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*Phase 3a Julia > Psychiatry > Flashcards

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
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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

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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’
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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
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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

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6
Q

Persecutory delusion

A

Outside agency to cause harm

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7
Q

Grandiose delusion

A

Inflated importance / self-esteem

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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

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9
Q

Delusion of (self-)reference

A

A neutral event is believed to have special and personal meaning e.g. tv, billboard

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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.

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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

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12
Q

Hypochondriacal delusion

A

illness, somatisation

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13
Q

Delusion of guilt

A

Delusional belief that one has committed a crime or other reprehensible act

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14
Q

Religious delusion

A

More refers to the content of a delusion, all can contain religious reference

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15
Q

Delusion/syndrome of subjective doubles

A

The belief that there is a doppelganger or double of themself carrying out independent actions

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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
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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
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18
Q

Folie a deaux

A

Shared delusional belief

  • a person living with a deluded person can come to share their belief
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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)

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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

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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

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22
Q

Thought withdrawal

A

The belief that thoughts have been taken out of their mind by an external agency

Schneiderian 1st Rank

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23
Q

Thought broadcasting

A

The delusion that ones thought are being broadcast out loud so they can be perceived by others

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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

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25
Q

Thought block

A

Pt experiences sudden break in the train of thought, leaving a blank

It may be explained as due to thought withdrawal

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26
Q

Loosening of Association

A

Lack of logical association between succeeding thoughts

–> incoherent speech

hard to follow patients train of thought

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27
Q

Circumstantiality

A

Talking at great length around the subject but returns to the topic.

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28
Q

Perseveration

A

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)

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29
Q

Confabulation

A

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
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30
Q

Somatic passivity

A

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

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31
Q

Made acts, feeling and drives (impulses)

A

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

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32
Q

Catatonia

A

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
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33
Q

Waxy flexibility (a type of catatonia)

A

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

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34
Q

Echolalia (a type of catatonia)

A

Automatic repetition of words heard.

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35
Q

Echoparaxia (type of catatonia)

A
  • an automatic repetition by the patient of movements made by the examiner.
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36
Q

Logoclonia (type of catatonia)

A

repetition of the last syllable of a word

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37
Q

Negativism (type of catatonia)

A

motiveless resistance to movement

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38
Q

Palilalia (type of catatonia)

A

repetition of a word over and again with increasing frequency.

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39
Q

Verbigeration (type of catatonia)

A

repetition of one or several sentences or strings of fragmented words, often in a rather monotonous tone.

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40
Q

4 categories of first rank symptoms

A
  1. Auditory hallucinations
  2. Delusions of thought interference
  3. Delusions of control
  4. Delusional perception
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41
Q

What does passivity include? (5 things)

A 
Somatic passivity
Made acts, feelings & drives (impulses)
Catatonia (multiple terms)
Stupor
Psychomotor retardation
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42
Q

Stupor

A

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

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43
Q

What is organic stupor caused by?

A

Lesions in the midbrain (the ‘locked-in’ syndrome)

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44
Q

Psychomotor retardation

A

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

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45
Q

Clouding of consciousness

A

Conscious level between full consciousness and coma

Covers a range of increasingly severe loss of function with drowsiness and impairment of concentration and perception

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46
Q

Mood symptoms (4)

A
  1. Flight of ideas
  2. Pressure of speech
  3. Anhedonia
  4. Apathy
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47
Q

Expression symptoms (5)

A
  1. Concrete thinking
  2. Loosening of association
  3. Circumstantiality
  4. Perseveration
  5. Confabulation
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48
Q

Perceptual symptoms (6)

A
  1. Illusion
  2. Hallucination
  3. Pseudo-hallucination
  4. Over-valued idea
  5. Delusion
  6. Delusional perception
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49
Q

Flight of ideas

A

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

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50
Q

Pressure of speech

A

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

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51
Q

Adhedonia

A

The feeling of absent or significantly diminished enjoyment of previously pleasurable activities

  • Core symptom of depressive illness
  • Also a -ve symptom of schizophrenia
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52
Q

Apathy

A

Lack of interest, enthusiasm, or concern

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53
Q

Presentation symptoms

A
  1. Incongruity of affect
  2. Blunting of affect
  3. Belle indifference
  4. Depersonalisation
  5. Derealisation
  6. Dissociation
  7. Conversion
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54
Q

Incongruity of affect

A

Objective impression that the displayed affect is not consistent with the current thoughts or actions

e. g. laughing while discussing trauma
- Schizophrenia

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55
Q

Blunting of affect

A

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

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56
Q

Belle Indifference

A

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 ]
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57
Q

Depersonalisation

A

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

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58
Q

Derealisation

A

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
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59
Q

Dissociation

A

The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory

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60
Q

Conversion

A

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
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61
Q

Difference between dissociation and conversion

A

In conversion, the emotion abnormality produces physical symptoms, while in dissociation there is impairment of mental functions e.g. in disturbance amnesia

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62
Q

Mannerism

A

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

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63
Q

Stereotyped behaviour

A

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
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64
Q

Obsession

A

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
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65
Q

Compulsion

A

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
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66
Q

Akathisia

A

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
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67
Q

Gender dysphoria

A

A persistent aversion toward some or all of those physical characteristics or social roles that connote ones own biological sex

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68
Q

Gender identity

A

a persons inner conviction of being male or female

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69
Q

Transvestism

A

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

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70
Q

Phobia

A

A particular stimulus, event, or situation which arouses anxiety in an indv and is therefore associated with avoidance

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71
Q

Projection

A

A mechanism in which what is emotionally unacceptable in the self is unconsciously rejected + attributed (projected) to others

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72
Q

Transference

A

The redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood

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73
Q

Defined concept

A

Classes of concepts (delusions)

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74
Q

Concept systems

A

Sets of related concepts (schizophrenia)

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75
Q

Phenomenology

A

description of signs and symptoms

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76
Q

Formal thought disorder

A

Refers to all pathological disturbances in the form of thought

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77
Q

Affective (mood) disorders

A

Depression

Bipolar disorder

(Cyclothymia)

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78
Q

Core symptoms of depression

A

Low mood
Anergia (reduced energy levels)
Anhedonia (lack of pleasure)

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79
Q

Whats the leading cause of maternal death, postpartum?

A

Suicide

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80
Q

Criteria for mild depression?

A

Core features plus 2-3 others (for at least 2 weeks)

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81
Q

Criteria for moderate depression?

A

Core features + 4 others + functioning affected

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82
Q

Criteria for severe depression without psychotic symptoms?

A

Several symptoms, suicidal, marked loss of functioning

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83
Q

Criteria for severe depression with psychotic symptoms?

A

Typically mood congruent (nihilistic and guilty delusions, derogatory voices)

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84
Q

Bipolar I

A

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
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85
Q

Bipolar II

A

More episodes of depression, only mild hypomania

Lesser degree of mania that does not affect functioning to the same degree

No psychotic symptoms

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86
Q

Rapid cycling bipolar

A

episodes only last a few hours or days

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87
Q

Cyclothymia bipolar

A

bipolar disorder not otherwise specified

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88
Q

How long does hypomania last for? what is it

A

4 + days

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89
Q

How long does mania last for?

A

> 1 week

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90
Q

What % of women get PND after childbirth?

A

13%

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91
Q

List 6 psychoses

A
  1. Schizophrenia
  2. Delusion disorder
  3. Schizotypal disorder
  4. Depressive psychosis
  5. Manic psychosis
  6. Organic psychosis
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92
Q

Lifetime risk Schizophrenia

A

1%

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93
Q

Schizophrenia onset

A

Typically 2nd - 3rd decade (10-29) but 2nd (smaller) peak incidence in late middle age

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94
Q

How many years earlier do pts with schizophrenia die than general population?

A

25 years

Increased risk of infection, from CVS disease, resp, infection

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95
Q

1st Rank Symptoms (schizophrenia)

A

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)

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96
Q

Secondary symptoms (schizophrenia)

A

a. Delusions
b. 2nd person auditory hallucinations
c. Hallucinations in any other modality.
d. Thought disorder
e. Negative symptoms

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97
Q

Positive symptoms (schizophrenia)

A
  • Hallucinations
  • Delusions
  • Passivity phenomena
  • Thought alienation
  • Lack of insight
  • Disturbance in mood
    Respond well to medications
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98
Q

Negative symptoms

A
  • 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
Q

Pharmacokinetics

A

What the body does to the drug

- absorption, distribution, elimination

100
Q

Pharmacodynamics

A

What the durg does to the body

angoism + antagonism
receptor sensitivity

101
Q

what are the 4 key neurotransmitter systems?

A
  1. dopamine (DA)
  2. seratonin (5HT)
  3. acetylcholine (ACh)
  4. glutamate (Glu)
102
Q

What are the functions of dopamine?

A 
reward
pleasure, euphoria
motor function (fine tuning)
compulsion
preservation
103
Q

Serotonin pathways

A 
fear + panic
anxiety
functions
mood
memory
processing
sleep
cognition
104
Q

what does monoamines mean?

A

the 3 neurotransmitters of dopamine, serotonin and noradrenaline

105
Q

Causes of depression

A

Genetics
Biochemistry e.g. excess hydroxytryptamine
Endocrinology
Stressful events

106
Q

Likely pathophysiology of depression?

A

serotonin + noradrenaline are reduced

both are monoamines

107
Q

What do antidepressants aim to do?

A

increase the amounts of serotonin + noradrenaline

108
Q

examples of SSRIs

A

Sertraline
Citalopram
Fluoxetine

109
Q

MOA SSRIs

A
  • serotonin reuptake pumps + transporters recycle any seratonin within the synapse
  • inhibition of these pumps increases free serotonin
110
Q

what does SNRI stand for and give 2 examples

A

serotonin noradrenaline reuptake inhibitor

  • Venlafaxine
  • Duloxetine
111
Q

SEs of SSRIs and SNRIs

A
  • sexual
  • weight gain
  • increased bowel movements
  • agitation
112
Q

Give an example of a MOAI and its MOA

A

Phenelzine

Blocks monoamine breakdown

113
Q

MOA tricyclic antidepressant

A

Inhibit reuptake of serotonin and noradrenaline

114
Q

What are the side effects of tricyclic anitidepressants? and the MOA of this?

A

ALSO block antimuscarinic receptors

  • dry mouth
  • constipation
  • urinary retention
  • blurred vision
115
Q

DDx mania

A

Infections, hyperthyroidism, SLE… etc.

Drugs e.g. amphetamines (speed)

116
Q

Mx Bipolar Affective Disorder

A 
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
Q

MOA lithium

A

Inhibits cAMP production

cAMP inhibits monoamines

So, lithium inhibits cAMP which leaves monoamines alone

118
Q

Lithium SEs

A

Tremor, thyroid, renal

Tremors
Dry mouth, thirsty, diarrhoea
Skin and hair changes
Underactive thyroid (decreased TSH)
Metallic taste
119
Q

Why should pregnant women not take lithium?

A

Ebsteins phenomena (a congenital heart disease)

120
Q

How to retain water in people taking lithium?

A

Sodium restricted diets
diuretics + NSAIDs

regular renal function tests

121
Q

Symptoms and signs of lithium toxicity

A

coarse tremor
hyperreflexia
seizures
heart block

122
Q

Mx lithium toxicity

A

STOP lithium
rehydrate
haemodialysis

123
Q

At what conc does lithium toxicity occur?

A

> 1.0 mmol/L

normal range is 0.6 - 1.0

124
Q

Causes of lithium toxicity

A

sudden dehydration (on holiday)
overdose
other medications
systemic illness

125
Q

Causes of Schizophrenia

A

genes
environment
early use of cannabis

social factors

  • urban upbringing
  • migrant groups
126
Q

DDx schizophrenia

A

bipolar disorder
drugs + alcohol
CNS tumors
head injury

(rule these out as other causes of psychosis)

127
Q

What are the 3 features that symptoms need to have for a diagnosis of schizophrenia?

A
  1. be present for much of the time for at least 1 month

3. significantly impair work or home functioning

128
Q

What is the dopamine hypothesis in schizophrenia?

A

Overactivity of D2 receptors: mesolimbic = hallucinations

Underactivity of D1 receptors: mesocortical = blunted + apathetic

129
Q

MOA typical/1st generation antipsychotics

A

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
Q

Give 2 examples of typical antipsychotics

A
  1. Chlorpromazine (an antihistamine with sedative effects)

2. Haloperidol

131
Q

What pathway are EPSEs linked to?

A

Nigrostriatal pathway

132
Q

What are the 4 EPSEs of antipychotics?

A
  1. Parkinsonism
  2. Acute dystonia
  3. Akathisia
  4. Tardive dyskinesia
133
Q

Another SE of typical antipsychotics that is not EP?, and its pathway?

A

Hyperprolactinaemia
e.g. galacorrhea + infertility

Tuberoinfundibular pathway

134
Q

List the 4 atypical / 2nd generation antipsychotics

A

Clozapine
Risperidone
Olanzapine
Quetiapine

135
Q

What drug for treatment- resistant schizophrenia?

A

Clozapine

136
Q

Why are atypical antipsychotics good? and what line treatment are they for schizophrenia?

A

Because they have no EPSEs

3rd line (after 2 typical ones), and before ECT

137
Q

SEs of atypical / 2nd gen antipsychotics

A

Sexual (dysfunction)
Metabolic (weight gain, DM)
Cardiac

138
Q

Agoraphobia

A

fear of being in situations where escape and help might be difficult

139
Q

Criteria for diagnosis of GAD

A

Excessive anxiety across different situations for >6 months

AND three of the following:

  • tiredness
  • poor concentration
  • irritability
  • muscle tension
  • sleep disturbance
140
Q

Causes (GAD)

A

genetic predisposition
stress
events

141
Q

Difference between panic disorder and GAD?

A

Panic: recurring + regular panic attacks often for no apparent reason

GAD: feel anxious all the time about everyday events

142
Q

Treatment (GAD)

A

Symptom control (listen)
Regular exercise
Meditation
CBT + relaxation

Drugs: SSRIs, benzos,,

Hypnosis

143
Q

Physical symptoms panic disorder

A

palps, CP, choking, tachpnoea, etc.

144
Q

Psychological symptoms panic disorder

A

feeling of impending doom

fear of dying / losing control

145
Q

DDx panic disorder

A

other anxiety disorder
substance misuse
endocrine

146
Q

Mx Panic disorder

A

SSRIs

147
Q

Parasthesia definition

A

tingling / numbeness / skin crawling

148
Q

Features of OCD

A

obsessive thoughts + compulsive acts

149
Q

Features of the thoughts / images in OCD?

A

unpleasant
repetitive
intrusive
irrational

recognised as own thoughts by pts

150
Q

To be OCD, what features do the O / Cs have to have?

A
  • Cause distress or interfere w social or individual functioning
  • not be a result of another psychiatric disorder
151
Q

Mean age for OCD

A

20 yrs

152
Q

Mx OCD?

A

**Exposure and response prevention (CBT based treatment)

Psychological : CBT, supportive psychotherapy
Pharmacological : SSRIs

153
Q

Give some examples of psychosocial treatment

A
  • Recovery model
  • Social inclusion work
  • Psychoeducation
  • Psychological therapy and counselling
154
Q

Define formulation

A

Constructing a meaningful narrative of the person’s symptoms and problems as part of a life story

155
Q

What are the elements of biopsychosociio formulation?

A

(Bio, psycho and social)

AND

  • Predisposing (vulnerability)
  • Precipitating (triggers)
  • Prolonging (maintaining)
  • Protective (strengths)
156
Q

What does IAPT stand for?

A

Improving Access to Psychological Therapy

157
Q

What does IAPT involve?

A

Primary care psychotherapy service

GP / self referral

Mainly depression + anxiety

Mainly CBT and guided self-help

158
Q

What is the psychodynamic (psychoanalytic) model of psychotherapy?

A
  • Making connections between past and present
  • Becoming more aware of the unconscious processes which are giving rise to symptoms
  • Giving meaning to symptoms
159
Q

How long does NHS psychodynamic (psychoanalytic) therapy take?

A

~ 1 year

involves weekly sessions

Therapeutic relationship allows things to be worked on safely

160
Q

What is 1st wave CBT?

A

behavioural therapy

161
Q

What is 2nd wave CBT?

A

cognitive (behavioural) therapy

162
Q

What is 3rd wave CBT?

A

combines mindfulness and acceptance techniques with CBT

163
Q

How does CBT differ from psychotherapy?

A

The focus is mainly on the here and now, and on problems in day to day life rather than on the therapeutic relationship

164
Q

Describe counselling

A

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
Q

Describe cognitive analytic therapy

A

Integrates cognitive and psychoanalytic approaches

Patient describes how problems have developed from events in their life and their personalexperiences

Focus on their ways of coping and how to improve

The therapist writes a letter at the beginning and end of treatment

166
Q

How many sessions in cognitive analytical therapy?

A

Brief (16-24 sessions), 50 mins

167
Q

Describe interpersonal therapy

A

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
Q

Who is Dialectic Behavioural Therapy aimed at helping?

A

Problems associated with borderline personality disorder
- Repeated self harming, relationship problems …

Individual and group sessions combined as a programme

169
Q

How many sessions in dialectic behavioural therapy?

A

Program of regular indv + group sessions sessions over a period of 12 to 18 months

170
Q

Goal of dialectic behavioural therapy

A

to help patients learn to manage difficult emotions by letting them experience, recognise and accept them

171
Q

What does dialectic behavioural therapy combine?

A

behavioural and third wave CBT

172
Q

Describe family therapy

A

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
Q

Marital therapy

A

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
Q

What psychotic disorders occur in the elderly?

A
  • Late onset Schizophrenia
  • Persistent Delusional disorder
  • Psychotic depression
  • Charles Bonnet Syndrome
  • Dementia (delusions, hallucinations, delirium)
175
Q

What is paraphrenia?

A

another word for late onset (after 45yrs) schizophrenia

176
Q

Key differences in late onset schizophrenia and younger onset?

A

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
Q

Why does late onset schizophrenia often go undiagnosed?

A

Because older pts with the disorder tend to be socially isolated

178
Q

What is the “partition” delusion?

A

Occurs in late onset schizophrenia

Leads pt to believe that people or objects can transgress impermeable barriers

179
Q

RFs for paraphrenia?

A
  • Social isolation
  • Sensory deficits
  • Reclusive and suspicious pre-morbid personality
  • F > M
180
Q

Factors associated with positive outcome of paraphrenia?

A

Early identification, early treatment and good social support

181
Q

Criteria for Dx of Persistent Delusional Disorder

A

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
Q

Common delusions in elderly delusional disorder diagnosis

A 
Skin infestation
illness / cancer
being spied on
followed
imprisoned
infidelity
183
Q

Types of delusions in psychotic depression

A

Mood congurent delusions

Nihilistic delusions

  • Cotard’s syndrome
  • Owing money
  • Burden to others

Somatic delusions

  • Unable to swallow
  • Pain
184
Q

Types of hallucinations in psychotic depression

A

Believe they smell

2nd person derogatory auditory hallucinations

185
Q

Charles-Bonnet Syndrome

usually age-related macular degeneration

A

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
Q

Define mental disorder

A

any disorder or disability of the mind

excluding alcohol and drug use

187
Q

What is the duration of a Section 2

A

28 days (cannot be renewed)

188
Q

What is the purpose of a section 2

A

Assessment (although Tx can be given without patients’ consent - can be appealed against: tribunal must appear within 7 days)

189
Q

What professionals are involved in a section 2 and 3?

A
  • 2 Drs (One S12 approved)

- AMPH

190
Q

What does AMPH stand for?

A

approved mental health professional

191
Q

Evidence required for a section 2?

A

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
Q

What is the duration of a section 3?

A

6 months (and can be renewed)

193
Q

What is the purpose of a section 3?

A

Treatment

194
Q

Evidence required for section 3

A

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
Q

What is the duration of section 4?

A

72 hrs

196
Q

What is the purpose of a section 4?

A

Emergency order

Only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay”

197
Q

Professionals required for a section 4

A

1 doctor (doesn’t have to be S12 approved)

1 AMHP

198
Q

Evidence required for a section 4

A

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
Q

How long does a section 5(4) last for who’s holding power is it?

A

6hrs

Nurses’ holding power until Dr can attend

200
Q

What is the purpose / reason for a section 5(4)

A

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
Q

How long does section 5(2) last for and who’s holding power is it?

A

72 hrs

Doctors holding power to allow time for a S2 or S3 assessment

202
Q

What is the purpose / reason for a section 5(2)

A

For a pt ALREADY admitted (can be psych or general hospital) but wanting to leave

Cannot be coercively treated

203
Q

What are the police sections?

A

Section 135 and section 136

204
Q

How long does a section 135 last for?

A

36hrs

205
Q

Where and why can a section 135 be given?

A

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
Q

How long does section 136 last for?

A

24hrs (extended by 12hrs if medic)

207
Q

Where and why can a section 136 be given?

A

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
Q

Principles to think of for sections

A
  • Where is the patient?

- Have they been detained before?

209
Q

How many days do psychotic symptoms have to occur to be schizophrenic? - and what section is this relevant to?

A

30 days

Section 2- allows 28 days of assessment

210
Q

CAMHS vs Adult Psych

A

less pharma Tx

creative therapies

involving famly, school, college etc

211
Q

What % of mental health problems are established by age 14?

A

50%!

212
Q

What physical diseases does childhood physical abuse increase likelihood of?

A

Heart diseaese in women
Cancer in both
COPD

213
Q

What is attachment theory?

A

“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
Q

Difference between Knight’s move and Flight of Ideas?

A

Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

215
Q

What do metabolic SEs of antipsychotic drugs include?

A

hyperlipidemia, hypercholesterolemia, hyperglycemia and weight gain

216
Q

what is the most common endocrine disorder resulting from lithium toxicity?

A

hypothyroidism

217
Q

MOA of venlafaxine?

A

Seratonin and noradrenaline reuptake inhibitor

218
Q

most common form of delusions in schizophrenia?

A

Persecutory delusions

219
Q

What are the feature of neuroleptic malignant syndrome?

A

FALTER

Fever
Arms
Leukocytosis
Tremors
Elevated CPK
Rigidity
220
Q

What is the treatment for neuroleptic malignant syndrome?

A

Bromocriptine

221
Q

Treatment for acute dystonic reaction?

A

Procyclizine

222
Q

Treatment for serotonin syndrome

A

Cyproheptadine

223
Q

Flattening of affect

A

reduced range of emotional expression

224
Q

Incongruity of affect

A

mismatch between emotional expression and content

225
Q

Obsession

A

An unwanted recurrent thought (experienced as intrusive)

226
Q

To do:

A 
types of schizophrenia / psychosis
tangent
mild depression symtpoms 
personality disorders
psych emergencies
who can release them from sections
227
Q

Mx Psychosis

A

Bio
- Antipsychotics (+clozapine for Rx resistance)

Psycho

  • Family therapy
  • CBT

Sicio:

  • family intervention / carer support
  • employment / activity / education
  • support with engagement / ebenefits / PIS
228
Q

Dx of bipolar disorder with a Hx of manice episodes, on olanzapine. No relapses in 3 years, can he drive? DVLA?

A

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
Q

Baby Blues

A

Transient condition 75-90% up to 2/52 postnatal weeks

NORMAL

230
Q

Puerperal psychosis

A

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
Q

Mx Depression

A 
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
Q

Hypnotics

A
  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
Q

Anxiolytics

A

NB first line (&2nd line) intervention is talking treatment / IAPT
Pregabalin

234
Q

Antidepressants

A

**look @slide

Tetracyclic: Na and Serato

  • Mirtazapine
  • SE: sedation, wt gain
235
Q

Antipsychotics

A

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
Q

Mood stabilisers

A
  1. Lithium
  2. Antipsychotics
  3. Anticonvulsants
237
Q

ADHD Rx

A

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
Q

Psychological interventions for mood disorders

A

Primary care / vol sector

  • counselling
  • psychoeducation (group / individual)
  • CBT

Secondary /tertiary

  • dialectic behavioural therapy
  • psychoanalytic psychoterapy
  • group therap
  • family therapy
239
Q

Psychological interventions for mood disorders

A

Primary care / vol sector

  • counselling
  • psychoeducation (group / individual)
  • CBT

Secondary /tertiary

  • dialectic behavioural therapy
  • psychoanalytic psychoterapy
  • group therap
  • family therapy
240
Q

EUPD

A
  • Self-harm
  • Distured or uncertain self-image
  • Efforts to avoid abandonment
  • Chronic feelings of emptiness
  • Impulsivity
  • Difficulty maintaininy healthy relationships
241
Q

Anankastic PD

A

Obsessive

242
Q

What score to assess depression?

A

PHQ-9 score

243
Q

Score to assess risk of suicide

A

The sad person score

*Phase 3a Julia (8 decks)

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