Psychiatry Flashcards
1
Q
Key features of Generalised Anxiety Disorder
A
- Anxiety >6 months not restricated to a particular circumstance.
- Aetiology - genetics, life stressor, F>M, brain damage, reduced ANS response, more in 45-59y
- Dx= 4 of: (*including 1 ANS hyperstimulation)
- Palpitations*
- Sweating*
- Shaking*
- Dry mouth*
- Dizzy
- Derealisation/ depersonalisation
- Fear of losing control
- Fear of dying
- ‘On edge’
- Difficulty concentrating
- Difficulty going to sleep
- SOB
- Lump in throat
- Chest pain
- N+V
- Hot flushes/ chills
- Numbness/ tingling
- Muscle tension
- Restlessness
- Irritability
- Tx:
- Education
- CBT/ pscyhotherapy
- Medical - 1st line= SSRI eg citalopram
- BDZ in acute eg lorazepma
2
Q
Key features of panic disorder
A
- Panic disorder= recurrent panic attacks.
- Panic attack= period of intense fear. Rapid onset, peak 10 mins, lasts <30 mins. Spont. + situational.
- Aetiology: F>M, esp teens/ middle age. More post-synaptic response to seratonin.
- Presentation: ANS hyperstimulation
- Tremor
- Tachycardia
- Tachypnoea
- Hyertension
- Sweating
- GI upset
- Tx:
- CBT
- 1st line: SSRI
- 2nd line - TCA, SNRI, MAOi
3
Q
Key features of phobic disorder
A
- Recurrent Sx on anxiety in presence of specific object –> avoidance.
- Eg acoraphobia, social phobia
- Aetiology- F>M, onset 7-20y, conditioned theory.
- Tx:
- Behavioural - graded exposure
- Cognitive - educational + coping strategies
- Medication if severe - SSRI (?PRN BDZ eg flying)
4
Q
Key features of obsessive compulsive disorder
A
- Obsessionsal thoughts and/or compulsive acts. Repeated rituals interfere with functioning.
- Aetiology- F>M, esp 20s. Dysregulation of seratonin.
- Tx:
- CBT, psychotherapy
- 1st line= SSRI –> alt SSRI –> clomipramine
- ECT
5
Q
Key features of PTSD
A
- Severe psychological disturbance <6m after traumatic even –> re-experiencing of elements of event + ++arousal, avoidance, emotional numbing, interfering with functioning.
- ICD-10:
- >2 persistent Sx of increased pscyhological sensitivity + arounsal, difficulty sleeping, irritability, anger, poor concentration, hypervigillance, increased startle response.
- Persistent reliving of stressor - flashbacks, dreams, memories.
- Avoidance.
- Inability to recall.
- Tx:
- 1st line= Rapid eye movement desensitisation
- CBT
- Exposure therapy
- Meds - SSRIs eg paroxetine, amitrptylline
6
Q
Key features of somatoform disorder
A
- = Repeated presentation of physical Sx + requests for medical Ix despite -ve results + reassurance.
- At least 6 Sx in 2 different body systems.
- Hypochondrical disorder= >6m preoccupation with having >1 serious dosrder
- Tx:
- Ix - rule out DDx
- Try to avoid meds. Only effective when co-morbid anxiety.
7
Q
State and Trait anxiety
A
- State= Temp. Condition due to percieved threat
- Trait= Personality characteristic
8
Q
Anxiety management
A
- Dx - rule out physical condition, meds, co-morbidities
- Low intensity CBT, pscyhoeducation
- 1st line - high intensity psychological intervention. 2nd line drugs
- Psychological Tx + drugs
- Drugs:
- 1st line = SSRI
- 2nd line GAD - pregabalin
- BDZ short term
9
Q
Key features of Mental Health Act 2007
A
- Part 1 = Mental disorder (not substances or LD) and at risk to self or others
- Part 2= Sections + holding orders
- Section 2= 28d. MD + risk. No capacity/ consent. AMHP, section 12 doctor + other doctor
- Section 3= 6 months. Same + nearest relative agreement.
- Section 4= emergency. 72h. 1 doctor + 1 AMHP.
- Holding powers - already admitted. 5(2)= 72h, awaiting assessment. 5(4)= 6h - by nurses.
- Police powers - 135 inside home, 136 outside house –> place of safety for 48h
- S17= approved leave
10
Q
Key features of the Mental Capacity Act
A
- Capacity= situational
- Assessing capacity:
- Understand the consequences
- Retain and repeat information
- Weigh up the options
- Communicate
- –> Lack any one of these –> act in best interests.
- Assume a person has the capacity to make a decision themselves, unless it’s proved otherwise
- Wherever possible, help people to make their own decisions
- Don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision
- If you make a decision for someone who doesn’t have capacity, it must be in their best interests
- Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms
11
Q
Definition of delirium and causes
A
- = Acute onset of fluctuating cognitive impairment
- Types:
- Hyperactive - agitation, arousal. Risk of falls
- Hypoactive - Lethargy, psychomotor retardation. Risk of sores, dehydration
- Mixed- variable.
- Causes= PINCH ME
- Pain
- Infection/ Intracranial
- Neoplasm/ Nutrition
- Constipation
- Hydration
- Medications - psychoactive, sedating, steroids, L-dopa, opiates, alcohol.
- Metabolic - Electrolytes, thyroid, glucose
- Environment - esp sensory impairment
12
Q
Presentation of delirium
A
- Incoherent speech
- Disorganised thinking
- Impaired consciousness
- Impaired cognitions
- Reduced attention
- Impaired sleep-wake cycle
- Drowsy
- Agitation/ retardation
- Emotional lability
- Anxiety/ depression
- Delusions - paranoid, persecutory
- Hallucinations es pvisual
13
Q
Ix an Tx of delirium
A
- Ix:
- 4-AT (delirium test), MMSE, AMTS, CAM (confusion assessment method)
- Bedside - o2, BM, ECG, urine dip, sputum
- Bloods - FBC, U+Es, glucose
- Imaging- CXR
- Tx:
- ID + Tx cause
- Optimise condition - hydration, nutrition, elimination, pain
- Optimise environment - lighting, clocks, pics
- Support and involve family - re-orientation
- Avoid sedation - quiet room. If needed- Haloperidol or clozapine in PD
14
Q
Bloods in confusion screen
A
- FBC
- U+Es
- LFTs
- TFTs
- B12
- Folate
- HbA1c
- Vit D
- Calcium, phosphate, magnesium
- CRP
15
Q
Confusion Assessment Method - Identification of delirium
A
- Confusion - acute and fluctuating
- Inattention
- Either:
- Disorganised thinking - disorganised, incoherent, illolgical
- Altered level of consciousness - lethargy, stupor, comatose, hypervigilant
- Either:
16
Q
Dementia - what is it, presentation, Ix and Tx
A
- = Progressive global cognitive deficits with functional impairment. DDx excluded. Sx at least 6m.
- Presentation:
- Hallucinations + deliusions
- Anxiety/ depression
- Personality changed
- Reduced cognition
- Pathological emotion
- Seizures
- Functional impairment
- Memory loss
- Ix:
- Bedside - ECG, MMSE, Adden-Brookes, EEG
- Bloods - FBC, LFTs, U+Es, glucose, ESR, TFTs, calcium, Mg, phosphate, B12, folate, CRP, cultures
- Imaging - CT/ MRI head, CXR
- Tx: Bio-Psycho-Social!
- Cons - support, OT, physio, NB driving
- Meds- SSRI for depression/ anxiety. Cognitive enhancement based on type of dementia
17
Q
Key features of Alzheimer’s Disease
A
- RF: Age, Downs, head injury.
- Pathophysiology- Plaques and tangles. Reduced ACh
- Presentation;
- Early - Memory loss, disorientation, behaviour change (agression, wandering, temper, sexual disinhibition)
- Middle - Loss of intellect, aphasia, apraxia, agnosia, loss of executive function
- Late - Declining physical condition, change in gait, spasticity, weight loss, seizures
- Tx:
- AChEi - Donepezil (urinary incontinence), rivastigmine, galantamine
- NMDA - memantine
18
Q
Key features of dementia with Lewy Bodies
A
- Mixed pathology - lewy bodies, plaques, tangles, vascular
- Presentation:
- Dementia
- Depression
- Falls + syncope
- Visual hallucinations
- REM sleep disorder
- Parkinsonism
- Fluctuating cognition
- Ix: CT, DAT, MRI, SPECT
- Tx:
- Avoid antipsychotics
- AChEi/ memantine trial
- AntiPD for motor Sx
- Clonazepam for motor Sx
19
Q
Key features of fronto-temporal dementia
A
- Early onset 45-65y. Slow decline.
- Presentation:
- Disinhibition - overeating, sexual etc
- Speech - mutisms
- Reduced cognition
- Poor personal hygiene
- Loss of insight
- Blunted emotion
- Wandering
- Ix: MRI, SPECT. Loss of fronto-temporal. Spared memory!
- Tx: non-specific
20
Q
Key features of vasacular dementia
A
- Cause= thromboembolism/ infarction
- Presentation:
- ?Prev stroke
- Depression
- Behaviour slowing
- Seizures
- Neuro - rigid, brisk reflexes
- Stepwise
- Focal neurology and signs
- Early emotional + personality change
- Ix: cholesterol, clotting, ?ECHO, carotid doppler
- Tx: x smoking, Anticoagulation, HTN control
