Psychiatry Flashcards
1
Q
what is an illusion
A
misperception of real stimuli e.g. waking up and mistaking your coat for a person
2
Q
what is a hallucination
A
perception in the absence of external stimulus
3
Q
what is an over-valued idea
A
belief sustained beyond reason but held with less rigidity
4
Q
delusion
A
false belief that is firmly maintained in spite of evidence to the contrary
5
Q
delusional perception
A
delusional belief resulting from a real perception
6
Q
thought insertion
A
thoughts have been inserted by an external agency
7
Q
thought withdrawal
A
thoughts stolen by external agency
8
Q
thought broadcast
A
thoughts are broadcast so everyone can hear
9
Q
thought echo
A
auditory hallucination where thoughts are being heard aloud
10
Q
thought block
A
sudden interruption in train of thoughts, leaving a blank
11
Q
concrete thinking
A
lack of abstract thinking
12
Q
loosening of association
A
lack of logical association between thoughts
13
Q
loosening of association
A
lack of logical association between thoughts = incoherent speech
14
Q
circumstantiality
A
talking at great length but still returns to topic
15
Q
perseveration
A
repetition of a word (organic/frontal disorder)
16
Q
tangential
A
does not return to topic
17
Q
confabulation
A
giving a false account to fill a memory gap
18
Q
somatic passivity
A
delusional belief that body sensations are due to an external agency
19
Q
made acts, feelings and drives
A
experience being carried out by the patient is considered alien/imposed
20
Q
catatonia
A
significantly excited or inhibited motor activity
waxy flexibility or posturing
21
Q
stupor
A
loss of activity with no response to stimuli
22
Q
psychomotor retardation
A
slowing of thoughts and movements
23
Q
flight of ideas
A
rapidly skipping from one thought to distantly related ideas
24
Q
neologisms
A
use of novel/made up words
25
pressure of speech
rapid rate of delivery; may be associated with rhymes and puns
26
poverty of speech
reduced amount, range and content of speech
27
anhedonia
inability to derive pleasure from activities previously enjoyed
28
flattening of affect
reduced range of emotional expression
29
incongruity of affect
mismatch between emotional expression and content
30
obsession
unwanted recurrent and intrusive thought
31
compulsion
an irresistible urge to behave in a certain way
32
compulsion
an irresistible urge to behave in a certain way
33
belle indifference
apparent lack of concern at symptoms/disability
34
depersonalisation
thoughts and feelings do not seem to belong to oneself
35
derealisation
feeling as if you are looking at yourself from outside
36
stereotypy
persistent repetition of a behaviour without cause
37
mannerism
habitual gesture of language or behaviour
38
types of hallucinations
command
39
types of delusion
Persecutory: outside agency to cause harm
grandiose
self-referential
Misidentification: Capgras/impostor; Fregoli; intermetamorphosis; subjective doubles
nihilistic: e.g. cotard
religious
hypochondrial
Guilt: responsible for harm
40
psychosis
loss of contact with reality
41
positive symptoms of psychosis
delusions
disordered thought/speech
hallucinations
42
negative psychotic symptoms
flat/blunted affect
poverty of speech
lack of motivation
poor ability to function
43
negative psychotic symptoms
flat/blunted affect
poverty of speech
lack of motivation
poor ability to function
44
types of schizophrenia
Paranoid – Auditory/visual hallucinations and delusions (persecutory and/or grandiose). No thought disorder or flattened affect.
Hebephrenia – or disorganised type. Thought disorder and flat affect present together.
Catatonic – either immobile or agitated/purposeless movement. Waxy flexibility. Echolalia /Echopraxia
Simple – insidious and progressive negative symptoms with no history of psychotic symptoms.
Residual – chronic negative symptoms
45
1st rank symptoms
3rd person auditory hallucination
thought alienation
delusional perception
passivity experiences
46
other types of psychosis
```
puerperal psychosis
schizoaffective disorder
acute transient psychosis
persistent delusional disorder
organic psychosis
```
47
management of psychosis
bio: antipsychotics (clozapine in resistant)
psycho: family therapy, CBT
48
features of mania
```
increased energy/libido
decreased need for sleep
increased talking speed/ racing thoughts
grandiose delusions
psychotic beliefs about ability/identity
inappropriate elation
irritability
high risk activities
functional impairment
```
49
features of mania
```
increased energy/libido
decreased need for sleep
increased talking speed/ racing thoughts
grandiose delusions
psychotic beliefs about ability/identity
inappropriate elation
irritability
high risk activities
functional impairment
```
50
features of hypomania
does not affect functioning
```
elevation of mood
talkativeness
overfamiliarity
increased libido
decreased sleep
irritability
```
51
features of bipolar disorder
Characterized by at least two episodes in which the patient's mood and activity levels are significantly disturbed
This disturbance consisting on some occasions of mania/ hypomania and on others depression
Periods of recovery between episodes
Depressive episodes tend to last longer (average 6 months)
52
management of bipolar disorder
bio: mood stabilsers, antidepressants, antipsychotics
psycho: CBT, relapse prevention, psychoeducation
53
depression: core symptoms, other symptoms and scoring
core
- low mood, anhedonia, reduced energy levels
other
- poor concentration, low self esteem, feeling guilty/worthless, hopelessness about the future
- disturbed sleep, diminished appetite
- self-harm/suicide, psychosis
mild: 2 core + 2 others
moderate: 2 core, 3-4 others
severe: 3 core, 4+ others
54
post natal mood disorders
Baby blues
post natal depression
puerperal psychosis
55
features of baby blues
Transient condition that affects up to 75-80% of mothers up to 2 weeks after giving birth
Involves mood lability, tearfulness, mild anxiety and depressive symptoms
Normal
56
features of postnatal depression
Post-natal depression
Depressive disorder in weeks / months post partum
Rx as for depression
Complex multifactorial aetiology
57
features of puerperal psychosis
Puerperal psychosis
Within days or weeks of delivery, risk to mother and baby
Often needs admission (MBU optimal) and high risk of recurrence in subsequent pregnancies
Probable hormonal aetiology in women predisposed to bipolar disorder
58
management of depression
```
Bio
Antidepressants
SSRI, TCA, SSRI+TCA ,+adjuvant
Psycho
Talking treatment e.g CBT, CAT
Group work / self help
Psychoeducation
```
59
management of depression based on severity
mild: watchful waiting, improving access to psychological treatment
moderate: SSRI + IAPT, consider psychiatric referral
severe: consider admission, ECT
60
hypnotic drugs: subtypes and examples
Benzodiazepines
Diazepam, Temazepam, Lorazepam, Chlordiazepoxide (alcohol withdrawal)
Z-drugs
Zopiclone, Zolpidem
Melatonin
Over 55s short term only
61
contraindication of hypnotics and withdrawal effects
not used in GAD
withdrawal effects: sleep disturbance, irritability, seizures, breakthrough anxiety, respiratory depression
62
anxiolytics
(only after talking intervention)
SSRI: sertraline (GAD)
benzodiazepine short term
pregabalin
63
antidepressant categories and examples
selective serotonin reuptake inhibitors: fluoxetine, sertraline, paroxetine, citalopram
serotonin noradrenaline reuptake inhibitors: venlafaxine, duloxetine
tricyclics: Amitriptyline, Lofepramine, Trazodone
tetracyclics: mirtazapine
monoamine oxidase inhibitors: Phenalzine and Moclobemide
64
side effects of SSRI
abdominal, suicidality, sexual dysfunction safe in OD
65
side effects of TCA
sedation, anticholinergic, cardiac arrhythmias
66
side effects of SNRI
suicidality, serotonin syndrome, sexual dysfunction
67
side effects of tetracyclics
sedation, wt gain
68
side effects of MAOI
Hypertesive crises related to tyrosine in cheese, red wine etc
69
antipsychotic mode of action
dopamine blockage
70
antipsychotic subtypes
1st generation – Sulpiride, Haloperidol, Flupentixol, Chlorpromazine (more Extra Pyramidal Side effects)
2nd Generation – “atypical” Olanzapine, Risperidone, Quetiapine, Amisulpride, Aripiprazole (more Metabolic Side Effects)
Clozapine: weight gain, neutropenia
71
what are extrapyramidal side effects
dystonia, dyskinesia, neuroleptic malignancy syndrome
72
what are metabolic side effects
DM, weight gain, lipids, NM
73
mood stabilising drug options
lithium
antipsychotics e.g. olanzapine
anticonvulsants: sodium valproate, carbamazepine, lamotrigine
74
lithium side effects
renal impairment, tremor, confusion, thyroid dysfunction, weight gain
75
medication for ADHD and their side effects
Methylphenidate (ritalin)
SE appetite suppression, psychosis
Atomoxetine
SE liver dysfunction, suicidality
76
types of psychological interventions
primary care:
counselling
psychoeducation
CBT
```
secondary care:
Dialectic Behavioural Therapy
Psychoanalytic Psychotherapy
Group Therapy
Family therapy
```
77
when is exposure and response prevention used
CBT based treament for OCD
78
when is Eye movement desensitization and reprocessing used
PTSD
79
when is family therapy used
young people, anorexia, psychosis
80
when is group psychodynamic therapy used
personality
| mood
81
when is interpersonal therapy used
personality
| mood
82
social interventions
```
Benefits
Care package
Cultural support
Help with meaningful activity
Help with Housing
Safeguarding issues
Anti-discriminatory language (stigma)
Interface with Criminal justice system
MHA / MCA
Self-determination / person centred care
Access/support with Education
Social integration
Building social capital
Weighing up of ethical dilemmas
social prescribing
health coaching
substance abuse support group
```
83
features of emotionally unstable personality disorder
```
disturbed or uncertain self-image
efforts to avoid abandonment
chronic feelings of emptiness
impulsivity
difficulty in maintaining health relationships
Unhelpful use of substances
self harm
fluctuating mood
```
84
psychiatric emergencies
```
Alcohol withdrawal
Delirium tremens
Wernicke’s encephalopathy
Lithium toxicity
Acute dystonic reaction
Neuroleptic malignant syndrome
Seratonin syndrome
Drug overdose
Catatonia
Acute confusional state
```
85
cluster A personality disorders
Cluster A (odd or eccentric disorders)
Paranoid: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
Schizoid: lack of interest and detachment from social relationships, apathy, and restricted emotional expression
Schizotypal: a pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions
86
cluster B personality disorders
Cluster B (dramatic, emotional or erratic disorders)
Anti-social: a disregard for the rights of others, lack of empathy, increased self-image, manipulative and impulsive behaviour.
Borderline: mood swings, instability in relationships, self-image/identity, behaviour and affect, often leading to self-harm and impulsivity.
Histronic: attention seeking behaviour and excessive emotions.
Narcissistic: grandiosity, need for admiration and a perceived lack of empathy.
87
Cluster C personality disorders
Cluster C (anxious or fearful disorders)
Avoidant: social inhibition and inadequacy, extreme sensitivity to negative evaluation.
Dependent: a pervasive psychological need to be cared for by other people.
Obsessive-compulsive: rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendship
88
5 key principles of the mental capacity act
You must be treated as if you have capacity unless it is proven you do not
You must be supported to make your own decisions including being given information in different ways.
You have a right to make unwise decisions as long as you have capacity
Anything done for you must be in your best interests
Anything done for you must be the least restrictive option available
89
what is section 2 of the mental health act
Detention in hospital for assessment of your mental health and potentially get treatment
Lasts up to 28 days
90
what is section 3 of the mental health act
Detention in hospital for treatment, which might be necessary your health, safety or for the protection of other people
Lasts up to 6 months
91
what is section 5 of the MHA
Section 5(2)
Doctor's holding power to allow an assessment under the MHA
Lasts up to 72 hours
Section 5(iv)
Nurses holding power
6 hours
Needs to be followed by MHA
92
what is section 135 of the MHA
Police removal from home to designated place of safety for MHA assessment
93
what is section 136 of MHA
Police removal from public place to designated place of safety for MHA assessment
94
who do you need for an assessment under the MHA
2 FY2+ Drs (one is section 12 approved)
Approved mental health professional
95
what conditions must be met for someone to be sectioned
mental health disorder
severe enough nature to warrant hospital detention
risk to self, others or health
96
who could release a patient from the section
RMO (responsible medical officer?)
consultant psychiatrist
nearest relative
mental health tribunal
97
what is needed for a diagnosis of schizophrenia
```
at least 1 first rank symptom AND
2 or more secondary symptoms:
- delusions
-2nd person auditory hallucinations
- any other hallucination
- thought disorder
- catatonic behaviour
- negative symptoms
```
98
what is needed for a diagnosis of generalised anxiety
Excessive anxiety across different situations
>6 months
Tiredness
Poor concentration
Irritability
Muscle tension
Disturbed sleep (usually initial insomnia rather than EMW)
99
what are the symptoms of panic disorder
physical: palpitations, chest pain, choking, tachypnoea, dry mouth, urgency or micturition, dizziness, blurred vision, parasthesiae
psychological: feeling of impending doom, fear of dying, fear of losing control, depersonalisation and derealisation
100
what is OCD
obsessive thoughts + compulsive acts
obsessive thoughts are repetitive, intrusive, irrational and unwanted
101
what is conversion
Unconscious mechanism of symptom formation, which operates in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature
102
dissociation
An experience where a person may feel disconnected from himself and/or his surroundings
103
akathisis
a condition marked by motor restlessness, ranging from anxiety to inability to lie or sit quietly or to sleep
104
Projection
A mechanism in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others. For example, mother may project their anxiety on their children claiming that they are anxious instead
105
transference
the redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood
106
what are the 4 Ps of a formulation
predisposing
precipitating
perpetuating/prolonging
protective
107
when is dialectic behavioural therapy used
(borderline) personal therapy
108
what is dialectic behaviour therapy
Goal is to help patients learn to manage difficult emotions by letting them experience, recognise and accept them
‘Dialectics’ means trying to balance seemingly contradictory positions
109
what is cognitive analytic therapy
mixture of psychoanalytical and cognitive therapy
110
mode of action of monoamine oxidase inhibitors
prevent degradation of serotonin by blocking the enzyme
111
how do tricylclics work
block 5HT and NA transporters and prevent the re-uptake of serotonin
112
what is serotonin syndrome and how is it treated
neuromuscular abnormalitiies, altered mental state, autonomic dysfunction
treatment: cyproheptadine
113
what is the attachment timeline
0 - 3 months: indiscriminate attachment
3 - 6 months: preference for main caregiver
6 - 12 months: attached to main caregiver
12 months +: increasingly able to separate from main caregiver
114
what is the mode of action of chlorpromazine
Dopaminergic blockade in the mesolimbic system
115
features of the mental state exam
```
appearance/behaviour
speech
mood and affect
thoughts
cognition
insight
risk
```
116
second and third line treatment for bipolar
sodium valproate
| carbamazepine
117
how many months does it take for lithium to work
18
118
therapeutic range for lithium
0.4 - 1 mmol/L
119
Important tests to carry on patients with lithium
```
renal function (U+E, creatinine)
TFT (hypothyroidism)
```
120
side effects of lithium
```
Leukocytosis
Insipidus diabetes
tremors
hypothyroidism
increased urine
mums beware (teratrogenic)
```
121
what is lithium toxicity
lithium levels above 2.5
```
Blurred vision
COARSE tremor (fine tremor= early s/e)
Muscle weakness
Ataxia
N and V
Hyper-reflexia
Circulatory failure
Oliguria
Seizures
Coma
```
122
side effect of venlafaxine and contraindication
Venlafaxine can raise BP and is CI in heart disease.
123
risk factors for suicide
```
Alcohol or substance misuse
Bipolar, personality disorder
Previous suicide attempts
Physical or sexual abuse
Possession of firearms
Incarceration
Chronic pain
```
124
warning signs for suicide
Obsessive thinking about death
Feelings of hopelessness, worthlessness, helplessness
Behahaviours suggestive of absolute death wish:
Putting financial affairs in order
Visiting people to say goodbye
125
management of suicidal ideation
High risk of imminent suicide attempt: consider inpatient treatment
Medium risk: consider home crisis plan & provide details of crisis team
126
criteria for a delusion
certainty
incorrigibility
impossibility
127
4 things necessary for a diagnosis of GAD
6 months history of tension worry or anxiety
4 of the following
- autonomic
- chest/abdomen
- brain/mind
- tension
- general
does not fulfil criteria for other anxiety disorders
physical/medical conditions not responsible
128
treatment of GAD
mild: active monitoring
moderate: self-help
severe: CBT or SSRI
referral for specialist care
129
symptoms of PTSD
emotional numbing
avoidance
inability to recall
re-experiencing
hyper - arousal
130
how long should symptoms have occured for:
```
GAD
PTSD
OCD
depression
bulimia
```
```
GAD: 6 months
PTSD: 1 month
OCD: 2 weeks
Depression: 2 weeks
bulimia: 3 weeks
```
131
First line therapy for PTSD
Trauma focussed CBT
| eye movement desensitisation and reprocessing
132
second line therapy for PTSD
venlafaxine or an SSRI
133
features of anorexia nervosa
```
Dieting
Denial
Dread of gaining weight
Disturbed beliefs about weight
Doesn’t want help
Dual effect– dieting + over-exercise/diuretics, laxatives and self-induced vomiting
Disinterested/socially withdrawn
Decline in weight = rapid
```
Weight below 85% of predicted (adults <17.5)
Refusal to maintain a normal body weight for age and height
134
physical signs of anorexia
```
Dry skin
Hypercarotenemia
Lanugo body hair
Acrocyanosis
Breast atrophy
Swelling of the parotid and submandibular glands
Thinning hair
```
135
blood results for anorexia
increased: Cs and GH
cortisol, beta-carotene, cholesterol and growth hormone
decreased: potassium, T3, glucose, oestrogen, testosterone, FSH, LH and phosphate
136
other medical tests for someone with anorexia
DXA
ECG: bradycardia, prolonged QT, T wave changes (hypokalaemia)
137
risk assessment in anorexia
management of really sick patients with anorexia nervosa
138
treatment for anorexia
child
1. anorexia based family therapy
2. CBT
adult
individual eating disorder focused CBT
Maudsley anorexia nervosa treatment for adults
specialist supportive clinical management
139
what is bulimia nervosa
Binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising
140
investigative results on someone with bulimia nervosa
metabolic alkalosis
ECG hypokalaemia: first degree heart block, tall p-waves, flattened t waves
141
features of bulimia nervosa
recurrent binge eating
lack of control during episode
recurrent compensatory behaviour (vomiting, misuse of laxatives, diuretics, fasting, excessive exercise)
once a week for 3 months
self-evaluation is unduly influenced by body shape and weight
142
OCD categories and management
mild: still able to function
= 1. CBT + ERP or group CBT; 2. SSRI
moderate: less able to function
= high intensity CBT + ERP +/- SSRI
severe: unable to function
= high intensity CBT + ERP + SSRI
143
opiate overdose
acute: drowsiness, respiratory depression, hypotension, pin point pupils
chronic: constipation
144
opiate overdose management
ABCDE
IV naloxone
oral activated charcoal
145
neuroleptic malignant syndrome
usually within 10 days of antipsychotic treatment
autonomic dysfunction, altered mental state, neuromuscular dysfunction
lab results: raised WBC and CPK
146
complications of NMS
pneumonia, cardiovascular collapse, thromboembolism, renal failure
147
management of NMS
1. stop drug
2. maintain fluid balance
3. diazepam for muscle rigidity
4. dantrolene for malignant hyperthermia
5. bromocriptine to stop dopamine blockade
148
section 4 of MHA
emergency; like section 5.2 but patient not already admitted
149
what are social determinants of health
conditions in which people are born, grow, live, work and age that affect health e.g. poverty, migration, social isolation, homelessness, education, trauma and abuse
150
what can be done to improve social determinants of health
```
Help with meaningful activity
Social prescribing
Health coaching
Benefits support
Care packages
Housing support
Support with social integration
```
151
what is tardive dyskinesia
side effect of antipsychotic medication
jerky or slow uncontrollable movements
152
what is acute dystonia and how is it managed
face grimasing, involuntary upward eye movement, muscle spasms in tongue, face, neck and back (arching forward)
procyclidine
153
community psychiatric teams
early intervention team: 1st episode of psychosis
assertive outreach team: complex mental health needs
crisis team: mental health crisis
154
long term complications of alcohol dependence
* Hepatic: alcoholic liver disease
* GI: chronic pancreatitis, chronic diarrhoea, Barrett’s oesophagus, gastritis, Mallory Weiss tears, peptic ulceration
* Cancer: hepatocellular, oesophagus, stomach, mouth, tongue, pharynx
* Cardiovascular: hypertension, arrythmias, dilated cardiomyopathy
* Neurological: WK syndrome, peripheral neuropathy
* Other: foetal alcohol syndrome, gout, osteoporosis, malnutrition, accidents, violent crime, diminished compliance
155
withdrawal
symptoms that occur after abstinence from a drug due to previous dependence
156
what are features of dependence syndrome
primary drug seeking behaviour
narrowing of repertoire
increased tolerance
loss of control consumption
signs of withdrawal when abstinent + using drugs to avoid withdrawal symptoms
continued drug use despite negative symptoms
157
tolerance
more of drug is needed to achieve the same effect
158
risk factors for alcohol misuse
male
low socioeconomic group/ educational attainment
young
jobs: drinks industry, travelling salesmen, doctors
first degree relative with alcohol problem
159
alcohol screening tools
CAGE
AUDIT (alcohol use disorders identification test)
Fast alcohol screening test
160
management of alcohol misuse
motivational interviewing + planning interventions
161
alcohol withdrawal syndromes
uncomplicated alcohol withdrawal: begins 4 - 12 hrs; coarse tremor, sweating, insomnia, tachycardia, nausea, vomiting, generalised anxiety, hallucinations or illusions
alcohol withdrawal with seizures: 6 - 48 hrs after last drink
Delirium tremens: peak incidence 48hrs after last drink
162
indications of prescribing a reducing regime
symptoms of withdrawal
history of alcohol dependence syndrome
>10 units a day for 10 days
163
preferred drug for reducing regime
benzodiazepam: chlordiazepoxide
164
biopsychological management of alcohol misuse
psychological: individual counselling, group support/therapy
biological: disulfram, acamprosate, naltrexone
165
name an aversive alcohol misuse drug, its mode of action and side effects
disulfram
inhibition of ALDH causing build up of acetaldehyde in bloodstream and unpleasant effects of headache, flushing, N+V and tachycardia
headache and halitosis
166
name an anti-craving alcohol misuse drug, its mode of action and side effects
acamprosate
enhances GABA transmission
GI upset, itch, rash, altered libido
167
what is wernicke-korsakoff syndrome
thiamine deficiency
wernicke encephalopathy: confusion, ataxia, nystagmus
korsakoff psychosis: inability to lay down new memories, retrograde amnesia
168
management of smoking addiction
nicotine replacement therapy
buproprion
varenicline
169
indication for hospital detox admission
o Past history of complicated withdrawals (seizures or delirium)
o Current symptoms of confusion or delirium
o Comorbid mental/physical illness, polydrug misuse or suicide risk
o Symptoms of Wernicke – Korsakoff syndrome
o Severe nausea/vomiting; severe malnutrition
o Lack of stable home environment
170
short and long term use of IVDU
* Short term: overdose – respiratory depression, damage to blood vessels, infection (embolism?), risky behaviour
* Long term: HIV, endocarditis, chronic venous insufficiency, thrombosis, MSK infections, addiction, psychosis, malnutrition, chronic hepatitis
171
paracetamol overdose medication
N-acetylcysteine
172
learning disability vs. learning difficulty
```
• Learning disability: global,
o Mild 50 – 69
o Moderate 35 – 49
o Severe 20 – 34
o Profound <20
```
• Learning difficulty: one specific aspect of learning, IQ is normally fine
173
risk factors for schizophrenia
* Genetics: MHC locus, DRD2, DISC1
* Complications of pregnancy, delivery and the neonatal period
* Delayed walking and neurodevelopmental difficulties
* Early social service contact and disturbed childhood behaviour
* Severe maternal malnutrition
* Maternal influenza in pregnancy + winter births
* Degree of urbanisation at birth
* Use of cannabis especially during adolescence
174
3 features of ADHD
Attention-deficit/ hyperactivity disorder
inattention
hyperactivity
impulsiveness
175
management of ADHD
bio: ritalin (methylphenidate), atomexitin
psycho: family therapy (+/- parent management therapy), psychoeducation
social: school liaison
176
features of autism spectrum disorder
difficulty with social relationships
problems in communication
restrictive and repetitive behaviour, activities or interests
sensory sensitivity
177
subtypes of delusional disorder
```
erotomatic
grandiose
jealous
persecutory
somatic
```
178
management of delusional disorder
CBT
| olanzapine, SSRI
179
risk factors for GAD
Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent
180
Mimimum time for SSRI
continue for at least 6 months
181
preffered SSRI in CAMHS
fluoxetine
182
non blood investigation for antipsychotics
ECG: QT
BP + pulse
weight gain + abdominal girth
183
annual investigations for patients on antipsychotics
```
weight BMI/weight/ abdominal girth
fasting lipids
blood glucose
liver function
ECG
U+E
FBC
TFT
Prolactin
BP and pulse
```
184
annual investigations for patients on clozapine
```
weight BMI abdominal girth
fasting lipids
blood glucose
liver function
ECG
U+E
FBC
Prolactin
BP + Pulse
```
185
tardive dyskinesia medication
tetrabenazine
186
what receptors do antipsychotics work on
D2 receptors
187
treatment of akathisia
propanalol
188
investigations for overdose
```
toxicology
LFT
U+E
ABG
clotting screen
```
189
panic attack
| panic disorder
panic attack: period of intense fear characterised by a constellation of symptoms e.g. feeling of impending doom
panic disorder: recurrent panic disorders
190
types of OCD
Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
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common obsessions in OCD
Fear of being contaminated by germs or dirt or contaminating others
Fear of losing control and harming yourself or others
Intrusive sexually explicit or violent thoughts and images
Excessive focus on religious or moral ideas
Fear of losing or not having things you might need
Order and symmetry: the idea that everything must line up “just right”
Superstitions; excessive attention to something considered lucky or unlucky
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common compulsions in OCD
Excessive double-checking of things, such as locks, appliances, and switches
Repeatedly checking in on loved ones to make sure they’re safe
Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
Spending a lot of time washing or cleaning
Ordering or arranging things “just so”
Praying excessively or engaging in rituals triggered by religious fear
Accumulating “junk” such as old newspapers or empty food containers
