Psychiatry Flashcards
Symptoms of generalised anxiety
W.A.T.C.H.E.R.S
- Worry
- Anxiety
- Tension in muscles
- Concentration difficulty
- Hyper-arousal (irritability)
- Energy loss
- Restlessness
- Sleep distrubances
Kubler-Ross dying process: stages
"Death Always Brings Great Acceptance": Denial Anger Bargaining Grieving Acceptance
Borderline personality traits
PRAISE:
Paranoid ideas
Relationship instability
Affective instability/ Abandonment fears/ Angry outbursts
Impulsiveness/ Identity disturbance
Suicidal behaviour/ Self-harming behaviour
Emptiness
Bipolar mania symtpoms
MANIAC
Mouth (pressure of speech)/ Moodl Activity increased Naughty (disinhibition) Insomnia Attention (distractability) Confidence (grandiose ideas
Physical illnesses mimicking anxiety disorders
“Physical Health Hazards That Appear Panciky”:
Phaeochromocytoma Hyperthyroidism Hypoglycaemia Temporal lobe epilepsy Alcohol Paroxysmal arrhythmias
Depression: major depression criteria
DEAD SWAMP:
Depressed mood most of the day
Energy loss or fatigue
Anhedonia
Death thoughts (recurrent), suicidal ideation or attempts
Sleep disturbances (insomnia, hypersomnia)
Worthlessness or excessive guilt
Appetite or weight change
Mentation decreased (ability to think or concentrate, indecisiveness)
Psychomotor agitation or retardation
Schizophrenia- negative features
A's Avolition (low motivation) Asocial behaviour Anhedonia Alogia (poverty of speech) Affect blunted Attention deficits
Impotence causes
PLANE:
Psychogenic: performance anxiety
Libido: decreased with androgen deficiency, drugs
Autonomic neuropathy: impede blood flow redirection
Nitric oxide deficiency: impaired synthesis, decreased blood pressure
Erectile reserve: can’t maintain an erection
Eating disorder screening questions
Mnemonic: SCOFF
Make yourself SICK when you feel uncomfortably full?
Worry you have lost CONTROL over how much you eat?
Recently lost more than 14 pounds within three months?
ONE stone’s worth of weight
Believe you are FAT when others say you are too thin?
Would you say that FOOD dominates your life?
Symptoms anorexia
FEEDD
Fear of weight gain Endocrine disturbance Emaciated BMI <17.5kg/m2 Deliberate weight loss Distorted body image
Alcohol withdrawal: clinical symptoms
HITS H- Hallucinations (visual, tactile) I- Increased vital signs and insomnia T- Tremens (delirium tremens) lethal S- Shaking, Sweating, Seizures, Stomach pain (nausea/vomiting)
ICD-10 criteria for anorexia diagnosis
FEED
Fear of weight gain Endocrine disturbance Emaciated Deliberate weight loss Distored body image
ICD-10 criteria for bulimia nervosa diagnosis
‘Bulimia Patients Fear Obesity’
Behaviours to prevent weight gain (compensatory)
Pre-occupation with eating (sense of compulsion)
Fear of fatness (including self perception of being too fat)
Overeating (at least two episodes a week over a period of 3 months)
Screening for alcohol dependence
The CAGE questionnaire
Cut down: Have you ever felt you needed to Cut down on your drinking?
Annoyed: Have people Annoyed you by criticizing your drinking?
Guilty: Have you ever felt Guilty about drinking?
Eye-opener: Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Two “yes” responses indicate that the possibility of alcoholism should be investigated further
Clinical features of delirium
DELIRIUM
Disordered thinking Euphoric, fearful, depressed, angry Language impaired Illusions, delusions, hallucinations Reversal of sleep-wake cycle Inattention Unaware/ disoriented Memory deficits
Physical features of Down’s syndrome
PROBLEMS
Palpebral fissure Round face Occipital and nasal flattening Brushfield spots Brachycephaly Low-set ears Epicanthic folds Mouth open and protruding tongue Strabismus Single Palmer crease Sandal gap deformity
Symptoms of normal pressure hydrocephalus
Wet, wobbly, confused
Urinary incontinence, ataxia, dementia
Somatoform disorders
PUSHy Somatoform
Persistent somatoform pain disorder Undifferentiated Somatization disorder Hypochondriacal disorder Somatoform autonomic dysfunction
Side effects of ECT
PC DAMS
Peripheral nerve palsies Cardiac arrhythmias, Confusion Dental and oral trauma Anaesthetic risks - N&V, sore throat Muscular aches and headaches Short-term memory impairment, status epilepticus
Anti-depressant a) first and second line b) in bulimia nervosa c) IHD/post MI d) post natally (breast feeding) e) OCD
a) SSRI eg citalopram, sertraline
b) fluoxetine
c) sertraline
d) paroxetine
e) fluoxetine, sertraline, citalopram
Clinical features of OCD
FORD Car
Failure to resist - at least one obsession or compulsion
Originate from patients mind - recognise they’re not influenced by others
Repetitive and Distressing - must be acknowledged by patient as excessive or unreasonable
Carrying out the obsessive thought or compulsive act is not in itself pleasurable but reduces anxiety levels.
Contraindications to ECT
MARS
MI <3 months ago, or Major unstable fracture
Aneurysm (cerebral)
Raised ICP
Stroke <1 month ago, history of Severe epilepticus, Severe anaesthetic risk
Define delirium tremens and its features
Withdrawal delirium develops between 24hours and 1 week after alcohol cessation.
Characterised by
Cognitive impairment Visual disturbance - hallucination/illusions Autonomic instability Marked tremor Paranoid delusions
Key features and treatment of delirium tremens
Dehydration and electrolyte disturbances
Benzodiazepines, haloperidol, IV pabrinex
