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TP Specialties > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is a Section 136?

A

Section used by the police. If someone in a public place seems to be suffering from a mental disorder they can be put into a place of safety for up to 24 hours.

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2
Q

What is a section 5(2)?

A

Used for patients who have a designated bed in a hospital i.e. not A&E.

Requires 1 doctor and the patient can be held for up to 72 hours

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3
Q

What is a section 2?

A

Admission for assessment of mental health disorder that last up to 28 days.

Requires 2 doctors - 1 needs to be an independent section 12 approved and 1 needs to have previous knoweledge of the patient.

Nearest relative should be consulted

AMHP will make the final decision based on the recomendations from the two doctors

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4
Q

What is a section 3?

A

Admission for treatment of a mental health disorder for up to 6 months.

Requires 2 doctors - 1 needs to be an independent section 12 approved doctor and 1 should have previous knowledge of the patient

Nearest realtive needs to agree to the admission

AMHP will make the final decision based on the recomendations from the two doctors

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5
Q

What are the indications for ECT?

A
  • Severe depression with life threatening or psychotic features
  • Established mania
  • Catatonic states
  • Positive psychotic symptoms
  • Severe postnatal depression
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6
Q

What are the side effects of ECT?

A
  • Anaesthetic complications
  • Loss of memory
  • Headaches
  • Nausea
  • Muscle Pains
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7
Q

What is the aetiology of Alzheimer’s disease?

A

Beta amyloid plaques between neurones and tangles of hyperphosphorylated tau inside neurones, atrophy and cholinergic loss

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8
Q

What is the clinical presentation of Alzheimer’s disease?

A
  • Amnesia with recent memories lost first and early disorientation
  • Aphasia (difficulties finding words)
  • Agnosia (difficulties recognising people)
  • Apraxia (inability to carry out skilled tasks)
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9
Q

What is the aetiology of Vascular dementia?

A

Multiple cortical infarctions resulting from widespread cerebrovascular disease

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10
Q

What is the clinical presentation of vascular dementia?

A
  • Step wise progression
  • Symptoms will reflect the site of the lesions and therefore can be patchy with some areas of personality and cognition maintained
  • Will fall early
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11
Q

What is the aetiology of Lewy Body Dementia?

A

Eosinophillic intracytoplasmic neuronal structures composed of alpha syneuclein with ubiquitin aka Lewy Bodies

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12
Q

What is the clinical presentation of Lewy Body Dementia?

A
  • Fluctuating confusion and marked variations in level of alertness
  • Vivid visual hallucinations
  • Parkinsonian signs
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13
Q

What is the aetiology of frontotemporal dementia?

A

Neurodegenerative disorders associated with degeneration of the anterior part of the brain. There are also intracellular inclusion bodies

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14
Q

What is the clincal presentation of frontotemporal dementia?

A
  • Frontal symptoms such as: Coarseness of personality, loss of language fluency, self-neglect, inattentiveness, peurile preoccupations, economy of effort and impulsive responding
  • Memory impairment
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15
Q

What are the general clinical features of dementia?

A
  • Memory loss
  • Agitation
  • Agression
  • Apathy
  • Acquired chronic and progressive cognitive impairment that is enough to impair activities of daily living
  • Diagnosis based on a history of change in cognitive functioning
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16
Q

What blood tests should be carried out in a patient suspected of having dementia?

A
  • FBC
  • TFTs
  • LFTs
  • B12
  • Metabolic Panel
  • HIV testing
  • Syphilis testing
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17
Q

What is the medical management of dementia?

A
  • All therapies should be started early and stopping therapies will cause a rapid and irreversible deterioration
  • Consider anti-depressants in patients showing symptoms
  • NMDA Receptor antagonists (Memantine) is particularly useful in alzheimers
  • Acetycholinesterase Inhibitors (donepezil, rivastigmine) have also been shown to slow the rate of cognitive decline
  • AVOID anti-psychotics in Lewy Body dementia
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18
Q

What is psychosis?

A

A mental state in which reality is grossly distorted with the following features:

  • Hallucinations
  • Delusions
  • Thought disorder
  • Negative symptoms
  • Psychomotor function abnormalities
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19
Q

What is a delusion?

A

An unshakeable false belief that is not accepted by other members of the patients culture

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20
Q

What is an overvalued idea?

A

A plausible belief tha ta patient becomes preoccupied with to an unreasonable extent

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21
Q

What is circumstantial and tangential thinking?

A

Speech that is delayed in reaching its final goal because of over inclusion of details.

Circumstantial thinking will eventually reach the end goal whereas tangential thinking will jump from topic to topic never reaching the end goal

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22
Q

What is flight of ideas?

A

Accelerated thinking that results in a stream of connected concepts

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23
Q

What is loosening of association?

A

When a patient’s train of though shifts suddenely from one very looseley related idea to another. In its worst form will become word salad

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24
Q

What is thought blocking?

A

When a patient experiences a sudden cessation to their flow of thought, often mid sentence

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25
Q

What are the negative symptoms of psychosis?

A
  • Apathy
  • Poverty of thought
  • Speech defecity
  • Blunted affect
  • Social Isolation
  • Poor self-care
  • Cognitive deficits
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26
Q

What are the main side effects of Olanzapine?

A
  • Sedation

- Weight gain

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27
Q

What are the main side effects of Quetiapine?

A
  • Sedation

- Weight gain

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28
Q

What are the main side effects of Clozapine?

A
  • Be aware of Agranulocytosis!! (affects 0.7%)
  • Sedation
  • Anti-cholinergic side effects
  • Weight gain
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29
Q

What are the general side effects of Antipsychotics?

A
  • Extrapyrimidal side effects (dystonia, akathisia, parkinsonism, tardive dyskinesia)
  • Hyperprolactinaemia (typical more than atypical)
  • Weight gain
  • Sedation
  • Increased risk of diabetes
  • Dyslipidaemia
  • Anticholinergic side effects
  • Arrythmias
  • Seizures
30
Q

What is neuroleptic malignancy syndrome?

A
  • Potentially fatal side effect of antipsychotics
  • Usually triggered by a change in drug or a dose increase
  • Symptoms: Muscle stiggness and rigidity, altered conciousness, fever, tachycardia, labile BP, raised CK and WCC
31
Q

What are the first rank symptoms of schizophrenia?

A
  • Thought echo, insertion, withdrawal or broadcast
  • Delusions of control of passivity
  • Auditory hallucinations giving a running commentary and discussing the patient amongst themselves
  • Bizzare delusions
32
Q

What is the biopsychosocial approach to managing a schizophrenic patient?

A

Biological:
- First line should be an atypical antipsychotic such as Olanzapine

Psychological:

  • CBT
  • Family therapy
  • Concordance therapy to engage patient with their treatment

Social:

  • Admission to hospital
  • Social skills training
  • Adressing education, housing, social activities and personal skills to improve QOL
33
Q

What are the clinical features of delusional disorder?

A
  • Development of a single set of delusions for the period of at least 3 months
  • Onset in middle age
  • Schizophrenic type delusions SHOULD NOT be present
34
Q

What is the ICD-10 criteria for depression?

A

At least 2 weeks of at least 2 of the following symptoms:

  • Depressed mood that varies little day to day and is not reactive
  • Anhedonia
  • Anergia
35
Q

What are the biological symptoms of depression?

A
  • Early morning wakening
  • Depression worse in the morning
  • Marked loss of appetite and weight loss
  • Somatisation
  • Psychomotor retardation
  • Psycomotor agitation
  • Loss of libidio
36
Q

What are the cognitive symptoms of depression?

A
  • Reduced concentration and memory
  • Poor self esteem
  • Guilt
  • Hoplessness
  • Suicidal ideation
37
Q

What is the biopsychosocial approach to the management of depression?

A

Social:
- Encourage social reengagement

Psychological:

  • CBT
  • Psychodynamic therapy

Biological:

  • First line SSRIs: Sertraline or Fluoxetine
  • Consider Mirtazipine in patients with decreased appetite or sleeping issues
38
Q

What are the side effects of SSRIs?

A
  • GI Disturbance (especially if stopped suddenely)
  • Anxiety and agitation
  • Loss of appetite and weight loss
  • Insomnia
39
Q

What are the side effects of TCAs?

A
  • Anticholinergic
  • Adrenergic receptor blockade
  • Histaminergic receptor blockade (sedation)
  • Cardiotoxic side effects (significant in OD)
40
Q

What is the classification for Mild, Moderate and Severe depression?

A

Mild: 4 or more symptoms (at least 2 core)

Moderate: 5 or more symptoms with difficulties in concentration

Severe: 7 or more symptoms (all 3 core) and unable to continue normal activities

41
Q

What are the clinical features of mania?

A

Biological Symptoms:

  • Decreased need for sleep
  • Increased energy

Cognitive Symptoms:

  • Elevated sense of self esteem or grandiosity
  • Poor concentration
  • flight of ideas
  • Pressure of speech
  • Impaired judgement and insight

Psychotic:

  • Disorder thought form
  • Circumstantiality and tangentiality
  • Flight of ideas
  • Delusions
  • Perceptual distrubance (not hallucinations or illusions)
42
Q

What is the medical management of mania?

A

Acute:

  • If needed rapid tranquilize with IV/IO Lorazepam or Haloperidol
  • Anti-psychotic such as olanzapine
  • Benzodiazepine for sedation if needed

Long term:
- Mood stabilisers, first line is Lithium

43
Q

What are the symptoms of lithium toxicity?

A
  • Lithium levels >1.2mmol/L
  • GI Disturbances
  • Sluggishness
  • Giddiness
  • Ataxia
  • Gross tremor
  • Fits
  • Renal failure
44
Q

What can cause lithium toxicity?

A
  • Fluid and salt balance changes from diet, dehydration oro D&V
  • NSAIDs or ACEi
  • Accidental or deliberate OD
45
Q

What are the clinical features of an acute stress reaction?

A
  • Transient state that starts within minute of the trauma and resolves within 1-3 days
  • Dazed
  • Disorientation
  • Narrowing of attention
  • Inability to process external stimuli
  • Amnesia of the stressor
46
Q

What are the clinical features of Adjustment disorder?

A
  • Recent stressor within 3 months
  • Out of proportion with expected reactions to the stressor
  • Symptoms that cause marked distress and impairment in functioning

Categories of symptoms:

  • Depressed mood
  • Anxiety
  • Mixed anxiety depression
  • Conduct disturbance
  • Mixed disturbance of emotions and conduct
  • Unspecified
47
Q

What are the symptoms of anxiety?

A
  • Apprehension
  • Motor tension
  • Autonomic overreactivity
48
Q

What are the clinical features of panic disorder?

A
  • Acute episodes of 100% anxiety

- Self limiting and last no longer than 30 mins

49
Q

What is agoraphobia?

A

Fear of being unable to escape to a safe place, includes a fear of open spaces and situations that are confined and difficult to leave without attracting attention

50
Q

What are obsessions and compulsions?

A

Obsessions:
- Recurrent, unwanted intrusive thoughts, images, or impulses that enter the patients mind, despite attempts to resit them

Compulsions:
- Repeated, stereotyped and seemingly purposeful rituals that the patient feels compelled to carry out even though they are irrational and often have no link to the obsession

51
Q

What are the clinical features of PTSD?

A
  • Re-experiencing
  • Avoidance
  • Hyperarousal
  • Emotional detachment
  • Decreased intrerest in activities
  • Powerful emotions including anger, loss of control, shame and uncontrollable crying
52
Q

What is the management of PTSD?

A
  • SSRIs first line
  • CBT
  • Eye movement desensitisation and reprocessing therapy
53
Q

What are the features of paranoid personality disorder?

A
  • Sensitive
  • Unforgiving
  • Suspicious
  • Possesive and jealous of partners
  • Excessive self-importance
  • Conspiracy theories
  • Tenacious sense of rights
54
Q

What are the features of schizoid personality disorder?

A
  • Anhedonia
  • Limited emotional range
  • Little sexual interest
  • Apparent disinterest to praise or criticism
  • Lacks close relationships
  • Prefers one player activities
  • Normal social conventions ignored
  • Excessive fantasy world
55
Q

What are the features of Histrionic personality disorder?

A
  • Attention seeking
  • Concerned with own appearance
  • Theatrical
  • Open to suggestion
  • Racy and seductive
  • Shallow affect
56
Q

What are the features of emotionally unstable personality disorder?

A
  • Affective instability
  • Explosive behaviour
  • Impulsive
  • Outbursts of anger
  • Unable to plan or consider consequences

Boderline:

  • Self-image unclear
  • Chronic empty feelings
  • Abandonment fears
  • Relationships are intense and unstable
  • Suicide attempts and self-harm

Impulsive:

  • Lacks impulse control
  • Outburts or threats of violence
  • Sensitivity to being thwarted or criticised
  • Emotionally unstable
  • Inability to plan ahead
  • Thoughtless of consequences
57
Q

What are the features of antisocial personality disorder?

A
  • Forms but cannot maintain relationships
  • Irresponsible
  • Guiltless
  • Heartless
  • Temper lost easily
  • Someone else’s fault
58
Q

What are the features of anankastic personality disorder?

A
  • Doubtful
  • Excessive detail
  • Tasks not completed
  • Adheres to rules
  • Inflexible
  • Likes own way
  • Excludes pleasure and relationships
  • Dominated by intrusive thoughts
59
Q

What are the features of avoidant personality disorder?

A
  • Avoid social contact
  • Fears rejection/criticism
  • Restricted lifestyle
  • Apprehensive
  • Inferiority
  • Doesn’t get involved unless sure of acceptance
60
Q

What are the features of dependent personality disorder?

A
  • Subordinate
  • Undemanding
  • Feels helpless when alone
  • Fears abandonment
  • Encourages others to make decisions
  • Reassurance needed
61
Q

What are the clinical features of delrium tremens?

A
  • Onset 48 hours into abstinence
  • Duration fro 3-4 days
  • Symptoms: Confusion, hallucinations, affective changes, gross tremor, autonomic disturbance, delusions
62
Q

What is the management of delirium tremens?

A
  • Chlordiazepoxide
  • Parenteral thiamine
  • Fluid and electrolyte restoration
63
Q

What is Wernicke’s encephalopathy?

A
  • Caused by thiamine deficiency
  • Triad of: Confusion, ataxia and opthalmoplegia
  • Medical emergency and requires urgent parenteral thiamine
64
Q

What is Korsakoff’s syndrome?

A
  • Irreversible anterograde amnesia
  • Patient able to register new events but unable to recall them in a few minutes
  • May confabulate
65
Q

What is nutritional decompensation?

A
  • BMI <13
  • Weight loss >1kg per week
  • Purpuric rash
  • Cold peripheries
  • Core body temperature <34.5
  • Hypotension with systolic <80
  • Bradycardia <40
  • Inability to stand from squatting
  • Electrolyte imbalance
66
Q

What are the clinical features of anorexia nervosa?

A
  • BMI <17.5 or weight 15% less than expected
  • Deliberate weight loss
  • Distorted body image
  • Endocrine dysfunction: amenorrhoea, impotence, loss of libido and delayed puberty
67
Q

What is the management of anorexia nervosa?

A
  • Ensure effective engagement
  • Psycho-education
  • Treat comorbid illnesses
  • Nutritional management and weight restoration with realistic targets
  • Psychotherapies such as CBT and family therapy
68
Q

When would you consider inpatient treatment for someone with anorexia nervosa?

A
  • BMI <13 or extremely rapid weight loss
  • Serious physical complicaations
  • High suicide risk
69
Q

What are the clinical features of bulimia nervosa?

A
  • Binge eating
  • Purging
  • Body image distortion
  • BMI >17.5
70
Q

What is the management of bulimia nervosa?

A
  • Treat medical complications
  • Fluoxetine (SSRI) - helps control impulses
  • Treat comorbid psych illness
  • CBT

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