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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

psychiatric history components

A

Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP

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2
Q

Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP

A

categories for a psychaitric history

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3
Q

psychiatric history: information

A

PT details, under section vs informal visit, PT vs collateral history

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4
Q

PT details, under section vs informal visit, PT vs collateral history

A

points to cover in the information section of a psych history

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5
Q

psych history: introductions

A

who’s who, roles, purpose of interview, consent, permission to take notes

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6
Q

who’s who, roles, purpose of interview, consent, permission to take notes

A

points to cover in the intriductions section of a psych history

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7
Q

psych history: PC

A

ideally get PT’s own words

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8
Q

ideally get PT’s own words

A

for psych PC in hisory

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9
Q

psych history: HPC

A

can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before

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10
Q

psych history: HPC depression

A

SOCRATES, is mood always low, when worst, anything to lift mood, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work, thoughts abouth themselves, the world, the future

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11
Q

SOCRATES, when worst, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work

A

HPC things to ask about if depressive PC

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12
Q

can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before

A

for HPC psych

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13
Q

psych history: HPC psychosis

A

strange thoughts, others commented on strange things, plots against you/out to get you, interference with thoughts (insertion, withdrawal, broadcasting), see/hear things that others can’t, get messages from things you see/hear, insight, controlled by others, how longs has this been going on, has it changed over time

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14
Q

strange thoughts, others commented on strange things, plots against you, interference with thoughts, see/hear things that others can’t, insight, how longs has this been going on, has it changed over time

A

questions to ask in HPC for psychosis

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15
Q

psych history: HPC generalised anxiety

A

general feeling, on edge, worry, irritable, unable to relax, fears, increased vigilance, insomnia (initial/middle/fatigue on waking), tremor, tachycardia

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16
Q

general feeling, on edge, worry, irritable, unable to relax

A

psych history HPC to ask for generalised anxiety

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17
Q

psych history: HPC panic attacks

A

hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers, fear, impending doom

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18
Q

hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers

A

HPC questions to ask in panic attacks PC

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19
Q

psych history: HPC phobias

A

fears that you/others may consider irrational, obsessive thoughts

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20
Q

fears that you/others may consider irrational, obsessive thoughts

A

things to ask in HPC for someone presenting with phobias

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21
Q

psych history: SH

A

lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems

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22
Q

lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems

A

psych history: SH

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23
Q

psych history: PPH

A

contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers

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24
Q

contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers

A

psych history: PPH

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25
Q

psych history: DH

A

current medication, allergies, previous regimes, recreational drugs, alcohol (CAGE), side effects, compliance/feelings towards their medications

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26
Q

current medication, allergies, previous regimes, recreational drugs, alcohol, side effects, compliance/feelings towards their medications

A

psych history: DH

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27
Q

psych history: FH

A

who is in their family, who close to, occupations, an MH disease in family/suicides

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28
Q

who is in their family, who close to, occupations, an MH disease in family/suicides

A

FH psych history to ask

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29
Q

psych history: PH

A

childhood: where born, parents together, schooling (attendance, grades, friends), moved a lot, siblings, enjoyed childhood, abuse
occupational: jobs held, reason for leaving, free time
psychosexual: first sexual encounter, orientation, relationships/marital status, reasons for ending, children
forensic: any problems with the police

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30
Q

childhood, occupational, psychosexual, forensic

A

ask about in PH

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31
Q

psych history: PP

A

(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests

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32
Q

(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests

A

psych hisotry: PP

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33
Q

CAGE questionnaire

A

have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?

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34
Q

have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?

A

CAGE questionnaire

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35
Q

psych assessment includes

A

psych history + MSE

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36
Q

psych history + MSE =

A

full psych assessment

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37
Q

MSE components

A

appearance, behaviour, speech, mood, thoughts, perception, cognition, insight

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38
Q

appearance, behaviour, speech, mood, thoughts, perception, cognition, insight

A

MSE components

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39
Q

appearance + behaviour

A

self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements

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40
Q

self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements

A

appearance + behaviour

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41
Q

speech

A

form: rate + flow, incoherent
content: appropriateness, congruency

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42
Q

tardive dyskinesia

A

involuntary movements fo face + neck, may follow use of antipsychotics

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43
Q

involuntary movements fo face + neck, may follow use of antipsychotics

A

tardive dyskinesia

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44
Q

waxy flexibility

A

PT stays in the same position that they’ve been put in e.g. schizophrenia/structural brain disorder

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45
Q

PT stays in the same position that they’ve been put in e.g. schizophrenia/structural brain disorder

A

waxy flexibility

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46
Q

forced grasping

A

takes examiner’s hand whenever offered, e.g. dementia/chronic schizophrenia

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47
Q

takes examiner’s hand whenever offered, e.g. dementia/chronic schizophrenia

A

forced grasping

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48
Q

stereotypies uniform

A

repetitive non-goal directed actions e.g. schizophrenia

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49
Q

repetitive non-goal directed actions e.g. schizophrenia

A

stereotypies uniform

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50
Q

form: rate + flow, incoherent
content: appropriateness, congruency

A

speech

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51
Q

presure of speech

A

goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)

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52
Q

goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)

A

pressure of speech

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53
Q

mutism

A

severe depression/schizophrenia

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54
Q

perseveration

A

repeating the same words/phrases e.g. dementia/frontal lobe trauma

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55
Q

repeating the same words/phrases e.g. dementia/frontal lobe trauma

A

perseveration

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56
Q

neologisms

A

creating new words e.g. schizophrenia

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57
Q

creating new words e.g. schizophrenia

A

neologism

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58
Q

echolalia

A

repeating the same words/phrases as examiner e.g. schizophrenia

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59
Q

repeating the same words/phrases as examiner e.g. schizophrenia

A

echolalia

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60
Q

mood

A

subjective vs objective, depression, anxiety, mania, congruency, lability

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61
Q

subjective vs objective, depression, anxiety, mania, congruency, lability

A

mood

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62
Q

thoughts

A

delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals

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63
Q

delusions in schizophrenia

A

primary delusions, thought alienation, presecutory delusions

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64
Q

primary delusions, thought alienation, presecutory delusions

A

delusions in schizophrenia

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65
Q

delusions in depression

A

nililistic, hypochondrial, worthless, guilt, hopelessness

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66
Q

nililistic, hypochondrial, worthless, guilt, hopelessness

A

delusions in depression

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67
Q

delusions in mania

A

grandiose

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68
Q

grandiose

A

delusions in mania

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69
Q

thought alienation

A

insertion, withdrawal, broadcast, plots to harm you

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70
Q

insertion, withdrawal, broadcast, plots to harm you

A

thought alienation

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71
Q

depersonalisation

A

feeling unreal/any part of the body is unreal e.g. in anxiety disorders

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72
Q

feeling unreal/any part of the body is unreal

A

depersonalisation

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73
Q

derealisation

A

feeling that things around them are unreal e.g. in anxiety disorders

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74
Q

feeling that things around them are unreal

A

derealisation

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75
Q

delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals

A

thoughts

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76
Q

perception

A

aka hallucinations, illusions

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77
Q

aka hallucinations, illusions

A

perception

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78
Q

cognition

A

orientation to person, place + time, MMSE, AMTS, ACE-R

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79
Q

MMSE, AMTS used to assess

A

cognition

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80
Q

insight

A

recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment

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81
Q

recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment

A

insight

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82
Q

auditory illusion

A

auditory sound misinterpreted by listener

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83
Q

auditory sound misinterpreted by listener

A

auditory illusion

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84
Q

illusions

A

can occur in any sensory modality and aren’t usually an indicator of a mental illness/psychiatric problem

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85
Q

can occur in any sensory modality and aren’t usually an indicator of a mental illness/psychiatric problem

A

illusions

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86
Q

affect illusion

A

associated with specific mood state e.g. someone may see a loved one who has recently died

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87
Q

associated with specific mood state e.g. someone may see a loved one who has recently died

A

affect illusion

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88
Q

completion illusion

A

inattention when reading e.g. misreading words, completing faded letters

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89
Q

inattention when reading e.g. misreading words, completing faded letters

A

completion illusion

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90
Q

pareidolia

A

perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds

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91
Q

perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds

A

pareidolia

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92
Q

most common side efffect of clozapine

A

urinary incontinence

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93
Q

side effect of clozapine that we’re most worried about

A

agranulocytosis

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94
Q

agranulocytosis

A

side effect of clozapine that we’re most worried about

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95
Q

urinary incontinence is the most common side effect of

A

clozapine

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96
Q

methylphenidate

A

CNS stimulant used to treat ADHD, also used as an apetite surpressor + in the treatment of sleep disorders e.g. narcolepsy

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97
Q

CNS stimulant used to treat ADHD

A

methylphenidate

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98
Q

methyylphenidate SE

A

insomnia, agitation, HTN, weight loss

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99
Q

insomnia, agitation, HTN, weight loss

A

methylphenidate SE

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100
Q

psychiatric drugs which cause weight gain

A

olanzapine (SGA), mirtazapine (NaSSA)

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101
Q

olanzapine + mirtazapine can cause

A

weight gain

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102
Q

Schneider’s 1st rank symptoms of schizophrenia

A 
auditory hallucinations (thoughts spoken aloud/voices referring to themselves in the 3rd person/commentary)
thought withdrawal/insertion/interruption/broadcasting
delusional perceptions
feelings/actions controlled by external agents (passisivity)
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103
Q

auditory hallucinations, thought disordered, delusional perceptions, feelings/actions controlled by external agents

A

schneider’s 1st rank symptoms

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104
Q

schizophrenia diagnosis

A

6/12 duration, at least 2 symptons (1 must be positive)

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105
Q

6/12 duration, at least 2 symptons (1 must be positive)

A

schizophrenia

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106
Q

negative symptons schizophrenia

A

avolition, asocial, apathetic, affect blunting, alogia, attention deficit, paucity of speech, poor memory

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107
Q

avolition, asocial, apathetic, affect blunting, alogia, attention deficit

A

negative symptons schizophrenia

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108
Q

brief psychotic disorder

A

symptoms <1/12

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109
Q

psychotic symptoms <1/12

A

brief psychotic disorder

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110
Q

schitzoaffective disorder

A

mix of psychotic and affective symptoms, alternating not simultaneously

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111
Q

mix of psychotic and affective symptoms, alternating not simultaneously

A

schizoaffective disorder

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112
Q

ICD-10 diagnostic criteria for depression

A
  1. persistent low mood/sadness
    plus at least 1 of the following most days/most of the time for at least 2/52: 2. loss of interest/pleasure 3. fatigue/low energy
    associated symptoms: 4. disturbed sleep 5. poor concentration/indecisiveness 6. low self-confidence 7. poor/increased appetite 8. suicidal thoughts/acts 9. agitation/slowing of movement 10. guilt/self-blame
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113
Q

of the ICD-10 10 symptoms of depression 0-3/10

A

not depressed (don’t forget to also assess functional impact)

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114
Q

of the ICD-10 10 symptoms of depression 4/10

A

mild depression (don’t forget to also assess functional impact)

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115
Q

of the ICD-10 10 symptoms of depression 5-6/10

A

moderate depression (don’t forget to also assess functional impact)

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116
Q

of the ICD-10 10 symptoms of depression 7-10/10

A

severe depression +/- psychosis, symptoms >1/12, every symptom should be present for most of every day

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117
Q

not depressed score according to ICD-10

A

0-3/10 (don’t forget to also assess functional impact)

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118
Q

mild depression score according to ICD-10

A

4/10 (don’t forget to also assess functional impact)

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119
Q

moderate depression score according to ICD-10

A

5-6/10 (don’t forget to also assess functional impact)

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120
Q

severe depression score according to ICD-10

A

7/10 every symptom should be present for most of every day, symptoms for >1/12

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121
Q

first line medical management of depression

A

SSRI

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122
Q

second line medical management of depression

A

switch to a different SSRI

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123
Q

DSM-IV criteria for subthreshold depression

A

<5/10 symptoms

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124
Q

DSM-IV criteria for mild depression

A

few if any symptoms > the 5/10 to make the diagnosis, minor functional impairment

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125
Q

DSM-IV criteria for moderate depression

A

symptoms/functional impairment -/- mild + severe

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126
Q

DSM-IV criteria for severe depression

A

most of the /10 symptoms, marked interference with functioning, +/- psychotic symptoms

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127
Q

DSM-IV <5/10 symptoms

A

subthreshold depression

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128
Q

DSM-IV 5/10 symptoms

A

mild depression

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129
Q

DSM-IV most of the /10 symptoms

A

severe depression

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130
Q

all severities depression management

A

treat comorbid physical ailments, treat substance misuse problems

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131
Q

mild depression management

A

self help groups, structured physical activity groups, guided self help, computerised CBT, behavioural couples therapy

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132
Q

moderate depression management (+ unresponsive mild)

A

add antidepressant, individual CBT, interpersonal therapy

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133
Q

severe depression management

A

ECT (poor PO intake), admission, crisis team, antipsychotic (if psychotic)

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134
Q

third line medical management of depression

A

SNRI

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135
Q

flight of ideas

A

mania

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136
Q

thought block

A

sudden interruption in train of thought e.g. schizophrenia, depression

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137
Q

circumstantiality

A

thinking proceeds slowly via convoluted path, final point is eventually reached e.g. particular personality traits, mania

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138
Q

psychomotor retardation

A

slowing of thoughts/speech e.g. depression

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139
Q

tangentiality

A

deflected path of speech, never reaching point/answering question e.g. psychosis, dementia, delerium

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140
Q

sudden interruption in train of thought

A

thought block e.g. schizophrenia, depression

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141
Q

thinking proceeds slowly via convoluted path, final point is eventually reached

A

circumstantiality e.g. particula personality traits, mania

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142
Q

slowing of thoughts/speech

A

psychomotor retardation e.g. depression

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143
Q

deflected path of speech, never reaching point/answering question

A

tangentiality e.g. psychosis, dementia, delerium

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144
Q

delusional mood

A

feels something going on around them, can’t describe it, becomes > clear /specific when the delusional idea/perception occurs

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145
Q

feels something going on around them, can’t describe it, becomes > clear /specific when the delusional idea/perception occurs

A

delusional mood

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146
Q

delusion of love

A

2’ delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met

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147
Q

2’ delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met

A

deluson of love

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148
Q

de Cleraumbault’s syndrome

A

delusion of love involving a celebrity

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149
Q

delusion of love involving a celebrity

A

de Cleraumbault’s S

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150
Q

delusional perception

A

delusion forms in response to an ordinary object e.g. traffic light changing sending a message

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151
Q

delusion forms in response to an ordinary object e.g. traffic light changing sending a message

A

delusional perception

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152
Q

autochthonous delusion

A

delusional ideas that arise out of nowhere, appear fully formed in the PT’s mind

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153
Q

delusional ideas that arise out of nowhere, appear fully formed in the PT’s mind

A

autochthonous delusions

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154
Q

delusions of jealousy

A

2’ delusions, e.g smell of perfume on partner’s coat means they’re having an affaire

155
Q

2’ delusions, e.g smell of perfume on partner’s coat means they’re having an affaire

A

delusions of jealousy

156
Q

other side effects of clozapine

A

neurtropaenia, myocarditis, sedation, seizures, hypersalivation, postural hypotension

157
Q

neurtropaenia, myocarditis, sedation, seizures, hypersalivation, postural hypotension

A

side effects of clozapine

158
Q

obsessional thoughts

A

recurrent, intrusive, unpleasant/disturbing thoughts/ideas/images, that are one’s own, but unwanted, recognises them as absurd

159
Q

compulsions

A

repettitive, purposeful, obsessional motor/mental actions, PT recognises as unnecessary but can’t resist performing them w/o anxiety

160
Q

obsessional motor actions, PT recognises as unnecessary but can’t resist performing them w/o anxiety

A

compulsions

161
Q

unpleasant/disturbiing thoughts/ideas/images, that are one’s own, but unwanted

A

obsessional thoughts

162
Q

histrionuc PD

A

self-dramatisation, theatrical, exaggerated emotions, suggestible/easiy led, shallow + labile affect, seeking to be centre of attention, inappropriate disinhibition/flirtiness, over concern with physical attractiveness

163
Q

EUPB/boarderline PD

A

self-image disturbances, short term v intense relationships, emotional crisis when relationships end, self harm, feeling of chronic emptiness

164
Q

anakastic PD/obsessive-compulsive PD

A

preoccupied with detail/rules/organisation/schedules, perfectionism hinders completion of tasks, pedantic + preoccupied, reduced enjoyment, loss of relationships

165
Q

schizoid PD

A

emotionally detached, asocial, little interest in others, preoccupied by fantasy

166
Q

paranoid PD

A

high/inappropriate suspicion of people + their intentions, feel victim of ‘ganging up’/plots, difficult to convince otherwise

167
Q

self-dramatisation, theatrical, exaggerated emotions, suggestible/easiy led, shallow + labile affect, seeking to be centre of attention, inappropriate disinhibition/flirtiness, over concern with physical attractiveness

A

histrionic PD

168
Q

self-image disturbances, short term v intense relationships, emotional crisis when relationships end, self harm, feeling of chronic emptiness

A

EUPD/borderline PD

169
Q

preoccupied with detail/rules/organisation/schedules, perfectionism hinders completion of tasks, pedantic + preoccupied, reduced enjoyment, loss of relationships

A

anakasticPD/obsessive-compulsive PD

170
Q

emotionally detached, asocial, little interest in others, preoccupied by fantasy

A

schizoid PD

171
Q

high/inappropriate suspicion of people + their intentions, feel victim of ‘ganging up’/plots, difficult to convince otherwise

A

paranoid PD

172
Q

trailing illusion

A

associated with hallucinogenics, moving object perceived as a series of images

173
Q

associated with hallucinogenics, moving object perceived as a series of images

A

trailing illusion

174
Q

LBD

A

deteriorating cognition, visual hallucinations, Parkinsonianisms

175
Q

deteriorating cognition, visual hallucinations, Parkinsonianisms

A

LBD

176
Q

Charles Bonnet S

A

psychophysical visual disturbances, complex visual hallucinations, in partial/severe blindness, PT is aware that hallucinations aren’t real

177
Q

psychophysical visual disturbances, complex visual hallucinations, in partial/severe blindness, PT is aware that hallucinations aren’t real

A

Charles Bonnet S

178
Q

Li toxicity

A

anorexia, diarrhoea, vomiting, drowsiness, restlessness, dysarthria, dizziness, ataxia, incoordination, m twitches, coarse tremor, hyperreflexia, convulsions, AKI, collapse, coma, death

179
Q

anorexia, diarrhoea, vomiting, drowsiness, restlessness, dysarthria, dizziness, ataxia, incoordination, m twitches, coarse tremor, hyperreflexia, convulsions, AKI, collapse, coma, death

A

Li toxicity

180
Q

drugs associated with Li toxicity

A

thiazides

181
Q

hypnogogic hallucinations

A

going off to sleep, auditory>other modalities

182
Q

going off to sleep hallucinations, auditory>other modalities

A

hypngogic

183
Q

hypnopompic hallucinations

A

waking up

184
Q

waking up hallucinations

A

hypopompic

185
Q

reflex hallucination

A

true sensory stimulus causes a hallucination in a different sensory modality

186
Q

true sensory stimulus causes a hallucination in a different sensory modality

A

reflex hallucination

187
Q

autoscopy

A

experience of seeing oneself + knowing that it is oneself

188
Q

experience of seeing oneself + knowing that it is oneself

A

autoscopy

189
Q

autoscopy aka

A

phantom mirror image

190
Q

phantom mirror image aka

A

autoscopy

191
Q

lilipitian hallucination

A

visual hallucination associated with micropsia e.g delerium

192
Q

visual hallucination associated with micropsia

A

liliputian hallucination e.g. delerium

193
Q

elementary hallucination

A

flashes of light

194
Q

flashes of light hallucination

A

elementary

195
Q

extracampine hallucination

A

hallucination outside of limits of sensory field e.g. seeing someone behind them when they’re looking forward

196
Q

hallucination outside of limits of sensory field e.g. seeing someone behind them when they’re looking forward

A

extracampine

197
Q

SNRI stands for

A

selective noradrenaline-seratonin reuptake inhibitors

198
Q

duloxetine

A

SNRI

199
Q

asessing memory

A

repeat something back after 5 mins

200
Q

assessing orientation in time, place + person

A

day, date, time, identity/job, names

201
Q

assessing attention + concentration

A

counting backwards

202
Q

assesing dyspraxia

A

drawing intersecting pentagons

203
Q

assessing receptive dysphasia

A

following a command

204
Q

assessing expressive dysphasia

A

naming objects

205
Q

assessing the components of executive (frontal lobe) functioning test

A

approximation (guessing distances), abstract reasoning (1, a, 2, b, next in sequence), verbal fluency (words beginning with a, 1 min), proverb interpretation

206
Q

repeat something back after 5 mins tests

A

memory

207
Q

day, date, time, identity/job, names tests

A

orientation to person, place, time

208
Q

counting backwards tests

A

attention + concentration

209
Q

drawing intersecting pentagons tests

A

dyspraxia

210
Q

following a command tests

A

receptive dysphasia

211
Q

naming objects tests

A

expressive dysphasia

212
Q

risk assessment is the balance between

A

PT risks factors vs PT rights

213
Q

risk assessment components

A

risk to self (suicide, DSH, self neglect, accidental harm), risk to others, risk from others, safeguarding children/vulnerable adults

214
Q

tools to help assess risk

A

Hx, MSE, past behaviour, collateral, previous notes

215
Q

risk of self harm determine

A

suicidality: thoughts, plans, intentions, things that prevent them acting, DSH: previous episides, circumstance, method, management, predisposing factors: FH suicide, social isolation, substance misuse, disengagement from/unwillingness to engage with support services, hopelessness, worthlessness

216
Q

risk of harm to others determine

A

(to whom, f, severity, methods) acts/threats of violence, arson, sexual inappropriateness, containment, compliance with previous/current psychaitric intervention, increased risk: discontinuation of medicaton, change in recreational drug use, EtOH/drug misuse, impulsive/unpredictable behaviour, recent stressful life event, persecutory delusions, delusions of control/passivity phenomenon, command hallucinations)

217
Q

passivity phenomenon

A

the belieft that one is no longer in control of one’s own body, thoughts or feelings, controlled by some external agent

218
Q

risks of self neglect/accidental self harm can manifest as

A

malnutrition, failure to access health care, living in squalid conditions, falls (fraility, intoxication), failure to safeguard against fire/explosion, wandering (getting lost, unsafe t to be out), poor road safety, accidental OD/under dose, vulnerability to crime (front door open, inviting in strangers)

219
Q

risks to vulnerable adults mneumonic

A

how safe

220
Q

how safe mneumonic means

A

HOme safety (leaving gas on), Wandering, Self neglect, Abuse, crime vulnerability, Falls, Eating (malnutrition)

221
Q

the belieft that one is no longer in control of one’s own body, thoughts or feelings, controlled by some external agent

A

passivity phenomenon

222
Q

how safe mneumonic to remember

A

risk to vulnerable adults

223
Q

psychiatric investigations

A

FBC, ESR, U+E, glucose, TFT, LFT, Ca, folate, B12, syphilis, MSU, CXR, CT head/MRI, EEG

224
Q

classes of medications used in psychiatry

A

antipsychotics, antidepressants, antimanic drugs/mood stabilisers, hypnotics/anxiolytics, stimulants, antidementia

225
Q

DoLS applies to

A

people in hospitals/care homes who lack capacity, are deprived of their liberty (i.e. not able to come + go as they please), not under a section of the MHA

226
Q

DoLs authorisatoinis granted by

A

2 assessors

227
Q

DoLS must conform to the following

A

> 18 y.o., no LPA/advinced decision/court of protection conflicts, lacks capacity, MH disorder, not under MHA, not to enable MH treatment, best interest

228
Q

DoLS must be renewed

A

annually

229
Q

MHA section 2

A

28/7, authorised by 2 Drs, for assessment purposes

230
Q

MHA section 3

A

6/12, 2 Drs, treatment purposes

231
Q

MHA section 4

A

72h, 1 Dr, urgent assessment from community, no t to arrange section 2

232
Q

MHA section 5(2)

A

72h, 1 Dr, urgent detention of inPT

233
Q

MHA section 5(4)

A

6h, registered MH nurse, urgent detention of psych inPT in the absence of a Dr

234
Q

MHA section 135

A

72h, police officer, removal from home to place of safety

235
Q

MHA section 136

A

72h, police officer, premouval from public space to place of safety

236
Q

28/7, authorised by 2 Drs, for assessment purposes

A

MHA section 2

237
Q

6/12, 2 Drs, treatment purposes

A

MHA secion 3

238
Q

72h, 1 Dr, urgent assessment from community, no t to arrange section 2

A

MHA section 4

239
Q

72h, 1 Dr, urgent detention of inPT

A

MHA section 5(2)

240
Q

6h, registered MH nurse, urgent detention of psych inPT in the absence of a Dr

A

MHA section 5(4)

241
Q

72h, police officer, removal from home to place of safety

A

MHA section 135

242
Q

72h, police officer, premouval from public space to place of safety

A

MHA section 136

243
Q

in order to warrent sectioning

A

PT deemed to have MH disorder sufficient to warrent detention due to risk, unwilling to attend voluntarity

244
Q

who can apply for a MHA section

A

AMHP - approved MH professional: social worker, nurse, psychologist, OT (not a Dr)

245
Q

at least one of the Drs completing the MHA section has to be

A

section 12 approved

246
Q

depression DD

A

normal sadness (berevement, physical illness), psychotic depression, schizophrena, EtOH/drug withdrawal

247
Q

biological mechanism behind depression

A

reduction in seratonin/noradrenaline availiability in the brain

248
Q

duration of antidepressant therapy

A

at least 6/12, taper off dose, can continue for prophylaxis

249
Q

depression prognosis - single episodes

A

duration 3-8/12, 50% recurrence

250
Q

depression prognosos - severe depression

A

80% recurence, suicide risk

251
Q

reduction in seratonin/noradrenaline availiability in the brain is the hypothersises mechanism behind

A

depression

252
Q

biological mechanism behind anxiety

A

low GABA levels, frontal cortex remodelling in stress, heightened amygdala activation

253
Q

anxiety is associated with

A

childhood abuse, separations, demand for high achievement, excessive conformity, life stresses, physical health probelms

254
Q

panic attack definition

A

unpredictable recurrent episodic panic attacks, not restricted to a particular situation, associated with persistent worry RE another attack/maladaptive behavioural changes

255
Q

panic attack vicious cycle

A

catastrophic misinterpretation of ambiguous physical sensation e.g. SOB increase arousal, creating a +ve feedback loop

256
Q

generalised anxiety discorder

A

generalised, persistent, excessive anxiety/worry RE a number of events that the individual finds difficult to control, >6/12 duration

257
Q

generalised anxiety disorder DD

A

withdrawal from drugs/EtOH, excessive caffeine, depression, psychotic disorder, thyrotoxicosis, parathyroid DZ, hypoglycaemia, phaeochromocytoma, carcinoid S

258
Q

management of generalised anxiety disorder

A

individual guided self help (CBT principles), psychoeducational groups, face to face CBT, aplpied relaxation, SSRI, SNRI, pregabalin, BZD (not regularly, just for crises)

259
Q

CBT for generalised anxiety disorder aims to

A

identify morbid anticipatory thoughts, replace with > realistic cognition, learn + use distractions, breathing + relaxation exercises

260
Q

agoraphobia

A

fear + avoidance of places/situations from which escape may be difficult/help unavailable in the event of a panic attack

261
Q

agoaphobia diagnosis required anxiety to be restricted to these

A

crowds, public places, travelling away from home, travelling alone

262
Q

management of agoraphobia

A

CBT, graded exposure to situations, SSRI

263
Q

social phobia

A

persistent fear of social situations involving unfamiliar people/possible scrutiny by others, fear of humiliation/embarrasement

264
Q

management of social phobia

A

CBT, self help material, graded exposure to situations, social skills training, SSRI

265
Q

specific phobias

A

fear of specific people/objects/situations

266
Q

management of specific phobias

A

graded exposure to situation, response prevention, short term BZD

267
Q

low GABA levels, frontal cortex remodelling in stress, heightened amygdala activation might underly

A

anxiety disorders

268
Q

unpredictable recurrent, not restricted to a particular situation, associated with persistent worry RE another attack/maladaptive behavioural changes

A

panic attack

269
Q

catastrophic misinterpretation of ambiguous physical sensation e.g. SOB increase arousal, creating a +ve feedback loop

A

panic attack vicious cycle

270
Q

generalised, persistent, excessive anxiety/worry RE a number of events that the individual finds difficult to control, >6/12 duration

A

GAD

271
Q

fear + avoidance of places/situations from which escape may be difficult/help unavailable in the event of a panic attack

A

agoraphobia

272
Q

persistent fear of social situations involving unfamiliar people/possible scrutiny by others, fear of humiliation/embarrasement

A

social phobia

273
Q

fear of specific people/objects/situations

A

specific phobia

274
Q

risk factors for generalised anxiety disorder

A

35-54 y.o., divorced, separated, living alone, lone parent

275
Q

persecutory delusions e.g.

A

having enemies, feeling that someone is out to get you

276
Q

delusions of reference e.g.

A

getting specific messages for you from the TV

277
Q

Schneider’s 2nd rank symptoms

A

persecutory delusions, delusions of reference, hallucinations, neologisms/disorganised speech

278
Q

psychotic disorders include

A

schizophrenia, delusional disorder, schizoaffective disorder, psychotic depression, bipolar affective disorder

279
Q

DSM-V criteria for schizophrenia

A

6/12 duration, 2/5 of: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, negative symptoms

280
Q

subtypes of schizophrenia

A

paranoid, catatonic, hebephrenic, residual, simple

281
Q

paranoid schizophrenia

A

delusions + auditory hallucinations are evident

282
Q

catatonic schizophrenia

A

psychomotor disturbances are prominent (motor immobility to excessive activity), rigidity, posturing (waxt flexibility), echolalia, echopraxia

283
Q

echopraxia

A

copying behaviours

284
Q

hebephrenic schizophrenia

A

early onset, poor prognosis, unpredictable + irresponsible behaviour, innapropriate mood, incongruous affect, giggling, mannerisms, pranks, thought incoherance, fleeting delusions, hallucinations

285
Q

residual schizophrenia

A

Hx of paranoid/catatonic/hebephrenic schizophrenia, but in current illness negative/cognitive symptoms predominate

286
Q

simple schizophrenia

A

uncommon, negative symptoms w/o preceeding overt psychotic symptoms

287
Q

psychosis prodrome

A

anxiety, depression, ideas of reference, distress, declune in social functioning

288
Q

risk factors for developing psychosis

A

FH, advanced paternal age, winter birth, obstetric complications, developmental delay, smoking week in adolescence, childhood abuse

289
Q

other forms pfo psychosis

A

schizoaffective disorder, delusional disorder, brief psychotic episodes

290
Q

schizoaffective disorder

A

affective + schizophrenic symptoms occur together + with equal prominence

291
Q

delusional disorder

A

fixed delusion/delusional system with other areas of thinking/functioning preserved

292
Q

brief psychotic episodes

A

<6/12 duration

293
Q

management of acute psychotic episode (schizophrenia)

A

antipsychotics (lowest effective dose, PO, monitor SE, adherence), psychological therapy (self help, CBT, family therapy, art therapy), social support (engagement, hope, reduce stigma, supported employment, accommodation)

294
Q

two types of antipsychotic

A

typical/first generation, atypical/second generation

295
Q

antipsychotics are not so good at treating

A

the negative symptoms

296
Q

duration of treatment with antipsychotic before determining its effectiveness

A

4-6/52

297
Q

medication used in treatment R schizophrenia

A

clozapine

298
Q

schizophrenia good prognostic factors mneumonic

A

finding plans

299
Q

finding plans mneumonic meaning

A

Female, In relationship, good social support, No -ve symptoms, aDherence, Intelligence (> educated), No stress, Good premorbid personality, Paranoid subtype, Late onset, Acute onset, No substance misuse, Scan (CT/MRI) N

300
Q

suicide risk in schizophrenia is higher among

A

young men, 1st few y of illness, persistent hallucinations/delusions, illicit drug Hx, previous suicide attempts

301
Q

persecutory delusions, delusions of reference, hallucinations, neologisms/disorganised speech describe

A

Schnieder’s 2nd rank symptoms

302
Q

delusions + auditory hallucinations are evident describes

A

paranoid schizophrenia

303
Q

psychomotor disturbances are prominent (motor immobility to excessive activity), rigidity, posturing (waxt flexibility), echolalia, echopraxia

A

catatonic schizophrenia

304
Q

early onset, poor prognosis, unpredictable + irresponsible behaviour, innapropriate mood, incongruous affect, giggling, mannerisms, pranks, thought incoherance, fleeting delusions, hallucinations

A

hebephrenic schizophrenia

305
Q

Hx of paranoid/catatonic/hebephrenic schizophrenia, but in current illness negative/cognitive symptoms predominate

A

residual schizophrenia

306
Q

uncommon, negative symptoms w/o preceeding overt psychotic symptoms

A

simple schizophrenia

307
Q

fixed delusion/delusional system with other areas of thinking/functioning preserved

A

delusional disorder

308
Q

finding plans is a mneumonic for

A

good prognositic factors in schizophrenia

309
Q

young men, 1st few y of illness, persistent hallucinations/delusions, illicit drug Hx are at higher risk of

A

suicide attempts in schizophrenia

310
Q

self harm demographics

A

women, <35 y.o., lower socioeconomic classes, single, divorced

311
Q

self harm is associated with

A

depression, personality disorders

312
Q

self harm assessment

A

motivaiton (interrupt a sequence of events, attention, communication, wish to die), current psychiatric illness, suicide note, will, continued determination to die, hopelessness, method, discovery, employment

313
Q

self harm management

A

reduce risk, initiate/continue treatment, address ongoing social difficulties, what seems feasible to the PT, crisis team, SSRI, psychological therapy

314
Q

PTSD onset w/i

A

6/12 (ICD-10), 1/12 (DSM-5) of stressor

315
Q

dissociative symptoms of an acute stress reaction predict and increased risk of

A

PTSD

316
Q

dissociative symptoms of an acute stress include

A

wandering aimlessly, reduced sleep, nightmares

317
Q

symptons of PTSD

A

> 1/12 duration, persistent intrusive thoughts, reexperiences (memories, nightmares, flashbacks), avoidance of reminders, numbing, detachment, estrangement from others, sense of foreshortened future, increased arousal (hypervigilance, sleep disturbances, irritability, poor concentration, exaggerated startle response)

318
Q

treatment for PTSD

A

trauma-focused CBT, EMDR (eye movement desensitisation + reprocessing therapy), antidepressants (paroxetine, mirtazapine)

319
Q

PTSD definition

A

follows severe stressful experiencs of exceptionally threatening/catastrophic nature: assult, accident, disaster, act ro terrorism, war

320
Q

PTSD comorbidities

A

EtOH/drug abuse, depression

321
Q

PTSD risk factors

A

proportional to stressor, man-made>natural disaster, continuation of stress, lack of social support, other adversities, premorbid personality

322
Q

> 1/12 duration, persistent intrusive thoughts, reexperiences (memories, nightmares, flashbacks), avoidance of reminders, numbing, detachment, estrangement from others, sense of foreshortened future, increased arousal (hypervigilance, sleep disturbances, irritability, poor concentration, exaggerated startle response) may indicate

A

PTSD

323
Q

ex of obsessions

A

thoughts (blasphemy, sex, violence, contamination, numbesr), images (vivid, morbid, violent scenes), impulses (fear of jumping infront of a train), ruminations (continuous pondering), doubts

324
Q

ex of compulsions

A

had washing, cleaning, counting, checking, touching _ rearranging objects to achieve symmetry, checking _ repeating thoughts, hoarding, counting, desire to utter a forbidden word, asking endless Q’s to seek answers to commonplace facts, inappropriate + excessive tidiness

325
Q

OCD is characterised as

A

time consuming >1h/d, obsession +/- compulsion, most days for >2/52, distressing + interfere with activities

326
Q

other features of OCD

A

avoidance of trigger stimuli/activities, onset during adolescence

327
Q

OCD can be divided into 4 categories

A

obsessions + compulsions - hand washing concerned with contamination
checking compulsions in response to obsessional thoughts about potential harm - leaving gas on
obsessions w/o any covers compulsive acts
hoarding

328
Q

complications of OCD

A

depression, anxiolytic/EtOH abuse

329
Q

FH in OCD ask about

A

OCD, tics, Tourette’s S, parental overprotection

330
Q

a FH of tics, Tourette’s S, parental overprotection is associated with

A

OCD

331
Q

diagnostic features of anorexia nervosa

A

morbid fear of fatness, distorted body image, deliberate weight loss, amonorhoea, BMI <17.5, loss of libido

332
Q

anorexia nervosa DD

A

psychosis, DM, depression, substance/EtOH abuse, Addison’s, malabsorption, malignancy

333
Q

anorexia nervosa management

A

family therapy, motivational counselling, CBT, IPT (interpesonal psychotherapy), focused psychodynamic therapy, hospitalisation (sig physical abnormalities, suicide risk, BMI >13.5)

334
Q

anorexia nervosa FH ask about

A

eating disorders, OCD, depression

335
Q

anorexia nervosa personal Hx

A

abuse, overprotective/overcontrolling environment, overvaluation of food/eating/weight/body shape, troubled family relationships, bullied because of size

336
Q

anorexia nervosa subtypes

A

restrictive vs bulimic

337
Q

other features of anorexia nervosa

A

preoccupation with food, self-consciousness RE eating in public, socially isolating behaviour, vigorous exercise, constipation, cold intollerance, depressive/OCD symptoms

338
Q

physical signs of anorexia nervosa

A

emaciation, dry/yellow skin, lanugo hair on face/trunk, bradycardia, hypotension, anaemia, leucopenia, consequences of repeated V (hypokalaemia, alkalosis, pitted teeth, parotid swelling, Russell’s sign)

339
Q

bulimia nervosa diagnostic features

A

morbid fear of fatness, distorted body image, craving for food, uncontrolled binge eating, purging/V/laxative abuse, fluctuating weight, preoccupation with body weight/shape

340
Q

bulimia nervosa managemetn

A

CBT, IPT (interpersonal therapy), SSRIs (fluoxetine)

341
Q

bulimai nervosa associations

A

N/excessive body weight (fluctuant), loss of control/trance-like binges, self-loathing, depression, EtOH/drug abuse, DSH, stealing/sexual disinhibition, poor impulse control

342
Q

physical signs in bulimia nervosa

A

amenorrhoea, hypokalaemia, oesophageal tears

343
Q

opiates of abuse

A

heroin, morphine, methadone

344
Q

stimulants of abuse

A

cocaine, amphetamines

345
Q

hallucinogens of abuse

A

MDMA, GHB, GBL, LSD, mushrooms

346
Q

signs of opiate dependence

A

miosis, tremor, malaise, apathy, constipation, weakness, impotence, neglect, malnutrition

347
Q

opiate OD

A

miosis, resp depression, death

348
Q

cannabis negative effects

A

conjunctival irritation, reduced spermatogenesis, L DZ, flashbacks, transient psychosis, schizophrenia, depression, apathy

349
Q

opiate detox medications

A

methadone/buprenorphine

350
Q

mneumonic to assess dependence

A

CAN’T STOP

351
Q

cant stop mneumonic stands for

A

Compulsion to take substance, Aware of harms but persists, Neglect of other activities, Tolerance, Stopping causes withdrawal, Time preoccupied with substance, Out of control use, Persistant/futile wish to cut down

352
Q

psychoactive substance ICD-10 classification classes

A

acute intoxification, harmful use, dependence, withdrawal state, psychotic disorder, amnesic disorder, residual + late onset psychotic disorder

353
Q

acute intoxification (psychoactive substance)

A

transient disturbances of consciousness, cognition, perception, affect or behaviour following administration of psychoactive substance

354
Q

harmful use (psychoactive substance)

A

damage to individual’s health + adverse effects on family + society

355
Q

dependence (psychoactive substance)

A

signs of dependence (mneumonic), associated neglect of important social, occupationsal or recreational activities

356
Q

withdrawal state (psychoactive substance)

A

physical + psychological symptoms occuring on absolute/relative withdrawal of the substance, after repeated, usually prolonged +/- high dose use

357
Q

psychotic disorder (psychoactive substance)

A

psychosis during/immediately after use, vivid hallucinations, abnormal affet, psychomotor disturbances, delusions of persecution + reference

358
Q

amnesic disorder (psychoactive substance)

A

memory or other cognitive impairments caused by substance use

359
Q

residual + late onset psychotic disorders (psychoactive substance)

A

effects on behaviour, affect, personality or cognition that last beyond the period during which a direct psychological substance’s effect might be expected e.g. flashbacks

360
Q

management of substance misuse

A

rehab, hospital, community, CBT, motivational interviewing, self-help groups

361
Q

early opiate withdrawal signs

A

24-48h, craving, flu like symptoms, sweating, yawning

362
Q

late opiate withdrawal signs

A

7-10 days, mydriasis, abdo cramps, diarrhoea, agitation, restlessness, piloerection, tachycardia

363
Q

stigmata of alcohol abuse O/E

A

jaundice, spider naevi, palmar erythema, gynaecomastia, peripheral neuropathy

364
Q

complications of alcohol abuse

A

Wernike’s encephalopathy, peripheral neuropathy, ED, ejaculatory impotence, cerebellar degeneration, dementia, other physical + social complications, psychiatric complciations (depression, suicidal ideations, suicide attempts, severe anxiety, insomnia), foetal alcohol S (reduced m tone, poor coordination, developmental delay, heart defects, facial abnormalities)

365
Q

alcohol abuse management

A

abstinence, detoxificaion (in hospital if risk of delirium tremens), chlordiazepoxide, motivational interviewing, psychological therapies, self-help groups, disulfiram (flushing, headache, N, anxiety if EtOH ingested)

366
Q

treatment of delirium tremens

A

lorazepam, haloperidol or olanzapine

367
Q

miosis, tremor, malaise, apathy, constipation, weakness, impotence, neglect, malnutrition are signs of

A

opiate dependence

368
Q

conjunctival irritation, reduced spermatogenesis, L DZ, flashbacks, transient psychosis, schizophrenia, depression, apathy are negative effects of

A

canabis

369
Q

can’t stop is a mneumonic to remember factors suggestive of

A

dependence

370
Q

transient disturbances of consciousness, cognition, perception, affect or behaviour following administration of psychoactive substance

A

acute intoxification

371
Q

damage to individual’s health + adverse effects on family + society

A

harmful use

372
Q

signs of dependence (mneumonic), associated neglect of important social, occupationsal or recreational activities

A

dependence

373
Q

physical + psychological symptoms occuring on absolute/relative withdrawal of the substance, after repeated, usually prolonged +/- high dose use

A

withdrawal state

374
Q

psychosis during/immediately after use, vivid hallucinations, abnormal affet, psychomotor disturbances, delusions of persecution + reference

A

psychotic disorder

375
Q

memory or other cognitive impairments caused by substance use

A

amnesic disorder

376
Q

effects on behaviour, affect, personality or cognition that last beyond the period during which a direct psychological substance’s effect might be expected e.g. flashbacks

A

residual + late onset psychotic disorder

377
Q

craving, flu like symptoms, sweating, yawning

A

early opiate withdrawal signs 24-48h

378
Q

mydriasis, abdo cramps, diarrhoea, agitation, restlessness, piloerection, tachycardia

A

late opiate withdrawal signs 7-10 days

379
Q

bipolar affective disorder definition

A

recurent episodes of altered mood, activity + energy: depressive, manic, hypomanic, mixed

380
Q

mania characteristics

A

increased psychomotor activity, exaggerated optimism, inflated self esteem, decreased social inhibitions (sexual overactivity, reckless spending, dangerous driving, inappropriate business/religious/political initiatives), heightened sensory awareness, rapid thinking and speech, uninterruptible/pressured speech, flight of ideas, lack of insight

381
Q

bipolar affective disorder DD

A

substance abuse, endocrine disturbance, epilepsy, schizophrenia, schizoaffective disorder, personality disorder, ADHD, transient psychoses

382
Q

management of acute mania

A

haloperidol, olanzapine, quetiapine. risperidone

383
Q

mood stabilsers

A

Li, Na valproate

384
Q

bipolar affective dosirder management

A

indicidual/family/group therapy, Li (most effecive long tern treatment for BPAD, required blood monitoring)

Medicine (30 decks)

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