Psychiatry Flashcards
1
Q
What are the 3 core symptoms of depression?
A
- Anhedonia (loss of pleasure)
- Low mood
- Low energy
2
Q
List 6 biological symptoms of depression
A
- Change in sleep (too much or too little)
- Change in appetite
- Unexplained aches and pains
- Low sex drive
- Constipation
- Slow movements
- Changes to menstrual cycle
3
Q
List 6 psychological symptoms of depression
A
- Gulit
- Hoplessness
- Suicidal ideation
- Agitiation
- Loss of concentration
- Loss of motivation
4
Q
What is the difference between grief and depression?
A
Grief - normal response, transient state.
5
Q
What are the stages of grief?
A
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Dont neccesarily move through the stages as they are, spend a different amount of time in each stage.
*Grief can occur with any life event that involves a BIG CHANGE
6
Q
List the different types of anxiety disorder
A
- Panic disorder
- OCD
- PTSD
- GAD
7
Q
What is needed for a clinical diagnosis of depression?
A
> 2 WEEKS of 2+ of the core symptoms followed by other symptoms
8
Q
What is a nihilistic delusion?
A
Belief that oneself or part of body not real or not working
9
Q
How long should you continue anti-depressants for after the symptoms of depression go away?
A
6 months+
10
Q
List 5 symptoms of hypomania
4+ days
A
- Elevated mood
- Increased energy
- Increased talkativeness
- Mild reckless behaviour
- Decreased need to sleep
- Sexual inhibition
- Sociability
11
Q
What is flight of ideas?
A
Making links between things that are very loosely related
12
Q
What is the treatment for acute manic episodes?
A
- Antipsychotics - haloperidol
- BZs - acute behavioural disturbances
NOTE: can be used to manage mood changes in the elderly
13
Q
What medications are contraindicated for use on their own during a manic episode?
A
Antidepressants - should always be stopped / prescribed with a mood stabiliser
14
Q
What is cyclothymia?
A
Cyclical mood variation to a lesser degree than in bipolar disorder
Must be present for > 2 years!
15
Q
Give 4 symptoms of lithium toxicity
A
- Dry mouth / extreme thirst
- Very sleepy
- Strange movements
- Nausea and vomitting
- Diarrhoea
- Confusion
16
Q
What is dysthmia?
A
Persistent low mood and deminished enjoyment, not severe enough to be consiudered as a depression
17
Q
List 3 first rank symptoms of schizophrenia
A
- Delusional perceptions
- 3rd person auditory hallucinations
- Thought allientation (wtihdrawal, broadcast, inseriom, deletion)
- Passitivity - someone is controlling their feelings ans actions
18
Q
What is the treatment for schizophrenia?
A
Antipsychotics
19
Q
How do you monitor people on antipsychotics and why do you do this?
A
- ECG - potential QTC prolongation
- Glucose and metabolite monitoring - diabetes and metabollic syndrome
20
Q
What is a psychosis?
A
severe mental disturbance characterised by loss of contact with external reality.
21
Q
What is the difference between psychosis and neurosis?
A
In neurosis, no loss of connection with reality. No change of the way of thinking of personality.
22
Q
Define GAD
A
- Generalised, persistent worry about events
- Individual finds difficult to control they worry , > 3 weeks.
23
Q
What is the pathophysiology of schizophrenia?
A
Dopamine excess or over-activity in the mesolimbic dopamenergic pathways
24
Q
Name 4 behavioural therapies
A
CBT
Graded self exposure
25
Define phobia
- Occur in response to a specific stimulus
26
What is agoraphobia?
Avodiance of places or situations that may be diificult to escape, e.g. crowds, public places, travelling from home
27
How would you differentiate between a phobia and panic disorder?
Panic attacks occur unpredictably and not in response to a phobia
28
What does the yerkes-dodson for curve describe in relation to anxiety?
Curve shows that increasing arousal leads to optimum performance up to a certain point, and then after that increasing arousal impairs performance.
29
Name 4 behavioural therapies
- CBT
- Exposure response prevention (ERP)
- Couple based courses
30
Name 4 behavioural therapies
- CBT
- Exposure response prevention (ERP)
- Couple based courses
- Motivational interviewing
- Indivual / group therapy
- Self-help groups
- Dialectal behavioural therapy
31
What is exposure response prevention?
Individual repeatedly exposed to the situation causing them anxiety, and prevented from performing the repetitive actions which overall lessens the anxiety.
32
Give 5 physical symptoms of a panic attack
- Palpatations
- Chest pain
- Tachypnoea
- Blurred vision
- Dizziness
- Sweating
33
What is the criteria for diagnosing OCD?
Obsessions and compulsions must be present on most days for > 2 weeks.
Not imposed by external influence - origionate from the mind of the individual.
At least one obession or compulsion must be acknowledged as excessive or unreasonable.
Carrying out the obsession / compulsion not pleasurable.
Cause distress or interfere with functioning.
34
List 3 side effects of SSRIs
WARNING TO ALL THOSE WITH DEPRESSION DUE TO THE FOLLOWING:
- Worsening of anxiety
- Suicidal thoughts
- Self-harm
35
What is an obsession?
What is a compulsion?
Obession is an unwanted intrusive thought, images that repeatedly enter the persons mind.
Compulsion - repetitive behaviour or act that makes that is performed with RELUCTANCE in response to the obsession - can be mental or physical. Not connected to the obsession in a realistic way.
36
How long does it take for SSRIs to kick in?
Around 12 weeks, so individuals need to be encouraged to stick at taking them.
37
What is body dismorphic disorder?
Preoccupation with an imagined defect in appeaance, or excessive concern over a small physical anomaly.
38
Can people become addicted to SSRIs?
No, cravings and tolerance do not occur.
39
Define stress
A mismatch between the external demands on an individual and their ability to cope
40
What is PTSD?
Post traumatic stress disoder
Follows a stressful event or situation, particularly a threatening or catastrphopic nature, likely to cause high stress in almost anyone.
Symptoms include:
- Increased arousal - autonomic sx
- Avoidance of reminders
- Numbing, detachment, estrangement from others
- Re-experiencing
41
What are the three categories of PTSD?
- Re-experiencing - flashbacks, nightmares, images or other sensory impressions from the event and reminders of the event that provoke distress.
- Avodiance or rumination
Avoid reminders, suppress memories or avoid thinking about it.
Ruminate excessively and prevent themselves from coming to terms with the experience.
Hyperarousal or emotional numbing
- irritability, difficulty concentrating, feeling of detachment, difficulty experiencing emptions, problems sleeping
42
What is an acute stress reaction?
Onset is minutes to hours, lasts < 3 days.
Response to exceptional physical and mental stress.
Symptoms > 1 month, assess for PTSD.
43
What is the treatment for PTSD?
Psychological:
- DEBRIEFING after an event
- CBT (trauma focussed)
- Eye movement densitisation and reprocessing (EMDR)
- Relaxation
- Treating comorbid conditions alongside, e.g. alcohol addictions.
Medications:
Treatment:
- SSRIs
- Stellate ganglion blocking therapy (reduce adrenaline)
44
List 5 symptoms of PTSD
- Intrusive thoughts / re-experiencing
- Avoidance
- Increased arousal
- Loss of interest in significant activities
- Numbing, detachment, estrangement from others
- Irritability
- Sleep disturbance
45
What are the current alcohol guidlines for men and women?
14 units per week for BOTH
46
What is in a unit of alcohol?
10ml or 8g pure alcohol
47
What are the 2 components of dependance?
PSYCHOLICAL
PHYSIOLOGICAL
48
List the signs of alcohol dependance
CANT STOP
```
C – compulsion to drink alcohol
A – aware of harmful effects but persists
N – Neglect of other activities
T – tolerance to alcohol
S – stopping causes withdrawal
T – time preoccupied with alcohol
O – out of control use
P – persistent, futile wish to cut down
```
49
What vitamin are alcoholics deficient in?
Vit b12 - THAIMINE.
50
What is a hypochondriac?
Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
The patient refuses to accept reassurance or negative test results
51
List 3 public health measures aimed to reduce alcohol addiction
- Increasing the alcohol tax
- Restricting sales on alcohol
- Education in schools
52
What is the model of behaviour change that could be used for alcohol addiction? (5 stages)
- Pre-contemplation
- Contemplation
- Planning/preparation
- Action
- Maintenance
- Sustained maintenance OR potential for relapse
53
List 3 screening tools used to identify alcohol dependacny
- AUDIT (alcohol use disorders identification test), > 15
- SADQ (severity of alcohol dependance questionnaire)
- CAGE
54
What is the name of the screening tool used to screen, diagnose, monitor and measure the severity of deression?
PHQ-9 form
55
How do you treat acute alcohol withdrawal?
- BZs - reduce tremor and agitation
- Vit B1 (pabrinex)
- IV fluids
- Correct nutritional and electrolyte balance
56
What medication can be used long term to help people withdrawing from alcohol?
Naltrexone (also can be used in opoid abuse, blocks the opid receptors)
57
What is DTs?
Delerium tremens
Acute confusion and disorientation
> GABA
Withdrawal
Develops 2-3 days after the last drink of alcohol
58
What are the stages of alcohol withdrawal?
Minor < 10 hours
Major 10-72 hours
- visual hallucinations
- tachycardia
- Hypertension and increased BP
- Tremor
Seizures
DTs - 2/3 days
- Visual hallucinations
- Fever
- Disoreintated
- Confused
59
What is the cause of Wernicke-Korsakoff syndrome?
Vit b1 or thiamine deficiency
60
What are the 3 cardinal symptoms of Wernickes?
1. ATAXIA
2. OPTHALMOPLEGIA (most commonly 6th nerve palsy)
3. CHANGES IN MENTAL STATE - Confusion
61
What are the symptoms of paracetamol overdose?
- RUQ pain - liver
| - Vomitting
62
How do you treat Wernickes/ Korsakoffs?
IV thaimine and glucose
63
What are the two cardinal symptoms of Korsakoffs?
(IRREVERSBILE)
1. Contabulation
2. STM loss
64
What is delirium?
Acute confusional state
65
List the key features of delirium
- Inattention
- Perceptual or cognitive disturbance
- Disorientation
-
66
How do you treat delirium?
Find out what is causing it ad try to treat this
67
What is a hallucination?
Perceptions occurring in the absence of an external physical stimulus.
Modalities include Auditory, visual, olfactory, gustatory, tactile, somatic
68
What is a delusion?
A false, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background. It is held with extraordinary conviction and subjective certainty. It is a phenomenon that is outside normal experience.
69
What two things can be seen in the brain of someone with alzheimers dementia?
- Tau tangles
| - B-amyloid plaques
70
What would you see on a CT scan of someone with Alzheimers dementia?
- Atrophy
| - Enlarged ventricles
71
How would you treat Alzheimers dementia?
NOT CURE, can reduce progression and increase life expectancy:
- NMDA antagonist - Memantine
- AchE inhibitor - Rivastigmine
72
What can be seen in the brain of someone with Parkinsons dementia?
Lewy bodies - basal ganglia and cerebral cortex
73
What medication must you avoid in patients with Parkisons / Lewy body dementia?
ANTI=PSYCHOTICS
74
List 7 causes of delirium
PINCH ME
```
Pain
Infection
Nutrition
Constipation
Hydration
```
Medicines
Environment
75
What is the method of transmission of huntingtons disease?
AUTOSOMAL DOMINANT, 100% penetrance
76
What is the gene defect in Huntingtons disease?
CAG repeat on chromosome 4
77
What is the pathophysiology of huntingtons?
GABA inhibition - increased stimulation of thalamus and cortex = increased movements. Increased dopamine.
78
List 4 signs of huntingtons
- Chorea (writhting movements)
- Cognitive decline - cortical atrophy
- Change in personality
79
What is munchausens syndrome?
Psychological disorder - someone pretends to be ill / deliberately produces symptoms of illness in themselves - main intention for this is so they are at the centre of attention.
80
How are personality disorders characterised?
Clustered into groups - A, B and C
- A = odd/eccentric
- B = flamboyant/dramatic
- C = fearful/anxious
81
What is the difference between dementia and delirium?
Dementia is chronic and progressive. No clouding of consciousness.
Depression
- Rapid onset
- Biological symptoms too such as weight loss and poor sleep
- MMSE - variable score
82
What personality disorders are classed in group B?
Borderline/emotionally unstable
Histrionic
Narcissistic
Antisocial
83
What personality disorders are classed in group C?
Avoidant/anxious
Dependent
Anankastic/obsessive compulsive
84
What are the stages of the MSE?
```
Appearance and Behaviour
Speech
Affect/Mood
Thoughts & Delusions
Perceptions & Hallucinations
Cognition
Insight
```
85
What is phenomenology?
Descriptions of signs and symptoms
86
List 4 signs of mania
- Pressure of speech
- Flight of ideas
- Grandiose delusions
- Increased energy / activity
- Over-familiarity
- Increased sex drive
- Decreased sleep
Risk is likely for these individuals
87
What is an illusion?
Misperceptions of real external stimuli
88
What is a hypnopompic hallucination?
Hallucination on waking
89
What is a hypnogognic hallucination?
Hallucination on falling asleep
90
What is a delusional perception?
A delusional belief resulting from a perception.
For example, a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as the defining moment when they realised they were being monitored by the government
91
What is confabulation?
Giving a false account to fill a gap in memory.
92
List 3 psychological symptoms of panic disorder
```
Feeling of impending doom
Fear of dying
Fear of losing control
Depersonalisation
Derealisation
```
93
Give some pros of classifying mental health disorders
- Allows for population study and health planning
- Education of current and future practitioners
- Organisation of disorders into diagnostic cases and reliable treatment options
- Psycho education of patients and their families
94
Give some cons of classifying mental health disorders
- Over generalised, de emphasises individual characteristics
- Knowing diagnostic criteria can lead to misattribution of symptoms – confirmation bias
- Diagnostic labels can lead to negative consequences – stigmatizes people
- Medicalise variations in human behaviour
95
How can you differentiate between lewy body dementia and parkinsons disease?
Lewy body = memory problems come first, or memory and movement problems come within 12 months of eachother
Parkisons = movement disorder first, memory problems occur > 12 months later
96
What are the 3 cardinal signs of parkinsonism?
- Bradykinesia
- Tremor
- Rigidity
97
A man comes to see you in clinic. He has become forgetful, but says these periods have fluctuated and gotten worse over time but not gradually. He seems himself but is becoming frustrated by these bouts of worsening forgetfulness. What type of dementia is it likely that this man has?
Vascular
- Stepwise progression
- Fluctuations in symptoms
- No personality change
- Would explore CV risk factors
98
List 5 members of the psychiatry MDT
- CMHN
- social worker
- OT
- Psychologist
- Psychotherapist
99
Name 3 models of psychotherapy
- Psychodynamic
- CBT
- Counselling
- Cognitive analyhtical therapy
- Interpersonal therapy
- Dialectic behavioural therapy
- Family therapy
- Marital tehrapy
100
What are the stages of CBT?
THoughts, feelings, physical and behaviour.
101
What are the stages of the MSE?
ASEPTIC
```
Appearance and Behaviour
Speech
Emotions (mood and affect)
Perceptions & Hallucinations
Thoughts & Delusions
Insight
Cognition
```
102
What is the mental health act?
Main part - allows for 'sectioning' - the compulsory admission to hospital for those that are mentally ill (doctors should persaude patients to come in voluntarily, however in some circumstances patients may have to be sectioned to allow them treatment against their own will).
Also covers the care and treatment of mentally disordered individuals, the care of their propety and other related matters.
103
What is section 2 of the MHA?
Assessment - allows the patient to be sectioned for up to 28 DAYS.
Signed by 2 doctors and one social worker. Patient must be examined by 2 doctors within 5 days of eachother. Doctors cannot be employed by same organisation. One of the doctors has to have previosuly known the paitent.
Treatment can be given agaisnt the patients will, as this is seen as part of the assessment.
104
What is section 3 of the MHA?
Treatment - same as assessment but lasts for 6 months.
Cannot be detained if the nearest relative of the patient rejects.
105
What is section 4 of the MHA?
Emegergency order - admission for emergency treatment, lasts up to 72 HOURS.
Can be converted to a section 2 MHA and approved by a doctor.
106
What is serotonin syndrome
Excess of serotonin
107
How do SSRIs work?
Block reabsorption of serotonin in the synpatic cleft, increasing the amount available
108
What is cotards syndrome?
Feeling like a body part had died/does not exist
109
List some examples of SSRIs
- Sertraline
| - Paroxetine
110
What is 5HT?
Serotonin
111
What is the precursor molecule of noradrenaline?
Dopamine
112
From what amino acid does dopamine, noradrenaline, adrenaline come from
Tyrosine
113
What is the cause of serotonin syndrome
Increased levels of serotonin - usually due to being on more than 1 SSRI at a time
114
What is the treatment for serotonin syndrome?
- Stop all serotonin medications the individual is on
- Supportive
- CYPROHEPTADINE - serotonin antagonist
115
When taking MAOIs, what foods must the individual avoid?
TYRAMINE containing:
- Strong or ages cheeses
- Beers on tap / home brewed
- Cured or smoked meats and fish
- Certain beans such as fava and broad beans
116
When taking MAOIs, what foods must the individual avoid?
TYRAMINE containing:
- Strong or ages cheeses
- Beers on tap / home brewed
- Cured or smoked meats and fish
- Certain beans such as fava and broad beans
Excess tyramine - increases in nerve endings, increasing the amount of catecholamines, which can lead to a hypertensive crisis and stroke.
117
Why must people on lithium be monitored?
Narrow therepeutic range (0.8-1.2) - therefore therepeutic monitoring is needed to avoid toxicity
118
What levels of lithium are cinsidered to be toxic?
> 1.5 mEq/L
119
What are the clinical features of anorexia?
Restriction of energy intake relative requirements, leading to low body weight in context of age, sex, development and physical health.
(Weight loss > 15% below normal for weight and height).
Intense fear or becoming fat and dreading fatness, in pursuit of abnormally low weight target, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
BMI < 17.5kg/m2 (> 18 years old, for younger than this BMI cwentil charts used as their may be an inappropriate lack fo weight gain rather than loss)
120
List 4 biological features of anorexia
- GI symptoms - abdo pains, constipation, fullness
- Fatigue
- Dizziness
- Intolerance of cold
- Ammenhorroea
- Low pulse rate
- Low blood pressure
- Low body temperature
121
What may be seen on an ECG of someone with anorexia?
- Arrythmia --> Hypokalaemia
| - Long QT interval, T wave changes
122
What is neuroleptic malignant syndrome?
A medical emergency which occurs in patients taking antipsychotics. It is characterised by altered mental state, generalised rigidity, fever, fluctuating blood pressure and high temperature.
123
What are medically unexplained symptoms (MUS)?
Physical symptoms for longer than 3 months which affects functioning but can not be readily explained
124
What drug can be used to ween someone off herion?
Methadone
125
What is section 2 of the MHA?
Assessment - allows the patient to be sectioned for up to 28 DAYS.
Signed by 2 doctors and one approved social worker (ASW). Patient must be examined by 2 doctors (one ST12) within 5 days of each other. Doctors cannot be employed by same organisation. One of the doctors has to have previosuly known the paitent.
Treatment can be given agaisnt the patients will, as this is seen as part of the assessment.
126
What is section 3 of the MHA?
Treatment - same as assessment but lasts for 6 months.
Cannot be detained if the nearest relative of the patient rejects.
Can be renewed - 6 months - 1 year.
127
What is the difference between a learning difficulty and a learning disability?
Learning difficulty doesnt affect intellect, whereas learning disability is linked to overall congntiive impairment - interfere with learning basic skills and higher skills.
128
What drug can be used to reverse opoid overdose?
Naloxone
129
What is addiction?
A chronic, relapsing brain disease that is characterised by drug seeking and use, despite harmful consequences
130
What is the difference between PTSD and a phobia?
Phobia - irrational fear
131
What tests could you do to assess cognitive ability?
- Addenbrookes
| - MMSE
132
What signs would you see in someone with hypercalcaemia
moans, stones, bones and groans
133
What is refeeding syndrome?
Can occur when a starving patient is fed too much too qucikly.
Supplements trigger synthesis of glycogen, fat and protein in the cells which are detrimental to the serum concentrations of potassium, magnesium and phosphorus (as requires these electrolytes to synthesus them).
Can be really fatal, therefore have to replenish vitamins before being able to feed normal amlints again.
134
What are the extrapyrmidal side effects of taking antipsychotics long term?
Tardive dyskinesia -characterised by uncontrolled facial movements such as lip-smacking.
Akathisia - severe restlessness with patients having difficulty in sitting still. Patients may rock, tap their legs or cross and uncross the legs. It typically occurs with long term use of antipsychotics.
Parkinsonism
Acute dystonia - sustained muscle contractions
135
How do antipsychotics work?
Dopamine receptor agonists
- acts on 4 main pathways: mesolimbic, mesocortical, nigrostriatal and tuberoinfundibular
136
What risks are associated with using atypical antipsychotics in elederly patients?
- Stroke
| - VTE
137
SE of antipsychotics
- antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
- sedation, weight gain
- raised prolactin: galactorrhoea, impaired glucose tolerance
- neuroleptic malignant syndrome: pyrexia, muscle stiffness
- reduced seizure threshold (greater with atypicals)
- prolonged QT interval (particularly haloperidol)
138
Why are BZs good to use in alcohol withdrawal?
Also enhance GABA mediated inhibition in the CNS (similar to chronic alcohol consumption)
139
List 4 risk factors for suicide
- Male gender
- Alcohol and drug abuse
- Mental Illness
- Living alone
- Bereavement
- Chronic pain
- Debt
- job loss
140
List a protective factor that reduce the risk of someone comitting suicide?
- Family support
- Children
- Religious belief
141
What type of antipsychotic is haloperidol?
First generation - typical
142
What is the difference between first and second generation antipsychotics?
First generation: Specific for D2 receptors
Second generation: not selective for any type of dopamine receptor. SE vary depending on what receptors the drug is selective for. Less chance of resulting in extra-pyramidal side effects compared with typicals.
143
Why is FBC monitoring essential for patients takinng clozapine?
Agranulocytosis and neutropenia
144
What metabollic condition can result from anorexia?
HYPOTHYROIDISM
145
What is the management of anorexia?
- CBT ED
- MANTRA
- Specialist supportive clinical management
146
What biological gender is a transgender man?
46XX - woman
147
What is the difference between a delusion and a delusional perception?
Delusion = false belief firmly maintained despite solid evidence to suggest the contrary
Delusional perception - should really be called perceptional delusion, as the problem, as a correctly sensed and interpreted stimulus (i.e. a perception) is given some additional significance - e.g. the trafiic light is red (real stimulus and correctly interpreted) which means the government are watching me.
148
How do you classify hallucinations?
Olfactory
Auditory: elementary (sounds) and complex (voices, music)
1st person = patients hear their own thoughts spoken out loud as they think them
2nd person = patients hear a voice talking to them - can be persecutory, complimentary, or issue the patient a command
3rd person = patients hear a voice speaking about them, referring to them in the third person
Tactile: sensory input, e.g. insects crawling under the skin (formication) as may be experienced by long term cocaine users.
Gustatory: perception of taste without a stimulus.
Visual
149
What is neuroleptic malignant syndrome?
A medical emergency which occurs in patients taking antipsychotics.
It is characterised by altered mental state, generalised rigidity, fever, fluctuating blood pressure and high temperature.
Tends to occur early in treatment.
150
Give 5 conditions in which people may experience hallucinations
- Schizophrenia
- Parkinsons / LBD
- Charles Bonnet syndrome
- Delerium tremens
- Hypnagognic hallucination
- Hypno
- Epilepsy
- Drug induced
151
What is Charles bonnet syndrome?
Loss of vision - macular degeneration, individuals see things that aren't real.
Two types:
- Simple repeated patterns (e.g. grids, lines, shapes, vivid colours)
- Complex images of people, objects or landscapes
152
List some SOCIAL interventions
(ROPE LEARN THESE FOR THE EXAM, IMPORTANT) - fill rest in when the PP is sent out
- Help with employment / housing / benefits
- Carer / family support
- Help with meaningful activity / OT / voluntary work / exercise
NOTE:counselling is nOT a social intervention
153
When should clozapine be used?
For treatment resistance depression, after all other avenues have been explored=
154
Define belle indifference
Apparent lack of concern at symptoms, e.g. someone with no limbs is actually really happy that they don't have limbs
Characteristic of conversion disorder
155
What is the difference between stereotypy and mannerisms?
- Stereotypy is repetition of a movement that is not goal directed. The nature of the movement creates a problem, e.g. lifting ones arm into the air all the time.
- Mannerisms serve a purpose, are of habit, and only really become a problem when they become very frequent.
156
Define incongruity of affect
A mismatch between emotion and content, e.g. someone laughing at someones death
157
What is a secondary auditory hallucination?
Someone talking to you
| you
158
What is a third auditory hallucination?
Someone talking about you
| she/he
159
What is the difference between an overvalued idea and a delusion?
Overvalued idea is an idea that the person can be talked out of, whereas a delusion is a sustained, unshalen belief despite the evidence against it.
160
Define concrete thinking
Lack of abstract thinking.
| Commonly seen in ASD, psychosis, ASD.
161
What is perseveration?
Repetition of a certain word
| Seen in wenickes encepalopathy and frontal lobe disorders.
162
What is somatic passivity?
A bodily sensation imposed by external forces
163
Define catatonia
A significantly excited / inhibited motor activity
Waxy flexibility or posturing
Commonly seen in psychosis.
164
What is the difference between type 1 and type 2 bipolar disorder?
Type 1 = > 2 episodes of mania, elements of recovery inbetween.
Type 2 = hypomania episodes.
NOTE: can diagnose both without having had an episode of depression.
165
What is a lasting power of attorney?
> 18 and have mental capacity, can choose someone to make financial, property and medical decisions for you in the future.
Individuals must be over the age of 18 to be eligible.
166
List 4 risk factors for suicide
- Male gender
- Alcohol and drug abuse
- Mental Illness
- Living alone
- Bereavement
- Chronic pain
- Debt
- job loss
- FHx
- Homelessness
167
What is the difference between first and second generation antipsychotics?
First generation: Specific for D2 receptors
Second generation: not selective for any type of dopamine receptor, and also serotonin receptors. SE vary depending on what receptors the drug is selective for. Less chance of resulting in extra-pyramidal side effects compared with typicals.
168
List some SOCIAL interventions
(ROPE LEARN THESE FOR THE EXAM, IMPORTANT) - fill rest in when the PP is sent out
- Employment
- Carer / family support
- Education
- Support with benefits
NOTE:counselling is nOT a social intervention
169
What is the medical treatment pathway (Drugs) for depression?
SSRI (try them on two)
TCA
SSRI +TCA
Clomazipine last resort
170
What is the first line treatment for mild depression?
Watchful waiting for 2 weeks
171
What is the main side effect of atypical antipsychotics?
- Metabollic syndrome - weight gain, diabetes mellitus, increase in lipids
172
What is the first line treatment for ADHD?
Methylphenidate
173
What are the SE of methylphenidate (ADHD)?
- Similar in structure to amphetamines, and therefore result in appetite suppression, reduce the end height in children.
They are contraindicated in someone who has a history of psychosis.
174
What extrapyramidal symptom can not be treated using procyclidine?
Tardive dyskinesia
175
List 4 signs of borderline personality disorder
- Unstable relationships
- emptiness
- Implusivity
- Disturbed sense of self-image
176
What does section 136 of the MHA say?
Police can remove someone from a public place to a place of safety for a MHA assessment - police discrepancy.
177
What does section 135 of the MHA say?
Is a great power than section 136, police officers can move individuals from private property to a place of safety for a MHA assessment - social worker discrepancy.
178
What are the 3 conditions that need to be met in order to detain someone?
- Individual must have a mental health disorder
- Individual must be a risk either to themselves or others
- There is good reason to warrant attention in hospital
179
Who would be the individuals involved in someone with psychosis?
- Early intervention team
| - Home treatment / crisis team
180
What are neoligisms?
Made up words
Usually seen in mania - associated with puns, rhymes, pressure of speech
181
Give 4 features of dependence
CANT STOP
```
Compulsio to drink
Aware of harm / damage
Neglect of others and other activities
Tolerance
Stereotypical drinking pattern
Stopping = withdrawl
TIme preoccupied with substance
Over the top usage
Persistance with wanting to stop, but never doing so
```
182
What delusions would you see in depressive psychosis?
Nihillistic
| Cotards
183
Define panic disorder
Reoccuring panic attacks that are unpredictable and unrestricted in terms of the situation
> 4 attacks per week for > 4 weeks
184
What are the 3 most common obsessions seen in OCD?
Three C's
- Cleaning
- Checking
- Counting
185
What area of the brain is affected in parkinsons disease?
Decrease of dopamenergic neurons in the substantia niagra, resulting in less dopamine
186
List 4 risk factors for repreated self harm
(Depends on situation, usually clinical vinette will be someone broken up with boyfriend, depressed and low ijn mood, cuts on arms)
- Depression
- Previous self harm
- Stressful life event
- Living alone
- Personality disorder
- Planned - sent a message before doing it
- Substance abuse
187
What 4 things do you need to assess capacity?
- Understand
- Retain
- Weigh up the decision
- Communicate the decision effectively
188
A lady arrives at A and E having taken an oiverdose of TCAs. What is one important investigation you MUST do?
ECG - effect rythm of the heart.
189
What is the treatment for acute alcohol withdrawal?
REMEMBER THIS
Chlordiazepoxide
190
List 4 mood stabilisers
- Lithium
- Carbamezapine
- Sodium valproate
- Lamotregine
- Antipsychotics
191
How would you distinguish between mild, moderate and severe dementia?
Mild
2 typical symptoms + 2 core symptoms
Moderate
2 typical symptoms + 3+ other core symptoms
Severe
3 typical symptoms + 4+ other core symptoms
192
What drug is given to reverse paracetamol overdose?
N-acetyl cysteine
193
How can a patient be discharged from MHA section 2/3?
- RHO
- hospital manger
- Neatest relative
194
What are the features of paranoid PD?
- Distrust and suspicion
Common beliefs include:
- others are exploiting or decieving them
- friends are untrustworthy
- partner / spouse is unfaithful
- hidden meaning in events others percieve as benign
195
What are the features of schizoid PD?
Characterised by withdrawal from affectional, social and other contacts.
This type of person is isolated and has a limited capacity to experience pleasure and express feelings.
196
What are the features of dissocial /antisocial PD?
There is a tendency to act outside social norms, a disregard for the feelings of others and an inability to modify behaviour in response to adverse events (eg, punishment).
A low threshold for violence and a tendency to blame others may be features.
Hostile attitude.
Signs include: recklessness, ireesposnsible behaviour, decietfulness.
197
Emotionally unstable / borderline PD
Impulsive
Act without appreciating the consequences.
Difficulty maintaining relationships
Efforts to avoid abandonment
Unhelpful use of substances
Outbursts of emotion and quarrelsome behaviour
Suicidal gestures and attempts
198
Histrionic
Characterised by shallow and labile affectivity and theatricality. There is lack of consideration for others and a tendency for egocentricity. People with this type of personality often crave excitement and attention.
May display 'la belle' indifference - a seemingly indifferent attachment whilst describing dramatic symptoms
199
Anankastic
Characterised by feelings of doubt, perfectionism and excessive conscientiousness. There is a compulsion to check and a preoccupation with details. This personality type tends to be stubborn, cautious and rigid. Insistent and unwelcome thoughts may intrude or impulses that do not attain the severity of an obsessive-compulsive disorder.
200
Anxious (avoidant)
Characterised by feelings of tension and apprehension, insecurity and inferiority. People with this type yearn to be liked and accepted, are sensitive to rejection. There is a tendency to exaggerate potential dangers and risks, leading to an avoidance of everyday activities.
201
Dependent
Characterised by a reliance on others to take decisions and a fear of abandonment. There is an excessive reliance on authority figures and difficulty in acting independently. This can affect the capacity to deal with the intellectual and emotional demands of daily life.
202
What is a crisis plan?
Used to identify triggers, advise on self-help stratefgies and identify when the individual should seek help.
203
Name 2 genetic conditions associated with learning diabilities
- Downs syndrome
| - Fragile X
204
What do you need to do in order to deem that someone does not have capacity?
- Assume a person has the capacity to make a decision themselves, unless it's proved otherwise
- Wherever possible, help people to make their own decisions
don't treat a person as lacking the capacity to make a decision just because they make an unwise decision
- If you make a decision for someone who doesn't have capacity, it must be in their best interests
- Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms
205
What are DOLS?
Deprivation of liberty safeguards
- Taking away a persons
- CHecks aimed to make sure that any care that restricts a persons liberty is both appropriate and in their best interests
206
What are DOLS?
Deprivation of liberty safeguards
- Taking away a persons freedom. They are not free to leave, under continuous supervision, the individual lacks consent to be a part of these arrangements.
- Checks aimed to make sure that any care that restricts a persons liberty is both appropriate and in their best interests - person is protected. in order to get permission for DOL, CH / hopsital must get strict perfmission.
207
What drugs are contraindicated for patients on SSRIs?
NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: see above
triptans: avoid SSRIs
monoamine oxidase inhibitors (MAOIs) - risk of serotonin syndrome
208
What foods must patients taking MAOIs avoid and why?
Tyramine containing - cheese, red wine, mature meat
Hypertensive crisis
209
List some examples of SSRIs
- Sertraline
- Fluoxetine
- Citalopram
210
Can you take SSRIs during pregnancy?
Weigh up the risks and the benefits - can cause slight increased risk of congenital heart malformations (first trimester) and pulmonary hypertension (third trimester)
211
What endocrine disorder is associated with chronic lithium toxicity?
Hypothyroidism
212
What type of delusions are seen in mania?
Grandiose
213
What scoring system can be used to assess alcohol withdrawal severity?
The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
214
What medication is used for the treatment of paracetamol overdose?
N-acetyl cysteine
215
What is the management of schizphorenia?
- Oral antipsychotics
| - CBT
216
What are the indications for doing ECT?
- Treatment resistant severe depression
- Manic episodes
- An episode of moderate depression know to respond to ECT in the past
- Life threatening catatonia
217
What can clozapine be used for?
Treatment resistance schizophrenia
218
What are the SE of clozapne?
- Agranulocytosis - therefore need FBC monitoring
- Leucocytosis
- Constipation
- Reduces siezure threshold, making them more likely
219
How can you tell the difference between dementia and depression?
Depression over dementia:
- Short history, rapid onset
- Biological symptoms e.g. weight loss, sleep disturbance
- Patient worried about poor memory
- Reluctant to take tests, disappointed with results
- Mini-mental test score: variable
- Global memory loss (dementia characteristically causes recent memory loss)
220
What drug can be used to treat the extra-pyramidal side effects (EPSE) of antipsychotics?
What EPSE cannot be treated by this drug?
Procyclidine
Tardive dyskinesia
221
How would neuroleptic malignant syndrome typically present?
- Hyperthermia
| - Muscle rigidity
222
What is the first line treatment for a diagnosis of PTSD?
- CBT
| - EMD (eye movement desensitisation)
223
How long must symptoms be present before a diagnosis of PTSD can be given?
> 1 month
224
List 2 signs of PTSD
- Re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
- Avoidance: avoiding people, situations or circumstances resembling or associated with the event
- Hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
- Emotional numbing - lack of ability to experience feelings, feeling detached
225
What is the difference between mania and hypomania?
Mania = psychotic symptoms
226
Define thought withdrawal
Belief that an external force is extracting thoughts from your mind
227
What are the four first rank symptoms of schizophrenia?
- Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient's behaviour
- Thought disorder/thought allienation:
thought insertion
thought withdrawal
thought broadcasting
- Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
- Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. 'The traffic light is green therefore I am the King'.
228
What are the signs of sleep paralysis?
- Transient paralysis of skeletal muscles either on awakening or going to sleep
- Hallucinations that appear during the episode
229
List 4 symptoms of mania
- Insomnia
- Increased appetite
- Hypersexuality
- Irritable
- Poor attention
- Elevated mood
230
At what age can a diagnosis of personality disorder be made?
18- Only be made once the personality has fully develped and their adaptive behaviours have become fixed.
231
What is the treatment for schizophrenia?
- Anti-psychotics
| rapid tranquilisation may be required at any stage
232
List 4 signs / symptoms of mania
Grandiose ideas.
Pressure of speech.
Excessive amounts of energy.
Racing thoughts and flight of ideas.
Overactivity.
Needing little sleep, or an altered sleep pattern.
Easily distracted - starting many activities and leaving them unfinished.
Bright clothes or unkempt.
Increased appetite.
Sexual disinhibition.
Recklessness with money.
233
What is the first line treatment (long term) for bipolar disorder?
Lithium
234
What would you see on the blood film of someone with alcohol intoxication?
Macrocytosis - MCV
235
What is gender dysphoria?
A mismatch between the biological gender and the chosen gender of an individual, causing distress.
236
What surgical procedures could you do for a transgender man?
- Phalloplasty
- Mastectomy
- Hysterectomy
237
What are the four symptoms seen in narcolepsy?
- Hypnagognic hallucinations
- Excessive sleepiness
- Cataplexy
- Sleep paralysis
238
What test would you do for someone with narcolepsy?
Polysomnography (EEG and MSLT - multi sleep latency test)
239
What is the treatment for narcolepsy?
- Stimulants - methylphenidate (also used in ADHD)
240
What are the four types of EPSE?
- Acute dystonia (includes oliguric crisis, muscle rigidity and spasm)
- Akathesia (inner restlessness)
- Parkinsonism
- Tardive dyskinesia
241
What receptors do typical antipsychotics act upon?
D2 receptors (dopamine 2)
242
What is an oliguric crisis?
Eyes deviate up and to the side
Type of acute dystonia (EPSE)
243
Can you treat tardive dyskinesia?
Tetrabenazine
244
At what levels would lithium be classified as toxic?
> 1.5
245
What are the components of the mental exam?
'ASPETIC'
- appearance and behaviour
- speech
- perception
- emotions - mood and effect
- thoughts
- insight
- cognition
246
How would you treat an acute dystonic attack?
Procylcidine IM
247
What is a section 5(2)?
For patients in hospital
Doctors holding power allowing assessment under the MHA
Lasts 72 hours
248
What is a section 5(4)?
For patients in hospital
Nurse holding power
6 hours
249
What is the SADPERSONS scale?
Used to determine suicide risk.
```
Sex (male)
Age
Depression (2)
Previous attempt
Excess alcohol / substance abuse
Rational thinking loss (2)
Social support lacking
Organised plan (2)
No spouse
Sickness
```
Low < 4
Medium < 6
High 7-10
250
How would you assess a patients suicide risk?
Current episode of self harm - before, during, after. Past episodes and what happened then
Overdose -> more about the medications
Cuts -> ask more about how they felt, what they used
Past psych history - ever been admitted to hospital, other conditions
Screen for other mental health disorders:
- Depression
- Psychosis (delusions, hallucinations, thought insertion)
- Anorexia
Social history: explore support network, explore finances and life stress, alcohol smoking and recreational drug use are important
251
What is the treatment for paracetamol overdose?
NAC
252
How long should you continue anti-depressants for after symptoms improve?
6 months
*need to chekc improve or remission
253
What is an over-valued idea?
Belief sustained beyond logical reason, but held less firmly than a delusion
254
What is thought withdrawal?
Thoughts have been stolen by external agency
255
What is thought broadcast?
Thoughts are being broadcast so they can be heard by others
256
What is thought echo?
Form of auditory hallucination in which the patient hears their thoughts spoken aloud
257
What is pressure of speech?
Rapid rate of delivery may be associated with use of rhymes and puns
258
Define depersonalisation
Thoughts and feelings do not seem to belong to oneself
259
Define dereasilisation
Feeling as if you are looking at yourself from the outside
260
List the different types of auditory hallucination
1st person
2nd person: People talking to you
3rd person: People talking about toy
Command: Voice telling you to do things
261
List 3 different causes of pshycosis
Drug induced
Schizophrenia
Depressive psychosis
262
How would you classify this hallucination?
Patients hear their own thoughts spoken out loud as they think them
1st person, auditory
263
How would you classify this hallucination?
Patients hear a voice talking to them telling them to kill themselves
2nd person, auditory, command
264
How would you classify this hallucination?
Voices talking about the patient, referring to them in the third person
3rd person, auditory
265
How would you classify this hallucination?
Patients hear a voice talking to them telling them that they are worthless
2nd person, auditory, persecutory
266
List 3 positive symptoms of schizophrenia
Positive = added to the individual, most of the population do not have them
Delusions
Disordered thoughts/speech
Hallucinations – auditory, visual, tactile, olfactory, gustatory
Respond well to medications
267
List 3 negative symptoms of schizophrenia
Negative = deficits of the normal emotional response
```
Flat/blunted affect
Poverty of speech
Lack of motivation
Poor ability to function
Respond less well to medications
```
268
List some of the different types of shcizophrenia
Paranoid – Auditory/visual hallucinations and delusions (persecutory and/or grandiose). No thought disorder or flattened affect.
Hebephrenia – or disorganised type. Thought disorder and flat affect present together.
Catatonic – either immobile or agitated/purposeless movement. Waxy flexibility. Echolalia /Echopraxia
Simple – insidious and progressive negative symptoms with no history of psychotic symptoms.
Residual – chronic negative symptoms.
269
List 3 types of antidepressant
- Serotonin
- Citalopram
- Fluoxetine
270
What should people who are on MAOI's avoid?
Tyrosine containing foods - cheese and red wine
271
List 3 psychological interventions
PRIMARY CARE:
Counselling
Psychoeducation (group /individual)
Cognitive Behavioural Therapy
```
SECONDARY CARE:
Dialectic Behavioural Therapy
Psychoanalytic Psychotherapy
Group Therapy
Family therapy
```
272
What are the five key principles of the mental capacity act?
```
Have capacity until proven you don't
Supported to make your own decisions
Right to make unwise decisions
Best interests decisions
Least restrictive option
```
273
What conditions must be met regarding mental health in order to detain someone?
Must have a mental health disorder
| Putting themselves or others at risk
274
What is the treatment of acute dystonic reaction?
Procyclidine IM (anticholinergic)
275
What is the treatment of serotonin syndrome?
ABCDE
Supprortive
May give cyproheptadine
276
What is the treatment of NMS?
```
ABCDE
Supportive
Cooling - hyperthermia
May give benzos for agitation
Treat the rhabdomyolysis
```
277
Name some of the drugs that can cause serotonin syndrome
```
Tramadol
SSRI's
SNRI's
MAOI's
Tricyclics
St Johns Wort
```
278
Should you stop antidepressants during a manic episode?
YES!
Can trigger it
279
What signs would indicate an atypical grief reaction?
Prolonged grief reaction, > 1 year
280
What signs would indicate a delayed grief reaction?
Normal functioning up until several months after the event
281
What is the treatment for a phobia?
Graded response therapy and response prevention (i.e. gradually expose the person to what they have been afraid of)
282
What is the first line treatment for adolescent anorexia?
Family therapy
283
List three different types of eating disorder
Binge eating
Anorexia
Bullimia
284
List three different types of eating disorder
Binge eating
Anorexia
Bulimia
285
What are the normal BMI types?
Normal BMI = 18.5 - 24.9
286
How can you differentiate between anorexia and bulimia?
Anorexia = BMI < 18.5, osteoparosis, amenorrhoea, refeeding syndrome
Bulimia = binge/purging. Signs = tooth decay (due to gastric acid in the mouth), Russels sign (cuts on the knuckles from patients putting their fingers in their mouth), hypochloraemic hypokalaemia metabolic alkalosis
287
What is refeeding syndrome?
Patient has been nutritionally defined, and then you refeed them
Results in electrolye abnormalities - hypokalaemia (u wave on the ECG), low magnesium (muscle spasms, fatigue, nystagmus, tremors), low phosphorous (myocardial infarction, seizure - need phosphate for ATP, cells use ATP for energy).
288
What does the course of SSRI's look like?
No - continue on for 6 months after remission
289
What is somatisation disorder?
Have physical / somatic symptoms, cannot be explained > 6 months
290
What is a hypondriac?
Think they have got an illness despite negative tests
291
What is malingering?
Fraudulent simulation or exaggeration of sympotms for money /gain
292
What is munchausens?
Intentional production of symptoms
293
What is the first line management of OCD?
Exposure prevention therapy
294
What is the first line management of OCD?
Exposure prevention therapy, CBT,
295
What is othellos syndrome?
Pathological jealousy
296
How do you treat akathisia (inner restlessness)?
Propanolol
297
How do benzodiazepines work?
ENHANCE the effect of GABA (by increasing number of chlorine channels, GABA is inhibitory), meaning muscle relaxation, sedation, anticonvulsant
298
What are the indications for mirtazipine?
Usually used in elderly as less drug interactions
SE include increased appetite and sedation which can be good for the elderly
299
What should you do if a patient presents to you with mania / severe depression?
Refer URGENTLY to community mental health team - at risk to themselves and others
300
What is the first line treatment of borderline personality disorder?
Dialectal behaviour therapy
301
What is the medical treatment for alcohol withdrawal, and what is its mechanism of action?
Disulfuram
Works as basically an aversion therapy! Inhibits enzyme acetaldehyde dehydrogenase (alcohol converted into acetaldehyde in the body, usually broken down by this enzyme, hwoever when allowed to build up can cause unpleasant side effects such as vomitting, nausea, sickness, etc).
302
List 4 medical problems associated with chronic alcohol abuse
CVS: cardiomyopathy, hypertension
GI: pancreatitis, oesophageal varices, gastric ulcers
Liver: alcoholic fatty liver
Neuro: peripheral neuropathy, ataxia
303
What are 4 signs suggestive that someone has an addiction
- Narrowing of repetoire
- Increased tolerance
- Comes before anything else e.g. relationships
- Compulsion
- Attempted and failed abstinence
304
Why do we see prolactin levels raised in those taking antipsychotics?
Antipsychotics are dopamine antagonists (typical = D2 receptors). Prolactin is inhibited by dopamine, therefore with reduced inhibition levels will increase - gynaecomastia in males.
305
Why do the extra pyramidal symptoms of antipsychotics occur?
Dopamine reduction.
Dopamine helps to control and co-ordinate movement - without it, get parkinsoniam symptoms. l
306
What is very important to find out before you can confirm that someone is having a delusion?
Social and cultural norms of the individual - if it is in keeping with this, it is not a delusion
307
How does NAC work?
increases glutathione stores
Paracetamol = increases NAPQI (toxic metabolite). Glutathione stores are depleted - NAC works to increase stores thus remove toxic metabolite from the body
308
What medication can you give in the first hour when someone ingests paracetamol?
how does it work?
Activated charcoal
Large surface area - binds toxic metabolites, preventing them from being absorbed from GI tract
309
What team in hospital can be contacted to speak to patients with acute deterioration in mental health?
Crisis / intervention teams
310
Name 2 management options for susbtance misuse
Harm reduction - needle exchange to prevent change of blood bourne viruses
Methodone
Support gorups / CBT
311
What are the signs of dependence?
CANT STOP
Compulsion
Aware of harm
Neglecting everything else
Tolerance
Stop - withdrawal symptoms
Too much time
Out of control use
Persistent want to give up but can't
312
List 3 prevention methods to reduce alcohol consumption in the population
- Restricing alcohol sale
- Education in schools
- Increasing alcohol taxation
313
What is the first, second and third line treatment for enuresis?
1st: reward chart
2: enuresis alarm
3: desmopressin (synthetic ADH)
314
What two deficits are included in autism spectrum disorder?
1. social and communication deficits
2. restricted or repetitive behaviours / interests / activities
symptoms described on a scale of severity, where the individual falls on this level can guide treatment and support needed
315
Mother presents with post-partum psychoses. What are the three parts of your treamtment plan?
1. Assess suicide risk and risk to baby
2. Antipsychotics
3. Admit as in patient to specialist mother-baby unit
316
What is the mechanism of action of SSRI's?
Increased serotonin
317
What is the mechanism of action of SNRI's?
Increased serotonin and noradrenaline
318
List 4 signs of lithium toxicity
```
Tremor
Nausea
Vomitting
Diarrhoea
Ataxia
Drowsiness
Confused
```
319
What 3 things do you need to section someone?
Need to have a mental disorder
Severe enough to warrant detention in hospital
Interests of safety of patient / others
320
What is an IMCA?
legal safegaurd for people who lack capacity, independent and impartial
