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3rd year > Psychiatry 2.0 > Flashcards

Psychiatry 2.0 Flashcards

1
Q

What are the 2 mechanisms of tolerance?

A

Dispositional

Pharmacodynamic

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2
Q

What is the difference between the 2 mechanisms?

A

Dispositional - less drug reaches the active site. Less drug absorbed, drug metabolised faster, more drug excreted.

Pharmacodynamic - drug has less action at the active site. Fewer drug receptors, less efficient drug receptors.

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3
Q

What are the key points in dispositional tolerance?

A

Less drug reaches the active site:

  • Decreased rate of absorption
  • Increased rate of metabolism to inactive metabolites.
  • Decreased rate of metabolism to active metabolites.
  • Increased rate of excretion.
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4
Q

What are the key points in Pharmacodynamic tolerance?

A

Site of action is less affected by the drug:

  • down-regulation or internalisation of drug receptors.
  • reduced signalling down stream of drug receptors.
  • some other compensatory mechanism.
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5
Q

What can development of tolerance lead to?

A

Withdrawal symptoms.

e.g. reduced transmitter release can lead to increased sensitivity to transmitter.

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6
Q

What happens in 1. normal synaptic transmission, 2. Drug effect, 3. Development of drug tolerance, 4. Drug withdrawal.

A
  1. Normal response
  2. Reduced response
  3. Normal response
  4. Increased response
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7
Q

What is the withdrawal phenomena?

A

The withdrawal effect is usually the reverse of the acute effect.
Development of tolerance may lead to physical dependence in order to avoid the withdrawal effect.

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8
Q

What is the reward pathway?

A

Neurones project from the ventral tegmental area to the nucleus accumbens and prefrontal cortex.
When VTA neurones are stimulated dopamine is released.
This causes a sensation of pleasure and reward.

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9
Q

Why has the reward pathway evolved?

A

Normally activated by eating, drinking and sex.

Encourages those ‘healthy’ behaviours that lead to propagation of your genes.

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10
Q

What are some drugs able to do to the reward centres?

A

Tap into the reward pathway and increase dopamine levels e.g.
Heroin increases firing rate of dopaminergic neurones.

This produces the psychological component of addiction - craving.

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11
Q

What are the 2 distinct components of drug dependence?

A

Physical which develops as a consequence of tolerance to the drug.

Psychological craving which is as result of stimulation of the reward pathways in the brain.

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12
Q

How long does it take for cocaine to start affectng your body?

A

Depends on dose and rate of entry to the brain.
Smoking - almost immediate
Injecting - 15 to 30 secs
Snorting - 3-5 mins

The effects of crack smoking are very intense but quickly over (15mins)

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13
Q

What are the effects of cocaine?

A 
Stimulant and euphoriant
Increased alertness and energy. 
Increased confidence and impaired judgement. 
Lessens appetite and desire for sleep. 
Damage to nose and airways. 
Convulsions with resp failure. 
Cardiac arrhythmia's and MI. 
Hypertension and CVA. 
Toxic confusion. 
Paranoid psychosis.
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14
Q

What are cocaine withdrawal affects?

A 
Depression 
Irritability 
Agitation 
Craving 
Hyperphagia 
Hypersomnia
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15
Q

What are side effects of amphetamine?

A

Toxic confusion occasionally with convulsions and death.

Amphetamine psychosis in heavy chronic use.

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16
Q

What are the different kinds of opiates?

A 
Opium 
Morphine 
Heroin 
Methadone 
Codeine and dihydrocodeine.
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17
Q

What are the effects of heroin?

A 
Analgesia 
Drowsiness and sleep 
Mood change 
Resp depression 
Cough reflex depression
Decreased sympathetic outflow. 
Lowering body temp.
Papillary constriction 
Constipation. 
Reduced consciousness. 
Pinpoint pupils.
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18
Q

Effects of opiates?

A

Intense but transient feeling of pleasure.

  • “a rush”
  • Almost orgasmic.
  • Physical and emotional anaesthetic.
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19
Q

Side-effects of opiates?

A

First time - nausea/vomiting and headache.

Medium term - phlebitis, anorexia, constipation.

Longer term - tolerance, withdrawal, Social and health problems

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20
Q

What is opiate withdrawal syndrome?

A 
Craving 
Insomnia 
Yawning 
Muscle pain and cramps 
Increased salivary, nasal and lacrimal secretions. 
Dilated pupils
Piloerection.
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21
Q

What does methadone maintenance allow?

A

Decriminalises drug use.
Allows normalisation of lifestyle.
Reduces IV misuse
Leakage on to the illicit market.

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22
Q

What does ecstacy (mixed LSD and amphetamine) do to you?

A

Euphoria followed by feeling of calm.
Increased sociability.
Inability to distinguish between what is and isn’t desirable.
Effects after 20 mins lasting 2-4hours.

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23
Q

What are side effects of Ecstasy?

A

Nausea and dry mouth
Increased blood pressure and temperature.
Dehydration
Large doses can cause anxiety and panic.
Drug induced psychosis.

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24
Q

What are the psychological effects of cannabis?

A

Relaxing or stimulating, euphoriant, increases sociability and hilarity, increases appetite, changes in time perception.

In higher dose - anxiety, panic, persecutory ideation, hallucinatory.

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25
Q

What are the ill effects of cannabis?

A

Respiratory problems as with tobacco.
Toxic confusion.
Exacerbation of major mental illness.

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26
Q

What are anabolic steroids?

A

Family of drugs comprising testosterone and many synthetic analogues.

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27
Q

What are physical effects of anabolic steroids?

A

Muscle hypertrophy from steroid use in particularly marked in the upper body in the pectoralis, deltoid, trapezius and biceps.

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28
Q

What are the steroid side effects?

A

Skin - acne, stretch marks, baldness.

Feminisation in males with hypogondism and gynaecomastia.

Virilisation in women including hirsutism, deep voice, clitoral enlargement, menstrual irregularities.

CVS - increases cholesterol and hypertension.

Growth deficits due to premature closure of epiphyses.

Liver disease - cholestatic jaundice, liver tumours.

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29
Q

What are the psychological effects of steroids?

A

Irritability and anger
Hypomania and mania
Depression and suicidality or withdrawal.

30
Q

What is the definiton of Psychosis?

A

Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality.

31
Q

What are the clinical presentation of psychosis?

A

Hallucinations - have the full force of clarity of true perception. Located in external space, no external stimulus, not willed or controlled.

32
Q

What is the definition of a delusion?

A

Unshakeable idea or belief which is out keeping with the person’s social and cultural background; it is held with extraordinary conviction.

e.g. grandiose, paranoid, self referential.

33
Q

What is Schizophrenia?

A

A severe mental illness affecting:
Thinking
Emotion
Behaviour

Most common cause of psychosis:
Affects 1 per 100 pop
Males = females
15-35 years onset.

34
Q

What are the symptoms of Schizophrenia?

A

Positive = Hallucinations, Delusions, Disordered thinking.

Negative symptoms = Apathy, lack of interest, lack of emotions.

35
Q

How is Schizo diagnosed?

A

ICD - 10
For more than a month in the absence of organic or affective disorder. at least one of following:

  1. Alienation of thought as thought echo.
  2. Delusions of control, influence or passivity.
  3. Hallucinatory voices giving running commentary on patient’s behaviour.
  4. Persistent delusions of cultural inappropriate or completely impossible.

AND/ OR two of:
1. Persistent hallucinations in modality.

  1. Neologisms, breaks or interpolations in the train of thought.
  2. Catatonic behaviour, excitement, stupor.
  3. Negative symptoms such as marked apathy.
36
Q

What are the different types of Schizo?

A 
Paranoid. 
Hebephrenic. 
Catotonic. 
undifferentiated. 
Post-schizophrenia depression. 
Residual. 
Simple. 
Other. 
Unspecified.
37
Q

What can cause Psychosis?

A

Biological factors
Psychological factors
Social factors
Evolutionary theories

38
Q

What can be differential diagnosis for psychosis?

A

Delirium or acute organic brain syndrome.

39
Q

What is depressive episode with psychotic symptoms?

A

Delusions of guilt, worthlessness and persecution.

Derogatory auditory hallucinations.

40
Q

What are Manic episode symptoms?

A

Delusions of grandeur, special powers or messianic roles.

Gross overactivity, irritability and behavioural disturbance: Manic excitement.

41
Q

How is Schizophrenia managed?

A

SIGN guidelines.

42
Q

What is the prognosis and recovery like in Schizophrenia?

A

80% recovery after first episode of psychosis.

Up to 50% have moderate recovery.

Good:
No FH, good premorbid function. Acute onset. Mood disturbance.

Poor:
Slow onset.
Suicide risk higher.
Poorer if starts in childhood.

43
Q

What are the Cluster A personality disorders? And what is the prominent problem?

A

Problems with perceived safety of interpersonal relationships.

Paranoid Personality Disorder
Schizoid personality disorder
Schizotypical personality disorder.

44
Q

What is the diagnostic criteria for Paranoid PD?

A

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. Indicated by 4 of the following:

  1. Suspects, without sufficient basis, that others exploiting them.
  2. Is preoccupied with unjustified doubts about loyalty.
  3. Reluctant to confide in others because of fear of information being used against them.
  4. Reads hidden demeaning into bening remarks.
  5. Presistently bears grudges.
  6. Perceives attacks on their character or reputation.
45
Q

What is the diagnostic criteria for Schizoid personality disorder?

A

A pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts. Indicated by four of the following:

  1. Neither desires nor enjoys close relationships, including being part of a family.
  2. Almost always choses solitary activities.
  3. has little, if any, interest in having sexual experiences with another person.
  4. Takes pleasure in few, if any, activities.
  5. Lacks close friends or confidants other than first-degree relatives.
  6. Appears indifferent to the praise or criticisim of others.
  7. Shows emotional detachment.
46
Q

What is Schizotypal Personality disorder? and what is the diagnostic criteria?

A

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive distortions. Indicated by 5 of the following:

  1. Ideas of reference
  2. Odd beliefs or magical thinking that influences behaviour, inconsistent with subcultural norms.
  3. Unusual perceptual experiences
  4. Odd thinking and speech
  5. Suspiciousness
  6. Inappropriate or constricted affect.
  7. Behaviour or appearance that is odd or eccentric.
47
Q

What are the main cluster B personality disorders?

A 
Antisocial  
Narcissitic 
Borderline 
Histrionic 
Personality disorder.
48
Q

What is Antisocial Personality disorder? and what is the diagnostic criteria?

A

Pervasive pattern of disregard for and violation of the rights of others, occurring since 15. Indicated by 3 of following:

  1. Failure to conform to social norms with respect to lawful behaviours.
  2. Deceitfullness, repeated lying, conning others.
  3. Impulsivity
  4. irritability and aggresion - assaults repeated.
  5. Recklessness
  6. Irresponsibility.
  7. Lack of remorse
49
Q

What is borderline personality disorder? and what is the diagnostic criteria?

A

A pervasive pattern of instability of interpersonal relationships, self-image, and marked impulsivity, beginning early adulthood. Indicated by 5 of the following:

  1. Frantic efforts to avoid real or imagined abandonment.
  2. Pattern of unstable and intense interpersonal relationships.
  3. Identity disturbance.
  4. Impulsivity in 2 areas.
  5. Recurrent suicidal behaviour
  6. Chronic feeling of emptiness.
50
Q

What is Narcissitic personality disorder? and what is the diagnostic criteria?

A

Pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood.

Indicated by 5 of the following:

  1. Grandiose sense of self-importance.
  2. Pre-occupied with fantasies of unlimited success, power.
  3. Believes that they are “special”
  4. Requires excessive admiration.
  5. Sense of entitlement.
  6. Lacks empathy
  7. Arrogant.
51
Q

What is Histrionic Personality Disorder? And what is the diagnostic criteria?

A

Pervasive pattern of excessively emotionally and attention seeking beginning by early adulthood and present in a variety of contexts. Indicated by 5 or more:

  1. Uncomfortable in situations where they are not centre of attention.
  2. Interaction with others is often characterised by inappropriate sexually seductive or provocative behaviour.
  3. Displays rapidly shifting and shallow expressions of emotions.
  4. Consistently uses physical appearance to draw attention.
  5. Self -dramatisation
  6. Suggestible
  7. Thinks relationships are more intimate than they are.
52
Q

What are the cluster C personality disorders?

A

Obsessive-Compulsive
Avoidant
Dependent
Personality disorders.

53
Q

What is Obsessive-compulsive personality disorder? and what is the diagnostic criteria?

A

Pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility and openness.
Indicated by 4 of the following:

  1. Preoccupied with details, rules, lists
  2. Shows perfectionism that interferes with task completion.
  3. Excessively devoted to work and productivity.
  4. Overconscentious
  5. Unable to discard worn-out objects.
  6. Rigidity and stubborness.
54
Q

What is avoidance personality disorder? and what is the diagnostic criteria?

A

Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Indicated by 4 of the following:

  1. Avoids occupational activities that involve interpersonal contact.
  2. preoccupied by criticism
  3. Shows restraint within personal relationships.
  4. Views self as socially inept, personally unappealing.
  5. Reluctant to take personal risks.
55
Q

What is Dependent personality disorder and what is the diagnostic criteria?

A

Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation.
Indicated by 5 of the following:

  1. Difficulty making everyday decisions.
  2. Needs others to assume responsibility
  3. Difficulty expressing disagreement.
  4. Difficulty initiating things.
  5. Urgently seeks another relationship as source of care.
  6. Goes to excessive lengths to get support from others.
56
Q

What have genetic studies shown about some mental illness?

A

ADHD and Autism are highly genetic.

Depression and anxiety are also substantially genetic.

57
Q
  1. What is separation anxiety?

2. What is social phobia?

A
  1. Fear of leaving parents and home.

2. Fear of joining group.

58
Q

What are the features of anxiety disorders?

A

Anxious thoughts and feelings.
Autonomic symptoms.
Avoidant behaviour.

59
Q

Motivational factors affecting school attendance?

A 
Learning difficulties
Lack of friends
Bullying 
Lack of parental attention or concern. 
Maternal depression.
60
Q

What happens to activity in Amygdala in anxiety disorders?

A

Activity is supressed by right ventrolateral amygdala.

Reduced connectivity between right and ventrolateral cortex and amygdala in generalised anxiety.

61
Q

Treatment of anxiety

A

Behavioural - learning alternative patterns of behaviour, desensitization, overcoming fear, managing feelings.

Medication - serotonin re uptake inhibitors e.g. fluoxetine

62
Q

What are the principles of cognitive behavioural therapy?

A

Thoughts
Behaviour
Feelings

63
Q

Long term effects of successful behavioural treatment

A

Challenge
Success
Self-confidence
Resilience

64
Q

How do you approach CBT with children and families?

A 
Mostly B and T. 
Parents as collaborators. 
Step-wise approach
Externalisation 
Overcoming barriers to change.

Psychoeducation
Goal-setting
Motivating

65
Q

What are the models of stress?

A

Biochemical “engineering”
Medicophysiological
Psychological (Transactional)

66
Q

What are the Psychological stress coping mechanisms?

A

Interactive.
Problem focused - Efforts are directed towards modifying stressor. Prep, studying, interview practice.

Emotion focused - Modify emotional reaction. Mental defence mechanisms. Relaxation training. Take a sedative drug.

67
Q

What are the symptom groups of anxiety?

A 
Psychological arousal 
Autonomic arousal 
Muscle tension 
Hyperventilation 
Sleep Disturbance
68
Q

What are the psychological arousal?

A 
Fearful anticipation 
Irritability 
Sensitivity to noise 
Poor concentration 
Worrying thoughts
69
Q

What are the autonomic arousal?

A

GI - dry mouth, swallowing problems, dyspepsia, nausea, loose motions frequently.

Resp - Tight chest, difficulty breathing.

Cardio - Palpitations / missed beats, chest pain.

Genitourinary - frequency/urgency.

CNS - dizziness and sweating

70
Q

Definition of delusion

A

Unshakable idea or belief which is out of keeping with the person’s social and cultural background.
Held with extraordinary conviction.

3rd year (22 decks)

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