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Psychiatry Flashcards

1
Q

What are the 3 core symptoms of depression

A

Low/depressed mood
Anhedonia - loss of interest/pressure
Anergia

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2
Q

What are other typical symptoms of depression

A
  • Poor Appetite
  • Disrupted Sleep
  • Psychomotor Retardation (sluggish) or agitation
  • Decreased Libido
  • Reduced ability to concentrate
  • Feeling of worthlessness and inappropriate guilt
  • Recurrent suicidal thoughts/attempts
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3
Q

What is the Diagnosis of Depression

A
  • 2 core symptoms (Severe = 3) + 2 or more typical symptoms
  • Symptoms present throughout the day
  • For every/nearly every day
  • For > 2 weeks
  • Must represent change from normal personality
  • Without drugs/alcohol, medical disorders or bereavement
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4
Q

What are the causes of depression

A

Biological - Hereditary, Familial, Low monoamine (Low serotonin, Low dopamine, Low noradrenaline)
Psychological - Personality trait, Low self esteem
Social - Disruption due to life events, stress and social isolation

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5
Q

What may be symptoms of severe depression

A

Cotard Syndrome - Nihilistic Delusions
Auditory and Visual Haluucinations
Delusions

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6
Q

What are differentials for depression

A 
Psychotic Disorders 
Dysthymia
Substance Misuse 
Dementia 
Sleep and Neurological Disorders 
Physical Illness 
Medication SE e.g Beta Blockers
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7
Q

What conservative management can be done for depression

A 
Exercise 
Engaging in productive activity 
Socialising 
Improving Sleep - good sleep hygiene
Relaxation Techniques
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8
Q

How is mild depression managed

A

Low intensity psychological interventions - sleep hygiene, anxiety management, guided self help (books, websites and apps), computerised CBT

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9
Q

How is moderate depression managed

A

Combination of Antidepressant + high intensity psychological intervention (CBT), group therapy, family therapy

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10
Q

How is severe depression managed

A 
This includes psychotic depression, increased risk of suicide and atypical depression - THINK:
S uicide plan
U nexplained guilt or worthlessness
I nability to function
C concentration impaired 
I mpaired appetite 
D creased sleep
E energy low

Urgent - Rapid mental health assessment and maybe inpatient admission - Give ECT &/or rapid prescription of Antidepressants

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11
Q

What are the NICE guidelines for Antidepressants

A

1st line: SSRI e.g Sertraline, Citralopram and Fluoxetine (<18yrs)
2nd line: Alternative SSRI
3rd line: SNRI (venlafaxine) or NaSSA/Tetracyclic (mirtazapine) if two SSRIs haven’t worked
4th line: Lithium, TCA, Monamine Oxidase Inhibitors

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12
Q

What are side effects from ECT

A

Amnesia
Headaches
Confusion

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13
Q

When is ECT used

A

When other treatments have been ineffective and a condition is life threatening (severe manic episode, severe depression, catatonia)

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14
Q

What is one contraindication for ECT

A

Cochlear Implant

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15
Q

What are the SE of SSRIs

A

The 8S’s

  • Sodium (low)
  • Serotonin Syndrome
  • Sexual Dysfunction
  • Sleep (insomnia)
  • Sickness (nausea/vomiting) and Stomach Upset (diarrhoea, constipation, abdo pain)
  • Size (weight gain)
  • Stress
  • Suicide (first 2 weeks increased risk of suicide)
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16
Q

How long do SSRIs take to work and what should you be aware of when starting them

A

Can take up to 4 weeks to work there may be initial worsening of symptoms and increased risk of suicide

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17
Q

Once effective dose of antidepressant how long should they be continued for and what symptoms can occur if you stop them suddenly

A

6 months

Flu like symptoms, headaches, shock like sensations, dizziness, insomnia - withdraw over 4 weeks or longer to reduce these

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18
Q

How do SSRIs work

A

Prevent reuptake of serotonin in the synaptic cleft therefore increasing Serotonin levels

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19
Q

What does mirtazapine do

A

Mirtazzzzapine makes you sleepy (Zzz)

Weight Gain

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20
Q

What is serotonin Syndrome

A 
A life threatening condition caused by to much serotonin (co-administration of some antidepressants or not cross tapering can cause it) 
Classic Triad: 
- Neuromuscular Excitability 
- Autonomic Dysfunction 
- Altered Mental Status

Symptoms: Hyperthermia, Diaphoresis, Hypertension, Tachycardia, N/V, diarrhoea, Tremor, Hypertonia/rigidity, Hyperreflexia, Confusion, Seizure

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21
Q

How is serotonin syndrome managed

A

Immediately stop Antidepressants
Supportive care: fluid replacement, antihypertensives
Benzodiazepines: to sedate
Cooling Methods

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22
Q

What can antidepressants sometimes induce

A

A manic episode

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23
Q

What is a side effect of Citralopram

A

Dose dependent prolongation of QT interval so check ECG - unnoticed can lead to Torsades de Pointes

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24
Q

What is Mania

A
  • Abnormally elevated, expansive or irritated mood and increased goal directed behaviour, energy and activity not attributable to organic psychic disorder or psychotropic substances
  • Lasting for at least a week
  • Significantly impairs function
  • Patient requires hospitalisation
  • There may be psychotic symptoms
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25
Q

What is hypomania

A
  • Abnormally elevated, expansive or irritated mood and increased goal directed behaviour, energy and activity not attributable to organic psychic disorder or psychotropic substances
  • Lasting at least 4 days
  • Does not significantly impair function, hospitalisation or present
  • No psychotic features
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26
Q

What symptoms may be seen in mania/hypomania

A

Mood:
- Irritability, Euphoria, Elevated mood

Behavior:

  • Increased goal directed activity (Hyperactivity, Hyper-sexuality, increased libido, increased socialising, new projects)
  • Increased talkativeness and pressure of speech
  • Loss of social inhibition ( socially and sexually inappropriate, reckless actions)
  • Decreased need to sleep

Cognition:

  • Flight of Ideas and Racing thoughts
  • Heightened self esteem/grandiosity
  • Distractibility/Poor Concentration

Psychotic Symptoms: (definite manic)

  • Delusions
  • Hallucinations
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27
Q

What is the main difference between mania and hypomania

A

The severity of symptoms e.g significant impairment of function, hospitalisation etc.

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28
Q

What is Bipolar Disorder

A

A disorder characterised by two or more episodes in which patients mood/activity levels are significantly disturbed consisting of episodes of mania/hypomania +/- depression

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29
Q

What is Bipolar 1

A

Manic episodes WITH OR WITHOUT major depressive episodes

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30
Q

What is Bipolar 2

A

Hypomanic episodes AND major depressive episodes

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31
Q

What is Cyclothymia

A
  • Cyclical moods of hypomania and depression but not severe enough to meet diagnosis of bipolar
  • Symptoms have to last at least 2 years, present at least half the time and never absent for longer than 2 months
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32
Q

What is rapid cycling

A

Patients have 4 or more episodes of depression, mania or hypomania in one year

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33
Q

What could be a differential for bipolar

A

Substance/Medication induced bipolar/mania
- occurs during/shortly after intoxication/ withdrawal

  • Alcohol
  • Steroids
  • Illicit Substances e.g amphetamines, cocaine
  • Antidepressants
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34
Q

What Ix should be done for bipolar

A 
Clinical Diagnosis 
ALWAYS assess suicide risk 
Screen for drugs and toxins e.g urine 
Infections
Past Fx - strong genetic component  
CT
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35
Q

How should acute mania be managed

A

Any SG Antipsychotics - rapid onset of action for agitated patients

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36
Q

After successful management of a manic/depressive episode what needs to be given for long term maintenance of bipolar

A

A Mood Stabiliser

  • Lithium
  • Sodium Valproate (SE: hair)
  • Lamotrigine (SE: rash/SJS)
  • Carbamazepine (SE :rash/neutropenia)
  • 2nd Line: Olanzapine

Psycho: Talking therapy

Social: Family or carer support/employment/ activity support/education

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37
Q

Why does lithium blood concentration have to be checked regularly

A

It has a narrow therapeutic index (small changes in dose/blood concentration can have severe effects)
- Elderly show increased sensitivity to lithium

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38
Q

What adverse effects can lithium cause

A

Lithium toxicity from impaired renal function/nephrotoxicity from lithium

  • Loss of vision
  • D&V
  • Ataxia
  • Tremor
  • Dysarthria
  • Coma
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39
Q

How can severe depressive episodes be managed in Bipolar

A

Antidepressants should not be given before initiating therapy with mood stabilisers and it may lead to a manic episode
(Antidepressants may be given after initiating mood stabilising therapy)

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40
Q

What are causes of anxiety

A 
Genetic Predisposition 
Disruption of Serotonin System
Substance Use 
Stress (work, home)
Events (divorce, job loss, moving)
Smoking
Psychological Trauma e.g child abuse 
Medical conditions e.g CVS, hyperthyroidism, respiratory illness
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41
Q

How can anxiety present

A

Cognitive: Agitation, feeling of doom, poor concentration, insomnia, fatigue, obsessions, compulsions, worry, depression

Somatic: Tension, trembling, sense of collapse, hyperventilation, headache, butterflies, sweating, palpitations, nausea

Behaviours: Reassurance seeking, avoidance, dependence on person

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42
Q

What is generalised anxiety disorder

A

Prolonged and excessive anxiety which is generalised and not focused on a single specific fear for at least 6 months

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43
Q

What are non medical treatments for anxiety

A
  • Symptom control: understanding somatic symptoms are not life threatening
  • Regular Exercise
  • Meditation - Mindfullness
  • Progressive Relaxation Training e.g deep breathing and relaxation of muscle groups
  • CBT
  • Behavioral Therapy - exposure and response therapy
  • Hypnosis
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44
Q

What are the medical treatments for anxiety

A
  • 1st line: SSRIs + CBT (gold standard)
  • 2nd line: Pregablin
  • Benzodiazapines for short term management until SSRIs become effective (DO NOT USE IN GENERALISED ANXIETY DISORDER PEOPLE BECOME DEPENDENT ONLY SHORT TERM)
  • Beta Blockers can help somatic symptoms
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45
Q

What is panic disorder

A

1) Recurrent and unexpected panic attacks that occur without known trigger
2) Persistent worry/change in behaviour due to fear of recurrent attacks for at least a month
3) Not effects of substance
4) Not another Disorder

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46
Q

What is panic disorder often associated with

A

Agoraphobia (can’t predict attacks which leads to avoidance)

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47
Q

How does Panic Disorder present

A

STUDENTS FEAR the 3Cs

Sweating 
Trembling 
Unsteadiness
Derealisation 
Elevated HR
Nausea 
Tingling 
SOB

FEAR of dying, losing control, going crazy

Chest pain
Choking
Chills

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48
Q

How is Panic Disorder managed

A

CBT
SSRIs
Benzodiazepines - for managing acute attacks

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49
Q

What are phobic disorders

A

Anxiety experienced only or predominantly in certain well defined situations that aren’t dangerous - resulting in situation being avoided or endured with dread

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50
Q

What are examples of Phobias

A

Agoraphobia
Social Anxiety Disorder/ Phobia
Simple Phobia

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51
Q

What is Agoraphobia

A

Pronounced fear of being in situations that are perceived difficult to escape from or difficult to seek help
e.g crowds, travel, events away from home, open spaces, enclosed spaces for at least 6 months

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52
Q

What is social anxiety disorder/phobia

A

Pronounced anxiety for 6 months or longer of social situations that may involve scrutiny from others (don’t want to be embarrassed or judged)

Can be SAD (meeting new people, eating in front of people) or Performance only SAD (public speaking)

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53
Q

What are simple/specific phobias

A

Intense and persistent fears of one or more situations or objects when encountered or anticipation for encounter e.g arachnophobia, claustrophobia, haematophobia

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54
Q

How may phobias present

A

Catastphohic thoughts
Panic Attacks
Avoidance

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55
Q

How are phobias treated

A

Psychologial Therapy - exposure and response prevention
SSRIs
Beta Blockers and Benzodiazepines in acute situations

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56
Q

How can a new diagnosis of a psychiatric illness affect driving

A

DVLA need informing of a diagnosis of a psychiatric disorder and medication you are on

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57
Q

What SE can MAOIs cause

A

Hypertensive Crisis - Cheese and Red Wine

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58
Q

What is OCD

A

Characterised by:

  • Persistent and Recurrent Intrusive thoughts, urges and images which cause anxiety/distress (obsessions)
  • Leading to repetitive behaviours/rituals to reduce the distress/anxiety of an obsession (compulsion)
  • These are time-consuming and significantly impair function/daily life
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59
Q

What is OCD caused and associated with

A

Unknown Genetic + Environment

Associations:

  • Tic Disorder
  • Personality Disorder
  • Mood Disorder
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60
Q

What are some examples of rituals

A

Cleaning
Dressing
Counting
Checking

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61
Q

What is the treatment for OCD

A

Psychotherapy: Exposure & Response Prevention Therapy
Medication: SSRI e.g Fluoxetine TCA e.g Clomipramine
Social: Family Intervention, Support with Engagement, Employment, Education, Involvement in Activities, Carer Support

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62
Q

What is an acute stress reaction

A

A transient condition (hours to days) in reaction to a traumatic event resulting in dissociation and mixed emotions of anger, anxiety and confusion which impairs function

It usually resolves with psyhological intervention e.g talking to friends and family

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63
Q

What is an adjustment disorder

A

A maladaptive behaviour or emotional response to a stressor resulting in impaired function that lasts under 6 months when the stressor is removed e.g cancer diagnosis, divorce

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64
Q

What is PTSD

A

A reaction to a traumatic event which significantly impairs function lasting longer than a month

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65
Q

What are the symptoms of PTSD

A

Intrusions e.g Intrusive thoughts of event, Flashbacks, Nightmares

Avoidance e.g avoidance of thoughts, feelings, external stimuli associated with event

Negative affected mood or cognition e.g guilt, fear and depression, memory loss/distortion, negative beliefs, detachment

Arousal or Reactivity e.g Hyperarousal, Hyper-vigilance, easily startled, sleep disturbance

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66
Q

What are the comorbid conditions associated with PTSD

A

Depression
Emotional Numbness
Drug/Alcohol Abuse
Anger/Violence

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67
Q

What can cause PTSD

A 
Sexual Abuse - main cause 
War
Combat Exposure 
Natural Disasters
Accidents
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68
Q

What is the treatment for PTSD

A

Psychotherapy: CBT and Eye Movement Desensitisation And Reprocessing (EMDR)

Medications: SSRIs or SNRI
SGA if presenting with psychotic symptoms
Benzo can be used short term but REMEMBER addiction and dependence

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69
Q

What is Derealisation

A

Feeling of detachment from Surroundings

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70
Q

What is Depersonalisation

A

Feeling of detachment from ones body, thoughts and feelings (sometimes described as observing yourself from outside your body like a movie)

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71
Q

What can depersonalisation and derealisation lead to

A

Altered sense of time
Emotionally/Physically numb
Weak sense of self
Trouble recognising people, places and objects

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72
Q

What is Dissociative Amnesia

A

A person is unable to recall periods of their life or events that happened in the past , they may also have forgotten a learned skill or talent

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73
Q

What is a symptom of dissociative amnesia

A

Inability to recall ones past with loss of identity/formation of a new identity with unexpected purposeful travel to a new location and act as a different person in different life (can last hours to months)

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74
Q

What can cause dissociation

A

Childhood Truama
Trauma
Substance Misuse
Anxiety Disorder

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75
Q

What is the treatment for dissociation

A

Psychotherapy: CBT

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76
Q

What criteria is used to diagnose Schizophrenia

A

Schneider

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77
Q

What are the 1st rank symptoms of Schizophrenia

A
  1. Thought Disorder e.g. insertion, withdrawal, broadcast
  2. 3rd Person Auditory Hallucinations in the form of Running Commentary or talking about them amongst themselves (thought echo)
  3. Delusional Perception
  4. Passivity
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78
Q

What are 2nd rank symptoms of Schizophrenia

A
  1. Persistent hallucinations in any modality (somatic, visual, tactile)
  2. Second person auditory hallucinations
  3. Paranoid and Persecutory Delusions
  4. Delusions of Reference
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79
Q

What are positive symptoms of Psychosis

A

Hallucinations
Delusions
Illusions
Disorganised Thoughts and Speech Process e.g loosening of associations, word salad, neologisms, flight of ideas, circumstantial speech, tangential speech, pressured speech

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80
Q

What are negative symptoms of Psychosis

A 
Blunted/Flat Effect 
Apathy 
Alogia/Poverty of Speech 
Anhedonia 
Emotional and Social Withdrawal
Self Neglect 
Catatonia/ Psychomotor Retardation
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81
Q

What are cognitive symptoms of Psychosis

A

Impaired Memory
Inattention
poor executive functioning

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82
Q

What are differentials for Psychosis

A
  • Schizophrenia - recurrent/chronic disorder
  • Affective Psychosis - e.g depression/bipolar
  • Transient Psychotic Disorders e.g triggered by stress
  • Drug Induced by Psychosis
  • Schizoaffective Disorder
  • Schizophreniform Disorder
  • Delusional Disorder
  • Psychosis due to medical condition e.g brain tumour or head injury
  • Personality Disorders
  • Dementia
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83
Q

What is the diagnosis for Schizophrenia

A

Psychotic Symptoms lasting at least 6 months and are present much of the time

(all other possible cases of psychosis need to be ruled out)

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84
Q

How is Schizophrenia managed

A

Psycho: CBT, Abstinence from drugs
Medication: Antipsychotics
Social: Family intervention, social support (housing, benefits, employment, education) support with engagement, carer support

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85
Q

Who are Psychosis patents referred to following the acute phase

A

The Early Intervention Team

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86
Q

What is Schizoaffective Disorder

A

Features of Schizophrenia and a major mood disorder (depression/bipolar) present at the same time without being caused by any other medical disorder or substance misuse (psychosis is the predominant feature)

(Neither a variant of schizophrenia or mood disorder!!!!)

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87
Q

What is the treatment for Schizoaffective Disorder

A

Manage Both Conditions:

  • Antipsychotic
  • Mood Stabiliser
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88
Q

What is Schizotypical disorder and how is it managed

A

A personality disorder characterised by odd and eccentric behaviour and magical thinking, may present a partial expression to schizophrenia

Management: Treated without Medication

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89
Q

What is Schizophreniform and how is it managed

A

Given to disorders that don’t reach the. threshold for Schizophrenia but have some symptoms of it and deterioration of function

Management: Antipsychotics

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90
Q

What do antipsychotics do

A

Dopamine Antagonists - Block the D2 receptor

Reducing Dopamine Neurotransmission

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91
Q

What are the two broad groups of Antipsychotics

A

First Generation Antipsychotics - D2 Antagonists

Second Generation Antipsychotics/ Atypical Antipsychotics - D2 & 5HT2A Antagonists

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92
Q

What are some examples of second generation antipsychotics

A

Clozapine
Olanzapine
Risperidone
Quetiapine

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93
Q

What are some examples of first generation antipsychotics

A

Haloperidol
Promethazine
Chlorpromazine

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94
Q

What is the difference between first and second generation Antipsychotics

A

The SE:
- FGA - are associated with higher risk of EPS

  • SGA - are associated with a lower risk of EPS but with higher risk of metabolic side effects
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95
Q

What are Extrapyramidal SE

A

Drug induced movement disorders caused by disruption of dopaminergic pathways

Symptoms:
- Acute Dystonia - continuous painful muscle spasms and contractions

  • Parkinsonism - Rigidity, Tremor, bradykinesia and shuffling gait
  • Akathisia - Restlessness
  • Tardive Dyskinesia - involuntary movements generally of the tongue, mouth and jaw e.g repetitive lip smacking and chewing
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96
Q

How can you manage EPSE

A

Try to reach lowest tolerate dose

  • Acute Dystonia: Anticholinergics (Procyclidine/Benztropine) or Antihistamines (Cyproheptadine)
  • Parkinsonism: Dose reduction, switch to SGA, Anticholinergic (Procyclidine/Benztropine)
  • Akathisia: Dose reduction, switch, Propranolol +/- Anticholinergic (Benztropine)

Tardive Dyskinesia - May be irreversible

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97
Q

What are metabolic SE

A

Weight Gain
Hyperglycaemia/Insulin Resistance - Diabetes
Dyslipidaemia

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98
Q

What are other SE of Antipsychotics

A
  • Hyperprolactaemia
  • Prolonged QT
  • Sexual Dysfunction - erectile dysfunction, reduced libido, reduced arousal
  • CV effects - Olanazapine & Rispiridone can increase risk of stroke in elderly when used to treat dementia!!!, Myocarditis and Cardiomyopathy

Daytime Drowsiness

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99
Q

What is a life threatening emergency associated with antipsychotics

A

Neuroleptic Malignant Syndrome

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100
Q

How does Neuroleptic Malignant Syndrome present

A

Fever
Muscle Rigidity
Autonomic Instability
Delirium/Mental State Change

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101
Q

What will be seen on Investigations of Neuroleptic Malignant Syndrome

A

Markedly Raised Creatine Kinase

Leukocytes

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102
Q

What is the management of Neuroleptic Malignant Syndrome

A

Stop Antipsychotic!!!!
Supportive measures - Admit to ICU
Dantrolene - reduces fever/hyperthermia and muscle rigidity

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103
Q

What is Clozapine

A

Most popular drug for treatment resistant Schizophrenia (Wonder Drug)

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104
Q

What are Clozapine Risk

A
  • Neutropenia and potentially fatal agranulocytosis
  • Prolonged QT complex, Fatal Myocarditis and Cardiomyopathy
  • Intestinal Obstruction (can be fatal)
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105
Q

Who is at high risk of Suicide

A

(Most common caused of death in men under 35)

  • Previous Suicide attempts
  • Mental Illness e.g Depression, Bipolar
  • Gender: male
  • Age: high risk in elderly
  • Marital Status: Widow>Divorced>Single>Married
  • Occupation: Highest risk in unemployed and retired
  • Ethnicity
  • Woman have higher suicide attempts but men have higher suicide success rate due to more lethal methods
106
Q

What is important to assess after suicide attempt

A
  • Circumstances of Act - What happened that day to make you do it
  • Background of act - how things have been preceding in months up to event
  • Relevant Family and Personal Hx
  • The intention behind the act: did they wish to die or did they want to be found/change a circumstance
  • Summary: Any plans, Other attempts, Any preparations e.g notes
107
Q

How can survivors of Suicide be helped

A

Therapy
Family Intervention if they want
Treat Co-morbid conditions e.g Substance misuse, Depression, Anxiety
Prevention Strategies e.g Samaritans, Doctors
Admission???

108
Q

Why do people self harm

A 
Communicating a message 
Release from Psychological pain 
Gaining Power by escalating conflict 
Emotional Immaturity 
Inability to cope with stress
Availability of Drugs
109
Q

What are risk factors for self harm

A

Witnessed: FHx, Friends, Celebrities
Biological
Development: Child neglect, physical, emotional and sexual abuse
Peer Relations: Bullying, Conflicts
Psychological: Identity Problems (culture, sexual orientation, borderline)
Antisocial Behaviour: conduct disorder, substance misuse

110
Q

How is self harm managed

A

Prioritise treatment of physical effects of self harm
Assessment
1. Initial risk management: immediate risk of suicide
2. On going risk of subsequent self harm
3. Relevant psychiatric, medical, social issues

111
Q

What is Delirium

A

Acute AND fluctuating:

  • altered level of consciousness
  • global impairment of cognitive function/ Disorganised Thinking
  • Inattention
112
Q

What are symptoms of Hyperactive Delerium

A 
Agitated 
Aggressive 
Incoherent Speech 
Disorganised Thoughts 
Delusions and Disorientation
Hallucinations 
Sleep Disturbance
113
Q

What are symptoms of Hypoactive Delirium

A 
Sluggish 
Drowsy 
Less reactive/slow responses  
Sleep Disturbance 
Withdrawal
114
Q

What are causes of Delirium

A

PINCH ME

Pain e.g post op
Infection
Nutrition
Constipation
Hydration

Medication
Environment/Electrolytes

115
Q

What medications can cause delirium

A

Anticholinergics!!!!
Benzodiazepines
Antidepressants/Antipsychotics
Opioids

116
Q

Who are at high risk of developing delirium

A

Post operative patients
Elderly Patients
Multiple Comorbidities

117
Q

What investigations should be performed for Delirium

A 
U&amp;Es and LFTs
FBC
Blood Gas 
Glucose
Cultures (blood/MSU)
Urine Toxicology
ECG
CT head
CXR
LP
118
Q

What are differentials for patients presenting with confusion on a ward

A

Delirium
Delirium Tremens
Dementia

119
Q

What are the differences between Dementia and Delirium

A

Dementia:
Slowly Progressive Deterioration
Early on - alert
Clear consciousness

Delirium:
Sudden acute onset 
Fluctuating levels of cognitive impairment and consciousness 
Inattention 
Reversible 
Often Visual Hallucinations present
120
Q

How do you manage Delirium

A

Identify cause and treat it

Medication: Haloperidol
Avoid Sedation e.g Benzos

Optimize surroundings:

  • Good daily routine and sleep hygiene
  • Proper lighting for time of day
  • Manage Noise
  • Engagement - glasses and hearing aids
  • Cognitive Stimulation e.g familiar objects and family
121
Q

When may you give Benzodiazepines to treat Delerium

A

In patients who are delirious due to alcohol and benzodiazepine withdrawal
Haloperidol is contraindicated as it lowers seizure threshold

122
Q

What is Dementia

A

A chronic and Progressive global impairment of cognitive function (across multiple cognitive domains) that must impact on the general function of the patient

123
Q

What are the Cognitive symptoms of Alzheimer’s

A 
The 4A's: 
Amnesia 
Aphasia 
Apraxia 
Agnosia

Executive Dysfunction
Loss of Orientation

124
Q

What are the non cognitive symptoms of Alzheimers

A

Psychosis: Delusions and Hallucinations
Mood: Anxiety, Depression
Behaviour: Apathy, Agitation, Wandering, Aggression and Repetitive & Purposeless Activity
Personality Change: misidentification, sexual disinhabition

125
Q

what are risk factors for Alzheimers

A 
Increasing age 
Sex - Female 
Low Intelligence/Education
Family Hx 
APO E4
Downs Syndrome 
Head injury, Smoking, HTN, Diabetes
126
Q

What are protective factors for Alzheimers

A

APO E2
High Intelligence/ Education
Oestrogen

127
Q

When can someone be given a diagnosis of Alzheimers

A

6 months

128
Q

What medications can be used to slow progression Alzheimer’s

A

Acetyl Cholinesterase Inhibitors - Rivestigmine or Donepezil

NMDA Antagonist - Memantine

129
Q

What is the presentation of Lewy body Dementia

A 
Fluctuating Cognitive Impairment 
Visual Hallucinations 
Parkinsonian Symptoms 
REM sleep Disorder 
Memory Problems 
Autonomic Dysfunction - orthostatic Hypotension (INCREASED RISK OF FALLS), Urinary Incontience, Constipation
130
Q

What is important to remember about Lewy body Dementia

A

They are very sensitive to Antipsychotic Medication - Can lead to severe Parkinsonism, hallucinations and even loss of Consciousness

131
Q

How does Frontal Temporal Dementia present

A 
Behaviour/Personality Change 
Social and Interpersonal Inhibition 
Emotional Blunting/Unconcern  
Poor insight 
Speech Problems 
Poor motivation and loss of attention
132
Q

How does Vascular Dementia present

A

History of Strokes/TIAs - leading to sudden onset and stepwise deterioration
Memory Problems
Mild Decline: in thinking, reasoning and information processing
Evidence of focal brain damage

133
Q

How is Dementia Ix

A

Full Collateral Hx

Memory Assessment - MOCA, Addenbrookes, ACE 3, (FAB - Frontal temporal dementia)

Functional Assessment

FBC
B12 and Folate - major cause of cognitive impairment
TSH (hypothyroidism)
U&E, LFTs - renal/hepatic failure, alcoholism
Serology - Syphilis/HIV
CT/MRI

134
Q

How is Dementia Managed

A
  • Acetyl Cholinesterase Inhibitors - mainly Alzheimers
  • NMDA Antagonists - mainly Alzheimers
  • Depression - SSRIs
  • Behaviour and Psychological Symptoms of Dementia - Antipsychotics
  • Carer Assessment & Support
  • Risk Assessment
  • Environmental Adaptions - for mobility and accommodation (institutionalised care)
  • Therapies - Music, ART etc.
135
Q

What is in the criteria for substance misuse disorder

A
  • Strong Desire to take Substance (craving)
  • Impaired Control of substance use
  • Withdrawal State: when reducing or ceasing use
  • Tolerance - Continuously having to increase dose
  • Progressive neglect of self, others, pleasures, interests
  • Risky use - persisting use despite harmful consequences snd using in hazardous situations e.g work, driving
136
Q

What is tolerance

A

Need for individuals to continuously increase the dose of a substance to achieve same desired effect

137
Q

What is withdrawal

A

Substance dependent collection of symptoms that appear after cessation of prolonged heavy drug use

138
Q

What symptoms may be seen in an opioid overdose

A 
Pin point pupils (miosis)
Hypotension
Bradycardia
Respiratory Depression
Altered conscious state
139
Q

What symptoms may be seen in a cocaine overdose

A 
Mydriasis 
Hypertension 
Tachycardia 
Ataixa 
Seizures
140
Q

What is complications of cocaine

A

Tachycardia + Cociane induced vasospasm and vasoconstriction = Causing MI and maybe death

141
Q

What symptoms may be seen in an amphetamine overdose

A
  • Increased Libido
  • Mydriasis
  • Raised Body Temp and Sweating
  • Hypertension
  • Tachycardia and Arrhythmias
  • Hyponatremia: Dry mouth and sweating leads to increased thirst leading to drinking water without electrolyte repletion leading to hyponatraemia causing seizures and cerebral oedema
  • Overdose - Serotonin Syndrome
142
Q

How are cocaine and amphetamine toxicity managed

A

ABCDE
Fluid Therapy
Control Hypertension and Arrhythmias
Benzodiazepines

143
Q

How may cannabis in-toxicity present

A 
Mydriasis 
Hallucinations/Confusion 
Mild Tachycardia 
Dysphoria/ Anxiety 
Conjunctival Injection (red eyes)
Increased Appetite 
Dry mouth
Impaired concentration, reaction time and concentration
144
Q

How do you manage opioid intoxication

A

ABCDE
IV Naloxone (opioid antagonist)
Manage complications

145
Q

How does opioid withdrawal present

A

Flu like symptoms
GI complaints: N&V, cramps, diarrhoea
Sympathetic Hyperactivity: Tachycardia, Mydriasis, hypertension, hypertension
CNS stimulation: irritability, insomnia, aggression

146
Q

How do you manage opioid withdrawal

A

Methadone - daily observed dosing

Nalteroxone - (long duration opioid antagonist) used for withdrawal treatment after acute detoxification

Psychological Support - Counselling, CBT, address triggers

147
Q

What is gambling disorder

A

Addictive disorder in which individual feels a compulsion to gamble despite the negative consequences &/or multiple attempts to stop

148
Q

What are the diagnostic criteria for gambling

A

12 month period 4 of below:

  • Relying on others for financial support
  • Restlessness when attempting to stop
  • Constant preoccupation with gambling
  • Continuous gambling in attempt to undo losses
  • Jepordising relationships and careers as a result of gambling
  • Numerous failed attempts to quit gambling
  • Lying to others to conceal extend of gambling
  • Belief that gambling helps relieve dysphoria
149
Q

How can Gambling disorder be managed

A

Group therapy (gambling anonymous)
CBT
Treat underlying psychiatric disorder (often occurs with substance misuse and anxiety)

150
Q

What are features of alcohol addiction

A 
Features of increased tolerance and dependence 
Features of acute alcohol intoxication 
Features of alcohol withdrawal 
Difficulty/Failure of Abstinence 
Compulsion/Craving to Drink
151
Q

What are features of alcohol intoxification

A
  • Increased agitation
  • disinhibition
  • impaired judgement
  • skin flushing
  • tachycardia
  • significant reduction in attention responsiveness and alertness,
  • impaired vision
  • Ataxia
  • Dysarthria
  • dizziness
  • N&V
  • amnestic gaps
  • transition to coma with significantly impaired consciousness, lack of defensive reflexes and respiratory depression
152
Q

What screening tools are used for alcohol dependence

A

CAGE - Cut Down, Annoyed, Guilt and Eye opener
TWEAK
AUDIT
SADQ- C

153
Q

How do you calculate alcohol units

A

Percentage x Litres

154
Q

How does alcohol withdrawal present

A 
Agitation and Craving
tremor 
Insomnia
Sweating and Anxiety 
Headache 
Tachycardia and Raised BP
Withdrawal Seizures (tonic-clonic)
Visual and Tactile Hallucinations
155
Q

What complication can occur if alcohol is withdrawn suddenly

A

Delirium Tremens

156
Q

What is Delirium Tremens

A

A&E Emergency (10% mortality rate)
- It is an acute altered state of consciousness and confusional state with autonomic dysfunction (sympathetic hyper activation) due to sudden alcohol withdrawal

157
Q

How does Delirium Tremens present

A 
Impaired consciousness
Disorientation and Confusion
Visual Hallucinations (formication)
Tremor
Sweating 
Nausea
Tachycardia
Hypertension 
Generalied Tonic Clonic Seizures 
Hyperreflexia 
Death
158
Q

How do you treat Delirium Tremens

A

Admit
Monitor Vital signs
Oral or IV Lorazepam
Prophylactic Thiamine (B1)

159
Q

Why would you give lorazepam for someone with Liver disease

A

It is metabolised in kidneys instead of liver therefore doesn’t become toxic levels in blood

160
Q

How do you manage withdrawal of Alcohol

A

Chlordiazepoxide - no withdrawal symptoms
Prophylactic IV Thiamine

(if liver failure use Lorazepam instead)

161
Q

What can be used to aid recovery from alcohol misuse

A

Psychotherapy:
Alcoholics Anonymous
Family Therapy
CBT

Medication
Naltrexone - reduces pleasure that alcohol brings on
Acamprosate - reduces cravings for alcohol
Disulfiram - inhibits the enzyme that metabolises ethanol leading to increased sensitivity to alcohol and amplifying negative symptoms of alcohol (toxic reaction)

162
Q

Why does Disulfiram need to be used with caution

A

IF you continue to drink with it and ignore toxic reaction it can lead to death

163
Q

What are long term consequences of alcohol

A
  • Liver - Fatty Liver - hepatitis - Cirrhosis
  • CNS - poor memory and cognition, falls, accidents
    Wernickes Encephalopathy
    Korsakoffs Syndrome
  • Gut - Pancreatitis
  • Heart - Arrhythmias, Stroke, Increased BP
  • Skeleton - Osteoporosis (Ca2+ disturbance)
  • Sperm - Low fertility
  • Cancer: Mouth, Oesophageal, Bowel, Breast
164
Q

What is Wernickes Encephalopathy and Korsakoffs Syndrome both caused by

A

Chronic Thiamine (B1) deficiency

84% who have Wernickes will progress to Korsakoffs

165
Q

What is the classic triad of Wernickes Symptoms

A

Confusion
Wide based gait ataxia
Ophthalmoplegia

(Acute, Reversible)

166
Q

What will Wernickes commonly progress to

A

Korsakoffs Syndrome

  • Confabulation
  • Anterograde Amnesia (new memories)
  • Personality change: apathy, decrease in executive function
  • Lack of Insight

(Chronic, Irreversible)

167
Q

How may be Wernickes or Korsakoffs be diagnosed

A

Bloods - Low thiamine, abnormal LFTs

MRI - Haemorrhage or Atrophy of Mammillary Bodies

168
Q

How do you manage Wernickes

A

Medical Emergency - Give IV Thiamine

169
Q

How do you manage Korsakoffs

A

It is often irreversible

Give oral Thiamine supplementation to prevent further progression

170
Q

What is an illusion

A

Misperception of a real stimuli

171
Q

What is a hallucination

A

Perception in the absence of an external stimuli

172
Q

What is an over valued idea

A

Belief sustained against logic/reason but held with less rigidity than a delusion

173
Q

What is a delusion

A

Unshakable beliefs, irrespective of counter argument that are unexpected and out of keeping with patients culture or background

174
Q

What is Delusional Perception

A

Delusional belief resulting from a real perception

175
Q

What is thought insertion

A

Thoughts been inserted by external agency

176
Q

What is thought withdrawal

A

Thoughts been stolen by external agency

177
Q

What is thought broadcast

A

Thoughts being broadcast so they can be heard by others

178
Q

What is thought echo

A

Form of auditory hallucinations in which patient hears their thoughts being spoken aloud

179
Q

What is thought block

A

Sudden interruption in train of thought, leaving a blank

180
Q

What is concrete thinking

A

Lack of abstract thinking

181
Q

What is loosening of association

A

Lack of logical association between thought

182
Q

What is circumstantiality speech

A

Taking a great length around the subject before giving their answer

183
Q

What is tangential speech

A

Does not return to the topic

184
Q

Confabulation

A

Giving a false account to fill a memory gap

185
Q

What is passivity

A

The belief that ones thoughts and actions are being controlled

186
Q

What is somatic passivity

A

Delusional belief that the bodily sensations are from an external force

187
Q

What is made acts, feelings and drives

A

The experience being carried out by the patient is considered alien/imposed

188
Q

What is catatonia

A

Significantly excited or inhibited motor activity (waxy flexibility)

189
Q

What is stupor

A

Loss of activity with no response to stimuli, may mark progression of motor retardation

190
Q

What is psychomotor retardation

A

Slowing of thoughts and movements

191
Q

What is flight of ideas

A

Rapid skipping from one thought to distantly related ideas

192
Q

What is neologisms

A

Made up words

193
Q

What is pressure of speech

A

Rapid rate of delivery may be associated with rhymes and puns

194
Q

What is poverty of speech

A

Reduced amount, range and content of speech

195
Q

What is anhedonia

A

Lack of pleasure in activities usually enjoyed

196
Q

What is flattening of affect

A

Reduced range of emotional expression

197
Q

What is incongruity of effect

A

Mismatch between emotional expression and content of conversation

198
Q

What is an obsession

A

A recurrent unwanted thought (intrusive)

199
Q

What is a compulsion

A

An irresistible urge to behave in a certain way

200
Q

What is belle indifference

A

An apparent lack of concern at symptoms/disability

201
Q

What is stereotypy

A

Persistent repetition of a behaviour without cause

202
Q

What is mannerism

A

Habitual gesture of language or behaviour

203
Q

What is delusion of reference

A

A coincidental or innocuous event which is believed to have some special meaning or strong personal significance e.g an earthquake in SE Asia seen on TV was caused by him

204
Q

What are some types of delusions

A
  • Persecutory
  • Erotomanic - (belief someone is in love with them usually someone with higher status e.g celebrity)
  • Religious
  • Grandiose
  • Jealous
  • Nihilistic
  • Delusional Misidentification
205
Q

What are the two types of Delusional Misidentification

A

Capras - person close to them has been replaced by a double

Fregoli - Single person impersonating multiple people

206
Q

What is Somatisation Disorder

A

persistent unexplained somatic/physical symptoms (heartburn, fatigue headache) for > 6 months with a Hx of extensive diagnostic testing and medical procedures

207
Q

What is the diagnostic criteria for Somatisation Disorder and how is treated

A

1 or more somatic symptom causing significant stress or impairment resulting in excessive thoughts, feeling and behaviours about symptom manifesting in 1 of following:

  • constant thinking about severity of symptoms
  • constant anxiety about symptom
  • excessive amounts of energy/time attending to symptom

Treatment: CBT

208
Q

What is conversion disorder

A

Neurological symptoms that can’t be explained by a neurological condition

  • 1 or more neurological conditions which are incompatible with recognised neurological/medical conditions
  • Causing significant distress/psychosocial impairment
209
Q

What is a personality disorder

A

Long lasting rigid and maladaptive personality patterns (thought, affect and behaviour) that lead to significant distress or functional impairment

210
Q

What criteria do all personality disorders meet

A
  • They affect several areas of function e.g impulse, relationships, cognition, affectivity
  • they are chronic and stable over time
  • They impair function in important areas of life e.g social and work
  • Diagnosed at 18 years and above
  • Cause considerable personal distress
211
Q

What are the three clusters of personality disorders

A

A - Odd and Eccentric
B - Emotional, Dramatic and Erratic
C - Fearful, Avoidant and Anxious

212
Q

What are the types of personality disorders in Group A

A

Paranoid - pervasive distrust
Schizoid - voluntary detachment from individuals
Schizotypical - odd, eccentric and magical thinking

213
Q

What are the types of personality disorder in Group B

A

Dissocial/ Antisocial (DSM - 5) - conduct disorder, deceitful, agression, lack of remorse

Emotionally Unstable

Histrionic - Attention seeking and Dramatise with excessive emotions

Narcissistic - Grandiosity, need for admiration and lack empathy

214
Q

What are the two types of emotionally unstable personality disorder

A

Borderline - Fear of abandonment, Mood Swings, Chronic feelings of Emptiness, Unclear self image/identity and unstable relationships, self harm and splitting

Impulsive - Inability to control anger or plan, unpredictable affect or behaviour

215
Q

What are the types of personality disorder in cluster C

A

Avoidant - fear of rejection, feeling of inadequacy and involuntary social withdrawal

Dependent - requiring others to take responsibility, lack of self confidence, feeling helpless, seeking new relationships

Obsessive - Compulsive - Rigid routines, perfectionists and obsession with control

216
Q

How do you manage personality disorder

A

Psychotherapy:

  • Dialectical Behavioural Therapy - works well in borderline!
  • Group Therapy
  • CBT - usually ineffective

Medication usually not effective but can be used to manage symptoms e.g
- Mood Stabilisers, Antipsychotics, SSRIs

High rates of Suicide and other mental illness

217
Q

What are some examples of social intervention management

A 
Benefits 
Cultural Support 
Care Package 
Help with meaningful activity 
Help with housing 
Safeguarding 
Access/Support with Education
Employment 
Social Integration 
Support with Engagement/Person Centred Care
Anti Discriminatory Language 
Help with abstinence of addictions
218
Q

What is the mental health act

A

Law which allows people with a mental disorder to be admitted to hospital, detained and treated for that mental disorder without consent to protect themselves and others

The treatment implies the treatment of your mental disorder

219
Q

What is Section 2 of the mental health act

A

Detention in hospital for assessment of your mental health and potentially get treated

Lasts up to 28 days

220
Q

What is Section 3 of the mental health act

A

Detention in hostile for treatment, necessary for your health, safety and protection of others

Lasts up to 6 months

221
Q

What is section 5(2) of the mental health act

A

Any Doctors holding power to allow assessment under the MHA

Lasts up to 72 hrs for assessment for a section 2 or 3

222
Q

What is a Section 5 (4) of the mental health act

A

Nurses holding power to allow assessment under the MHA

Lasts up to 6 hours for assessment for a section 2 or 3

223
Q

What is a section 136 of the mental health act

A

Police removal from public place to designated place of safety for MHA assessment

224
Q

What is a section 135 of the mental health act

A

Police removal from home to designated place of safety for MHA assessment

225
Q

Who do you need to undertake an assessment under the mental health act

A

Approved mental health professional (AMPH)
Section 12 approved doctor
Another registered doctor

226
Q

What conditions must be met regarding their mental health to retain them

A

Mental Health Disorder
With a nature or degree to warrant detention in hospital
Risk to self or others

227
Q

Who can release someone from their section

A

Consultant Psychiatrist
Mental Health Tribunal
Nearest Relative
Hospital Manager Hearing

228
Q

What is the mental capacity act

A

Applies if you have a mental health problem but do not have the mental capacity to make certain decisions about healthcare or residential care

Can be used to give treatment for physical health problems that have nothing to do with mental health problem

229
Q

What are the 5 key principles of the mental capacity act

A
  • You must be treated as if you have capacity until it is proven you don’t
  • You must be supported to make a decision e.g giving info in different ways
  • You have the right to make an unwise decision as long as you have capacity
  • Anything done under act must be in the patients best interest
  • Anything done under act must be the least restrictive option available
230
Q

What are the 4 key things to assess capacity

A

Understand information
Weigh up information
Retrain information
Communicate Decision

231
Q

What can be given to tranquillise aggressive behaviour

A

Lorazepam
OR
Antipsychotic (e.g Olanzapine) - Don’t give if patient already on a regular antipsychotic (QT prolongation)

232
Q

What are differentials for weight loss

A 
Diabetes!!!!!
IBS/IBD/Coeliac 
Hyperthyroidism 
CHD
Neoplasm 
Anorexia Nervosa 
Depression/OCD/Anxiety 
Substance Misuse 
Autism 
CF
233
Q

What is the criteria for Anorexia Nervosa

A
  • Low weight: <85% predicted or BMI = 17.5
  • Intense fear of gaining weight/fatness
  • Deliberate restriction of weight through calories or exercise
  • Endocrine changes e.g amenorrhoea, reused libido
234
Q

What may cause Anorexia

A

Biological: Genetics, Serotonin Dysregulation

Psychological: Depression, Anxiety, OCD, perfectionism and personality type

Developmental: Adverse life events, parents with eating disorder

Sociocultural: Substance abuse, media exposure, image awareness activities (ballet), bullying

235
Q

What are weight loss techniques used in anorexia

A
  • Exercise
  • Amphetamines
  • Calorie Restriction
  • Not taking Medication e.g propylthiouracil or Carbimazole or taking too much thyroxine
  • Purging
  • Laxatives
  • Vomiting
  • Cold Showers
236
Q

How does anorexia present

A

General: Fatigue, reduced cognition, sleep disturbance, hypothermia, dizzy

GI: Constipation

Reproductive: Sub-fertility, Secondary Amenorrhoea

Haematological: Anaemia, Low WCC + platelets

Endocrine/Electrolytes: Raised cortisol and adrenaline,
hypokalaemia, low phosphate and low magnesium

Cardiovascular: Low BP, Bradycardia, prolonged QT, arrhythmias

Bone: Osteoporosis and Fractures

Other: Dental caries, Dry skin, Russells Sign, Brittle hair

237
Q

What can be used to screen for Anorexia

A

SCOFF Questionnaire

Sick (make yourself sick if you feel full)
Control (worry about losing control)
One stone (in 3 months)
Fat (think you’re fat but others say you’re thin)
Food (dominate your life)

238
Q

What are red flags for Anorexia Nervosa

A 
BMI <13 
Temp <34.5 
Vascular BP <80/50 and pulse <40
Muscles - failure to so SUSS
Blood: Low potassium and low phosphate
ECG: prolonged QT complex
239
Q

How is Anorexia managed

A

Psychotherapy: CBT

Bio: BMI<15, unstable vital signs (hypothermia, electrolyte imbalance and bradycardia) - admit to hospital hospitalisation for re-feeding via NG or parenteral
Dietician/Nutritional Support
SSRIs, Antipsychotics?

Social: Family Intervention, Addressing family dynamics, carer support

240
Q

What can severe anorexia lead to

A

Low potassium can lead to prolonged QT - arrhythmias and death

241
Q

What is a complication of Anorexia treatment

A

Refeeding Syndrome
Very rapid increase in food intake causes massive insulin release - increased displacement of potassium, magnesium and phosphate massive shift intracellular - causing low potassium, magnesium and phosphate

242
Q

How does referring syndrome present

A 
Rhabdomyolysis 
Respiratory or Cardiac Failure 
Low BP
Arrhythmias (torsades de points)
Seizures and Death
243
Q

How is referring syndrome managed and how is it prevented

A

Electrolyte Substitution
Consult dietician to develop slow referring plan
Monitor Electrolytes: Mg, PO4 and K+

244
Q

What risks need to be assessed for anorexia

A 
Cardiac risk
Refeeding risk
Falls risk
Seizure risk 
Self Harm risk
245
Q

What is the criteria for Bulimia

A

Recurrent Episodes of Binge eating (uncontrolled eating)
Preoccupation of control of body weight
Regular use of mechanism to overcome fattening effects e.g laxatives, exercise
BMI - >17.5

246
Q

What symptoms may be seen in Bulimia

A 
Fatigue
Dental Caries 
Gastritis 
Russells Sign 
Cardiomyopathy 
Swelling of hands and feet 
Low potassium, metabolic alkalosis, hypochloraemia
247
Q

How is Bulimia managed

A

Psychotherapy: CBT, self help books, food diary
Nutritional Rehabilitation
Medication: SSRIs (fluoxetine)

248
Q

What are risk factors for autism and what may be associated with autism

A

Risk: Strong underlying genetic component

Associations: Epilepsy and ADHD

249
Q

What are the two core symptoms of Autism

A
  1. Impairment in communication and social interaction
  2. Restricted repetitive patterns of behaviour, interests and activities

Other symptoms: impaired language and intellectual impairment

250
Q

What symptoms are you going to get due to impairment in communication and social interaction

A
  • Inability to form relationships and make friends
  • Unaware of the existence and feelings of others
  • Lack of desire/motivation to communicate and interact with others
  • Communicating needs only
  • Disordered or delayed language
  • Repeats Speech
  • Reduced Empathy
  • Difficulties in adjusting behaviour to social situations
  • Poor eye contact
251
Q

What symptoms are you going to get due to restricted repetitive patterns of behaviour

A
  • Stereotyped movement’s: Hand flapping
  • Preoccupation with parts of objects: excessive smelling/touching
  • Inability to play or write imaginatively
  • Resists change/distress over change
  • Obsessions/Rituals likes a strict routine
  • Plays same game over and over
  • Narrow fixations e.g lining up toys
  • Odd speech e.g echolalia
252
Q

What is the management of Autism

A
  • Early intensive behavioural intervention
  • Speech Therapy
  • Education and Information
  • School Liaison/Support
  • ASD Parent Training/Workshop
  • Supportive tools e.g PECs, visual cues, timetables, visual behaviour support
  • Medication to manage comorbities e.g Risperidone
253
Q

How does Ashbergers Differ on the Autism Spectrum

A

No intellectual or language impairment

254
Q

What are the three core symptoms of ADHD

A

Impulsivity
Inattention
Hyperactivity

255
Q

What is needed for the diagnosis of ADHD

A

Present before 12 years
Developmentally inappropriate
Several Symptoms in 2 or more settings
Interfere with normal levels of functioning

256
Q

What are symptoms of inattention

A
  • Poor Attention/easily distracted
  • Difficulty sustaining attention during activities and tasks
  • Inability to complete tasks
  • Struggles to organise tasks
  • Forgetful/Loses things
257
Q

What are symptoms of hyperactivity

A
  • Squirms and figets
  • Restless
  • Talks Excessively
  • No Quiet hobbies
258
Q

What are symptoms of Impulsivity

A
  • Blurts out answers
  • Interrupts others
  • Cannot take turns
259
Q

What can ADHD be associated with

A 
Disruptive and Impulsive Behaviour 
Aggression and Antisocial Behaviour 
Conduct Disorder 
Alcohol and Drug Problems 
Accidents 
Self harm and Suicide
260
Q

How is ADHD assessed

A

Collateral Hx doctors, teachers, parents

Behavioural Observation in varying contexts

261
Q

What is the cause of ADHD

A

Genetics
Environmental Factors
Neurobiological
CNS insults (prematurity, fetal alcohol syndrome)

262
Q

How is ADHD managed

A 
Education and Information 
ADHD parenting programme
School support and Liaison 
Medications
- 1st line: Methylphenidate 
- 2nd line: Atomoxetine

Specialties (4 decks)

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