Psychiatry Flashcards
1
Q
Illusion
A
A misperception a real stimuli
e.g. see a coat on wall and see a man there / think a crack on a wall is new zealand
(false interpretation of what one sees - optical, auditory, tactile)
- True sensation
- Illusion that the hat was dancing
2
Q
Hallucination
A
Perception in the absence of an external stimulus
(A sensory experience that does not exist outside the mind)
- No external experience
Can be in any modability: visual, auditory (2nd and 3rd person), olfactory, gustatory, tactile, proprioceptive
*Hearing voices e.g. “people talking about me”
2nd person = personality disorder
3rd person/running commentary = schizophrenia
Visual = think lewy body / organic
3
Q
Pseudo-hallucination
A
An involuntary sensory experience vivid enough to be regarded as a hallucination but recognised by the patient as being unreal
- Hearing voices from ‘inside my head’
4
Q
Over-valued idea
A
Belief sustained beyond logic/rason but held with less rigidity than a delusion. Can be talked out of it.
A single abnormal belief that is not delusional or obsessional in nature but preoccupying to the extent of dominating the sufferer’s life
- Exaggerated belief sustained beyond logic
- Anorexic patient thinking they are fat
5
Q
Delusion
A
False belief that is firmly maintained in spite of incontrovertible evidence to the contrary.
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.
Phenomenon outside normal experience.
Knowledge claims, not belief claims
Delusions are held without insight
6
Q
Persecutory delusion
A
Outside agency to cause harm
7
Q
Grandiose delusion
A
Inflated importance / self-esteem
8
Q
Delusion of control
A
A.k.a passivity phenomena. 1st rank symptoms of schizophrenia
Delusional belief that one is no longer in sole control of one’s own body
9
Q
Delusion of (self-)reference
A
A neutral event is believed to have special and personal meaning e.g. tv, billboard
10
Q
Nihilistic delusion
A
The delusion that things (or everything, including the self) do not exist; a sense that everything is unreal
e.g. bowels rotted, already dead etc.
11
Q
Delusional misidentification
A
E.g. Capgras syndrome: that familiar people have been replaced with outwardly identical strangers / imposter syndrome
e.g. Fregoli syndrome: that stranger are ‘really’ familiar people
12
Q
Hypochondriacal delusion
A
illness, somatisation
13
Q
Delusion of guilt
A
Delusional belief that one has committed a crime or other reprehensible act
14
Q
Religious delusion
A
More refers to the content of a delusion, all can contain religious reference
15
Q
Delusion/syndrome of subjective doubles
A
The belief that there is a doppelganger or double of themself carrying out independent actions
16
Q
Difference between primary and secondary delusion
A
Primary: ununderstandable, occur in schizophrenia
Secondary: understandable, in accordance with some other psychopathological condition
- may be understood in terms of a person’s background, culture or emotional state
17
Q
Delusional perception
A
1st rank symptom, in which a person misinterprets a normal perception to have special meaning for them
- A cloud in the sky means he has to save the world
18
Q
Folie a deaux
A
Shared delusional belief
- a person living with a deluded person can come to share their belief
19
Q
Concrete thinking
A
literal thinking thats focused on the physical world and causes difficulties when dealing with abstract ideas
lack of abstract thinking, normal in childhood, and occuring in adults with organic brain disease and schizophrenia (ASD, psychosis)
20
Q
Thought alienation
A
Patients feel that thoughts are no longer in their control
bit of a catch all term, as encompasses broadcast, withdrawal and insertion
21
Q
Thought insertion
A
The delusion that certain thoughts are not their own, have been implanted by an outside agency
“alien”
Schneiderian 1st Rank Symptom
22
Q
Thought withdrawal
A
The belief that thoughts have been taken out of their mind by an external agency
Schneiderian 1st Rank
23
Q
Thought broadcasting
A
The delusion that ones thought are being broadcast out loud so they can be perceived by others
24
Q
Thought echo
A
The experience of an auditory hallucination in which the patient hears their thoughts spoken aloud
Either simultaneous with them thinking it or a moment or two afterwards
S1stRS
25
Thought block
Pt experiences sudden break in the train of thought, leaving a blank
It may be explained as due to thought withdrawal
26
Loosening of Association
Lack of logical association between succeeding thoughts
--> incoherent speech
hard to follow patients train of thought
27
Circumstantiality
Talking at great length around the subject but returns to the topic.
28
Perseveration
repetition of a word, theme or action despite absence or cessation of a stimulus
beyond that point at which it was relevant and appropriate
(Usually associated with organic / frontal disorder / Wernicke's encephalopathy - Vit B1 Def)
29
Confabulation
Giving a false account to fill a memory gap (not deliberate / lie) (commonest association Korsakov's psychosis)
The process of describing plausibly false memories for a period in which pt has amnesia.
- Confident about their memories despite contradictory evidence
- Seen in chronic alcohol abuse + thiamine deficiency (Wernicke-Korsakoff syndrome), and in dementia
30
Somatic passivity
Delusional belief that one is a passive recipient of bodily sensations from an external agency
"i know the heat in my left toe is coming from outside forces"
1stRS
31
Made acts, feeling and drives (impulses)
The experience being carried out by the patient is considered as alien / imposed (a made action)
Delusional belief that ones free will has been removed and an external agency is controlling ones actions, feelings or impulses
A form of passivity
S1stRS
32
Catatonia
Significantly excited or inhibited motor activity (with waxy flexibility or posturing)
Increased resting muscle tone which is not present on active or passive movement (in contrast to rigidity associated with PD and extra-pyramidal side-effects)
- A motor symptom of schizophrenia
33
Waxy flexibility (a type of catatonia)
the patient's limbs when moved feel like wax or lead pipe, and remain in the position in which they are left. Found rarely in (catatonic) schizophrenia and structural brain disease
34
Echolalia (a type of catatonia)
Automatic repetition of words heard.
35
Echoparaxia (type of catatonia)
- an automatic repetition by the patient of movements made by the examiner.
36
Logoclonia (type of catatonia)
repetition of the last syllable of a word
37
Negativism (type of catatonia)
motiveless resistance to movement
38
Palilalia (type of catatonia)
repetition of a word over and again with increasing frequency.
39
Verbigeration (type of catatonia)
repetition of one or several sentences or strings of fragmented words, often in a rather monotonous tone.
40
4 categories of first rank symptoms
1. Auditory hallucinations
2. Delusions of thought interference
3. Delusions of control
4. Delusional perception
41
What does passivity include? (5 things)
```
Somatic passivity
Made acts, feelings & drives (impulses)
Catatonia (multiple terms)
Stupor
Psychomotor retardation
```
42
Stupor
Loss of activity with no response to stimuli; may mark a progression of motor retardation
Absence of movement and mutism where there is no impairment of consciousness
43
What is organic stupor caused by?
Lesions in the midbrain (the 'locked-in' syndrome)
44
Psychomotor retardation
Slowing of thoughts and movements
Decreased spontaneous movement and slowness in instigating and completing voluntary movement
(Usually associated with subjective/personal sense of actions being more of an effort and subjective retardation of thought)
Depression, psychotropics, PD
45
Clouding of consciousness
Conscious level between full consciousness and coma
Covers a range of increasingly severe loss of function with drowsiness and impairment of concentration and perception
46
Mood symptoms (4)
1. Flight of ideas
2. Pressure of speech
3. Anhedonia
4. Apathy
47
Expression symptoms (5)
1. Concrete thinking
2. Loosening of association
3. Circumstantiality
4. Perseveration
5. Confabulation
48
Perceptual symptoms (6)
1. Illusion
2. Hallucination
3. Pseudo-hallucination
4. Over-valued idea
5. Delusion
6. Delusional perception
49
Flight of ideas
Rapid skipping from one thought to a distantly related ideas (just about follow)
Subjective experience of one's thoughts being more rapid than normal, with each thought having a greater range of consequent thoughts than normal
Meaningful connections (though perhaps distantly related) are maintained
50
Pressure of speech
A speech pattern consequent upon pressure of thought.
Speech is rapid, hard to interpret, and with increasing severity of illness, connection between ideas is harder to follow
Suggestive of mania
51
Adhedonia
The feeling of absent or significantly diminished enjoyment of previously pleasurable activities
- Core symptom of depressive illness
- Also a -ve symptom of schizophrenia
52
Apathy
Lack of interest, enthusiasm, or concern
53
Presentation symptoms
1. Incongruity of affect
2. Blunting of affect
3. Belle indifference
4. Depersonalisation
5. Derealisation
6. Dissociation
7. Conversion
54
Incongruity of affect
Objective impression that the displayed affect is not consistent with the current thoughts or actions
e. g. laughing while discussing trauma
- Schizophrenia
55
Blunting of affect
Objective loss of the normal degree of emotional sensitivity and sense of the appropriate emotional response to events (w/o evidence of depression or psychomotor retardation)
A -ve symptom of schizophrenia
56
Belle Indifference
An apparent lack of concern at symptoms / disability
A surprising lack of concern for, or denial of, apparently severe functional disability
- Conversion disorder
- Hysteria
- Medical illness: [ CVA ]
57
Depersonalisation
Thoughts and feelings do not seem to belong to oneself
An unpleasant subjective experience in which the patient feels as if they have become 'unreal'.
Associated with a sense of detachment from one's own body
Non-specific symptom and also occurs in normal people
58
Derealisation
Feeling as if you are looking at yourself from the outside
An unpleasant subjective experience where the patient feels as if the world has become unreal
- Non-specific symptom of a number of disorders
59
Dissociation
The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory
60
Conversion
The development of features suggestive of physical illness but which are attributed to psychiatric illness or emotional disturbance rather than organic pathology
- unconscious mechanism of symptom formation
- operates in conversion hysteria
61
Difference between dissociation and conversion
In conversion, the emotion abnormality produces physical symptoms, while in dissociation there is impairment of mental functions e.g. in disturbance amnesia
62
Mannerism
Abnormal and occasionally bizarre performance of a voluntary, goal-directed activity
(problem is frequency)
e. g. conspicuously dramatic manner of walking
- alone, not an example of a mental health problem
63
Stereotyped behaviour
Persistent repetition of a movement, not goal directed (problem is movement)
A repetitive and bizarre movement which is not goal-directed (in contrast to mannerism)
- Action may have delusional significance tothe patient
- Seen in schizophrenia
64
Obsession
An unwanted recurrent thought (experienced as intrusive)
An idea, image, or impulse which is recognised by the patient as their own, but which is experienced as repetitive, intrusive and distressing
- Return of the obsession can be resisted for some time at the expense of mounting anxiety
- In some situations compulsions can relieve the anxiety
65
Compulsion
An irresistable urge to behave in a certain way
A behaviour or action which is recognised by the patient as unnecessary and purposeless but which they cannot resist performing repeatedly (e.g. handwashing)
- The drive to perform the action is recognised as their own
- Associated with a subjective sense of need to perform the act, often in order to avoid the occurence of an adverse event
66
Akathisia
A subjective sense of uncomfortable desire to move, relieved by repeated movement of the affected park (usually the legs)
- A SE of treatment with neuroleptic drugs
67
Gender dysphoria
A persistent aversion toward some or all of those physical characteristics or social roles that connote ones own biological sex
68
Gender identity
a persons inner conviction of being male or female
69
Transvestism
Sexual pleasure derived from dressing or masquerading in the clothing of the opposite sex, with the strong with to appear as a member of the opposite sex
70
Phobia
A particular stimulus, event, or situation which arouses anxiety in an indv and is therefore associated with avoidance
71
Projection
A mechanism in which what is emotionally unacceptable in the self is unconsciously rejected + attributed (projected) to others
72
Transference
The redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood
73
Defined concept
Classes of concepts (delusions)
74
Concept systems
Sets of related concepts (schizophrenia)
75
Phenomenology
description of signs and symptoms
76
Formal thought disorder
Refers to all pathological disturbances in the form of thought
77
Affective (mood) disorders
Depression
Bipolar disorder
(Cyclothymia)
78
Core symptoms of depression
Low mood
Anergia (reduced energy levels)
Anhedonia (lack of pleasure)
79
Whats the leading cause of maternal death, postpartum?
Suicide
80
Criteria for mild depression?
Core features plus 2-3 others (for at least 2 weeks)
81
Criteria for moderate depression?
Core features + 4 others + functioning affected
82
Criteria for severe depression without psychotic symptoms?
Several symptoms, suicidal, marked loss of functioning
83
Criteria for severe depression with psychotic symptoms?
Typically mood congruent (nihilistic and guilty delusions, derogatory voices)
84
Bipolar I
Mania + depression
(sometimes only mania)
At least 2 epidodes in which the pts mood and activity levels are significantly distured
- Persistent incrased energy & sexual drive
- Decreased nede for sleep
- Increased talking speed and racing thoughts
- Grandiose beliefs / inflated self esteem
- Psychotic overestimation re identity / caapbility
- Inappropriate elation or euphoria
- Irritability / mixed picture
-
- ** FUNCTIONAL IMPAIRMENT / RISK LIKELY
85
Bipolar II
More episodes of depression, only mild hypomania
Lesser degree of mania that does not affect functioning to the same degree
No psychotic symptoms
86
Rapid cycling bipolar
episodes only last a few hours or days
87
Cyclothymia bipolar
bipolar disorder not otherwise specified
88
How long does hypomania last for? what is it
4 + days
89
How long does mania last for?
>1 week
90
What % of women get PND after childbirth?
13%
91
List 6 psychoses
1. Schizophrenia
2. Delusion disorder
3. Schizotypal disorder
4. Depressive psychosis
5. Manic psychosis
6. Organic psychosis
92
Lifetime risk Schizophrenia
1%
93
Schizophrenia onset
Typically 2nd - 3rd decade (10-29) but 2nd (smaller) peak incidence in late middle age
94
How many years earlier do pts with schizophrenia die than general population?
25 years
| Increased risk of infection, from CVS disease, resp, infection
95
1st Rank Symptoms (schizophrenia)
a. Thought alienation (insertion, w/d, broadcast)
b. Passivity phenomena
c. 3rd person auditory hallucinations
- arguing or conversing, or commenting on patient's actions
d. Delusional perception (actually a delusion which has perceptual origin)
96
Secondary symptoms (schizophrenia)
a. Delusions
b. 2nd person auditory hallucinations
c. Hallucinations in any other modality.
d. Thought disorder
e. Negative symptoms
97
Positive symptoms (schizophrenia)
- Hallucinations
- Delusions
- Passivity phenomena
- Thought alienation
- Lack of insight
- Disturbance in mood
Respond well to medications
98
Negative symptoms
- Blunting of affect
- Amotivation
- Poverty of speech
- Poverty of thought
- Poor non-verbal communication
- Clear deterioration in functioning
- Self neglect
- Lack of insight
Respond less well to medications
99
Pharmacokinetics
What the body does to the drug
| - absorption, distribution, elimination
100
Pharmacodynamics
What the durg does to the body
angoism + antagonism
receptor sensitivity
101
what are the 4 key neurotransmitter systems?
1. dopamine (DA)
2. seratonin (5HT)
3. acetylcholine (ACh)
4. glutamate (Glu)
102
What are the functions of dopamine?
```
reward
pleasure, euphoria
motor function (fine tuning)
compulsion
preservation
```
103
Serotonin pathways
```
fear + panic
anxiety
functions
mood
memory
processing
sleep
cognition
```
104
what does monoamines mean?
the 3 neurotransmitters of dopamine, serotonin and noradrenaline
105
Causes of depression
Genetics
Biochemistry e.g. excess hydroxytryptamine
Endocrinology
Stressful events
106
Likely pathophysiology of depression?
serotonin + noradrenaline are reduced
| both are monoamines
107
What do antidepressants aim to do?
increase the amounts of serotonin + noradrenaline
108
examples of SSRIs
Sertraline
Citalopram
Fluoxetine
109
MOA SSRIs
- serotonin reuptake pumps + transporters recycle any seratonin within the synapse
- inhibition of these pumps increases free serotonin
110
what does SNRI stand for and give 2 examples
serotonin noradrenaline reuptake inhibitor
- Venlafaxine
- Duloxetine
111
SEs of SSRIs and SNRIs
- sexual
- weight gain
- increased bowel movements
- agitation
112
Give an example of a MOAI and its MOA
Phenelzine
Blocks monoamine breakdown
113
MOA tricyclic antidepressant
Inhibit reuptake of serotonin and noradrenaline
114
What are the side effects of tricyclic anitidepressants? and the MOA of this?
ALSO block antimuscarinic receptors
- dry mouth
- constipation
- urinary retention
- blurred vision
115
DDx mania
Infections, hyperthyroidism, SLE... etc.
Drugs e.g. amphetamines (speed)
116
Mx Bipolar Affective Disorder
```
BIO:
Lithium (carbonate) - mood stablizer
Sodium Valporate (not in women of CBA, hair)
Carbamazepine (rash / neutropenia)
Lamotrigine (rash SJS)
Olanzapine (metabolic / EPS)
```
PSYCHO:
tralking treatment e.g. CBT, replase prevention, psychoeducation
SOCIO
- support with engagement / beliefs
117
MOA lithium
Inhibits cAMP production
cAMP inhibits monoamines
So, lithium inhibits cAMP which leaves monoamines alone
118
Lithium SEs
Tremor, thyroid, renal
```
Tremors
Dry mouth, thirsty, diarrhoea
Skin and hair changes
Underactive thyroid (decreased TSH)
Metallic taste
```
119
Why should pregnant women not take lithium?
Ebsteins phenomena (a congenital heart disease)
120
How to retain water in people taking lithium?
Sodium restricted diets
diuretics + NSAIDs
regular renal function tests
121
Symptoms and signs of lithium toxicity
coarse tremor
hyperreflexia
seizures
heart block
122
Mx lithium toxicity
STOP lithium
rehydrate
haemodialysis
123
At what conc does lithium toxicity occur?
> 1.0 mmol/L
| normal range is 0.6 - 1.0
124
Causes of lithium toxicity
sudden dehydration (on holiday)
overdose
other medications
systemic illness
125
Causes of Schizophrenia
genes
environment
early use of cannabis
social factors
- urban upbringing
- migrant groups
126
DDx schizophrenia
bipolar disorder
drugs + alcohol
CNS tumors
head injury
(rule these out as other causes of psychosis)
127
What are the 3 features that symptoms need to have for a diagnosis of schizophrenia?
2. be present for much of the time for at least 1 month
| 3. significantly impair work or home functioning
128
What is the dopamine hypothesis in schizophrenia?
Overactivity of D2 receptors: mesolimbic = hallucinations
Underactivity of D1 receptors: mesocortical = blunted + apathetic
129
MOA typical/1st generation antipsychotics
Block D2 receptors, which are the most abundant ones and thought to be overactive. (!! but at a cost)!
But they dont improve the negative symptoms caused by underactive D1 receptors
130
Give 2 examples of typical antipsychotics
1. Chlorpromazine (an antihistamine with sedative effects)
| 2. Haloperidol
131
What pathway are EPSEs linked to?
Nigrostriatal pathway
132
What are the 4 EPSEs of antipychotics?
1. Parkinsonism
2. Acute dystonia
3. Akathisia
4. Tardive dyskinesia
133
Another SE of typical antipsychotics that is not EP?, and its pathway?
Hyperprolactinaemia
e.g. galacorrhea + infertility
Tuberoinfundibular pathway
134
List the 4 atypical / 2nd generation antipsychotics
Clozapine
Risperidone
Olanzapine
Quetiapine
135
What drug for treatment- resistant schizophrenia?
Clozapine
136
Why are atypical antipsychotics good? and what line treatment are they for schizophrenia?
Because they have no EPSEs
3rd line (after 2 typical ones), and before ECT
137
SEs of atypical / 2nd gen antipsychotics
Sexual (dysfunction)
Metabolic (weight gain, DM)
Cardiac
138
Agoraphobia
fear of being in situations where escape and help might be difficult
139
Criteria for diagnosis of GAD
Excessive anxiety across different situations for >6 months
AND three of the following:
- tiredness
- poor concentration
- irritability
- muscle tension
- sleep disturbance
140
Causes (GAD)
genetic predisposition
stress
events
141
Difference between panic disorder and GAD?
Panic: recurring + regular panic attacks often for no apparent reason
GAD: feel anxious all the time about everyday events
142
Treatment (GAD)
Symptom control (listen)
Regular exercise
Meditation
CBT + relaxation
Drugs: SSRIs, benzos,,
Hypnosis
143
Physical symptoms panic disorder
palps, CP, choking, tachpnoea, etc.
144
Psychological symptoms panic disorder
feeling of impending doom
| fear of dying / losing control
145
DDx panic disorder
other anxiety disorder
substance misuse
endocrine
146
Mx Panic disorder
SSRIs
147
Parasthesia definition
tingling / numbeness / skin crawling
148
Features of OCD
obsessive thoughts + compulsive acts
149
Features of the thoughts / images in OCD?
unpleasant
repetitive
intrusive
irrational
recognised as own thoughts by pts
150
To be OCD, what features do the O / Cs have to have?
- Cause distress or interfere w social or individual functioning
- not be a result of another psychiatric disorder
151
Mean age for OCD
20 yrs
152
Mx OCD?
**Exposure and response prevention (CBT based treatment)
Psychological : CBT, supportive psychotherapy
Pharmacological : SSRIs
153
Give some examples of psychosocial treatment
- Recovery model
- Social inclusion work
- Psychoeducation
- Psychological therapy and counselling
154
Define formulation
Constructing a meaningful narrative of the person's symptoms and problems as part of a life story
155
What are the elements of biopsychosociio formulation?
(Bio, psycho and social)
AND
- Predisposing (vulnerability)
- Precipitating (triggers)
- Prolonging (maintaining)
- Protective (strengths)
156
What does IAPT stand for?
Improving Access to Psychological Therapy
157
What does IAPT involve?
Primary care psychotherapy service
GP / self referral
Mainly depression + anxiety
Mainly CBT and guided self-help
158
What is the psychodynamic (psychoanalytic) model of psychotherapy?
- Making connections between past and present
- Becoming more aware of the unconscious processes which are giving rise to symptoms
- Giving meaning to symptoms
159
How long does NHS psychodynamic (psychoanalytic) therapy take?
~ 1 year
involves weekly sessions
Therapeutic relationship allows things to be worked on safely
160
What is 1st wave CBT?
behavioural therapy
161
What is 2nd wave CBT?
cognitive (behavioural) therapy
162
What is 3rd wave CBT?
combines mindfulness and acceptance techniques with CBT
163
How does CBT differ from psychotherapy?
The focus is mainly on the here and now, and on problems in day to day life rather than on the therapeutic relationship
164
Describe counselling
Fairly short, aims to help patient be clearer about their problems and come up with their own answers
Often used to help someone cope with recent events they have found difficult. It does not aim to help you change as a person
165
Describe cognitive analytic therapy
Integrates cognitive and psychoanalytic approaches
Patient describes how problems have developed from events in their life and their personal experiences
Focus on their ways of coping and how to improve
The therapist writes a letter at the beginning and end of treatment
166
How many sessions in cognitive analytical therapy?
Brief (16-24 sessions), 50 mins
167
Describe interpersonal therapy
Aims to help the patient understand how problems may be connected to the way their relationships work
Helps identify how to strengthen relationships and find better ways of coping
168
Who is Dialectic Behavioural Therapy aimed at helping?
Problems associated with borderline personality disorder
- Repeated self harming, relationship problems …
Individual and group sessions combined as a programme
169
How many sessions in dialectic behavioural therapy?
Program of regular indv + group sessions sessions over a period of 12 to 18 months
170
Goal of dialectic behavioural therapy
to help patients learn to manage difficult emotions by letting them experience, recognise and accept them
171
What does dialectic behavioural therapy combine?
behavioural and third wave CBT
172
Describe family therapy
Systemic psychotherapy works with a family's strengths to help family members think about (and try) different ways of behaving with each other
Often used in CAMHS
173
Marital therapy
A therapist or pair of therapists meet with a couple and work on problems together
Might deal with problems between the partners or stresses both partners are facing (eg. loss of a child)
174
What psychotic disorders occur in the elderly?
- Late onset Schizophrenia
- Persistent Delusional disorder
- Psychotic depression
- Charles Bonnet Syndrome
- Dementia (delusions, hallucinations, delirium)
175
What is paraphrenia?
another word for late onset (after 45yrs) schizophrenia
176
Key differences in late onset schizophrenia and younger onset?
Pts have less negative symptoms and formal thought disorder compared to early onset
Also: - Less of a familial risk
AND: better outcomes, and response to low dose anti-psychotics
177
Why does late onset schizophrenia often go undiagnosed?
Because older pts with the disorder tend to be socially isolated
178
What is the "partition" delusion?
Occurs in late onset schizophrenia
Leads pt to believe that people or objects can transgress impermeable barriers
179
RFs for paraphrenia?
- Social isolation
- Sensory deficits
- Reclusive and suspicious pre-morbid personality
- F > M
180
Factors associated with positive outcome of paraphrenia?
Early identification, early treatment and good social support
181
Criteria for Dx of Persistent Delusional Disorder
Main feature: over 3/12 history of long standing delusions
- single / related
- culturally appropriate
- no PERSISTANT hallucination
- no organic cause
More common in older people, related to sensory e.g. smells, e.g. I know people upstairs are posining my fridge
182
Common delusions in elderly delusional disorder diagnosis
```
Skin infestation
illness / cancer
being spied on
followed
imprisoned
infidelity
```
183
Types of delusions in psychotic depression
Mood congurent delusions
Nihilistic delusions
- Cotard's syndrome
- Owing money
- Burden to others
Somatic delusions
- Unable to swallow
- Pain
184
Types of hallucinations in psychotic depression
Believe they smell
| 2nd person derogatory auditory hallucinations
185
Charles-Bonnet Syndrome
| usually age-related macular degeneration
Experience of complex visual hallucinations in a person with partial or severe blindness
Patients understand that the hallucinations are not real and often have insight compared to other disorders
186
Define mental disorder
any disorder or disability of the mind
| excluding alcohol and drug use
187
What is the duration of a Section 2
28 days (cannot be renewed)
188
What is the purpose of a section 2
Assessment (although Tx can be given without patients' consent - can be appealed against: tribunal must appear within 7 days)
189
What professionals are involved in a section 2 and 3?
- 2 Drs (One S12 approved)
| - AMPH
190
What does AMPH stand for?
approved mental health professional
191
Evidence required for a section 2?
a. The pt is suffering from mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b. The pt ought to be detained for his or her own health or safety, or the protection of others
1. Mental health disorder
2. Nature or degree to warrant detention in hospital
3. Risk to self, others or health
192
What is the duration of a section 3?
6 months (and can be renewed)
193
What is the purpose of a section 3?
Treatment
194
Evidence required for section 3
a. The patient is suffering from mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital; and
b. The treatment is in the interests of his or her health and safety and the protection of others; and
c. Appropriate treatment must be available for the patient
195
What is the duration of section 4?
72 hrs
196
What is the purpose of a section 4?
Emergency order
Only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay”
197
Professionals required for a section 4
1 doctor (doesn't have to be S12 approved)
1 AMHP
198
Evidence required for a section 4
a. The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b. The patient ought to be detained for his or her own health or safety, or the protection of others
c. There is not enough time for 2nd doctor to attend (risk)
199
How long does a section 5(4) last for who's holding power is it?
6hrs
| Nurses' holding power until Dr can attend
200
What is the purpose / reason for a section 5(4)
For a pt ALREADY admitted (can be a psychiatric or general hospital) but wanting to leave
Cannot be treated coercively whilst under this section
201
How long does section 5(2) last for and who's holding power is it?
72 hrs
Doctors holding power to allow time for a S2 or S3 assessment
202
What is the purpose / reason for a section 5(2)
For a pt ALREADY admitted (can be psych or general hospital) but wanting to leave
Cannot be coercively treated
203
What are the police sections?
Section 135 and section 136
204
How long does a section 135 last for?
36hrs
205
Where and why can a section 135 be given?
Police/MPH to enter patient's home
private place --> private place of safety e.g. local psychiatric unit or police cell
(Needs a court order)
206
How long does section 136 last for?
24hrs (extended by 12hrs if medic)
207
Where and why can a section 136 be given?
Person suspected of having a mental disorder in a public place
e.g. motorway to transport to a place of safety
NOT in someones home!
e.g. personality disorder didn't want to be discharged so does something "mad" in public
208
Principles to think of for sections
- Where is the patient?
| - Have they been detained before?
209
How many days do psychotic symptoms have to occur to be schizophrenic? - and what section is this relevant to?
30 days
Section 2- allows 28 days of assessment
210
CAMHS vs Adult Psych
less pharma Tx
creative therapies
involving famly, school, college etc
211
What % of mental health problems are established by age 14?
50%!
212
What physical diseases does childhood physical abuse increase likelihood of?
Heart diseaese in women
Cancer in both
COPD
213
What is attachment theory?
“An infant needs to develop a relationship with at least one primary caregiver for the child's successful social and emotional development, and in particular for learning how to effectively regulate their feelings"
214
Difference between Knight's move and Flight of Ideas?
Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
215
What do metabolic SEs of antipsychotic drugs include?
hyperlipidemia, hypercholesterolemia, hyperglycemia and weight gain
216
what is the most common endocrine disorder resulting from lithium toxicity?
hypothyroidism
217
MOA of venlafaxine?
Seratonin and noradrenaline reuptake inhibitor
218
most common form of delusions in schizophrenia?
Persecutory delusions
219
What are the feature of neuroleptic malignant syndrome?
FALTER
```
Fever
Arms
Leukocytosis
Tremors
Elevated CPK
Rigidity
```
220
What is the treatment for neuroleptic malignant syndrome?
Bromocriptine
221
Treatment for acute dystonic reaction?
Procyclizine
222
Treatment for serotonin syndrome
Cyproheptadine
223
Flattening of affect
reduced range of emotional expression
224
Incongruity of affect
mismatch between emotional expression and content
225
Obsession
An unwanted recurrent thought (experienced as intrusive)
226
To do:
```
types of schizophrenia / psychosis
tangent
mild depression symtpoms
personality disorders
psych emergencies
who can release them from sections
```
227
Mx Psychosis
Bio
- Antipsychotics (+clozapine for Rx resistance)
Psycho
- Family therapy
- CBT
Sicio:
- family intervention / carer support
- employment / activity / education
- support with engagement / ebenefits / PIS
228
Dx of bipolar disorder with a Hx of manice episodes, on olanzapine. No relapses in 3 years, can he drive? DVLA?
Dx, doesn't preclude pt from driving. A disorder in itself doesn't , its about how it affects you. Neither does being on a particular medication, its about its affect
You should inform the pt that he should inform the DVLA about his Dx and wish to drive
229
Baby Blues
Transient condition 75-90% up to 2/52 postnatal weeks
| NORMAL
230
Puerperal psychosis
Within days or weeks of delivery, risk to mother and baby
Admission & high risk of recurrence in subsequent pregnancies
probable hormonal aetiology in women predisposed to biopolar disorer
PSYCHIATRIC EMERGENCY
231
Mx Depression
```
BIO
- antidepressants
- SSRI, TCA, SSRI + TCA, + adjuvant
- ECT
PSYCHO
- talking treatment e.g. CBT, CAT
- Group work / self help
- Psychoeducation
SOCIO
```
```
MILD:
- watchful waiting
- IAPT
MOD:
- SSRI + IAPT
- consider referral to psych
SEV:
```
**
232
Hypnotics
1. Benzos
2. Z-drugs
3. Melatonin: over 55s short term only
Used as anxiolytics in the short term
NOT IN GENERALISED ANXIETY
w/d effects include: sleep disturbance
233
Anxiolytics
NB first line (&2nd line) intervention is talking treatment / IAPT
Pregabalin
234
Antidepressants
**look @slide
Tetracyclic: Na and Serato
- Mirtazapine
- SE: sedation, wt gain
235
Antipsychotics
Depot and oral
1. st gen: haloperidol, chlorpromazine
- (more EPS) : acute dystonia treat with (check)
2nd Gen: "atypical": olanzapine, risperidone, quetiapine, aripiprazole (more metabolic syndrome).
SEs: EPS, metabolic (DM, wt gain, lipids, NMS)
Clozapine
SE: wt gain, less EOS, migraine?
236
Mood stabilisers
1. Lithium
2. Antipsychotics
3. Anticonvulsants
237
ADHD Rx
Methyphenidate (adults) : Ritalin
SE: appetite suppression, psychosis, misuse (similarly structurally to amphetamine). Can reduce end height in children
2nd line Atomoxetine
SE: liver dysfunction, abdo SE, suicidality
Parent training (1st line children)
238
Psychological interventions for mood disorders
Primary care / vol sector
- counselling
- psychoeducation (group / individual)
- CBT
Secondary /tertiary
- dialectic behavioural therapy
- psychoanalytic psychoterapy
- group therap
- family therapy
239
Psychological interventions for mood disorders
Primary care / vol sector
- counselling
- psychoeducation (group / individual)
- CBT
Secondary /tertiary
- dialectic behavioural therapy
- psychoanalytic psychoterapy
- group therap
- family therapy
240
EUPD
- Self-harm
- Distured or uncertain self-image
- Efforts to avoid abandonment
- Chronic feelings of emptiness
- Impulsivity
- Difficulty maintaininy healthy relationships
241
Anankastic PD
Obsessive
242
What score to assess depression?
PHQ-9 score
243
Score to assess risk of suicide
The sad person score
