?
- flumazenil
207
How is cocaine overdose managed?
- diazepam
208
How is opioid overdose managed?
naloxone
209
What is thought echo?
- hearing their own thoughts repeated back to them
- as an auditory hallucination
210
What is thought block?
- Patient suddenly halting in their thought process and can't continue
211
What is flight of ideas?
- rapid uncontrolled stream of thoughts
- leaps from one topic to another
- no clear focus
212
What is pressure of speech?
- increased vol and speed of speech
- frequently observed in mania
213
What is tangentiality?
- veering off main topic of discussion without return
- introducing unrelated or loosely connected thoughts
- challenging to maintain coherent conversation
214
What is perseveration?
- repetition of words or ideas when the other person is attempting to change the topic
- seem in autism, trauma, dementia
215
What is poverty of speech?
- lack of spontaneous speech
216
What is thought alienation?
- refers to thought insertion, withdrawal and broadcasting
- all Scheiderian first-rank symptoms - highly indicative of schizophrenia
217
What is confabulation?
- unintentional creation of false memories
- person believes info is genuine
- often occurs with memory gaps
- seen in Korsakoff syndrome, dementia
218
What is anhedonia?
- decreased interest or pleasure in most activities
219
What is depersonalisation?
- A feeling of detachment
- observing thoughts, feelings or body from the outside
- watching oneself from a distance
220
What is derealisation?
- sense that the external world feels unreal
- environment seems distant, disconnected from surroundings
- familiar things feel unfamiliar
221
What is flattening of affect?
- severe reduction in emotional expression
- little facial expression, tone, body language
- schizophrenia, depression
222
What is incongruity of affect?
- mismatch between emotional expression and situation or content of speech
- e.g. laughing whilst describing something sad
223
What is blunting of affect?
- reduction in intensity or range of emotional expression
- schizophrenia, depression
224
What is belle indifference?
- lack of concern or anxiety about serious physical symptoms or disabilities
225
What is circumstantiality?
- thought disorder
- indirect and delayed communication of ideas
- provides excess, unnecessary details before getting to the point
- eventually returns to topic
226
What is an illusion?
- misperception of real external stimulus
- without distortion of sensory processes
- based on actual stimuli
227
What is an overvalued idea?
- false or exaggerated belief
- sustained beyond reason
- less rigid than delusion
- persistent, influences behaviour
- belief shared by others
228
What is concrete thinking?
- thought process
- characterised by literal understanding of concepts
- difficulty with abstract concepts and figurative language
229
What is loosening of associations?
- thought disorder characterised by a pattern of speech
- lack of connections between ideas
- rapid shift from one topic to another
230
What are made acts and feelings?
- actions and emotions controlled by an external force
- first rank symptoms of schizophrenia
231
What is delirium?
- acute, fluctuating disturbance in attention and cognition
- age, dementia
232
What is conversion disorder?
- functional neurological disorder
- sensory and motor symptoms unexplained by neuro disease
- caused by underlying psychosocial factors
- history of stress or trauma
233
What are symptoms of a functional neurological disorder?
- weakness
- gait disturbance
- seizures
- sensory loss
- visual disturbance
234
What is catatonia?
- abnormal movement, communication and behaviour
- unusual postures, odd actions
235
What causes catatonia?
- severe depression
- bipolar disorder
- psychosis
236
What is stupor?
- state of near-complete unresponsiveness to external stimuli
- no movement, speech
237
What is psychomotor retardation?
- slowing or reduction of physical movements, speech, thought processes
238
In which conditions is psychomotor retardation seen?
- major depressive disorder
- bipolar disorder
- schizophrenia
- Parkinson's
239
What are the 3 dissociative disorders?
- dissociative amnesia
- dissociative identity disorder
- depersonalisation-derealisation disorder
240
What is dissociative amnesia?
- forgetting autobiographical info about oneself
- following a traumatic experience
- leads to memory gaps
241
What is dissociative identity disorder?
- multiple personality disorder
- clear lack of identity
- multiple separate identities with unique names, personalities, memories
- associated with severe stress and trauma in childhood
242
What is stereotypy?
- repetitive, purposeless movements and vocalisations
- e.g. hand flapping
243
What are mannerisms?
- peculiar voluntary gestures or behaviours
- ritualistic with symbolic meaning
- verbal or non-verbal
244
Where is stereotypy seen?
- ASD
- intellectual disability
- schizophrenia
- tic disorders
245
Where are mannerisms seen?
- schizophrenia
- personality disorders
- obsessive compulsive disorders
246
How is stereotypy/mannerisms treated?
- treat underlying condition
- behavioural intentions
- antipsychotics
247
What is poverty of thought?
- reduction in quantity or quality of thought
- manifested in speech
- lack of supplementary info
- concrete thinking
248
What is phenomenology?
- approach to mental disorders based on a patient's experience
- descriptive approach
- not trying to categorise symptoms
249
What is ECT?
- electroconvulsive therapy
- electrical energy is directed to brain and induces a brief, controlled seizure
250
What is ECT used for?
- severe depression
- severe depressive disorder
- catatonia
- severe mania
251
What are common side effects of ECT?
- short-term memory loss
- headache/muscle ache
- drowsiness
252
What is anorexia nervosa?
- person feels they are overweight despite normal or low bodyweight
- obsessively restricting calorie intake to lose weight
253
What is the presentation of anorexia?
- weight loss (15% below expected) or BMI <17.5
- amenorrhoea
- lanugo hair
- hypotension
- hypothermia
- mood changes
- low bone mineral density
254
What are the cardiac complications of anorexia?
- arrythmia
- cardiac atrophy
- sudden cardiac death
255
Why does anorexia cause amenorrhoea?
- disruption of HPG axis
- lack of LH and FSH
- leads to reduced activity of ovaries
256
What is bulimia nervosa?
- normal body weight that fluctuates
- binge eating > purging by vomiting/laxatives
257
How does bulimia present?
- erosion of teeth
- swollen salivary glands
- mouth ulcers
- GORD
- Russell's sign
258
What is Russell's sign?
- calluses on knuckles where they have been scraped across teeth
- seen in bulimia
259
What is binge eating disorder?
- episodes of excessive overeating
- loss of control
- pt likely to be overweight
260
How does binge eating disorder present?
- planned binge
- eating quickly
- unrelated to feelings of hunger
- uncomfortably full
- eating in dazed state
261
What is seen on bloods in binge eating disorder?
- anaemia
- leucopenia
- thrombocytopenia
- hypokalaemia
262
How are eating disorders managed?
- self-help
- psychological therapies/family therapy
- addressing other psychosocial factors
- admit to hospital
263
What is refeeding syndrome?
- occurs in extended severe nutritional deficit then resuming eating
- risk of arrhythmia and heart failure
264
What is the pathophysiology of refeeding syndrome?
- intracellular K, PO4 and Mg are depleted
- electrolytes move from cell > blood to maintain serum levels
- cell metabolism reduces
265
What occurs to chemicals during refeeding?
- 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
What are the serum levels in refeeding syndrome?
- low magnesium
- low potassium
- low phosphate
- fluid overload
267
How is refeeding syndrome avoided?
- slowly reintroducing food
- Mg, PO4, K, glucose monitoring
- fluid balance monitoring
- ECG monitoring
- supplementation with electrolytes and vitamins
268
What is seen biochemically in starvation?
- loss of glycogen stores
- low insulin
- ketogenesis
- normal serum electrolytes
- severe intracellular depletion
269
What are major risk factors for refeeding syndrome?
- BMI <16
- unintentional weight loss >15% within 3-6 mo
- little/no intake for >10 days
- low K, Mg, PO4 prior to feeding
270
What are minor risks for refeeding syndrome?
- 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
What are symptoms of hypophosphataemia?
- lethargy
- weakness
- bone pain
- altered mental state
- neuro symptoms
- ileus
- rhabdomyolysis
- arrhythmia
272
What are symptoms of hypomagnesaemia?
- neuromsk: tremor, seizure, weakness, confusion
- cv: palpitations, chest pain, arrythmia
273
What is neuroleptic malignant syndrome?
- caused by anti-dopaminergic drugs such as antipsychotics
- occurs within days
274
What are the symptoms of neuroleptic malignant syndrome?
- pyrexia
- altered mental status
- rigidity
- autonomic instability
275
How is neuroleptic malignant syndrome investigated?
- elevated creatine kinase levels > may lead to rhabdomyolysis
- leukocytosis
276
How is neuroleptic malignant syndrome treated?
- supportive
- dantrolene and bromocriptine
- begin antipsychotic challenge at 5 days
277
What is cognitive behavioural therapy?
- short-term, goal-oriented
- changing negative thought patterns
- improve emotional regulation and coping strategies
278
What is dialectic behavioural therapy?
- type of CBT
- emphasis mindfulness, distress tolerance
- used in borderline personality disorder
279
What is psychoanalytic psychotherapy?
- long-term
- focuses on unconscious processes, improves relationships
- used in depression, anxiety, personality disorders, trauma
280
What are anxiolytics and what do they treat?
- sedatives e.g. benzodiazepines
- anxiety
- insomnia
281
What are some examples of anxiolytics?
- diazepam
- lorazepam
- midazolam
282
What is the mechanism of benzodiazepines?
- enhance GABA
- an inhibitory neurotransmitter
283
What are the side effects of benzodiazepines?
- drowsiness
- confusion
- hypoventilation
- tolerance and dependence
- ataxia in elderly
284
What are stimulant drugs?
- used to treat ADHD
- methylphenidate
- lisdexamfetamine
