Psychiatry Flashcards
What are some common side effects of ECT?
Reversible memory loss - retrograde>anterograde
Tension headache
Nausea
Transient muscle pain
What are some less common side effects of ECT?
Skin burns
Prolonged seizure
What features in a psychiatric history would correlate with increased risk of harm?
Previous self harm/harm.
Suicide attempts - more serious if planned, precautions taken to avoid discovered, help sought after, note left.
Recent actions.
Recent major stress.
What features in a mental state would correlate with increased risk of harm?
Suicidal or violent thoughts
Significant mood disturbance.
Psychotic symptoms.
How can you formulate a risk assessment?
What are the risks?
How probable?
How intermediate and long lasting?
What can be done to reduce risk and what may affect probability?
When would a psychodynamic psychotherapy be used?
Anxiety disorders.
Weekly for up to years.
Focuses on changing current behaviours and feeling by analysing past experiences.
Interpersonal therapy.
Depressive disorders.
Weekly up to 4 months.
Focuses on understanding problematic interpersonal relationships.
Enable better control over mood and behaviour.
CBT.
OCD, phobia, anxiety.
6 weeks to 6 months.
Aims to change distorted, harmful, irrational or ineffective beliefs. Teach skills and strategies.
Motivational interviewing.
Substance abuse, depressive disorders.
2-4 sessions.
What are the risk factors for completed suicide?
Male, unemployed, isolated, mental or psysical illness, drugs, alcohol.
Current mental state.
Planned, final acts, secrecy.
What is ‘impaired control’ in substance dependancy?
Using in larger or longer amounts than intended.
Repeated failed attempts to cut down.
Desire to obtain and use.
What is ‘social impairment’ in substance dependancy?
Problems fufilling at work, school or social obligations
Reduced social and recreational activities
What is ‘risky use’ in substance dependancy?
Use in physically hazardous situations - driving a car
Use despite knowledge of physical problem - alcohol and cirrhosis
What is ‘pharmacological factors’ in substance dependancy?
Drug tolerance - need to increase dose to achieve affect
Withdrawl - substance dependant collection of symptoms that appear after cessation of prolonged drug use
What is the main active component of cannabis?
THC
What are the clinical features of cannabis?
Intoxication Anxiety or panic Red eyes Munchies Dry mouth Tachycaria and increase BP
What are the clinical features of cannabis withdrawl?
Unstable mood Depression Agression Sweating Headache
What is benzodiazepine rebound phenomena?
Re-emergence of symptoms absent or prev controlled after med stopped for a few days
What is the clinical features of benzodiazepine overdose?
ANS Sweating N,V and anorexia HTN Tremors Seizure
What is the management for benzo dependance?
Psychotherapy
Dose tapering
Seizure prophylaxis - carbamazepine
How does cocaine work?
Increases dopamine in the synaptic cleft
Inhibits Na channels - LA action
What is the treatment for nicotine addiction?
Councelling and support
Nicotine replacement therapy
Vareniciline - reduces potitive symptoms and prevents withdrawl
Bupropion - reduces cravings and withdrawl symptpms
How does caffeine work?
Increased cAMP.
What is ADHD?
Characterised by inattention, hyperactivity, and impulsivity.
Interferes with social and academic functioning.
Last for at least 6 months.
Occurs before the age of 7.
Present in multiple settings.
What is the pathology in ADHD?
Decreased dopamine.
What are the risk factors for ADHD?
Genetic predisposition.
Prematurity.
Exposure to alcohol inutero.
What are the symptoms of ADHD?
Short attention span. Hyperactivity. Constant failure in school. Inability to sit through cartoons. Disobediance.
What is the management of ADHD?
Behavioural - First line for preschool and adjuncts for school age.
Socio-education measures.
Parent training.
Methylphenidate - Ritalin.
Increases dopamine.
First line >6 year
What is the effects of Ritalin?
Increased mental performance.
Improved concentration.
Congnition.
Fine motor skills.
What are the main side effects of Ritalin?
Sympathic effects - dry mouth, sweating.
Epileptogenic potential.
Decreased growth rate (reversible if stopped).
Titrate slowly.
What drug is second line therapy?
Atomoxetine.
What is ASD?
Neurodevelopment disorder.
Evident before 2-3 yers of age.
Spectrum ranges from Kanners - Aspergers.
What are the risk factors for ASD development?
Geneticcs
Toxin exposure
Prenatal infections
What are the core features of ASD?
Persistent impairment in social and communication.
Restricted, sterotypical patterns of behaviour.
What are some additional features of ASD?
Intellectual impairment
Language impairment.
Motor abnormalities.
Epilepsy
Pica
Retts Syndrome.
Childhood autism/Kanners Syndrome.
Impaired language. Impaired intelligence. No eye contact with parents. Reduced emotional response. Repetitive movements. Distrubed by small changed in surroundings.
Aspergers Syndrome.
Normal language and cognitive development.
Normal or high IQ.
Exceptional skills/interests in specific areas.
Reduced ability to empathise.
Retts Syndrome.
Normal development until 7-24 months then onset.
Loss of motor, cognitive and language competancies.
Hand wringing.
Hellers Dementia.
Childhood dintingerative disorders.
Normal development then loss of acquired skills within several months.
What is the management of ASD?
Behaviour and educational management Competance training Structures Set limits Medical treatment for co-morbidities.
What are the indicators of poor prognosis in ASD?
Severe core symptoms.
Low IQ.
Poor or absent language skills.
Late initiation of treatment.
PSTD.
Symptoms which last >1 month following >1 traumatic event. Intrusive thoughts. Distressing dreams Flashbacks. Physiological reactions Avoiding memories/reminders Negative mood Detatchment Impact on fucntioning
What is the management for PTSD?
CBT - exposure ot trauma focuses, eye movement
SSRI, SNRI
What is word salad?
Incoherant thinking expressed as a sequence of words without logical connections.
What is neologisms?
The creation of new words with idiosyncratic meaning
What is echolalia?
Repition of speech
What is clang association?
Use of words based on rhyme patterns rather than meaning
What is circumstantial speech?
Non linear thought expressed as a long winded manner of explanation, before expressing the central idea
What is thought blocking?
An objective observation of abrupt ending in a thought process, sudden interuption in speech
What are first rank symptoms?
Thought insertion or withdrawl
Delusions of control
Delusional perceptions
3rd person auditory hallucinations
