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Psychiatry Flashcards

1
Q

Another word for ‘mood’ disorders

A

Affective

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2
Q

Rough prevalence of dementia in uk?

A

830,000

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3
Q

Risk factors for alzheimer’s disease

A 
Family hx
Genetics
Downs syndrome
Vascular risk factors 
Low physical activity 
Low mental activity
Depression
Loneliness
Smoking
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4
Q

Gene often mutated in Alzheimer’s

A

Apolipoprotein E (ApoE)

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5
Q

Define dementia

A

Progressive
Decline in cognitive function
Especially effecting memory
Usually global

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6
Q

What are the 7 A’s of dementia? What do they mean?

A

Apathy - not initiating things
Aphasia - decreased language, both spoken and written
Agnosia - lack of recognition
Amnesia - lack of memory
Apraxia - lack of ability to coordinate movements despite understanding and adequate muscle strength
Altered perception - misinterpretation of events and visiospacial
Anosognosia - lack of insight

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7
Q

What are the two core pathological hallmarks of Alzheimer’s disease. What is the effect on the cell signalling in the brain?

A

Deposition of extracellular beta amaloid
Formation of neurofibrillary tangles of tau proteins destabilising microtubules.
Results in cell apoptosis and low ACh, NA and 5HT

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8
Q

What brain regions does alzheimers mainly effect. Where is usually effected later

A

Temporal, parietal and hipocampus

Later frontal

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9
Q

How does alzheimers present on head imaging? What features of the scan suggest this?

A

Global atrophy +
Hippocampal atrophy +++
Suggested by increased ventricle size and sulci size

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10
Q

Other than imaging, what other test may show a change associated with alzheimers?

A

CSF - raised tau proteins.

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11
Q

What are the characteristics of vascular dementia?

A

Sudden onset
Stepped progression
Often memory and cognition but can effect where ever there are lesions

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12
Q

4 main causes of dementia

7 minor ones

A

Alzheimers, vascular, lewy body, frontotemporal

Parkinsons, huntingtons, progressive supranuclear palsy, cjd, wilsons, ms, hiv

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13
Q

What are the mental features of frontotemporal dementia?

A

Behaviour change
Language problems
Loss of world knowledge

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14
Q

What is largely preserved in frontotemporal dementia?

A

Praxis
Episodic memory
Spatial skills
Perception

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15
Q

What clinical signs may suggest frontotemporal dementia? (Group and specific)

A

Primitive reflexes

  • grasp
  • tap forehead and eyelids blink
  • oral reflexes - sucking related
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16
Q

What is the term for excessive blinking on tapping the forehead? What diseases is it related too?

A

Gabella tap
Frontotemporal dementia
Parkinsons

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17
Q

What drugs are used in altzheimers
Example
Side effects

A

Acetylcholinesterase inhibitors
Donazepil
Bradycardia, constipation, nausea and vomiting

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18
Q

What drug is useful in lewy body dementia to control behavioural issues?

A

Rivastigmine

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19
Q

On what chromosome is the genetic change that is linked to frontotemporal dementia found?

A

9

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19
Q

How is frontotemoral see on a CT?

A

Atrophy of the frontotemporal lobes only

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19
Q

What reaction may occur in a patient with lewy body dementia who is given an antipsychotic?

A

Severe extrapyramidal side effects

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20
Q

What specific imaging can be used in lewy body dementia? What is it? What other condition can it be used in?

A

DAT Scan - radioactive iodine with high affinity for presynaptic dopamine transporters

Parkinsons

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21
Q

What should be checked for in cognitive impairment?

A

Fbc, u+e, bm, lfts, b12+folate, tfts, hiv, syphallis, serum copper,
Cxr, ct head

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23
Q

What general pharmocological interventions may help in dementia and complications thereof?

A

Memantine

Depressed - SSRIs/mirtazapine

Agitation/aggression (if not manageable and no reversible cause) - lorazepam/haliperidol

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24
Q

What is the definition of psychosis? What are the four cardinal symptoms of psychosis?

A 
Experiencing a different reality to the majority of people without insight.
Hallucinations
Delusions
Formal thought disorders
Disorders of the self
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25
Q

What are hallucinations?

A

Perception in the absence of stimuli

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26
Q

What is the definition of delusions?

A

A firm belief that is held despite a lack of evidence and contradictory evidence out of keeping with the individuals social and cultural norms.

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27
Q

Some types of delusion

A 
Grandiose
Persecutory 
Guilt 
Reference
Hypochodriacal
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28
Q

Types of auditory hallucination

A

Second order - people speaking directly too the patient

Third order - people speaking to other people often about the patient

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29
Q

How would a patient with formal thought disorder present?

A

Rapidly changing incoherent speech. One sentence/word does not necessarily follow the last

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30
Q

What are disorders of the self? Two examples?

A

Difficulty in distinguishing self from non-self.
Thought broadcast
Thought insertion

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31
Q

Give three functional causes of psychosis with they typical psychiatric abnormality

A 
Schizophrenia (auditory hallucinations)
Severe depression (derisory hallucinations or delusions)
Mania (delusions of grandiose)
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32
Q

Some examples of organic causes of psychosis

A 
Dementia
Delirium
Infections
SOL
Endocrine disease
Epilepsy
Drugs (stimulants, levodopa, cannabis)
Alcohol withdrawal
Nutritional deficiencies
Electrolyte imbalances
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33
Q

What are the core symptoms of depression?

A

Low mood for 2 or more weeks
Anhedonia
Lack of energy

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34
Q

What are somatic symptoms of depression?

A

Decreased appetite
Weight loss
Decreased libido
Early morning wakening

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35
Q

What are mental symptoms of depression?

A 
Low self esteem
Guilt
Hopelessness
Diurnal variation in mood 
Decreased attention
Hypochondriasis
Suicidal thoughts
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36
Q

What features can complicate depression and make diagnosis hard?

A 
Psychosis 
Cognitive impairment (depressive pseudodementia)
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37
Q

What are the criteria for the classification of depression as mild, moderate and severe?

A

Mild - 2 core symptoms and 2 other
Mod - 2 core and 3 other
Severe - 3 core and more than three other

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38
Q

What types of psycosis typically occur with depression?

A

Hallucinations - second person auditory - derisory and suggestions of suicide
Delusions - nihilsm (poverty and non-existence)

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39
Q

Risk factors for depression

A 
Excessive alcohol
Female
Chronic illness
Social stress
Lack of support
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40
Q

What three categories can predisposing factors for mood disorders be divided into? Give some examples

A

Bio - genetics, physical health
Psycho - personality trait/disorder
Social - housing, relationships, finance

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41
Q

Biological treatments of depression?

A

Pharmacological - antidepressants

ECT

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42
Q

Psychological treatments of depression

A 
CBT
IPT (interpersonal psychotherapy)
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43
Q

Social treatments for depression

A

Helping sort finance, life etc!

General coping strategies

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44
Q

What physical health conditions may cause depression?

A

Hypothyroid
Cushings
Hyperparathyroidism (hypercalcaemia)
Brain tumours

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46
Q

What 2 types of sleep disturbance are there?

A

Initiation

Maintainance

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47
Q

What benzodiazapines are short acting?

A

Lorazepam, temazepam

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48
Q

What benzodiazapines are long acting?

A

Diazepam, nitrazepam

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49
Q

What is are issues with long term benzodiazepam use for insomnia?

A

Tolerance
Dependancy
withdrawal

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50
Q

What factors of benzodiazepams prescriptions would increase dependancy?

A 
Short acting
Long prescription
Strong dose 
Alcoholism
Drug dependancy 
Personality disorders
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51
Q

Other than dependance what are the disadvantages of using hypnotics to aid sleeping?

A 
Falls 
Confusion
Psychosis
Day time drowsiness 
Nightmares
Amnesia
Dizzyness
Depression
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52
Q

Definition of schizophrenia

A

A group of disorders causing distortion of thinking and perception with inappropriate or blunted affects.

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54
Q

What are the subtypes of schizophrenia?

A

Paranoid schizophrenia - large paranoid delusions
Catatonic schizophrenia - psychomotor disturbance both hyperkinesis and stupor
Hebephrenic schizophrenia - large affect changes and behaviour problems - disorganised speech, behaviour and emotions
Undifferentiated schizophrenia

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55
Q

Negative symptoms of schizophrenia

A

Apathy
Social withdrawal
Lack of motivation

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56
Q

None first rank positive schizophrenia symptoms

A

Other hallucination types
Behaviour disturbance
Secondary delusions

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58
Q

Prognosis of schizophrenia

A

1/3rd single psychotic episode
1/3rd multiple psychotic episodes
1/3rd multiple psychotic episodes with personality change

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59
Q

Treatments of schizophrenia

A

Bio - antipsychotics
Psycho - type a psychotherapy (opportunistic informal) and cbt
Social - family therapy, sheltered work, treatment adherence

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60
Q

What are the first rank symptoms of schizophrenia?

A

3rd person auditory hallucinations
Thought withdrawal, insertion or broadcast
Primary delusions
Delusional perception
Thoughs feelings or acts are controlled by others

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61
Q

What are schizotypal disorders?

A

Eccentric behaviour and anomalies of thinking like schizophrenia but not making the diagnosis

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62
Q

What are schizoaffective disorders?

A

Episodic affective and schizophrenic symptoms that do not justify a diagnosis of either schizophrenia or affective disorder (mania, depression, anxiety)
Essentially both schizophrenia and affective disorder together

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63
Q

What is a major theory of causation of depression?

What is a major flaw with it?

A

Monoamine theory of depression

Why do drugs eg. TCAs which rapidly raise NA and 5HT not rapidly resolve the depression

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64
Q

What is the proposed mechanism of ssris. How long can they take to have an effect? Why may this be?

A

Block serotonin reuptake
3-6 weeks
Increased cleft serotonin has negative feedback reducing serotonin release. With time presynaptic receptors desensitise and release returns to normal whilst serotonin still remains in cleft for longer

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65
Q

What percentage of patients respond to antidepressants?

A

70%

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66
Q

How long should antidepressants be continued past recovery from depression?

A

1 episode of depression in 5 years - 6 months

>1 episode of depression in 5 years - 2 years

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67
Q

What advice should be given to someone about stopping antidepressants? Why? What features?

A

Slow discontinuation
Risk of discontinuation syndrome - dizzyness, headache, lethargy, extrapyramidal effects, mania. Rapid onset within days, rapid resolution when drug restarted.

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68
Q

What are side effects of SSRIs?

A 
N+V
Diarrheoa and consitpation
Sexual dysfunction
Bleeding risk
Suicidal ideation
Hyponatraemia
Loss of appetite
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69
Q

Give four examples of TCAs

A

Amitriptyline
Imipramine
Nortriptyline
Dosulapin

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70
Q

How do TCAs effect NA?

A

Stimulate 5HT neurones which in turn stimulate NA neurones

Desensitise alpha 2 receptors on presynaptic membrane

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71
Q

What unwanted receptors do TCAs effect? What side effects associated with each?

A

Muscurinic - blurred vision, dry mouth, constipation, urinary retention, st/svt
Alpha adrenoceptors - postural hypotension
Histamine receptors - confusion
Myocardial Na channels - decreased Na influx so prolongs QRS and arrhythmia

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72
Q

Which TCA is most cardiotoxic?

A

Dosulepin (dothiapin)

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73
Q

Examples of SNRIs

A

Venlafaxine

Duloxetine

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74
Q

What differs in the side effect profile of SNRIs vs SSRIs - one positive and one negative.

A

Positive - less sexual dysfunction

Negative - hypo or hypertension

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75
Q

How does mirtazapine work?

A

Blocks alpha 2 adrenoceptors increasing amount of NA and 5HT in synaptic cleft

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76
Q

Additional benefits of mirtazapine?

A

Increases appetite

Sedative

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77
Q

Side effects of mirtazapine

A 
Weight gain
Postural hypotension
Urinary retention
Dry mouth
Fatigue 
Mania 
Blood disorders 
Hyponatremia
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78
Q

Other than mirtazapine what other antidepressant is involved in blocking receptors? Which does it block?

A

Trazodone
Blocks presynaptic 5HT and H1
Increases 5HT and NA

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79
Q

What can MAOIs interact with broadly?

A

Drugs - amine containing e.g. Cough mixtures or decongestants, other antidepressants
Drugs - also metabolised e.g. Opiates, barbiturates, alcohol
Foods - tyramine containing - e.g. Cheese, game, alcohol

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80
Q

Examples of MAOIs

A

Phenelzine

Isocarboxazid

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81
Q

Why is tyramine dangerous in MOAIs?

A

Usually metabolised by MAOIs
Acts as an indirect sympathomimetic causing release of NA
Hypertensive crisis

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82
Q

Why is lithium used?

A

Mania
Bipolar
Recurrent depression

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83
Q

Side effects of lithium

A 
Huge number
Arrhythmia, AV block, QT prolongation
Hypothyroidism 
Intercranial hypertension 
GI disturbance 
Renal disturbance inc. polydipsia and polyuria
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84
Q

What is the proposed mechanism of action of lithium?

A

Interaction with second messanger system

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85
Q

What is the core mechanism of action of antipsychotics?

A

Suppression of the mesolimbic and mesocortical dopaminergic pathways by antagonising dopamine receptors

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86
Q

What unwanted pathways do antipsychotics effect? With what effects?

A

Nigrostriatal - EPSE - parkinsonism, acute dystonic reactions, akathisia, tardative dyskinesia
Tubero-infundibular - hyperprolactiemia, gynecomastia, galactorrhlea, menstrual irregularities, impotence

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87
Q

What other categories of side effects are there for antipsychotics other than effecting the dopamine pathways?

A

Autonomic
Neuroleptic malignant syndrome
QT prolongation

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88
Q

What side effects of antipsychotics occur due to blockage of the desired dopamine pathway?

A

Impaired performance

Sedation

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89
Q

What autonomic receptors may be blocked by antipsychotics? What side effects do each cause?

A

Muscurinic - dry mouth, blurred vision, urinary retention, constipation
Alpha adrenoceptor blockade - postural hypotension, hypothermia
Histamine - sedation, weight gain, diabetes (unsure how on latter 2)
5HT - sedation

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90
Q

What is neuroleptic malignant syndrome?

A

A rare reaction to antipsychotics
Causes hyperthermia and muscle rigidity
Treat with cooling and dopaminergic agonists like bromocryptine

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91
Q

What are some examples of typical antipsychotics?

A

Haliperidol

Chlorpromazine

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92
Q

What side effects predominate in typical antipsychotics?

A

EPSEs

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93
Q

What are the major side effects of chlorpromazine?

A

Sedation
Agranulocytosis
Haemolytic anaemia

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94
Q

What are the major side effects of haloperidol?

A

Movement disorders

Prolonged qt

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95
Q

Examples (6) of atypical antipsychotics

A 
Clozapine
Risperidone 
Olanzapine
Quetiapine
Amisulpride
Aripriprazole
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96
Q

What atypical antipsychotic is especially useful in refractory patients? What are its major side effects? What side effects does it not tend to cause? Why?

A

Clozapine
Neutropenia, agranulocytosis, antimuscurinic
Low incidence of EPSE maybe due to 5HT blockage

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97
Q

Which antipsychotics are most likely to cause hyperprolactinaemia?

A

Typical

Risperidone

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98
Q

Which antipsychotic doesnt cause hyperprolacinaemia? Why?

A

Aripriprazole

Partial dopamine agonist

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99
Q

Which antipsychotics are most likely to prolong QT

A

Haloperidol

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100
Q

Which antipsychotics are most likely to cause weight gain and diabetes mellitus?

A

Clozapine and olanzapine

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101
Q

Which antipsychotics can be used in depot?

A

Haloperidol

Risperidone

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102
Q

What are disadvantages of use of depot injections of antipsychotics?

A

Increased risk of movement disorders

Cant stop quickly if side effects occur

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103
Q

What should be monitored in antipsychotic therapy GENERALLY?

A 
FBC, U+Es, LFTs annually 
ECG
Lipids and weight at 3 months then yearly. 
BM at 6 months then yearly 
Prolactin 6 months then yearly
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104
Q

Which antipsychotic requires more intensive monitoring?

A

Clozapine

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105
Q

What are the four extrapyramidal side effects?
Which is. Irreversible on. Withdrawal of drug
What is a possible treatment

A 
Dystonia - abnormal contraction
Akatheisa - restlessness
Parkinsonism - tremor
Tarditive dyskinesia - rhythmic contraction - irriversible
Procyclidine
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107
Q

What teratogenic fetature results from lithium? What is it?

A

Ebsteins anomaly

Tricuspid valve deplaced towards apex decreasing right ventricular size

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108
Q

Features of lithium toxicity

A 
Tremor 
Ataxia
Dysarthria
Coma
Convulsions
Death
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109
Q

What monitoring is required in a patient on lithium?

A

Litium levels
Tfts
Renal function

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110
Q

Other than lithium what other mood stabilisers are available?

A

Sodium valporate
Carbamezapine
Lamotragine

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111
Q

Psychiatric causes of anxiety as a mental health problem

A 
Phobia
Generalised
Panic
OCD
PTSD
Secondary to depression, bipolar, shizophrenia
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112
Q

Physical causes of anxiety as a mental health problem

A

Tumour
Hormonal
Infections

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113
Q

Symptoms of a state of anxiety

A

Cognitive - constant worry, hyperarousal, difficulty sleeping, irritiability, hard to concentrate, rumination
Somatic - shaking, sweating, palpitations, hyperventilation (with paraesthesia and carpopedal spasm)

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114
Q

How do people with anxiety disorders try to cope?

A

Avoidance

Self medication - e.g. Alcohol

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115
Q

What is a phobic anxiety

Examples

A

Intense and irrational fear of a specific situation, event or thing

  • social phobia
  • specific phobias (agoraphobia, needles, spiders)
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116
Q

What subcategories of social phobia are there?

A

Generalised

Specific (e.g. Public speaking)

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117
Q

What is a panic disorder?

A

Discrete episodes of intense fear accompanied by >4 anxiety symptoms more than twice a month with anxiety between attacks
Catastrophic misinterpretation of symptoms

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118
Q

What are the treatment options for phobic disorders?

A

SSRI

CBT

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119
Q

Treatment options for panic disorders (long term)

A

SSRI
Group therapy
CBT
Imipramine (tca)

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120
Q

What is generalised anxiety disorder?

A

Primary anxiety symptoms most days for several weeks or months. Worry is out of proportion to risk and regards multiple stimuli.

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121
Q

Pharmocological treatments for GAD?

A

Ssris
Tcas
Pregabalin

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122
Q

Psycological treatment for gad

A

CBT

Group therapy

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123
Q

Social treatment for gad

A

Self help
Exercise
Avoid caffine smoking and alcohol

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124
Q

What are the diagnositic criteria for OCD?

A

Repetitive and unpleasant obsessive or compulsive symptoms
Most days for >2 weeks
Has tried to stop and failed
Good insight

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125
Q

Treatment options for OCD

A 
CBT
SSRI
Clomipramine (TCA) 
MDT
Antipsychotic
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126
Q

Diagnostic criteria for ptsd

A

Delayed and protracted response
To exceptional threatening incident to self or loved one
Within 6 months

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127
Q

Signs and symptoms of ptsd

A

Reliving - nightmares, triggers, hypervigilance, startle reaction
Avoidance
Personality - blunting, anhedonia, detachment,

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128
Q

Treatment of ptsd

A

Bio - severe disease only - paroxetine, mirtazapine, amitriptyline
Psycho - trauma focussed CBT, EMDR (eye movement therapy)
Social - reduce alcohol, caffine, drug use etc.

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129
Q

Parts of the mental state exam?

A 
Appearence/behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
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130
Q

Parts of full cognition assessment?

A 
General (alertness) 
Orientation
Attention
Concentration
Language
Calculation
Abstraction
Memory 
Praxis (copying) 
Gnosis (making sense of sensory information)
Right hemisphere function (visiospatial)
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131
Q

What is delirium?

A

Global impairment of cognition, disturbed attention and conscious level with abnormal psychomotor, affect and sleep patterns

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132
Q

What features are typical of delirium timing?

A

Acute onset
Fluctuating
Worse at night

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133
Q

What are the subtypes of delirium, how may they present?

A

Hyperactive - arousal, restless, irritable, wandering

Hypoactive - quiet, sleepy, inactive, unmotivated

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134
Q

What are the core symptoms of delirium on top of the subtype behaviour?

A

Disturbed consciousness from alert to coma
Attention deficit
Visual hallucinations
Global cognitive impairment (orientation, speech, memory)
Labile mood
Disturbed sleep wake cycle

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135
Q

What are the features of delirium mediated hallucinations?

A

Fragmented or transient

Illusionary (misinterpretation)

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136
Q

Causes of delirium?

A

Acute CNS insult - cva, trauma, infection, epilepsy
Acute systemic illness - sepsis, infection, MI,
Drugs - recreational, prescribed
Withdrawal - e.g. Alcohol, benzos
Hypoxia

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137
Q

What drugs raise delirium risk?

A 
Diuretics
Sedatives
Opiates
Anticholinergics
Antidepressants
Antipsychotics
Antiparkinson
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138
Q

Risk factors for delirium? Inc specific condition with very high risk!

A

Age
Pre existing mental health problem
Severe illness
Hip fracture

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139
Q

How does delirium change patient outcome?

A

Worsens prognosis
Increases length of stay (3 fold!)
Increases mortality
Increases readmissions

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140
Q

Management ideas for delirium

A

Bio - antipsychotics (haloperidol or orlanzapine)
Psycho -
Social - food and drink, calm environment, moderate lighting, music, sensory aids, consistent staff, avoid intervention, promote sleep patterns (do they need 30min obs overnight!?)

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141
Q

What drugs to avoid prescribing to manage delirium?

A

Long acting benzos (e.g. Diazepam)

Multiple side effects e.g. Chlorpromazine

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142
Q

What are the types of memory?

A

Short term
Long term
- explicit (episodic, semantic)
- implicit (procedural, priming)

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143
Q

What is the difference between implicit and explicit memory?

A

Explicit is conscious memory

Implicit is unconscious memory

144
Q

What are the types of explicit memory? What are they?

A

Episodic - knowledge of events that have happened to the individual
Semantic - general world knowledge

145
Q

What are the types of implicit memory? What are they?

A

Priming - exposure to one stimulus effects response to another
Procedural - memory of an action

146
Q

What is more common, anorexia or bulimia nervosa?

What is the gender distribution?

A

Bulimia

10:1 f:m

147
Q

How low does BMI need to be to make the diagnosis of anorexia nervosa?

A

17

148
Q

What is the characteristic mindset of an anorexia nervosa patient?

A

Feels overweight despite being underweight

Disturbed body image with fear of fatness

149
Q

What are the two subtypes of anorexia nervosa? Which is most common?

A

Common - restrictive

Rare - binge purge

150
Q

How does binge purge anorexia differ from bulimia nervosa?

A

BP anorexia patients are underweight

151
Q

What psychiatric comorbidites are common with anorexia nervosa?

A

Obsession
Withdrawal
Impaired concentration

152
Q

What personality traits are common with anorexia nervosa?

A

-ve self evaluation

Perfectionism

153
Q

Do anorexia nervosa patients typically feel hungry or full? Why?

A

Full

Gastroparesis occurs delaying stomach emptying

154
Q

What physical complications commonly occur in anorexia nervosa?

A 
Thiamine deficiency
Amenorrhoea and impotence 
Osteoporosis
Gastroparesis 
Bone marrow suppression 
Brain shrinkage
155
Q

What is the characteristic pattern of bulimia nervosa?

A

Binge at least once a week for 6 months followed by a compensation/purge.

156
Q

What is a binge with respect to eating?

A

An abnormally large volume of food in an abnormally short period of time and feeling out of control.

157
Q

How may a bulimia nervosa patient purge?

A

Vomit
Drugs - amphetamines, laxitives, thyroxine, orlostat.
Extreme exercise

158
Q

What are psychiatric comorbidites associated with bulimia nervosa?

A

Depression
Anxiety
Impaired concentration
Substance misuse

159
Q

What personality types are associated with bulimia nervosa?

A

-ve self evaluation
Perfectionism
Impulsivity

160
Q

What physical complications are associated with bulimia nervosa?

A

Thiamine deficiency
Hypokalaemia (due to vomiting creating alkylosis thus k loss in kidney)
Hand callouses from putting hand in mouth
Hyponatraemia from laxatives
Bone marrow supression
Dental erosions
Mallory weiss tears
Parotid enlargement due to hyperstimulation

161
Q

Physical treatments for eating disorders?

A

Multivitamins

Paretal nutrition if gi dysfunction

162
Q

Treatment of bulimia nervosa

A

Bio - ssri (large dose)
Psycho - CBT
Social - psychoeducation and self help

163
Q

What therapy may be useful in treating a young anorexia patient?

A

Family therapy

164
Q

What therapy may be useful in a bulimia nervosa patient with personality disorder?

A

Dialectical behavioural therapy

165
Q

Which of anorexia nervosa and bulimia nervosa has the highest mortality? Which has the higher recovery rate?

A

Anorexia has higher mortality (6%)

Both recover similarly (75%)

166
Q

What are good prognostic factors for eating disorders?

A

Short duration
Adolescent onset
Family support

167
Q

What decreases prognosis in eating disorders?

A 
Duration
Severity
Psychiatric comorbidity 
Admitted
Vomiting
168
Q

Definition of bipolar

A

A severe effective disorder characterised by marked mood swings and a tendency to remiss and reoccur

170
Q

What are the subclassifications of bipolar disorder?

A

Type 1 - =/>1 manic episode +/- depressive episodes

Type 2 - =/>2 severe depressive episodes + hypomanic episodes

171
Q

In what age rang does bipolar tend to present?

A

Late teens and early adult

172
Q

Possible causes/risk factors of bipolar

A

Bio - genetic linkage, brain structure
Psycho -
Social - stressful experiences

173
Q

What psychotic symptoms are associated with bipolar?

A

Mania - grandiose delusions

Depression - persecutory delusions, hallucinations

174
Q

What are the symptoms of mania?

A 
Grandiose delusions
Happyness
Irritation with people who aren't as optimistic 
Hallucinations
Lots of energy - very active
Hypersexual 
Spur of moment decisions
Rash financial decisions / gambling 
Less inhibited / overfamiliar
175
Q

How long should mood stabilisers be continued after resolution of bipolar mood swings?

A

2 years

5 years if frequent, psychotic, substance misuse, continued stress

176
Q

What therapies are useful in bipolar?

A

Psychoeducation

CBT if depression occurs or threatens

177
Q

When should an ssri not be considered in a bipolar depressed patient? If they are prescribed when should they be stopped?

A

Recent manic episode
Rapid cycling disease

Slowly tailor off 8 weeks after effect

178
Q

What management could be considered in a manic episode of bipolar?

A

Bio - stop antidepressants, consider mood stabilisers and antipsychotics
Social - try to avoid mania precipitating situations such as parties when manic

179
Q

Management of bipolar between episodes

A

Bio - mood stabilisers
Psycho - psychoeducation
Social - exercise, support network of friends and family, decrease stress,

180
Q

How is lithium metabolised and excreted? What does this mean for monitoring?

A

Renal
Must monitor renal function to check both for damage from lithium and deteriorating function that could increase lithium levels

181
Q

What two terms can define different elements of bipolar disorder in terms of number and severity of episodes?

A

Rapid cycling - >4 mood swings in 12 months

Cyclothymia - mood swings not as severe as bipolar but can be longer

182
Q

What are the criteria for implementing the mental health act?

A

Must have a mental health disorder or disability of the mind
Significant risk of danger to self or other
No alternative to mitigate that risk

183
Q

In implementing the mental health act - what can ‘danger to self’ refer too?

A

Physical harm
Neglect
Deteriorating mental health

184
Q

What sections should i know of the mental health act?

A 
5(4)
5(2)
2
3
136
17
117
185
Q

What is mha section 5(4)

A

Mental health nurse
Detain inpatients not in A+E
For up to 6 hours
Where mental illness is suspected

186
Q

What is mha section 5(2)

A

Approved consultant or deputy as in policy
For inpatients
For up to 72 hours
For assessment of mental health condition

187
Q

What is mha section 2

A

Anywhere but prison
2 drs (at least one approved) and a mental health practitioner who isnt a dr
For 28 days
For assessment and treatment of mental disorder

188
Q

What is the right of appeal on MHA section 2

A

Can appeal in first 14 days with hearing in 7 days from appeal

189
Q

What is S3 of MHA?

A

Anywhere but prison
By 2 drs (one approved) and non dr mental health practitioner
For up to 6 months
For treatment of known mental health condition

190
Q

What is s136 of mental health act?

A

Police detain in public place to remove to place of safety

Held for up to 72 hours for assessment by dr and approved mental health practitioner

191
Q

What is section 17 of the mha?

A

For someone under s2 or s3 allowing leave

192
Q

What is section 117 of the mha?

A

Anyone under s3 gets this

Aftercare from local authority is provided free of charge

193
Q

What is the right of appeal for s3 mha?

A

Appeal once per renewal of section to a tribunal
Apply to mha manager for discharge
Ask for help of independant advocate
Patient rights leaflet

194
Q

How long can someone under s3 of the mha be treated against there will until further measures must be taken? What are the measures?

A

3 months

Second opinion appointed dr

195
Q

What are the different theories of addiction?

A 
Genetic
Neurobiological
Social
Behavioural
Attachment
196
Q

What is the attachment theory of addiction?

A

Care increases opiate stimulated areas in the brain thus neglected or abused patients may turn to drugs to replace these

197
Q

What is the social theory of addiction?

A

All drugs start with a social element - it is a bad indicator when abuse occurs alone

198
Q

What is the concept of reinforcement as applied to drug use?

A

Classical conditioning model - use of drug produces a good experience or removal of bad so drug is associated with this experience

199
Q

What property make drugs more reinforcing? Why?

A

Faster onset time - greater classical conditioning association

200
Q

What is tolerance as applied to illicit drugs? Why does it occur?

A

Need for higher dose for same effect
Down regulation of receptors
Upregulation of liver enzymes

201
Q

What is drug dependance?

A

The presence of a withdrawal reaction if a drug is stopped due to increased tolerance

202
Q

What is withdrawal in elicit drugs?

A

Reverse of tolerance

If drug is stopped downregulated receptors and increased enzymes result in a below baseline state.

203
Q

What are the basic principles of treatment in drug abuse?

A

Harm minimisation
Psychological
Reduce craving
Treat complications

204
Q

What is the principle of harm minimisation in drug use?

A

Accepts people use drugs, seeks to make it safer then try and reduce use.

205
Q

What is one unit of alcohol?

How many units in 1 litre of 40%

A

I0 ml of alcohol in a unit

40 units

206
Q

What is the recommended weekly allowance of alcohol for males and females?

A

M

207
Q

What classifies an individual at being an:
At risk drinker
Heavy drinker
Problem drinker?

A

At risk - M >21 F>14
Heavy - M >50 F>35
Problem - damage to health

208
Q

Why do alcoholics become thiamine deficient?

A

Most calories from alcohol so generally nutritionally deficient
Alcohol destroys thiamine pump in intestine

209
Q

What is the short term effect of alcoholic thiamine deficiency? How does it present?

A

Wernicke’s encephalopathy
Eye signs - nystagmus, lateral rectus nerve palsy, fixed pupils Encephalitis - confusion, vomiting
Ataxia - with broad based gait, cerebellar signs

210
Q

What is the progress of wernicke’s encephalopathy?

A

Can be stopped with thiamine administration but is irreversible.

211
Q

What occurs following repeated episodes of wernicke’s encephalopathy? How does it present?

A

Korsekoffs sydrome
Dementia like
Inability to form new memories
Confabulation

212
Q

How should wernicke’s encephalopathy be treated?

A

Iv thiamine

213
Q

Why might we prescribe in substance abuse?

A 
Harm minimisation
Reduce reinforcement
Ability to escape harmful social circles
Decrease criminalisation
Decrease cost to society
214
Q

What are risks of prescribing in substance abuse?

A

OD
Selling it on
Dependancy on prescription
Encourages external locus of control

215
Q

What would need to be checked prior to prescribing in suspected substance abuse? How?

A

Ensure dependancy

  • two urine checks
  • attend in withdrawal
216
Q

What drugs can be used to help opiate addiction?

A

Methadone
Buprenorphine
Naltrexone

217
Q

What are objective withdrawal symptoms of opiate withdrawal?

A 
Sweating
Yawning
Lacrimation
Coughing
Diarrhoea
Tachycardia
218
Q

What are the pharmocological characteristics of buprenorphine? What does thais mean for the drugs mechanism and safety? What is the disadvantage of it?

A

Partial opiate agonist that tightly binds to receptor
Hard to OD and heroin taken on top has no effect as some blocking properties and not displaced
Negative is if given when not in withdrawal percipitates an acute withdrawal reactoin

219
Q

What drugs are useful during alcohol withdrawal?

A

Benzodiazepines such as chlordiazepoxide

220
Q

What drugs are useful in preventing alcohol withdrawal?

A

Disulfarim

Acamprosate

221
Q

How does disulfarim it work? Whats the biggest issue?

A

Disulfiram
Prevents breakdown of acetylaldehyde causing hangover symptoms if patient drinks
If you drink though the hangover can get a fatal build up of acetylaldehyde

222
Q

How does acamprosate work?

A

Reduces alcohol craving

223
Q

What drugs could be considered propsychotic?

A

Cannabis

Stimulants

224
Q

Why may mh problems result in increased substance abuse?

A

Used as anxiolytics (e.g. Alcohol)
Used to mitigate side effects of meds (stimulants over antipsychotics)
Social vulnerability

225
Q

What is the hallmark interview technique in motivational interviewing? How does it work?

A

Reflection

Rephrasing what the patient has just said leading them to expand on it.

226
Q

What are the broad classifications of drug types?

A

Stimulants
Hallucinogens
Depressants

227
Q

Examples of stimulant drugs

A

Cocaine
Amphetamine
Nicotine

228
Q

Examples of hallucinogen drugs

A

LSD
Psilocybin
Cannabis

229
Q

Examples of general depressant illicit drugs

A

Opioids
Benzos
Alcohol

230
Q

What is cocaine that can be smoked called? Which is faster onset, smoked snorted or injected? Why?

A

Crack cocaine
Smoked
Because it has a faster onset so is more reinforcing

231
Q

What are the ‘positive’ effects of cocaine?

A

Euphoria, excitement

232
Q

What are the cardiovascular complications of cocaine

A

Blood vessel constriction
Increased heart rate
Thus hypertension and risk of MI

233
Q

Roughly how does cocaine work to produce its euphoric effects?

A

Blocks the reuptake of NA 5HT and dopamine from synapses

234
Q

How does cocaine produce its cardiovascular effects?

A

Blocks reuptake of catacholamines at synaptic nerve terminals

235
Q

Roughly how do amphetamines work?

A

They resemble NA, 5HT and dopamine
Very fat soluble so easily enter the brain
Compete for reuptake
Displace neurotransmitters from vesicles

236
Q

By what mechanisms are amphetamines toxic?

A

Overhydration - causes swelling of the brain

Rhabdomyolysis - results from dehydration and exercise

237
Q

What effect do stimulants have on appetite?

A

Reduce it

238
Q

What are the different effects of methamphetamine over amphetamine?

A

More stimulatory on cns with potential for psycosis

Less peripheral effects

239
Q

How does nicotine achieve its physiological effect?

A

Stimulation of nicotinic ach receptors!

240
Q

What does nicotine do to the cvs? What is the effect on someone with CAD?

A

Increases hr, co and bp

No vasodilation possible so angina to mi

241
Q

How does activation of nicotinic ach receptors cause effects on mood?

A

Nic ach receptors on presynaptic terminals of dopamine and serotonin

242
Q

What are hallucinogens?

A

Conpounds that can induce visual or auditory hallucinations and alter perception.

243
Q

What common medically used drugs are hallucinogens?

A

Atropine
Ketamine
Levodopa

244
Q

How is lsd thought to work?

A

Effects serotonin receptors in the raphe nuclei in the reticular activating system - the part of the brain that filters sensory inputs for stimuli that are irrelevant, unimportant or commpnplace

245
Q

What psychological effects can lsd have on an individual?

A

Mood changes - either euphoric or depressive/paranoid with related behavioural changes
Synesthesia
Illusions and hallucinations
Time distortion

246
Q

What are big risks with lsd?

A

Panic attacks
Suicidal ideation
Feeling of invulnerability
Flashbacks

247
Q

Why may a 2 hour trip when taking lsd be such a harrowing experience time wise?

A

Lsd distorts time perception so two hours could feel like days

248
Q

How could a bad lsd trip be treated?

A

Quiet environment
Reassurance
Diazepam

249
Q

What is the active ingedient in magic mushrooms?

A

Psilocibin

250
Q

What physical symptoms occur with lsd intoxication?

A 
Tachycardia
Mydriasis (large pupils)
Htn
Sweating
Hyperthermia
251
Q

What is the active substances in cannabis? What do they do?

A

THC - euphoria, hallucinations/illusions, hypnosis

CBD - antipsychotic

252
Q

What is a risk of the newer preparations of cannabis?

A

Decreased cbd to thc ratio thus more psychotic

253
Q

What does the active ingredient in cannabis bind too? Where are these receptors found?

A

Thc receptors
Frontal cortex
Hippocampus
Cerebellum

254
Q

What signs show cannabis use?

A

Injected sclera

Tachycardia

255
Q

Differentiate opiode, opiate,

A

Opioid - all agonists with morphine like activity

Opiate - any opioid derived from a poppy

256
Q

What are the opiate receptor subtypes?

A

Mu
Kappa
Delta

257
Q

Where are mu opioid receptors found? What effects do the different regions have when opioids are taken

A

Spinal cord and cerebral cortex - pain relief, euphoria
Brain stem - respiratory depression and nausea
Nucleus accumbens - compulsion and dependance

258
Q

What pysiological effects do opioids have on kappa receptors

A

Analgesia
Disorientation
Dysphoria
Depersonalisation of feeling

259
Q

What effect do opioids have on delta receptors?

A

Analgeisa

Emotional response

260
Q

What is the t1/2 of heroin?

A

4-6 hours

261
Q

Give an example of an opioid that has an agonist effect at kappa and an antagonist effect at mu receptors

A

Pentazicine

262
Q

What happens chemically in opiate withdrawal?

A

No stimulation of opioid receptors
Dompamine release and reduction of dynophine in nucleus acumbens
Release of NA (inhibited during opioid addiction) in nucleus accumbens and hippocampus causing NA storm

263
Q

What happens symptomatically in opioid withdrawal?

A

Symptoms
Abdo pains, anxiety, depression, irritability, craving, inisomnia
Signs
Vomiting, increased resp rate, fever, diarrhoea

264
Q

Where do benzodiazepines act?

A

GABAa receptors on the post synaptic membrane

265
Q

What are the clinical effects of benzodiazepines on GABA in different regions

A

Increase chlorine conductance so post synaptic inhibition causing:
Alleviation of anxiety - amygadala
Mental confusion and amnesia - cerebral cortex
Muscle relaxation - spinal cord, cerebellum, brain stem
Psychological dependancy - nuculus accumbens

266
Q

Withdrawal effects of benzos?

A 
Anxiety 
Insomnia
Agitation
Irritability
Psychosis
Seizures
267
Q

Why is diazepam one of the least addictive benzos?

A

Long t1/2 so less severe withdrawal

268
Q

What neurotransmitters are effected by alcohol?

To what end?

A

Decrease ACh release and NMDA antagonist - confusion/amnesia

Dopamine release increases

269
Q

Where is alcohol excreted?

A

5% unchanged lungs

95% metabolised and converted to CO2 and water

270
Q

What are the stages of alcohol metabolism?

A

Alcohol - acetylaldehyde - acetic acid - CO2 + water

271
Q

What is the half life of methadone. What are issues with this?

A

13-50hrs
Large interperson variability
[ ] will increase over days of admministration untill 5 half lives passed thus a safe dose on day one may not be by day 3

272
Q

What are risks for od when initiating methadone treatment? 2 non-modifiable and 3 modifiable

A 
Low opioid tolerance 
Long half life in patient 
Use of other cns depressants like alcohol
Too high initial dose
Increase dose to fast
273
Q

What are risky behaviours with buprenorphine precipitated by the patient?

A

Injecting or snorting it

Using with alcohol or benzos

274
Q

Why may buprenorphine and naloxone be combined in a tablet form for treatment of opioid addiction?

A

Naloxone has low oral bioavailability so does not effect the dose when taken properly. If user injects or snorts the tablet then the naloxone will stop it having an effect.

275
Q

How should methadone be dosed for opiate withdrawal on the first day?
What would alter this dose?

A

10-30mg od
Decrease with low tolerance or uncertain tolerance
Decrease with liver or kidney failure
Decrease with low body weight
Add further 10mg bolus if objective withdrawal signs shown

276
Q

How fast can methadone be increased?

A

5-10mg a day

No more than 30mg a week

277
Q

What is the standard buprenorphine dose

A

4-8mg

278
Q

When should buprenorphine be given? Why?

A

During withdrawal as it causes a withdrawal reacting if given when opioids still in system

279
Q

How should buprenorphine be increased?

A

Quite rapidly, can go up from 8 to 32 mg in days

280
Q

If users are still using heroin despite replacement what action can be taken?

A

Dose adjustment
Change regime (e.g. Back to maintenance if on reducing)
Increase interventions such as counselling, supervised consumption, urine testing
Withdraw/suspend if pt at risk and mdt agree - following warning!

281
Q

When should methadone maintainance change to detoxification?

A

Committed and informed patient
Stable social situation with support
Plans for continued support in place

282
Q

What drugs can be used in opiate withdrawal for symptomatic treatment?

A 
Lofexadine - alpha adrenergic agonist 
Loperimide for diarrhoea
Metoclopramide for nausea
Mebevarine for stomach cramps 
Diazepam for insomnia
283
Q

What is the role of naltrexone in opiate addiciton

A

Relapse prevention

284
Q

How should hypnotics be detoxed? Why?

A

Convert to diazepam and slowly reduce dose

Diaz is long t1/2, has variable tablet strengths, can be give OD

285
Q

What is the definition of a learning disability?

A

Condition that effects a persons ability to learn and function independently
Starts before the age of 18
Associated with a low IQ
and a deficite in >1 of communication, self care, home living, interpersonal skills, academic skills, safety

286
Q

How can the causes of learning disability be subdivided?

A

Pre-natal
Birth
Post natal

287
Q

Prenatal causes of learning difficulties

A

Downs syndrome

Fragile X syndrome

288
Q

Perinatal causes of learning difficulty

A

Cerebral palsy
Spina bifida
Premature birth
Infection in utero

289
Q

Post natal causes of learning difficulty

A 
Malnutrition
Epilepsy
Drugs/alcohol
Head injury
Lead poisoning
Infection e.g. Meningitis
290
Q

What are phenotypic features of fragile x?

A

High forehead
Long face
Large ears
Hyperextendible jaw

291
Q

Define mild learning difficulty

Level of functioning

A

IQ 50-69

Normal but delayed speech, reasonable comprehension, may live independently, able to do simple work, normal mobility

292
Q

Define moderate learning difficulty

Level of function

A

IQ 35-49
Speaks in simple phrases, low comprehension, needs supported living, delayed development of mobility, little social development

293
Q

Define severe learning difficulty

Level of function

A

IQ 20-34

Speaks few words, very low comprehension,needs full time supervision

294
Q

Define profound learning difficulty

Level of function

A

IQ

295
Q

What are risks with ld patients?

A 
Aggression and violence
Neglect (to and from)
Abuse (to and from)
DSH
Suicide
296
Q

What form dose dsh tend to take in ld patients?

A

Hitting walls

Banging head

297
Q

What physical problems are commonly associated with ld patients?

A 
Constipation 
Dental
Epilepsy 
GORD
Infections (ears) 
Obesity 
Mobility problems
Sensory impairment
Swallowing problems
298
Q

Why are psychiatric disorders more common in ld patients?

A 
Language and sensation difficulties
Epilepsy 
Mobility problems and physical ill health
Limited coping strategies
Limited social networks and choices
Adverse life events like bullying
299
Q

What is autism?

A

Neurodevelopmental disorder causing social problems, communication problems and restricted activities and imagination

300
Q

What are the three axis of autistic problems

A

Social
Activities
Communication

301
Q

How prevelant is the autistic spectrum amongst ld patients?

A

33%

302
Q

What differentiates autistic compulsions from ocd?

A

Autistic patients enjoy their compulsions

303
Q

What is the difference in sensitivites in autistic patients?

A

Hyper or hypo sensitivity

Can lead to sensitivity overload

304
Q

What things help autisitic patients?l

A

Safeguarding

Structure and routine

305
Q

How does paediatric psychiatry differ from adult in means of presentation and overall case view?

A

Presented by, and involves, family

306
Q

How do anxiety disorders in children often present?

A

Physically e.g. Ibs

307
Q

At what age do children begin to understand death?

A

10

308
Q

What is a caviat for basically all child and adolecent mental health disorders (autism, adhd etc.)

A

Must occur in multiple environments

309
Q

At what age can adhd be diagnosed?

A

Above 6

310
Q

What are the symptoms of adhd?

A

Poor concentration
Overactivity
Impulsivity

311
Q

Treatment options for adhd?

A

Parenting or school intervention
Stimulants - methylphenidate, atomoxetine
Treat comorbidites

312
Q

What comorbidities occur with adhd and autism commonly?

A

Anxiety

313
Q

Why are eating disorders in pre adolecence very seious?

A

Delayed puberty and growth

Worse prognosis

314
Q

How common are mental health problems in childhood?

A

At any one time 1 in 10 meet the criteria cor psychiatric disorder!

315
Q

What are the two types of conduct disorders?

Which is worse

A

Socialised

Unsocialised - worse

316
Q

What are risk factors for conduct disorders?

A 
Lack of boundaries
Rejection
Conflict
Abuse
Temperament
Comorbidities
317
Q

What are piaget’s stages of intellectual development? What happens in each?

A

Sensory motor phase (birth - 2)
-motor skills, understanding of world, body schemata
Concrete preoperational phase (2 - 6)
-mental representation of objects and actions, egocentric
Concrete operational phase (7 - 11)
Logical thinking in concrete terms, collecting
Formal operational phase >12
Abstract thinking, hypothesis testing

318
Q

List different theories in the development of child mental health problems

A

Biological theories e.g. Genetics
Family theories e.g. Dysfunctional families result in issues
Behavioural social learning theories e.g. Conditioning, attachment
Psychodynamic theories e.g. Freudian - repression, projection,
Cognitive development theories e.g. Piaget’s
Psychosocial theories e.g. Bullying

319
Q

If a child is presented with a single symptom or problem that falls short of a psychiatric diagnosis what should be considered?

A 
Frequency and severity
Other symptoms
Impact on development and academic performance
Impact on family and friends
Level of distress
320
Q

What are the five axis that can be used for describing a child mental health problem

A 
Psychiatric disorder (diagnosis by icd 10)
Specific developmental delay 
Global developmental delay
Physical disorders 
Social factors
321
Q

A child presents with psychosis? What are likely differentials?

A 
Drug use
Deleirium 
Affective disorder with psychosis 
Neurodegenitve disorder (rare)
Functional schizophrenia (rare)
322
Q

What factors influence the development of psychological factors in physical illness

A 
Chronic
Life threatening
Poor past experience
Lack of support
Poor understanding 
Individual coping mechanisms
Issues with communication and attachment
323
Q

What are therapy options in child mental health?

A

Individual therapy - addresses child’s thoughts
Behavioural therapy - reward and punishment
Cognitive therapy - challenges dysfunctional assumptions
CBT - combines above
Family therapy
Group therapy

324
Q

What medication could be used in a child with learning difficulties and behavioural problems as a last resort?

A

Risperidone

325
Q

Which ssri is licences for young people?

A

Fluoxetine

326
Q

What could be used for children with sleep disorders?

A

Melatonin

327
Q

What issues do marital problems have for child mental health?

A

Inconsistant parenting
Parents playing off one and other
Child playing parents off one and other
Failure of parents to support child

328
Q

Chemical name and side effects of ritilin

A

Methylphenidate

Low appetite, anxiety, insomnia, headaches, tachycardia

329
Q

What are the variable prognosis for ADHD

A

Some improve
Some continue but can be managed symptomatically
Some have secondary problems e.g. Conduct disorder, criminality

330
Q

What behavioural techniques can help patients with ADHD

A

Stopping and thinking before acting
Breaking tasks up into smaller ones
Prompting
Consistency in management

331
Q

What technique can be used to manage aggression in autism?

A

Redirecting it with reward

332
Q

Behavioural techniques to manage paeditric anorexia

A

Parental management of mealtimes
Increase calorific intake
Reward for eating
Setting targets

333
Q

How could obsessive compulsive disorder be managed in a child with learning difficulties?

A

Phased withdrawal - stopping behaviour for increasing periods of time

334
Q

What is a personality disorder?

A

Conditions in which individuals differ significantly from the average person in the way the think, perceive, feel or relate to others
Of their culture
Across multiple environments
Causing maladaptive behaviour

335
Q

What are the three p’s of personality disorder?

A

Persistent
Pervasive
Problematic

336
Q

How are personality disorders subdivided?

A

Cluster A - mad
Cluster B - bad
Cluster C - sad

337
Q

What are the cluster A personality disorders?

A

Paranoid - lack of trust, misinterpreting, sensitive, strong sense of rights
Schizoid - detached, aloof, little interest in people, solitary
Schizotypal - eccentric, odd, unconventional

338
Q

What are the cluster B personality disorders?

A

EUPD - impulsive, parasuicidal acts, unstable self image, dsh
Narcissistic - grandiose, arrogant, denigrating others
Antisocial - crime, problems with authority, disregard of rules, lack of empathy
Histrionic - theatrical, dramatic, seductive, suggestible, overreacts

339
Q

What are cluster C personality disorders?

A

Anankastic - rigid, stubborn, perfectionistic, order, rules, moral
Dependant - needs others to function, fear of abandonment
Obsessive compulsive
Anxious - persistent fear, sensitive to rejection

340
Q

Treatment options for personality disorder

A

Group therapy
Therapeutic community
Dialectical behavioural therapy
Transference focused therapy

341
Q

What is dialectical behavioural therapy?

A

Approved therapy for self harm to allow patients to ‘ground’ self

342
Q

Depressive symptom checklist

A 
Mood
Diurnal variation
Anhedonia
Exhaustion
Early morning wakening
Attention
Appetite
Weight 
Hopelessness
Future 
Libido
343
Q

Anxiety symptom checklist

A 
Provoking factors
Avoidance
Trigger in past
Panic 
Sleep
Nightmares
Concentration
Appetite
Self medication
344
Q

Psychosis symptom checklist

A 
Hallucinations 
Special talents
Persecuted
Paranoid
Thought insertion
Control
Thought withdrawal
345
Q

Mania symptom checklist

A 
Mood
Sleep
Spending
Regretted actions
Speed of thought
Criminality
346
Q

What mental health conditions do the dvla need to know about?

A 
Severe anxiety/depression with memory/concentration/agitation/suicidal thoughts.
Mania
Psychosis
Schizophrenia 
Personality disorder
347
Q

What may suggest a patient has depression with cognitive impairment rather than dementia with depression?

A

Faster onset rather than chronic deterioration
Younger age rather than almost exclusively elderly
Concern about memory loss rather than apathy
Constant rather than fluctuant depression
Responds to treatment rather than deteriorates

348
Q

Someone presents with paranoid delusions and hallucinations but no negative symptoms of schizophrenia. Possible diagnosis?

A

Paraphrenia

349
Q

Someone has an isolated delusion which isnt effecting their life or associated with other symptoms. What is this termed?

A

Encapsulated delusion

350
Q

Neuropathological features of altzheimers

A

Amyloid plaques
Neurofibrillary tangles
Loss of synapses
Atrophy

351
Q

Causes of acute confusion

A 
Seizure
Trauma
Bleed
Hypoglycaemia 
Delerium 
Hypothermia 
Electrolyte disturbance
352
Q

Causes of chronic confusion

A 
Dementia
Depression
Mild cognitive impairment
Tumour
Parkinsons
Nutritional deficiencies (wernicke korsikoffs)
353
Q

What is cam?

A

Confusion assessment method
Acute onset with fluctuation AND
Inattention AND
Disorganised thinking OR altered consciousness

IPE (17 decks)

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