Psychiatry Flashcards
What are the 3 criteria for compulsory treatment under the Mental Health Act (2014)?
- The person appears to have a mental illness
- They need treatment to prevent serious harm to the person, deterioration in their health or serious harm to another person
- There is no less restrictive way to proceed
Give a 1 line definition of Bipolar I disorder
Lifetime occurrence of at least one manic episode
How long must a hypomanic episode last by definition?
At least 4 consecutive days
Mnemonic for major depressive episode
5 DIG SPACES Depressed mood Interest (loss of) Guilt or worthless Sleep disturbance Psychomotor retardation or agitation Appetite change Concentration loss Energy loss Suicidal tendencies
What are the characteristics of the disorganised subtype of schizophrenia?
Prominent disorganised speech and behaviour, flat or inappropriate affect
How is anorexia nervosa stratified for severity?
BMI 17 and over = mild
BMI in the 16s = moderate
BMI in the 15s = severe
BMI under 15 = extreme
How long should your treat an episode of MDE if there have been 2 episodes in the past 5 years?
For at least 3 years after remission at the dose required to reach remission
What are the essential diagnostic features of bulimia nervosa?
- Binge eating (lots of food and no control)
- Prevent weight gain (eg vomit, diuretics, laxatives, fasting, exercising)
- At least once a week for 3 months
- Self-evaluation unduly influenced by body shape and weight
- Not exclusively during anorexia nervosa
Name 4 relatively indicative Sx of MDD?
ie relatively specific cf depression in other conditions
Anhedonia
Psychomotor retardation
Worthlessness
Guilt
Prystiq
What is the generic name?
What class of drug is it?
Desvenlafaxine
SNRI
How long can an Assessment Order last under the Mental Health Act?
24 hours (but can be extended to 72 hours under exceptional circumstances)
Mnemonic for serotonin syndrome
HARMED Hyperthermia Autonomic instability Rigidity Myoclonus Encephalopathy Diaphoresis
What are the characteristics of the residual subtype of schizophrenia?
Ongoing negative symptoms or
Two or more of the other subtypes in attenuated form
What does blunted affect mean?
Patient displays no signs of emotion eg no facial expression, body gestures, loss of empathy, loss of awareness of emotional significance of events. Suggests schizophrenia
Overall what proportion of illness time are patients with Bipolar depressed?
75%
Define hallucination
Perception-like experience in the absence of an external stimulus
What are the 3 essential diagnostic features of anorexia nervosa?
- Low weight
- Fear of gaining weight or interfering with weight gain
- Disturbed body image or lack of recognition of seriousness of low body weight
Give a 1 line definition of the diagnostic criteria for schizophreniform disorder
Less than 6 months of schizophrenia
One line definition of Malingering
Intentional production of physical or psychological Sx for external incentive eg Ferris Beuller
What are the ‘simplified’ DSM5 criteria for PTSD?
TRACH
Trauma Re-experience Avoidance Cognitive/mood changes Hyperarousal
Define delusion
Fixed belief that is not amenable to change in light of conflicting evidence
How long should your treat a first episode of MDE?
For at least 6-12 months after remission at the dose required to reach remission
What are the diagnostic criteria A for schizophrenia?
2 or more of the following, with at least one of 1, 2 or 3
- Hallucinations
- Delusions
- Disorganised speech
- Disorganised behaviour
- Negative symptoms
Give a 1 line definition of the diagnostic criteria for schizoaffective disorder
Psychotic episode and mood episode occur together, with at least 2 weeks of delusions or hallucinations either before or after the mood episode
Mnemonic for manic episode
3 IS RAPID 3 or more of the following: Inflated self-esteem Sleepless Risky behaviours Active or agitated Pressured speech Ideas racing Distractible
Cymbalta
What is the generic name?
What class of drug is it?
Duloxetine
SNRI
Acronym for Borderline personality disorder?
RAPE A MISS Relationships unstable Anger Paranoid ideation or depersonalisation Emptiness Abandonment Mood swings Impulsive Suicidal or self-mutilation Self image is unstable
Effexor
What is the generic name?
What class of drug is it?
Venlafaxine
SNRI
How long should your treat an episode of MDE if there have been 3 episodes in the past 5 years?
For at least 5 years after remission at the dose required to reach remission
Acute pharmacological Mx of first episode psychosis?
Atypical antipsychotic eg
Olanzapine 5-10 mg nocte increasing to max 30mg
Risperidone 0.5-1 mg nocte increasing to max 6mg
Quetiapine 50-100mg BD, increasing to max sdfasdfds
Give a 1 line definition of Bipolar II disorder
Lifetime occurrence of at least one MDE and at least one hypomanic episode, but never a manic episode
ie MDE + HME but not ME
One line definition of Body dysmorphic disorder
Preoccupation with a real or perceived defect in physical appearance
Define catatonic behaviour
Marked decrease in reactivity to the environment
One line definition of Somatisation disorder
Unintentionally produced multiple symptoms over multiple systems (pain, GI, sexual and pseudoneurological Sx) beginning before 30yo
Name 4 relative indications for ECT treatment in MDD?
Psychotic depression
Melancholic depression
Not eating
Suicidal ideation
What does restricted affect mean?
Decreased range of affect eg decreased number of emotions displayed
How long can a Treatment Order last under the Mental Health Act?
Up to 6 months for in-patient or 12 months for outpatient
Acronym for antidepressant discontinuation syndrome
FINISH Flu-like symptoms Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (anxiety/agitation)
One line definition of Factitious Disorder
Intentional production of physical or psychological Sx in order to assume the sick role and in the absence of external incentives
What are the characteristics of the catatonic subtype of schizophrenia?
2 or more of:
- Motor immobility (cataplexy or stupour)
- Excessive motor activity that is purposeless
- Peculiarities of movement (posturing, stereotypies, mannerisms or grimacing)
- Echolalia or echopraxia
What are the characteristics of the undifferentiated subtype of schizophrenia?
Doesn’t fit into any other subtype (eg no prominent delusions, auditory hallucinations, disorganisation, negative symptoms or catatonia)
Give a 1 line definition of cyclothymic disorder
2 years of hypomania and depressive periods, but without an episode of mania, hypomania or depression
ie No ME, HME or MDE
What is the difference between a manic episode and a hypomanic episode
- ME lasts at least 7 days vs 4 days
- ME is severe enough to impair functioning or there are psychotic features
Avanza.
What is the generic name?
What class of drug is it?
Mirtazipine
Tetracyclic
Give a 1 line definition of the diagnostic criteria for brief psychotic disorder
1-30 days of psychotic symptoms
How long must a manic episode go on for by definition?
At least 1 week
What aspects of affect must be assessed during the MSE?
Quality
Range
Reactivity
Congruence
Mnemonic for neuroleptic malignant syndrome
FEVER Fever Encephalopathy Vital sign instability Elevated WCC/CPK (creatine phosphokinase) Rigidity
How long can an Temporary Treatment Order last under the Mental Health Act?
Maximum of 28 days
One line definition of Conversion Disorder
Unintentionally produced Sx affecting motor or sensory functions
When does late-onset schizophrenia occur by definition?
Older than 40y
What are the characteristics of the paranoid subtype of schizophrenia?
Prominent delusions or auditory hallucinations
Give a 1 line definition of the diagnostic criteria for delusional disorder
One month or more of delusions, but no other psychotic symptoms
Main side effects of Aricept
Nausea, LOA, bradycardia
What is the lifetime prevalence of schizophrenia?
0.3 to 0.7%
