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3A REVISION > PSYCHIATRY 2 > Flashcards

PSYCHIATRY 2 Flashcards

1
Q

What is anxiety?

A

An unpleasant emotional state involving subjective fear, bodily discomfort and physical symptoms, often a feeling of impending threat or doom

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2
Q

What is the Yerkes-Dodson curve?

A

Anxiety can be beneficial to a certain point of optimal function, then performance declines with further anxiety

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3
Q

What groups of people is anxiety more common in?

A

Young adults
Middle age
Women

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4
Q

Causes of anxiety? (5)

A 
Low levels of GABA neurotransmitter
Stress in early life - separation, conformity
Alcohol/benzodiazepines
Genetics - 1st degree relatives
Life stress/physical illness
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5
Q

How does stress in early life cause anxiety?

A

Stress/separation leads to remodelling of the frontal cortex and amygdala, altering behavioural response as adults

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6
Q

What is generalised anxiety disorder?

A

Generalised, persistent, excessive anxiety or worry about a number of events that the person finds difficult to control lasting over 3 weeks

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7
Q

Symptoms of generalised anxiety disorder? (5)

A 
Apprehension and fear
Increased vigilance and restlessness
Sleeping difficulty, fatigue on waking
Motor tension, tremor
Autonomic hyperactivity - tachycardia
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8
Q

Treatment of generalised anxiety disorder? (5)

A 
CBT, group therapy, applied relaxation
SSRIs or SNRIs
2nd line pregabalin
Short term benzodiazepines
Beta blockers propanolol for tachycardia
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9
Q

What is a phobia?

A

Extreme irrational fear or aversion to something

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10
Q

What is agoraphobia?

A

Fear and avoidance of places or situations from which escape may be difficult, or help may not be available, often with panic disorder

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11
Q

Give 3 examples of places agorophobes would avoid

A

Crowds
Public places
Travelling alone or away from home

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12
Q

Treatment of agorophobia? (2)

A

CBT with graded exposure to situations

SSRIs

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13
Q

What is social phobia? (2)

A

Persistent fear of social situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others
Fear they will be humiliated or embarrassed

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14
Q

Treatment of social phobia? (3)

A

CBT
Self help, graded self exposure, social skills training
SSRIs 2nd line

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15
Q

What are specific phobias?

A

Fear of specific people, objects or situations

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16
Q

Treatment of specific phobias? (2)

A

Graded exposure and response prevention

Short term benzodiazepines i.e. for flying

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17
Q

What is panic disorder?

A

Recurrent episodic severe panic attacks which occur unpredictably and are not restricted to any particular situation

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18
Q

What is a panic attack?

A

Discrete periods of intense feat, impending doom or discomfort accompanied by symptoms

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19
Q

Symptoms of a panic attack? (9)

A 
Palpitations/tachycardia
Sweating, trembling, breathlessness
Feeling of choking
Chest pain or discomfort
Nausea/abdominal discomfort
Dizziness, paraesthesia
Chills and hot flushed
Derealisation or depersonalisation
Fear of losing control, dying
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20
Q

How long do panic attacks last?

A

A few minutes but anticipatory fear may develop and maladaptive behavioural changes - i.e. refusal to leave the house or be alone

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21
Q

What is the cognitive model of panic attacks?

A

Panic attacks occur when catastrophic misinterpretations of ambiguous physical sensations creates a positive feedback loop leading to panic

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22
Q

Treatment of panic disorder? (3)

A

CBT and SSRIs

2nd line tricyclic antidepressants

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23
Q

What is PTSD?

A

Post traumatic stress disorder - prolonged abnormal response to a severely stressful experience of an exceptionally threatening or catastrophic nature, usually within 6 month of event

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24
Q

Types of severe psychological stress? (5)

A 
Threat - war, terrorism
Disasters
Assault
Accidents
Loss
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25
Q

Normal reaction to psychological stress?

A

Fear, sadness, fatigue, denial, avoidance

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26
Q

What is abnormal stress reaction?

A

Exaggerated or maladaptive responses

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27
Q

Symptoms of PTSD? (9)

A 
Persistent intrusive thinking or re-experiencing of trauma - memories, nightmares, flashbacks
Avoidance of reminders of the event
Numbing and detachment from others
Loss of interest in activities
Sense of shortened future
Increased arousal
Hypervigilance, easy to startle
Poor concentration
Sleep disturbance
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28
Q

Common comorbid conditions with PTSD? (2)

A

Depression, substance misuse

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29
Q

What increases risk of PTSD? (3)

A

Magnitude of stress
Lack of support
Other life events occurring

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30
Q

Treatment of PTSD? (3)

A

Trauma focussed CBT
Eye movement desensitisation and reprocessing therapy (EMDR)
2nd line antidepressants

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31
Q

What are obsessions?

A

Unwelcome, persistent, intrusive senseless thought that the patient recognises are from their own mind and tried to suppress them

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32
Q

Types of obsessions? (5)

A 
Thoughts - numbers, contamination
Images
Impulses
Ruminations - constant pondering
Doubts
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33
Q

What are compulsions?

A

Repetitive, purposeful physical or mental behaviours performed with reluctance in response to an obsession, carried out by certain rules to try and neutralise discomfort - but often excessive and not realistically related to obsession

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34
Q

Examples of compulsions? (5)

A 
Hand washing
Counting, checking
Rearranging objects
Hoarding
Folie du pourquoi - seeking explanations for everything
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35
Q

What is OCD?

A

Obsessive compulsive disorder - characterised by time consuming (>1 hr a day) obsessions and/or compulsions most days for 2 weeks interfering with activities e.g. avoidance of triggers

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36
Q

Subtypes of OCD? (4)

A

Obsessions and compulsions related to contamination
Checking compulsions
Obsessions without overt compulsions
Hoarding

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37
Q

Causes of OCD? (4)

A

Genetics - OCD, tics, Tourette’s
Parental overprotection
Serotonin abnormalities
Abnormalities of cortico-striatothalamic circuit mediating social behaviour

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38
Q

What does brain MRI show in OCD?

A

Functional abnormalities of the frontal cortex and basal ganglia

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39
Q

How is compulsive behaviour maintained?

A

Anxiety reduction after performing the compulsion

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40
Q

Treatment of OCD? (4)

A

Psychoeducation, CBT involving exposure and response prevention
SSRIs
Tricyclic antidepressants
Possible psychosurgery - deep brain stimulation

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41
Q

What is adjustment disorder?

A

Abnormal psychological responses to life adversity e.g. job loss, moving, divorce which usually occurs within weeks of the event but does not last more than 6 months if the stressor does not persist

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42
Q

Presentation of adjustment disorder? (2)

A

Anxiety - autonomic symptoms, insomnia, irritable

Depression - sad, teary, worried

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43
Q

How is adjustment disorder diagnosed?

A

Insufficient symptoms of specific anxiety or depressive disorder
Identified stressor

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44
Q

Treatment of adjustment disorder?

A

Usually resolves after cause passes

CBT and problem solving strategies, therapy

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45
Q

What are the 5 stages of grief?

A

Denial, anger, bargaining, sadness, acceptance

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46
Q

What is somatisation disorder?

A

At least 2 years of multiple physical symptoms with no physical explanation, and patient refusal to accept conclusion that there is nothing wrong
Affects social and relationship functioning

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47
Q

Most common complaints in somatisation disorder?

A

Skin, GI

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48
Q

Most common group of people in somatisation disorder?

A

Women under 30

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49
Q

Cause of somatisation disorder?

A

Healthy anxiety causing misinterpretation of normal body sensations or mild discomfort as illness

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50
Q

Treatment of somatisation disorder?

A

Patient wants a diagnosis - rule out any illness

CBT

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51
Q

What is hypochondriacal disorder?

A

Non-delusional preoccupation with possibility of a serious illness (cancer, HIV) despite medical reassurance

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52
Q

Most common 2 groups of people in hypochondriacal disorder?

A

Men

Health workers

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53
Q

Treatment of hypochondriacal disorder?

A

Patient wants the all clear or fears confirmed to access treatment - rule out illness
CBT

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54
Q

What is conversion (dissociative) disorder?

A

Physical (mostly neurological) symptoms/signs occurring in the absence of pathology and with a clear relationship with a stressor

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55
Q

Types of dissociative disorder? (4)

A

Dissociative motor/sensory deficits - limb weakness, blind
Dissociative convulsions - nonepileptic seizures
Dissociative amnesia
Dissociative fugue - amnesia, planned journey away

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56
Q

Theory of dissociative disorder?

A

Painful thoughts or feelings are cut off from the conscious self and converted into more bearable physical symptoms

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57
Q

Treatment of dissociative disorder?

A

Rule out organic cause, treat any mood disorder

Therapy - identify secondary gain i.e. wanting sympathy

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58
Q

Difference between somatisation and dissociative disorders?

A

Dissociative disorders often present with actual physical signs rather than vague symptoms

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59
Q

What is persistent somatoform pain disorder?

A

Somatoform disorder where pain is the predominant symptom, cannot be attributed to a physical cause and created significant distress or impairment

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60
Q

Cause of somatoform pain disorder? (3)

A

Stress i.e. abuse
Learned theory - children ay imitate family for gain
Unconscious conflicts converted to pain to help cope

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61
Q

Treatment of somatoform pain disorder? (4)

A

Rule out organic cause
CBT
Possible pain medication
Treat concurrent anxiety or depression

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62
Q

What are personality disorders?

A

Deeply ingrained and enduring patterns of behaviour that are abnormal in a particular culture, leading to subjective stress and potentially distress of others

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63
Q

When do personality disorders usually start?

A

Childhood or adolescence

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64
Q

What causes personality disorders?

A

Genetics
Adverse intrauterine/perinatal factors causing abnormal cerebral maturation
Childhood sexual abuse
Poor parenting/adverse childhood environment

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65
Q

What is the cognitive theory of PDs?

A

People with PDs developed ways of coping with early life adversity that manifest as maladaptive traits later in life

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66
Q

What is the psychodynamic theory of PDs?

A

PDs result from insecure attachment in childhood and thus in adult relationships

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67
Q

General treatment of PDs? (5)

A 
Need boundaries and consistency
Housing and social help
Treat other psych illness and substance misuse
Short term sedatives in crisis
Mood stabilisers if impulsive
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68
Q

What are cluster A personality disorders?

A

Odd/eccentric

Paranoid, schizoid, schizotypal

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69
Q

What are cluster B personality disorders?

A

Flamboyant/dramatic

Emotionally unstable, histrionic, antisocial

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70
Q

What are cluster C personality disorders?

A

Fearful/anxious

Anxious/avoidant, dependent, anankastic

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71
Q

Symptoms of paranoid personality disorder? (5)

A

Cold affect
Distrust and suspicion
Preoccupied by mistrust of friends/family
Hypersensitive to negativity and rejection
Grandiose sense of personal rights
May progress to psychosis

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72
Q

Symptoms of schizoid personality disorder? (6)

A 
Social withdrawal
Restricted range of emotional expression
Restricted pleasure
Lacking trusted friends, isolated
Indifferent to praise or criticism
Aloof and insensitive to cultural norms
No increased risk of schizophrenia
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73
Q

Symptoms of schizotypal personality disorder? (6)

A

Pervasive social and interpersonal deficits
Ideas of reference
Magical thinking
Unusual perception - bodily illusions
Vague, circumstantial, tangential thinking
Inappropriate affect
May progress to psychosis

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74
Q

Symptoms of antisocial personality disorder? (6)

A 
Disregard of rights or safety for others
Gross irresponsibility
Low threshold for frustration and aggression
Incapacity for feeling guilt
Deceitful and scapegoating
Impulsive
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75
Q

How is antisocial personality disorder prevented and treated?

A

Prevention - target children with conduct disorder and educate parents
Group CBT

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76
Q

Symptoms of emotionally unstable personality disorder? (6)

A

Unstable and intense interpersonal relationships
Self damaging impulsivity - spending, sex, driving
Identity confusion, low self esteem
Chronic anhedonia
Recurrent self harm, suicidal behaviour
Effort to avoid real or imagined abandonment

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77
Q

Types of emotionally unstable personality disorder?

A

Impulsive

Borderline

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78
Q

Symptoms of impulsive emotionally unstable personality disorder? (5)

A 
Act unexpectedly without consequence
Conflict seeking
Angry outbursts
Unstable mood
Difficulty maintaining actions without immediate reward
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79
Q

Symptoms of borderline emotionally unstable personality disorder? (5)

A 
Uncertainty of self image or aims
Unstable relationships leading to crises
Effort to avoid abandonment
Self harm
Feeling empty
Strongly linked to childhood sexual abuse
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80
Q

Treatment of emotionally unstable personality disorder? (3)

A

Dialectical behaviour therapy, CBT
Continuity of care
Treat depression or anxiety
Can predispose to bipolar

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81
Q

Symptoms of histrionic personality disorder? (5)

A

Excessive shallow emotions, shallow/labile affect
Attention seeking and suggestibility
Inappropriate sexual seductiveness with immaturity
Narcissistic, grandiose
Exploitative actions

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82
Q

Symptoms of anxious/avoidant personality disorder? (4)

A

Feelings of tension and inadequacy
Social inhibitions
Unwilling to be involved with people unless certain of being liked
Restricted lifestyle to maintain physical security

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83
Q

Symptoms of dependent personality disorder? (6)

A

Need to be taken care of, submissive
Fear of separation, needs close relationships
Low self esteem, compliant with others
Needs excessive guidance to make decisions
Needs others to assume responsibility
Unwilling to make demands or express disagreement

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84
Q

Symptoms of anankastic personality disorder? (6)

A

Excessive doubt, caution, rigidity
Preoccupied with details, lists, order
Perfectionism interfering with task completion
Excessive conscientiousness
Productivity excludes pleasure and relationships
Pedantic, adheres to social norms

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85
Q

Difference between anankastic personality disorder and OCD?

A

Can progress to OCD (or depression)
In anankastic personality disorder, obsessional thoughts or impulses are not resisted - they don’t realise it’s a problem as with OCD who know the thoughts are a product of their own mind

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86
Q

What is anorexia nervosa?

A

Morbid fear of fatness with a distorted body image, and deliberate weight loss (BMI <17.5)
Restricted eating, compulsive over exercising

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87
Q

When does anorexia nervosa commonly start?

A

Between 13-20, women

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88
Q

Cause of anorexia nervosa? (7)

A 
Genetics - first degree relatives
Anxious, obsessive personality
Altered serotonin function
Childhood abuse
Overcontrolling environment
Media overvaluing body image
Troubled relationships
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89
Q

How does altered serotonin function predispose to anorexia?

A

Dysregulation of appetite and mood

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90
Q

Psychological symptoms of anorexia nervosa? (5)

A 
Constricted affect
Reduced emotional responsiveness
Preoccupied by food
Self conscious about eating in public
Isolated
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91
Q

Physical symptoms of anorexia nervosa? (4)

A

Amenorrhoea
Loss of sexual potency in men
Constipation
Cold intolerance

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92
Q

Physical signs of anorexia nervosa? (8)

A 
Emaciation
Dry/yellow skin
Lanugo hair
Bradycardia
Hypotension
Russell's sign - scarring back of hand from vomiting
Pitted teeth
Parotid swelling
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93
Q

Signs from blood tests in anorexia nervosa? (4)

A

Anaemia
Leucopaenia
Hypokalaemia
Alkalosis

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94
Q

Treatment of anorexia nervosa? (3)

A

Family intervention 1st if teenager
If adult CBT, IPT, family therapy
NG feeding under MHA

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95
Q

When do you have to admit anorexics to hospital? (4)

A

BMI <12.5
Arrhythmia
Hypoglycaemia
Suicide risk

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96
Q

Complications of anorexia nervosa? (3)

A

Refuse treatment as they value being thin
Osteoporosis
Suicide

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97
Q

Prognosis of anorexia nervosa?

A

75% recover or improve, 20% chronic disorder, 5% die

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98
Q

What is bulimia nervosa?

A

Morbid fear of fatness, craving for food and binge eating, recurrent behaviour to prevent weight gain i.e. vomiting or laxatives

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99
Q

Symptoms of bulimia nervosa? (4)

A

Normal or excessive weight often fluctuating
Loss of control during binging
Self loathing, depression
Other impulses - self harm

100
Q

Signs of bulimia nervosa? (3)

A

Amenorrhoea despite normal weight
Hypokalaemia
Signs of vomiting - Russell’s, pitted teeth

101
Q

Management of bulimia nervosa? (3)

A

CBT or IPT
Fluoxetine if depression
Medically stabilise if hypokalaemia is severe

102
Q

What are psychosexual disorders?

A

Sexual difficulties with psychological origins rather than physical origins

103
Q

Types of psychosexual dysfunction in males? (2)

A

Erectile failure

Ejaculatory failure

104
Q

Types of psychosexual dysfunction in females? (4)

A

Low sexual interest or pleasure
Vaginismus
Dyspareunia
Orgasmic dysfunction

105
Q

Causes of psychosexual dysfunction? (8)

A 
Stress 
Past sexual abuse
Poor relationship with partner
Physical conditions - MS, diabetes, hypothyroid
Poor adjustment i.e. after mastectomy
Depression or anxiety
Substance misuse
Medications - beta blockers, diuretics, antipsychotics, antidepressants, benzodiazepines
106
Q

Management of psychosexual dysfunction? (7)

A 
Treat underlying cause
Sildenafil for erectile dysfunction
Low dose antidepressants for premature ejactulation
Mechanical penile pumps
CBT
Sex education
Couples therapy
107
Q

How are disorders of sexual preference classified?

A

Variations in the sexual object or of the sexual act

108
Q

Examples of variations of the sexual object? (3)

A

Paedophilia
Fetishism - inanimate object
Transvetism

109
Q

Examples of variations of the sexual act? (2)

A

Exhibitionism

Voyeurism

110
Q

Management of variations of the sexual object?

A

Behaviour therapy

Antiandrogens for men

111
Q

What is exhibitionism? What are the types?

A

Indecent exposure
Genital exposure accompanied by excitement and arousal
Either those of aggressive temperament where act involves masturbation or inhibited temperament where penis is flaccid

112
Q

Treatment of variations of the sexual act? (3)

A

Psychodynamic therapy
Behavioural therapy
Hormonal treatment i.e. antiandrogens

113
Q

What is disorder of sexual identity?

A

Belief that sex assigned inappropriately, strong wish to be of other sex - more common in men

114
Q

Features of disorders of sexual identity?

A

Commonly disappears as get older

Do not regard themselves as homosexual

115
Q

Treatment of disorders of sexual identity? (2)

A

Gender reassignment surgery and hormones - after 2 years living as other gender
Psychotherapy

116
Q

What is Munchausen’s syndrome?

A

Factitious disorder - deliberately feigned symptoms, usually physical but sometimes psychiatric, results in multiple presentations and sometimes surgery

117
Q

Features of Munchausen’s syndrome? (2)

A

Patients often use different aliases and have no fixed home

Characteristically occurs in severe PDs

118
Q

Treatment of Munchausen’s syndrome? (2)

A

Confrontation without rejection

CBT

119
Q

What is Munchausen’s by proxy?

A

When the parent or guardian fakes illnesses in the child or dependent - form of abuse

120
Q

Possible reasons for Munchausen’s and Munchausen’s by proxy? (2)

A

Gain attention, sympathy, reassurance

Financial benefits

121
Q

Name 5 sleep-wake disorders

A 
Insomnia
Hypersomnolence
Narcolepsy
Restless legs
Substance use
122
Q

How common is night time wakefulness in children?

A

20%

123
Q

What causes sleep disorders?

A

Misalignment of the circadian rhythm system and external environment
Social/behavioural factors can perpetuate

124
Q

What is primary insomnia?

A

Sleeplessness not attributable to medical, psychiatric or environmental cause

125
Q

How is primary insomnia diagnosed? (4)

A

Difficulty initiating or maintaining sleep or suffering from non restorative sleep
Clinically significant distress or impairment in daily functioning
Does not occur exclusively during other illness
Not due to other conditions, or drugs

126
Q

Treatment of insomnia? (6)

A 
Possibly antihistamines
Melatonin
Benzodiazepines
Sedating low dose antidepressant - trazodone, mirtazepine, amitriptyline 
CBT
Relaxation therapy
127
Q

What is the difference between learning disability and learning difficulty?

A

Learning disability - globally reduced intellect (IQ below 70) and difficulty performing everyday tasks
Learning difficulty - specific problems processing certain forms of information e.g. dyslexia, no global reduction in intellect

128
Q

Types of learning disability and their IQ?

A

Mild 50-70
Moderate 35-49
Severe 20-34
Profound <20

129
Q

What causes learning disability?

A

Mild - limited social/learning opportunities, genetically low IQ
Moderate/severe/profound - specific biological cause e.g. Down’s syndrome

130
Q

Differences in symptoms between severity of learning disability?

A

Mild may live independently and have a job but not be able to cope with stress and complex social functioning
ranging to
Profound has very limited skills and language, deficits in movement and continence
Epilepsy more common the more severe the disability

131
Q

Define learning disability?

A

Low intellectual performance, from birth or early childhood, leading to reduced life skills

132
Q

Give a chromosomal, X linked, autosomal dominant and autosomal recessive cause of learning disability

A

Chromosomal - Down’s, Turner’s
X linked- Fragile X
AD - Neurofibromatosis
AR - metabolic disorders

133
Q

Give 2 antenatal causes of learning disability?

A

Infection - rubella, CMV

Hypoxia

134
Q

Perinatal causes of learning disability? (3)

A

Prematurity
Hypoxia
Intracerebral bleed

135
Q

Postnatal causes of learning disability? (5)

A 
Infection
Injury
Malnutrition
Hormonal
Epileptic
136
Q

Name 5 psychiatric conditions increased in people with learning disability?

A 
Depression
Anxiety
Behavioural disturbance
Mania
Schizophrenia
137
Q

What is Down’s syndrome?

A

Most specific cause of learning disability, trisomy of chromosome 21
Most have moderate-severe LD

138
Q

Complications of Down’s syndrome? (5)

A 
Alzheimer's
Hypothyroidism
Cardiac septal defects (AVSD)
Duodenal atresia
Leukaemia
139
Q

Physical features of Down syndrome child? (6)

A 
Broad hands with single palmar crease
Flat occiput
Epicanthal folds
Flat nasal bridge
Small mouth
High arched palate
140
Q

Treatment of Down’s?

A

Social and family support

Capacity legislation for best interests

141
Q

What is fragile x syndrome?

A

Most common cause of inherited learning disability, mutation of FMR1 gene on X chromosome, affects boys more severely

142
Q

How is fragile x inherited?

A

X linked dominant

143
Q

How is fragile x related to autism?

A

Fragile X is the most common identified cause of autism - 1/3 of fragile x have autism

144
Q

Features of fragile x syndrome? (5)

A 
Large head and ears
Poor eye contact
Abnormal speech
Hyperesensitivity to touch, auditory, visual stimuli
Head flapping, hand biting
145
Q

What is autism spectrum disorder?

A

Developmental disorders characterised by difficulties in social interaction and communication and by restricted/repetitive thought patterns

146
Q

Symptoms of autism spectrum disorder? (7)

A 
Failure to make relationships - aloof, poor empathy
Language and communication difficulties
Resistance to change, ritualistic
Restricted range of interests 
Stereotyped behaviour
Hypo/hyperrreactivity 
Some have isolated higher skills
147
Q

Treatment of autism spectrum disorder? (3)

A

Intensive behavioural treatments
Reward positive behaviour
Family support

148
Q

What are Aspergers and autism classified as?

A

Pervasive developmental disorders

149
Q

Features of Asperger’s? (4)

A

Less severe than autism
Later onset
Normal intelligence and language
Schizoid personality - pedantic, preoccupation with obscure facts

150
Q

What is enuresis?

A

Non organic, involuntary bladder emptying after 5 years of age, during day or night
Primary or secondary (period of previous continence)

151
Q

Causes of enuresis? (4)

A

Family history
Developmental delay
Unsettling events
Behavioural problems

152
Q

Management of enuresis? (5)

A 
Exclude physical cause e.g. UTI
Address fluid intake and toilet patterns
Reward systems
Enuresis alarms activated by moisture
Desmopressin
153
Q

What is Tourette’s syndrome?

A

Involuntary facial or vocal tics, mostly males, can be transient or chronic

154
Q

Causes of Tourette’s?

A

Family history of tics/OCD
Learning disability, autism, ADHD
Smoking/alcohol/cannabis during pregnancy
Possible imbalance of neurotransmitters

155
Q

Name 6 types of tic

A 
Coprolalia - swearing
Copropraxia - rude signs
Echolalia/echopraxia
Palilalia - repeating self
Self injury
Non obscene socially inappropriate behaviours
156
Q

Treatment of Tourette’s? (3)

A

Psychoeducation
Behavioural therapy - habit reversal, comprehensive behavioural intervention for tics (CBIT)
Possible antipsychotics

157
Q

How is attention-deficit hyperactivity disorder diagnosed? (4)

A

> 6 months of short attention span
Distractibility
Overactivity
Impulsivity

158
Q

What causes ADHD? (5)

A 
Genetics
Social adversity
Parental alcohol abuse
Diet - lead
Tranquilliser exposure
159
Q

What does ADHD commonly exist with? (5)

A 
Conduct disorder
Anxiety/depression
Learning difficulty
Antisocial behaviour
Substance misuse
160
Q

Treatment of ADHD? (3)

A

Parent education
Classroom behavioural interventions
Methylphenidate - ritalin

161
Q

What is conduct disorder?

A

Persistent disruptive, deceptive, aggressive behaviours

162
Q

5 examples of behavioural problems in conduct disorder

A 
Disobedience
Truancy
Lying
Arson
Stealing
163
Q

Causes of conduct disorder? (6)

A 
Low socioeconomic class
Learning difficulty/ADHD
Familial problems such as harsh parenting
Parents with alcohol dependence
Depression
Antisocial PD
164
Q

What is socialised and unsocialised conduct disorder?

A

Socialised - behaviour viewed as normal among peers

Unsocialised - solitary behaviour, peer rejection

165
Q

Management of conduct disorder? (3)

A

Parental education
Behavioural management
CBT, social skills therapy

166
Q

What is separation anxiety disorder?

A

Anxiety disorder in which an individual expresses excessive anxiety regarding separation from home or from people to whom the individual has strong emotional attachment

167
Q

When is separation anxiety most common?

A

6 months - 3 years

168
Q

Causes of separation anxiety disorder? (4)

A

Parental psychiatric illness
Early/traumatic separation
Life events - parental divorce/new school/bereavement
Predisposing temperament

169
Q

Management of separation anxiety disorder? (5)

A 
Counselling
CBT
Family therapy
Behavioural therapy
SSRIs for anxiety
170
Q

What are the top 4 most common illicit drugs used?

A

Cannabis
Cocaine
Ecstasy
Amphetamines

171
Q

The 7 types of substance use disorders?

A 
Acute intoxication
Harmful use
Dependence
Withdrawal state
Psychosis
Amnesia
Residual/late onset
172
Q

Signs of dependence? (8)

A 
Compulsion to take substance
Aware of harm but persists
Neglect of other activities
Tolerance
Withdrawal on stopping
Increasing time taken up by substance
Out of control use
Persistent futile wish to stop
173
Q

Causes of substance misuse? (5)

A 
Availability
Peer pressure - young men
Desire for pleasurable effects
Prescription drug use
Psychiatric illness - impulsivity, anxiety, PD
174
Q

Why do drugs give a pleasurable effect?

A

Activate the dopamine system in the mesolimbic reward pathway

175
Q

General management of substance misuse? (6)

A 
In community - hospital or rehab if severe
Rewards e.g. for sticking to methadone
CBT
Motivational interviewing
Self help groups
Harm reduction e.g. needle exchange
176
Q

Name 3 opioids

A

Heroin, methadone, morphine

177
Q

How are opioids taken? (5)

A

Snorted, smoked, oral, IV, SC

178
Q

Effects of opioids? (3)

A

Intensely pleasurable rush
Peace and detachment
CNS depression

179
Q

Signs of opioid dependence? (8)

A 
Mioisis (constricted pupils)
Tremor
Malaise
Apathy
Constipation
Weakness
Impotence
Neglect/malnutrition
180
Q

Risks of opioid use? (4)

A

HIV
Hepatitis B/C
Respiratory depression
Death (2-3% annually)

181
Q

Why are opioids so addictive?

A

Tolerance and withdrawal develop quickly

Short half life of heroin so need more quickly

182
Q

Management of opioid misuse? (4)

A

Methodone or buprenorphine for detox or maintenance
Harm reduction - needle exchange
Psychosocial support
Overdose - give naloxone

183
Q

Withdrawal symptoms from opioids? (4)

A

Cravings
Flu like symptoms
Sweating, tachycardia
Abdo cramps, diarrhoea

184
Q

Why is methadone used for opioid addiction?

A

Less euphoriant
Longer half life
Prevents withdrawal as prescribed at high dose

185
Q

What is the active compound in cannabis?

A

Tetrahydrocannabinol

186
Q

How is cannabis taken?

A

Orally, smoked

187
Q

Effects of cannabis? (4)

A

Euphoria
Relaxation
Increased appetite
Decreased body temperature

188
Q

Adverse effects of cannabis? (5)

A 
Conjunctival irritation
Decreased spermatogenesis
Schizophrenia/transient psychosis
Lung disease
Depression, apathy
189
Q

Treatment of cannabis?

A

Community therapy

190
Q

Name 2 stimulants

A

Cocaine

Amphetamines

191
Q

How are stimulants taken?

A

IV, snorted, smoked (crack cocaine)

192
Q

Effects of stimulants? (5)

A 
Brief high and euphoria
Increased energy and concentration
Depression and tiredness after use
Possible psychosis
Cocaine - hallucinations of insects, paranoia
193
Q

Treatment of stimulants?

A

Community therapy

194
Q

Name 3 hallucinogens

A

Ecstasy, LSD, magic mushrooms

195
Q

How are hallucinogens taken?

A

Orally

196
Q

Effects of hallucinogens?

A

Stimulant

Hallucogenic

197
Q

Adverse effects of hallucinogens?

A

Ecstasy - severe dehydration or hyponatraemia from excessive water
LSD - psychosis, seizures

198
Q

Effects of benzodiazepines? (3)

A

Dependence common
Seizures when withdrawing
Euphoria, less anxiety, relaxation

199
Q

How do benzodiazepines work?

A

Increase GABA-inhibitory neurotransmitter

200
Q

How are solvents taken and what effect does this cause?

A

Sniffed, red rash around mouth and nose

201
Q

Effects of solvents? (4)

A

Initial euphoria then drowsiness
Weight loss, nausea, vomiting
Cognitive impairment and polyneuropathy
Toxic fatal effects - bronchospasm, arrhythmias

202
Q

What is alcohol misuse?

A

Regular or binge consumption of alcohol sufficient to cause physical, neuropsychiatric or social damage

203
Q

How to work out alcohol units?

A

Volume of drink (ml) x ABV%

/1000

204
Q

Recommendations for alcohol per week?

A

14 units men and woman, 2 drink free days and no binges (4/5 drinks in 2 hours)

205
Q

Signs of alcohol intoxication? (5)

A 
Slurred speech
Impaired coordination and judgment
Labile affect
Hypoglycaemia
Coma
206
Q

Signs of alcohol withdrawal? (6)

A 
Malaise
Nausea
Autonomic hyperactivity
Tremor
Insomnia
Hallucinations/seizures
207
Q

What is delirium tremens? 4 signs

A

Severe life threatening alcohol withdrawal - rapid confusion, tremor, seizures, arrhythmia

208
Q

Treatment of delirium tremens/acute alcohol withdrawal? (3)

A

Give benzodiazepines! 1st
Antipsychotics
Rehydrate, correct electrolytes, give thiamine

209
Q

2 screening tests for alcohol

A

CAGE - tried to cut down, annoyed when asked about alcohol, guilty, eye opener
FAST - frequency of: can’t remember night before, failed to function normally, someone else being concerned

210
Q

Physical signs of alcohol misuse? (3)

A

Jaundice
Spider naevi
Peripheral neuropathy

211
Q

Causes of alcohol misuse? (7)

A 
Genetics e.g. different metabolism
Depression or other chronic illness
Occupation - soldiers, doctors
Culture
Availability and cost
Social reinforcement 
Environment - learning by copying
212
Q

What is classical and operant conditioning?

A

Classical - drinking associated with pleasure, activates mesolimbic dopaminergic reward pathway
Operant - avoiding withdrawal effects

213
Q

Complications of alcohol misuse? (8)

A 
Peripheral neuropathy
Erectile/ejaculatory impotence
Cerebellar degeneration
Dementia 
Liver failure
Social complications - jobs, relationships
Wernicke's/Korsakoff's
Depression and suicide
214
Q

Symptoms of alcohol related dementia?

A

Caused by long term use

Characterised by impaired executive function - planning, thinking, judgment

215
Q

Treatment of alcohol related dementia?

A

Stop drinking
Replace vitamins (thiamine)
May be permanent

216
Q

How to do acute detoxification of alcohol? (3)

A

In hospital if risk of seizures/delirium tremens
High dose of benzodiazepines then tapered
Rehydrate, give electrolytes, thiamine

217
Q

Psychological treatment of alcohol dependence? (3)

A

Motivational interviewing
Self help groups
Individual psychotherapy

218
Q

3 medications to maintain alcohol abstinence and how they work

A

Disulfiram - blocks alcohol metabolism causing headache, nausea if drink
Acamprosate - acts on GABA to reduce relapse and desire for alcohol
Naltrexone - opioid receptor antagonist and reduces desire for alcohol

219
Q

Prevention of alcohol misuse? (3)

A

Increase alcohol tax
Restrict advertisement and sale
Educate in schools

220
Q

Symptoms of Wernicke’s encephalopathy? (4)

A

Ataxia
Nystagmus
Opthalmoplegia
Acute confusion

221
Q

What causes Wernicke’s encephalopathy?

A

Thiamine deficiency - inadequate intake, decreased absorption from GI tract, poor utilisation all due to alcohol
Thiamine deficiency causes mamillary body damage

222
Q

Treatment of Wernicke’s encephalopathy?

A

Thiamine

223
Q

What is Korsakoff’s psychosis?

A

Confabulation and profound short term memory loss due to long term drinking - thiamine deficiency

224
Q

Treatment of Korsakoff’s psychosis?

A

Thiamine but unlikely to recover as damage done

225
Q

3 conditions lithium is used in

A

Bipolar
Mania
Schizoaffective disorder

226
Q

Why is lithium toxicity dangerous?

A

Lithium interacts with all body systems where sodium, potassium, calcium or magnesium are involved
Probably affects neurotransmitters

227
Q

What is the therapeutic range of lithium?

A

Narrow - 0.4-1mmol/L

228
Q

What monitoring needs to be done with lithium? (2)

A

Thyroid and renal (excreted by kidneys)

Serum lithium levels

229
Q

Side effects of lithium? (6)

A 
Nausea
Fine tremor
Weight gain
Oedema
Polydipsia and polyuria
Hypothyroid
230
Q

Signs of lithium toxicity? (7)

A 
Vomiting and diarrhoea
Coarse tremor
Slurred speech
Ataxia
Drowsy/confused
Seizure
Coma
231
Q

Treatment of lithium toxicity? (2)

A

Stop lithium

Iv fluids

232
Q

Causes of lithium toxicity? (2)

A

Dehydration, diuretics

233
Q

What causes serotonin syndrome?

A

Drugs that increase serotonin availability e.g. SSRIs, more likely 2 in combination

234
Q

Symptoms of serotonin syndrome? (7)

A 
Confusion
Delirium
Shivering
Sweating
Hypertension
Seizures
High temperature
235
Q

Treatment of serotonin syndrome?

A

Discontinue medications
Benzodiazepines
Body cooling
Serotonin antagonist - cyproheptadine

236
Q

What is neuroleptic malignant syndrome?

A

Potentially fatal complication of antipsychotics (usually typical) due to blockage of dopamine receptors

237
Q

Symptoms of neuroleptic malignant syndrome? (5)

A 
Hyperpyrexia
Autonomic instability
Confusion
Hypertonia
Raised creatinine phosphatse
238
Q

Treatment of NMS? (5)

A 
Stop antipsychotic
Body cooling - dontrolene
Hydrate
Benzodiazepines
Bromocriptine - dopamine agonist
239
Q

What is acute dystonic reaction?

A

Side effects of antipsychotics (usually typical) - is a movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting movements, fixed postures

240
Q

Name 4 acute dystonic reactions

A

Torticollis
Oculogyric crisis
Increased muscle tone
Tardive dyskinesia

241
Q

What is torticollis?

A

Head rotates to one side, back, to chest

242
Q

What is an oculogyric crisis?

A

Extreme sustained upward deviation of eyes, often with backward neck flexion and jaw clenching

243
Q

What is tardive dyskinesia?

A

Grimacing, sticking out tongue, smacking lips

244
Q

Treatment of acute dystonic reactions? (4)

A

Rehabilitation
Anticholinergics
Anti Parkinsons meds - ropinirole, bromocriptine
Diazepam

245
Q

What is paraphilia?

A

Paraphilic disorders are recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of oneself or the partner with the potential to cause harm

3A REVISION (17 decks)

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