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Phase 3A DJF > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

What are the aspects of the MSE?

A 
Appearance
Behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
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2
Q

What three aspects form the risk assessment?

A

Risk to self intentionally/unintentionally
Risk to others
Risk to society

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3
Q

What is the difference between neuroses and psychoses?

A

Neuroses are conditions where symptoms vary from normality only in severity (eg Depression)
Psychoses are conditions where symptoms are notably different from normal experiences (eg Schizophrenia)

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4
Q

What 3 aspects form psychiatric aetiology?

A

Predisposing factors
Precipitating factors
Perpetuating factors

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5
Q

How do SSRIs work?

A

SSRIs inhibit serotonin (5HT) uptake in synapses, thus increasing the level of synaptic serotonin and increasing neuronal firing.

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6
Q

What are the possible side effects of SSRIs?

A

Nausea, Vomiting, Headache, Diarrhoea, Dry mouth, Bleeding, Serotonin syndrome

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7
Q

What is serotonin syndrome?

A

A toxic, hyperserotonergic state causing agitation, confusion, tremor, diarrhoea, tachycardia, hyperthermia and hypertension

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8
Q

What can happen if SSRIs are withdrawn suddenly?

A

Discontinuation syndrome:

Shivering, anxiety, Dizziness, Headache, Nausea, ‘electric shocks’

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9
Q

How do tricyclic antidepressants work?

A

Inhibit monoamines and reuptake of serotonin and noradrenaline.

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10
Q

How do SNRIs work?

A

Inhibit reuptake of serotonin and noradrenaline in synapses

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11
Q

How does Mirtazapine work?

A

5HT2 and 5HT3 antagonist and alpha2-adrenergic blocker. These combine to increase noradrenaline and selected (2+3) serotonin transmission.
Causes sedation

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12
Q

What is the difference between mania and hypomania?

A

Hypomania describes symptoms of elevated mood that are within the boundaries of that individual’s personality - they may be doing same activities but with more rigour
Mania describes symptoms of elevated mood that are beyond the individual’s normal personality - new tasks or activities or psychotic features

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13
Q

Name the stages of normal grief

A 
Shock/disbelief
Anger
Guilt
Sadness
Acceptance/Resolution
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14
Q

What word describes a hallucination upon waking up?

A

Hypnopompic

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15
Q

What word describes a hallucination upon falling asleep?

A

Hypnogognic

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16
Q

Define a delusional perception

A

A delusion that forms as a result of a real perception (eg a bird landed in that tree, therefore I shall die today)

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17
Q

Define concrete thinking

A

Taking things absolutely literally

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18
Q

Describe circumstantiality

A

Taking a long, convoluted trip before eventually answering your question

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19
Q

What word describes a patient filling in holes in their memory with made up stories?

A

Confabulation

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20
Q

Define stupor

A

Non-response to environmental stimuli

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21
Q

What phrase describes jumping from topic to topic within the same sentence?

A

Flight of ideas

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22
Q

How do you describe high speed, high volume, one way conversation?

A

Pressure of speech

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23
Q

Define anhedonia

A

Loss of enjoyment of hobbies

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24
Q

How do you describe ‘poker face’

A

Blunting of affect

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25
Q

Define incongruity of affect

A

Mis-match between expressions and feelings

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26
Q

Define depersonalisation

A

Detachment from body (but still inside mind)

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27
Q

Define dissociation

A

Detachment from body and mind - out of body experience

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28
Q

Define derealisation

A

Feeling the world (except themselves) is fake

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29
Q

Describe akathesia

A

Restlessness caused as an extrapyramidal side effect of drugs

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30
Q

Describe section 2 of the MHA

A

Assessment section, but patients can be treated
Lasts 28 days (unrenewable)
Requires 2 doctors and 1 AMHP with evidence of mental disorder and risk of harm

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31
Q

Describe section 3 of the MHA

A

Treatment section
Lasts 6 months (renewable for 6 more months then annually after that)
Requires 2 doctors and 1 AMHP with a mental health diagnosis, reason for hospital based treatment which is in patient’s best interests and risk of harm

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32
Q

Describe section 4 of MHA

A

Emergency section - used until section 2 or 3 can be implemented
Lasts 72 hours
Requires 1 doctor or AMHP, evidence of mental health disorder and risk, and not enough time/people for different section to be used

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33
Q

Describe section 5(2) of the MHA

A

Doctor’s inpatient holding power (A&E not inpatients, use section 4)
Lasts 72 hours
Requires one doctor

Does NOT permit treatment against will

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34
Q

Describe section 5(4) of the MHA

A

Nurse’s holding power
Lasts 6 hours
Requires one nurse

Does NOT permit treatment against will

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35
Q

Describe section 135 of the MHA

A

Police section for access to private property in order to bring psychiatric patients into safe place for assessment

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36
Q

Describe section 136 of the MHA

A

Police section to bring psychiatric patients from a public place into safe place for assessment

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37
Q

Describe schozophrenia

A

A form of functional psychosis which affcts the brain’s function but not structure. It can involve positive and negative symptoms and may occur in later life

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38
Q

Describe the epidemiology of schozophrenia

A

Equal M=F, but males frequently more severe
Life time risk 1%
Typical onset in 20-30s

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39
Q

What are the risk factors for schozophrenia?

A

Young age
Family history
Childhood trauma (especially sexual abuse)
Cannabis use

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40
Q

What are the first rank symptoms of schizophrenia?

What are the other symptoms of schizophrenia?

A
  • Thought alienation (Insertion, Broadcast, Withdrawal)
  • Passivity phenomena (Being controlled)
  • 3rd Person auditory hallucinations
  • Delusional perceptions
Other hallucinations or delusions
Mood disturbance
Blunting of affect
Poverty of speech/thought
Self neglect
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41
Q

What investigations would be appropriate for ?schizophrenia?

A

FBC, U+E, LFT, Glucose, Ca, TFT, PTH, cortisol
CT/MRI head
Urine drug screen and MC+S

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42
Q

What is the management of schizophrenia?

A

Antipsychotics (eg. Olanzapine) - Do ECG prior to starting therapy as drugs can prolong Q-T interval
Rehabilitation to normal lifestyle
Treat comorbidities with psychotherapy or other medications

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43
Q

What antispychotic is good for treatment resistant schizophrenia?

A

Clozapine

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44
Q

What is the prognosis for schizophrenia?

A

Generally good with medication compliance

Better prognosis if acute onset with positive symptoms than chronic onset with negative symptoms

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45
Q

How do antipsychotic medications work?

A

Combined D1 receptor agonists and D2 receptor antagonists.
Underactive D1 receptors in mesocortical pathway cause negative symptoms, but overactive D2 receptors in the mesolimbic pathway cause positive symptoms. Blocking dopamine in nigra-stridal pathway causes extrapyramidal symptoms

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46
Q

What are the potential side effects of antipsychotics?

A 
Extrapyramidal side effects
Neuroleptic Malignant Syndrome
Weight gain
Urinary incontinence
Hypotension
Blurred vision
Hyperprolactinaemia
Sedation
Dry mouth
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47
Q

What is the epidemiology of depression?

A

Women twice as likely as men
Prevalence 10%
Leading cause of death in 20-24 year olds (suicide)

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48
Q

What are the risk factors for depression?

A 
Genetics
Traumatic childhood
Anxious, impulsive or obsessional personality
Divorce or Bereavement
Unemployment
Chronic illness
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49
Q

What are the symptoms of depression?

A 
Depressed mood (all day with little variation)
Anhedonia
Anergia/Apathy
Worthlessness/Hopelessness
Suicidal thoughts or attempts

All above continuing over 2 weeks with no organic cause and having an impact on person’s functioning

Also weight loss, appetite change, disturbed sleep, loss of libido, psychotic symptoms if severe

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50
Q

How is depression staged for severity?

A 
Mild = 2 core symptoms + 2 other symptoms
Mod = 2 core symptoms + 3+ other symptoms
Severe = all core symptoms + other symptoms
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51
Q

What investigations are appropriate for depression?

A

FBC, U+E, LFT, TFT, glucose, Ca, ESR, B12/Folate
If indicated, Toxicology, Syphilis, Dexamethasone suppression test (Cushing’s) or Cosyntropin stimulation test (Addison’s)

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52
Q

How is depression treated?

A 
Mild = Self help/CBT
Mod = Antidepressant + CBT/IAPT
Severe = add Crisis team, ECT, Antipsychotic
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53
Q

What is the prognosis for depression?

A

50% relapse

50% asymptomatic after 12 months

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54
Q

Name 5 types of antidepressant, give examples of each

A 
SSRI (Sertraline, fluoxetine)
SNRI (Venlaflaxine, Duloxetine)
Tricyclic (Amytriptyline, Trimipramine)
MOAIs (Phenelzine)
NaSSA (Mirtazapine)
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55
Q

Describe dysthymia

A

Low grade chronic depression where the patient can remember feeling well. Often treatment resistant. Rarely diagnosed.

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56
Q

Describe bipolar affective disorder

A

A combination of depressive episodes and (hypo)manic episodes, with normal periods in-between. Can be rapid cycling. Americans describe Type 1 (manic) or 2 (hypomanic).

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57
Q

Describe the epidemiology of bipolar

A

Prevalence 1%

M=F

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58
Q

What are the risk factors for bipolar?

A

Family history
Previous depression
Disturbed childhood

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59
Q

How does bipolar present?

A

Periods of normality followed by weeks of elevated mood and periods of clinical depression.
Elevated mood presents with energy, enthusiasm, high self esteem, distractability, over-familiararity and reduced sleep. Can be manic or hypomanic.

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60
Q

What is cyclothymia?

A

A milder form of bipolar where the depressive and manic episodes are milder

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61
Q

How do you treat an acute manic episode of bipolar?

A

Lorazepam or diazepam
ECT if life threatening
Stop antidepressants
Add mood stabiliser (Lithium or Valporate)

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62
Q

How should a bipolar patient be treated prophylacticly?

A 
Mood stabiliser (Lithium or Valporate)
Add 2nd gen antipsychotic if required
Psychoeducation of patient and family
CBT
support groups
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63
Q

What are the problems with Lithium and what are the potential side effects?

A

Narrow therapeutic index
Requires monitoring (serum level) 7 days after any dose change
Teratogenicity
Toxicity

SE: Polyuria, weight gain, tremor, GI upset, sedation, cognitive problems

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64
Q

In what way is lithium tetarogenic?

A

Ebstein’s abnormality (tricuspid malformation)

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65
Q

How does lithium toxicity present?

A 
Anorexia
Tremor
Myoclonic jerks
Diarrhoea
Dehydration
Restlessness
Hypertonia
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66
Q

What is the prevalence of generalised anxiety disorder?

A

5.7%

More common in females

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67
Q

What can be the cause of anxiety disorders?

A

Genetics
Insecure attachments/loss of parents
Overprotective or under-nurturing parents
Childhood trauma

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68
Q

What are the symptoms of generalised anxiety disorder?

A 
Restlessness
Fatigueability
Difficulty concentrating
Irritability
Palpitations
Sweating
Nausea
Hot and cold flushes
Easily startled
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69
Q

How is generalised anxiety disorder managed?

A

Benzodiazepine for somatic symptoms
SSRI for depressive symptoms
Beta blocker for CVR and autonomic symptoms
CBT
Buspirone for psychotic symptoms if present

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70
Q

What is the prognosis of generalised anxiety disorder?

A

Chronic and disabling condition, can be well controlled with treatment

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71
Q

Describe panic disorder

A

Recurrent panic attacks not secondary to an organic cause (drugs)
Can be spontaneous or triggered, sometimes nocturnal

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72
Q

Describe the epidemiology of panic disorders

A

3% lifetime risk
More common in women
Age of onset bimodal: 15-24 then 45-54

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73
Q

What are the risk factors for panic disorders?

A 
Marital separation or bereavement
Urban living
Lower educational achievement
Early parental loss
Abuse
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74
Q

What are the symptoms of panic disorders?

A

Attacks consisting of palpitations, hyperventilation, sweating, GI upset, fear of death, suicidal thoughts

Associated with fear of next attack and behaviour changes to avoid attacks

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75
Q

What investigations are appropriate in ?Panic disorder?

A

FBC, U+E, LFT, glucose, TFT, Ca, UMA/pHVA

ECG

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76
Q

What is the management of generalised panic disorder?

A

SSRI for 18 months
Short term benzodiazepine until SSRI takes effect
Add antipsychotic if severe and treatment resistant
CBT

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77
Q

What is the prognosis for attack disorders?

A

Good response to treatment but relapses frequent

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78
Q

Describe OCD

A

Obsessions and compulsions regarding one topic that interfere with the patient’s functioning. Insight often present at time of presentation
Associated with anxiety and depression and Tourette’s

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79
Q

What is the epidemiology of OCD?

A

Prevelance 2%
M=F
Age usually before 25

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80
Q

What can cause OCD?

A

Dysregulation of serotonin system
Genetics
Previous anxiety provoking event/trauma

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81
Q

What is the management of OCD?

A

CBT, focused on exposure and response prevention
Group/Family therapy
SSRI
ECT if serious or suicidal

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82
Q

What is the prognosis of OCD?

A

Frequently improvement with treatment but relapse rate high

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83
Q

Describe an acute stress reaction

A

A transcient disorder lasting hours or days immediately following an emotional stressor that has a severe threat to the individual’s or a loved one’s life or security

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84
Q

Describe the epidemiology of acute stress reactions

A

15-20% following exceptional stress

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85
Q

What are the symptoms of an acute stress reaction?

A 
Dazed and disorientated
Depression, anxiety, anger or despair
Social withdrawal
Aggression
Hopelessness
Excessive grief
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86
Q

How are acute stress reactions managed?

A

Reassurance but now medical intervention required unless becomes acute stress disorder

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87
Q

What is the prognosis for acute stress reactions?

A

Self resolves within a few hours

Can develop into acute stress disorder (Like PTSD but less than 4 weeks, PTSD if over 4 weeks)

88
Q

Describe PTSD

A

Severe psychological disturbance following a traumatic event, associated with anxiety, depression, substance misuse and somatization syndrome

89
Q

What is the epidemiology of PTSD?

A

Risk following event: Male 10% Female 25%

90
Q

What are the symptoms of PTSD?

A 
1 month history of symptoms impairing function within 6 months of stressful event:
Difficulty sleeping
Flashbacks
Hypervigilance
Easily startled
Concentration difficulties
Partial amnesia of stressful event
Avoidance of connections to stressful event
91
Q

How is PTSD managed?

A

CBT + trauma counselling
Eye movement desensitisation and reprocessing (EMDR)
Relaxation or hypnotherapy

2nd line: SSRI/Mirtazapine/Mood stabiliser

92
Q

What is the prognosis for PTSD?

A

50% recover fully

30% become chronic

93
Q

Describe a phobia

A

A recurring, excessive and unreasonable psychological or autonomic symptoms of anxiety in the anticipated or real presence of a specific feared object or situation

94
Q

What are the 5 topics/catagories of phobias?

A 
Animals
Nature
Blood and injuries
Situational
Other
95
Q

What is the lifetime prevalence of a phobia?

Gender bias?

A

12.5%

M=F, though F more likely to have animal phobias

96
Q

What is the age of onset of phobias?

A 
Animals = 7
Blood/Injury = 8
Situational = 20
97
Q

What are the symptoms of a phobia?

A 
In response to anticipated or presence of trigger:
Sweating
Tremor
Palpitations
Intense fear
Nausea
Lightheadedness and fainting
Hyperventillation
98
Q

What is the management of phobias?

A

Progressive exposure and desensitisation
CBT
Coping strategies
Initially BDZ or Beta blocker for symptom control

99
Q

What is the prognosis of a phobia?

A

If untreated can be a lifelong condition. Usually resolved slowly by treatment

100
Q

What is agoraphobia?

A

Fear of embarrassing situations

101
Q

What is somatisation disorder?

A

Repeated presentations of medically unexplained symptoms affecting multiple organs. Associated with significant psychological distress and causes functional impairment.
Risk of harm from resulting medical treatment

aka functional symptoms

102
Q

Splitting phenomena is commonly seen with somatisation disorder. What is this?

A

Where the patient decides they like certain things/people and dislike others with no obvious reason, making it tricky for certain staff to work with the patient as the patient has a strong dislike for them

103
Q

How is somatisation disorder managed?

A

Education of patient and family that these symptoms are real and disabling and have a psychological stressor cause.
Regular review by the same doctor
CBT

104
Q

Describe personality disorder

A

An enduring and pervasive disorder of inner experience and behaviour causing distress or social impairment to functioning. Often affect cognition, affect and behaviour

105
Q

What is the epidemiology of personality disorders?

A

Prevalence 10%

Antisocial, Histrionic and borderline (EUPD) most common

106
Q

What are the risk factors for personality disorders?

A

Genetics
ADHD
Poor parenting (harsh or inconsistent)
Childhood trauma (especially sexual abuse)

107
Q

Describe the features of Borderline personality disorder

A

Intense and unstable relationships
Impulsivity
Self harm
Unpredictable/mismatched affect and behaviour

108
Q

Describe the features of Paranoid personality disorder

A

Suspicious
Self referential
Preoccupied with conspiracies
Distrust of others

109
Q

Describe the features of Schizoid personality disorder

A

Emotionally cold
Detached
Lack of interest in others

110
Q

Describe the features of Schizotypal personality disorder

A

Peculiar ideas, perceptions or behaviours

Interpersonal discomfort

111
Q

Describe the features of Antisocial personality disorder

A

Lack of concern for others
Irresponsibility
Irritable and aggressive
Unstable relationships

112
Q

Describe the features of Histrionic personality disorder

A 
Dramatic
Shallow affect
Egocentric
Manipulative
Craves attention
113
Q

Describe the features of Narcissistic personality disorder

A

Grandiose
Need for admiration
Lacks empathy

114
Q

Describe the features of Anxious or Avoidant personality disorder

A

Self consciousness
Insecurity
Fear of negative judgement from others
Timid

115
Q

Describe the features of Dependent personality disorder

A

Clinging
Submissive
Desperation to be cared for
Helplessness when not receiving care

116
Q

What are the clusters of personality disorders and which ones fall into each cluster?

A

Cluster A - Odd and eccentric

  • Paranoid
  • Schizoid
  • Schizotypal

Cluster B - Emotional and dramatic

  • Borderline
  • Antisocial
  • Histrionic
  • Narcissistic

Cluster C - Anxious and fearful

  • Avoidant and Anxious
  • Dependent
117
Q

How are personality disorders managed?

A

Dialectical behaviour therapy (DBT)
CBT
Therapeutic community (day units designed as PD treatment centres to help people adjust to normal life)

2nd line - Antipsychotic or antidepressant

118
Q

What is the prognosis for personality disorders?

A

High suicide rates or accidental death rates

Worsened prognoses for any other mental health condition

119
Q

Describe the features of dependence syndrome

A

Primacy of drug seeking behaviour (the drug is the most important thing to patient, over food or shelter)
Narrowing of repertoire (drug, RoA, location)
Tolerance (can be lost suddenly in advanced dependence syndrome)
Loss of control (if they have one they will have many)
Continued use despite significant loss (job, loved one)
Withdrawal symptoms if abstinence attempted
Drug taking to avoid withdrawal symptoms

120
Q

How is alcohol dependence managed?

A

Motivational interviewing
Change to safe drinking or tee-total
Detoxification

121
Q

What are the symptoms of alcohol withdrawal? (Not including DTs)

A

4-12 hours post drink; Tremor, sweating, insomnia, tachycardia, N+V, anxiety. Craving for alcohol. Lasts up to 5 days

Seizures - grand mal, 6-48 hours post drink, high risk if previous epilepsy or head trauma

122
Q

What are the symptoms of Delirium Tremens?

A

1-7 days post drink (high risk if infection, high dependence or liver damage)
Acute confusion
Amnesia
Hallucinatios
Severity fluctuates hour by hour, worst at night
Risk of death from sudden CVR collapse (10%)

123
Q

Describe an alcohol detoxification?

A

Inpatient or community based

  • Reducing BDZ regime
  • Psychological counselling, motivational interviewing
  • Nutritional support: Thymine, MultiVits incl Mg and Vit B
124
Q

What medication can be given following an alcohol detoxification to aid abstinence?

A

Disulfiram - intensifies hangover
Acamprosate (or 2nd line = Naltrexone) reduce cravings

Most issues following detoxification are with abstinence

125
Q

What is the indication for an alcohol detoxification?

A

Consumption over 10 units per day for the previous 10+ days running

126
Q

Describe Wernicke-Korsakoff syndrome

A

Wernicke encephalopathy and Korsakoff psychosis are the acute and chronic phases of a single disease process of neuronal degeneration secondary to thiamine deficiency which is mostly seen in heavy drinking. (also starvation, anorexia nervosa and gastric resection)

127
Q

What are the symptoms of Wernicke encephalopathy?

A

Acute onset confusional state
Nystagmus or Ophthmaloplegia
Ataxic gait
Peripheral neuropathy, resting tachycardia, nutrient defficiency

128
Q

What causes the symptoms of Wernicke encephalopathy?

A

Thiamine deficience causes haemorrhages and secondary gliosis in periventricular and periaqueductal gray matter.

129
Q

How is Wernicke encephalopathy managed?

A

IV pabrinex (vit B1 replacement, 2 ampoules infused in 30mins BD)

130
Q

What is the prognosis for Wernicke encephalopathy?

A

If treated all resolves except ataxia, nystagmus and neuropathy which may be permenant

131
Q

What are the symptoms of Korsakoff psychosis?

A

Short term memory loss and variable length amnesia with confabulation filling amnesia episodes.

Working, procedural and emotional memory all unimpaired

132
Q

What is the management of Korsakoff psychosis?

A

Oral thiamine and multivitamin replacement for 2 years

OT assessment

133
Q

What is the prognosis following Korsakoff psychosis?

A

50% return to independent living

134
Q

Name three opiates

A

Heroin
Codeine
Methadone

135
Q

Name two depressants

A

Alcohol

Benzodiazepines

136
Q

Name three stimulants

A

MDMA
Cocaine
Amfetamines

137
Q

Name three hallucinogenics

A

LSD
Mushrooms
Ketamine

138
Q

Describe illegal highs

A

Synthetic alternatives to natural drugs which are often dangerously mixed together

139
Q

What is the management of substance abuse?

A

Harm reduction advice (don’t do it alone, avoid combining drugs, avoid IV injections)
Safer injecting advice (sterile needles, rotate site, go with blood flow)
Detoxification
Counselling and support sercives
Conversion to prescribed drug (if abstinence impossible)

140
Q

What is the management of acute drug overdose?

A 
ABCDE + resuscitation
Substance ID - pupils, breath smell, IV needlemarks, oral burns, hyperventillation
Gastric lavage
Activated charcoal
Dialysis
Psychological assessment
141
Q

Describe serotonin syndrome

A

A rare but potentially fatal syndrome caused by excessive serotonin, usually as a result of drug combinations or overdose

142
Q

What are the symptoms of serotonin syndrome?

A 
Confusion or coma
Agitation
Tremor
Rigidity
Hyperreflexia
Myoclonus
Ataxia
Diarrhoea
Hyperthermia
143
Q

What investigations are appropriate in serotonin syndrome?

A

FBC, U+E, LFT, Glucose, pH, Ca, Mg, Phosphate, CK, Tox screen
CXR
ECG

144
Q

What is the management of serotonin syndrome?

A

IV fluids
Cooling of patient
BDZ
Serotonin receptor antagonist (Chlorpromazine, Propranolol)

Consider cause - activated charcoal and gastric lavage if overdose

145
Q

What is the prognosis following serotonin syndrome?

A

Mostly resolved within 36 hours

146
Q

Name the four stages of extrapyramidal side effects

A

Acute dystonia
Induced Parkinsonism
Akathisia
Tardive Dyskinesia

147
Q

What are the risk factors of acute dystonia?

A 
Family history
Under 45
Male
Liver failure
high dose antipsychotic medication
Hypocalcaemia
148
Q

What are the symptoms of acute dystonia?

A

Symptoms occur within 7 days:
Painful muscle spasms occurring in episodes lasting minutes to hours
Mostly head and neck affected - head turning and jaw opening
More generalised in children (almost seizure like)

149
Q

What is the management of acute dystonia?

A

IM anticholinergic agent (Procyclidine), IV if life threatening. Continue for 7 days then titrate down
Change or lower antipsychotc
Check Ca for alternative cause (hypocalcaemia)

150
Q

How do antipsychotics cause drug induced Parkinsonism?

A

Blocking of D2 receptors in the nigrostriatal pathway causes Parkinsonism, as reduced dopamine in body.

151
Q

What are the symptoms of drug induced Parkinsonism?

A

Onset within 4 weeks:

Bilateral and often absent at night tremor, rigidity and bradykinesia

152
Q

What is the treatment of drug induced Parkinsonism?

A 
Drug change or dose reduction
Anticholinergic agent (Procyclidine)
153
Q

Describe akathisia

A

Feeling of inner restlessness accompanied by physical restlessness mostly of the legs
Onset variable but always due to drugs

154
Q

What are the risk factors for akathisia?

A 
High dose antipsychotics
Chronic antipsychotics
Rapid change in antipsychotic regime
Organic brain disease
Lithium
SSRIs
155
Q

What is the management of akathisia?

A

Rule out organic cause (full bloods and drug screen)
Change antipsychotic regime
Propranolol
Anticholinergic agent (Procyclidine)

156
Q

What is the prognosis of akathisia?

A

Can last 3 months

157
Q

Describe tardive dyskinesia

A

Repetitive involuntary, purposeless muscular movements mostly of face or neck. Considered the biggest tell for Schizophrenics who have concealed their mental illness with medication

158
Q

What is the prevalence of tardive dyskinesia ?

A

30% of chronic treated patients

159
Q

What are the risk factors for tardive dyskinesia?

A 
Chronic antipsychotics
Change in antipsychotic regime
Anticholinergic treatment
Female
Organic brain disease
DM
Lithium
160
Q

What are the symptoms of tardive dyskinesia?

A

Repeititve, involuntary, purposeless movements of face or neck
Becomes worse with distraction but suppressed by focused concentration
Absent when sleeping

161
Q

What is the management of tardive dyskinesia?

A

Reduce antipsychotic treatment
Reduce or stop anticholinergic treatment

If treatment resistant swap to Clozapine and try adjuvant BDZ

162
Q

What is the prognosis for tardive dyskinesia?

A

Tends to improve though symptoms wax and wane

163
Q

Describe Neuroleptic Malignant Syndrome

A

A rare, life threatening reaction to antipsychotic medication, antidepressants, Carbamazapine, Lithium, reducing antiparkinsonism medications or to the OCP

164
Q

Describe the incidence and mortality of Neuroleptic Malignant syndrome

A

Incidence 0.1%

Mortality under 20%

165
Q

What are the risk factors for Neuroleptic Malignant syndrome?

A 
Dehydration
Agitation
Catatonia
Rapid or large change in antipsychotic medications
High dose antipsychotic medications
Organic brain disease
Previous Neuroleptic Malignant Syndrome
166
Q

What are the symptoms of Neuroleptic Malignant Syndrome?

A 
Hyperthermia
Muscular rigidity
New confusion or agitation
Tachycardia
Tachypnoea
Hypertension or hypotension
Diaphoresis
Tremor
Urinary or bowel incontinence/retention/obstruction
Metabolic acidosis
167
Q

What is the diagnosis?

A 32 year old whose antipsychotic medication you have recently increased returns feeling hot, agitated and breathing quickly. They report stiff joints and occasionally have a shake they can’t control.
On examination you find tachycardia, hypertension and tachypnoea.

A

Neuroleptic Malignant syndrome

168
Q

What investigations are appropriate in Neuroleptic Malignant syndrome?

A 
FBC, LFT, U+E, Ca, Phos, CK, Cultures, tox screen, Coagulation studdies
Urine myoglobin
ABG
CXR
ECG
CT head
LP
169
Q

What is the management of Neurolepitc Malignant syndrome?

A

Benzodiazepine (for behavioural disturbance)
Stop causative drug (or restart antiparkinsonism drug)
Oxygen
Fluids
Cooling if hyperthermic
IV Sodium bicarbonate if rhabdomyelysis suspected (high CK)

170
Q

What is the prognosis of an uncomplicated Neuroleptic Malignant syndrome?

A

Good

171
Q

What can cause catatonia?

A 
Schizophrenia
Mania
Depression
Delirium
Neurological disorders
172
Q

Name the two forms of catatonia

Name three other types of catatonia (conditions)

A

Stuporous/Retarded
Excited/Delirious

Neuroleptic Malignant syndrome
Serotonin syndrome
Malignant catatonia

173
Q

Describe the symptoms of catatonia

A

Mutism
Posturing (holding a posture or position like a statue)
Negativism (lack of verbal response)
Staring
Rigidity or Waxy flexibility (body holds position in which it is placed by another person)
Echopraxia (repeating actions someone else does)
Echolalia (repeating words someone else says)
Stereotypy (frequent repetitive movements for no reason)
Agitation

174
Q

What investigations are appropriate in catatonia?

A

Vital signs
FbC, U+E, LFT, Glucose, TFT, Cortisol, Prolactin
CT head

175
Q

What is the management of catatonia?

A

Benzodiazepine if agitated and excited
ECT
Treat the underlying cause

176
Q

Describe schizoaffective disorder

A

A mental health condition with features of schizophrenia and mood affective disorder

177
Q

What is the lifetime prevalence of schizoaffective disorder?

A

0.7%

178
Q

What are the symptoms of schozoaffective disorder?

A 
Simultaneous symptoms of schizophrenia and bipolar:
Delusions
Hallucinations
Thought interference
Passivity
Mania/Hypomania
Depression
179
Q

What is the management of schizoaffective disorder?

A

Antipsychotic
Mood stabiliser
Benzodiazepine if currently manic and risk of harm

180
Q

What is the prognosis of schizoaffective disorder?

A

Moderate

Better than schizophrenia, worse than bipolar

181
Q

Describe schizotypal disorder

A

Schizophrenia without delusions or hallucinations.

Tends to run a stable course

182
Q

What are the symptoms of schizotypal disorder?

A 
Ideas of reference (everything relates to themselves)
Excessive social anxiety
Odd beliefs
Illusions
Eccentric behaviour and appearance
Inappropriate or constricted affect
Paranoia
183
Q

What is the treatment of schizotypal disorder?

A

Antipsychotics

CBT

184
Q

Describe delusional disorder

A

An uncommon disorder where patients experience non-bizarre delusions in the absence of hallucinations, thought disorders, mood disorders or flattening of affect.

185
Q

Name the subtypes of delusional disorder (7)

A

Erotomanic (celebrity is in love with patient)
Grandiose (Patient is superhero/god)
Jealous (aka Othello syndrome - belief partner has been unfaithful)
Persecutory (Belief others wish to harm patient)
Somatic (Beliefs regarding body eg. infestation, dysmorphia)
Mixed (multiple themes)
Unspecified

186
Q

What are the symptoms of delusional disorder?

A

Delusion present for over 1 month in the absence of hallucinations, thought disorder or mood disorder.
Unimpaired cognition or consciousness
Speech, mood and behaviour affected by emotional tone of delusion (congruent)
No insight

187
Q

What are the risk factors for delusional disorder?

A 
Old age
Isolation
Low socioeconomic status
Sensory impairment
Family history
Head trauma
188
Q

What is the management of delusional disorder?

A 
Admission if high risk
Separate patient from source of delusion
Antipsychotic
SSRI
Benzodiazepine if anxiety symptoms
Psychological therapy
189
Q

Describe counselling

A

A short term intervention that aims to help patients talk through their problems to find solutions

190
Q

Describe CBT

A

Cognitive behavioural therapy, structured sessions talking through situations describing the thoughts, resultant feelings and resultant behaviours that occur, and how these might be managed or changed for the better

191
Q

Describe cognitive analytical therapy

A

CBT + psychoanalysis

192
Q

Describe dialectic behavioural therapy

A

A process of learning to manage emotions through acceptance (used for EUPD)

193
Q

Describe family therapy

A

Assessment of family dynamics, often done with one therapist involved in the family situation and another watching from afar

194
Q

Describe interpersonal therapy

A

Like counselling but for relationship problems of grief counselling. Uses counsellor’s own experiences to open up the patient

195
Q

Describe trauma based counselling

A

Counselling aimed at working through the painful experience a patient endured that is causing them PTSD, and resolving the issues there

196
Q

Describe exposure

A

Graded and progressive exposure of a patient to the object that causes them fear or obsessions. Used in phobias, OCD and PTSD

197
Q

Describe psychodynamic or psychoanalytic therapy

A

A discussion between patient and therapist where the therapist interprets the patient’s symptoms or emotions as in relation to past events to find the source of the disturbance.

198
Q

What are the potential consequences of self harm?

A 
Suicide (deliberate or accidental)
Shame or social anxiety
Distress for friends and family
Physical damage causing a chronic condition (which might cause additional psychological strain)
Economic impact
199
Q

Define delusion

A

A firmly held belief despite contrasting evidence. The content is frequently impossible but the belief is unshakeable.

200
Q

Define hallucination

A

An interpretation of an absent stimulus.

Can be visual, olfactory, auditory, tactile, gustatory or somatic.

201
Q

What three aspects to a psychiatric presentation and management plan do you need to consider?

A

Bio
Psycho
Social

202
Q

Describe anorexia nervosa

A

An eating disorder where patients have a phobia of fat, and see themselves as being ugly and overweight despite being clinically underweight. It is most common in female teenagers

203
Q

Describe bulimia nervosa

A

An eating disorder where patients go through periods of binge eating but compensate for this by purging - vomiting, excessive exercise or taking laxatives. It is most common in female teenagers

204
Q

What are the symptoms of anorexia nervosa?

A 
Reduced oral intake
Low BMI
Feeling of being overweight despite low BMI
Taking appetite suppressant medication
Amenorrhoea
Dry skin
Lightheadedness
Fatigue
Mood disturbance
205
Q

What are the symptoms of bulimia nervosa?

A

Binge eating (no control)
Purging behaviours
Fear of putting on weight
Mood disturbance

206
Q

What investigations are appropriate in eating disorders?

A

FBC, U+E, LFT, TFT, glucose, B12, Folate,
ECG
BP
Vital signs

207
Q

What is the management of eating disorders?

A 
Urgent referral for CBT or Cognitive Analytic therapy
Family therapy
Dietary counselling
Avoidance of purging behaviours
Vitamin and mineral supplements
208
Q

What are the risks associated with treating eating disorders?

A

Refeeding syndrome
Wernicke’s encephalopathy
Neuroleptic Malignant Syndrome

209
Q

What is refeeding syndrome?

A

When starvation is followed by acutely increased oral intake it can cause low K, low Mg and low Phophate

210
Q

Describe attachment theory in relation to personality disorders

A

Attachment theory suggests that the connections formed between a baby and it’s parents, especially mother, in the first 5 years of life impact personality. If these are insecure or cut short by bereavement or departure this can lead to unstable personalities.

211
Q

What is the difference between learning disabilities and learning difficuties?

A

Learning disabilities are those that cause reduced intellectual ability.
Learning difficulties are those that do NOT affect intellectual ability.

212
Q

How are learning disabilities catagorised?

A

Mild
Moderate
Severe
PMLD (Profound and Multiple Learning Disabilities)

These are based on IQ and clinical judgement

213
Q

Describe dyslexia

A

Dyslexia is a learning difficulty with regard to spelling and words, where patients mix words up or spell things phonetically

214
Q

Describe dyspraxia

A

Dyspraxia is a learning difficulty with regard to fine and/or gross motor movements and coordinating them, giving rise to difficulties with sports and handwriting

215
Q

Describe dyscalculia

A

Dyscalculia is a learning difficulty with regard to numbers and time, making maths very complex or these people

216
Q

Describe ADHD

A

ADHD is a learning difficulty with regard to attention and hyperactivity. These people struggle to focus

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