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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Psychiatric assessment: what is modification?

A

Recognising when a process needs to be modified and how to modify e.g. distressed patient, reduced cognitive capacity, non-native speaker.

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2
Q

What is a forensic history?

A

Asking the patient about past juvenile crime, court appearances or convictions.

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3
Q

What 4 things are you assessing throughout a mental state examination?

A
  1. Appearance and behaviour. 2. Speech. 3. Mood. 4. Thoughts, delusions and hallucinations.
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4
Q

Psychiatric assessment: what is a risk assessment?

A

Consideration of how likely an event will occur, when it will occur and how bad will it be. E.g. harm to self, harm to others, suicide, self-neglect.

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5
Q

Formulation: what are the 5 P’s?

A
  1. Presenting problem. 2. Predisposing factors. 3. Precipitating factors. 4. Perpetuation factors. 5. Protective factors.
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6
Q

What is psychopathology?

A

The study of abnormal experience, cognition and behaviour.

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7
Q

What are the 2 essential components of psychopathology?

A
  1. Observation of behaviour. 2. Empathic assessment of subjective experience.
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8
Q

What is a concrete concept?

A

Real objects or situations e.g. tremor.

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9
Q

What is a defined concept?

A

Classes of concept e.g. delusions.

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10
Q

What are concept systems?

A

Sets of related concepts e.g. schizophrenia.

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11
Q

Give 3 examples of perceptual symptoms.

A
  1. Illusion. 2. Hallucination. 3. Pseudo-hallucination. 4. Delusion. 5. Over-valued idea.
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12
Q

Define illusion.

A

A misperception of real external stimuli.

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13
Q

What is a hallucination?

A

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.

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14
Q

Define pseudo-hallucination?

A

Pseudo-hallucinations appear to arise in the subjective inner space of the mind, not through one of the external sensory organs - this is how they differ from hallucinations.

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15
Q

What is meant be the term ‘over-valued idea’?

A

An over-valued idea is a false or exaggerated belief sustained beyond logic or reason e.g. I am the best employee ever.

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16
Q

Define delusion.

A

A false, unshakable idea which is out of keeping with the patients educational, cultural and social background; it is held with extraordinary conviction and certainty.

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17
Q

Give 5 examples of different types of delusion.

A
  1. Persecutory. 2. Grandiose. 3. Self-referential. 4. Nihilistic (Cotard’s syndrome). 5. Misidentification. 6. Religious. 7. Hypochondriacal.
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18
Q

What is the Capgras delusion?

A

The idea that someone has been replaced by an impostor.

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19
Q

What is the Fregoli delusion?

A

The idea that various people are in fact the same person.

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20
Q

Thoughts are a common psychiatric sign. Name 5 types of thoughts patients may report/describe.

A
  1. Thought insertion. 2. Thought withdrawal. 3. Thought broadcast. 4. Thought echo. 5. Thought block.
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21
Q

What is concrete thinking?

A

A lack of abstract thinking, in adults this may be due to organic disease or schizophrenia.

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22
Q

Define loosening of association.

A

A lack of logical association between succeeding thoughts, often leads to incoherent speech. It is impossible to follow the patients train of thought.

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23
Q

Define circumstantiality.

A

Irrelevant wandering in conversation.

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24
Q

What is perseveration?

A

Repetition of a word, theme or action.

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25
Q

What is confabulation?

A

Giving a false account to fill a gap in memory. This is often seen in dementia patients.

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26
Q

Define somatic passivity.

A

The delusional belief that one is a passive recipient of bodily sensations from an external agency.

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27
Q

Define catatonia.

A

Excited or inhibited motor activity in the absence of a mood disorder or neurological disease.

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28
Q

What is psychomotor retardation and in what conditions would it be present?

A

Slowing of thoughts and movements. It can be seen in depression, Parkinson’s disease etc.

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29
Q

Presentation: describe incongruity of affect.

A

Emotional responses that seem grossly out of tune with the situation or subject being discussed.

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30
Q

Presentation: what is blunting of affect?

A

An absence of normal emotional responses.

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31
Q

Presentation: what is depersonalisation?

A

Feelings of detachment from one’s own body; the patient feels like a spectator of his own activities.

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32
Q

Presentation: describe derealisation.

A

A sense of one’s surroundings lacking reality, surroundings may appear dull, grey, lifeless.

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33
Q

Presentation: describe dissociation.

A

When a person feels disconnected from his/herself and/or their surroundings.

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34
Q

Psychiatric signs: what is obsession?

A

A recurrent persistent thought, image or impulse; it remains despite efforts to resist.

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35
Q

Psychiatric signs: what is compulsion?

A

Repetitive, purposeful behaviour accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and resistance.

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36
Q

Psychiatric signs: what is akathisia?

A

Motor restlessness, ranging from anxiety to the inability to lie/sit still.

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37
Q

Phenomenology: what is projection?

A

What is emotionally unacceptable in the self is unconsciously rejected and projected to others e.g. mother projects her anxiety onto her children claiming they are anxious instead.

38
Q

Give 3 signs/symptoms of mania.

A
  1. Pressured speech. 2. Lots of projects/things going on. 3. Delusions. 4. Increased energy/activity. 5. Overfamiliarity. 6. Impulsivity.
39
Q

Give 2 examples of affective disorders.

A
  1. Depression. 2. Bipolar disorder.
40
Q

Give 3 symptoms of depression.

A
  1. Low mood. 2. Lacking energy. 3. Loss of pleasure. 4. Sleep disturbance. 5. Appetite change. 6. Feelings of guilt, hopelessness. 7. Suicidal thoughts.
41
Q

Give 3 symptoms often seen in bipolar disorder.

A
  1. Increased energy. 2. Pressured speech. 3. Recklessness. 4. Impaired judgement. 5. Inflated self-esteem. 6. Elevated mood.
42
Q

When is the onset of schizophrenia most typical?

A

In the 2nd or 3rd decade.

43
Q

Give a characteristic sign of schizophrenia.

A

Characteristic splitting of thoughts or a loss of contact with reality. Thoughts, perceptions, mood, personality, speech can all be affected.

44
Q

Give 3 first rank symptoms of schizophrenia.

A
  1. Thought alienation. 2. Passivity phenomena. 3. 3rd person auditory hallucinations. 4. Delusional perception.
45
Q

Give 3 second rank symptoms of schizophrenia.

A
  1. Delusions. 2. 2nd person auditory hallucinations. 3. Thought disorder. 4. Negative symptoms.
46
Q

Name 3 types of psychoses.

A
  1. Schizophrenia. 2. Delusional disorder. 3. Schizotypal disorder. 4. Depressive psychosis. 5. Manic psychosis. 6. Organic psychosis.
47
Q

Give 3 physical signs and 3 psychological signs of panic disorder.

A

Physical: 1. Palpitations. 2. Chest pain. 3. Tachypnoea. 4. Dry mouth. 5. Dizziness. Psychological: 1. Feeling of impending doom. 2. Fear of dying. 3. Fear of losing control. 4. Derealisation.

48
Q

Give 3 positive signs/symptoms.

A
  1. Hallucinations. 2. Delusions. 3. Passivity phenomena. 4. Thought alienation. 5. Lack of insight. 6. Mood disturbance.
49
Q

Give 3 negative signs/symptoms.

A
  1. Blunting of affect. 2. Amotivation. 3. Poverty of speech and/or thought. 4. Self-neglect. 5. Lack of insight. 6. Poor non-verbal communication.
50
Q

What 2 classification systems are used for psychiatric conditions?

A
  1. DSM5. 2. ICD10.
51
Q

Give 2 pros and 2 cons of using classification systems for psychiatric conditions.

A

Pros: 1. Allows for population study and health planning. 2. Aids education. Cons: 1. Over generalised. 2. Ignores individual characteristics. 3. Diagnostic labels may lead to stigma.

52
Q

Define personality disorder.

A

Inner experience and behaviour that deviates from expectations. Pervasive and inflexible, tends to begin in adolescence, is stable over time and leads to distress.

53
Q

What are the essential diagnostic features of a personality disorder?

A
  1. Impairments in self and interpersonal functioning. 2. Impairments in personality functioning. 3. Impairments are relatively stable across time and consistent across situations.
54
Q

What daily life tasks might someone with a personality disorder struggle with?

A
  1. Forming/maintaining friendships and work relationships. 2. Struggle to control feelings and behaviours. 3. Struggle to trust others.
55
Q

What is the main type of personality disorder?

A

Emotionally unstable personality disorder.

56
Q

Give 3 symptoms of a borderline type personality disorder.

A
  1. Emotional instability. 2. Difficult, intense relationships. 3. Feelings of emptiness. 4. Impulsive. 5. Self injurious behaviour. 6. Fear of abandonment/rejection.
57
Q

Why might someone with a borderline personality disorder self-harm?

A
  • Relieve psychic pain. - Express anger. - Reduce anxiety. - Feel in control. - Feel something when numb. - Communicate how they feel.
58
Q

How would you treat/manage someone with a personality disorder?

A
  1. Psychological therapies - dialectical behavioural therapy. 2. Structured clinical management. Medication is not mainstay.
59
Q

What principles underly the Mental Health Act?

A
  1. Respect for patients’ wishes and feelings. 2. Minimise restrictions on liberty. 3. Public safety. 4. Patient well-being and safety, 5. Involving patients in planning, developing and delivering care.
60
Q

Describe Section 2 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: assessment, treatment can be given without consent. 2. Duration: 28 days. 3. Professionals involved: 2 doctors, AMHP.
61
Q

Describe Section 3 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: treatment. 2. Duration: 6 months. 3. Professionals involved: 2 doctors, AMHP.
62
Q

Describe Section 4 of the MHA - purpose, duration, professionals involved.

A
  1. Purpose: emergency order. 2. Duration: 72 hours. 3. Professionals involved: 1 Dr and 1 AMHP.
63
Q

Lithium is an effective treatment for many psychiatric conditions including mania, bipolar disorder, depression etc. Why should it be used with care?

A

Lithium has a narrow therapeutic range which can lead to renal failure.

64
Q

What is dementia?

A

A progressive neurological disorder impacting cognition which causes functional impairment.

65
Q

Name 3 types of Dementia.

A
  1. Alzheimer’s. 2. Vascular. 3. Lewy Body.
66
Q

Give 3 differential diagnoses for dementia.

A
  1. Old age. 2. Depression. 3. Physical health problems e.g. DM, hypothyroid, vitamin deficiencies.
67
Q

What is the main investigative screening tool used for dementia?

A

ACE-III screening tool.

68
Q

Dementia: what 5 cognitive domains does the ACE-III screening tool assess?

A
  1. Attention. 2. Memory. 3. Fluency. 4. Language. 5. Visiospatial.
69
Q

What drugs can be used in the treatment of dementia?

A
  1. Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine. 2. NMDA antagonist e.g. Memantine. 3. RF reduction in vascular dementia is important too.
70
Q

What is pseudo-dementia?

A

Cognitive impairments secondary to a mental illness e.g. depression/anxiety.

71
Q

Give one way that you could distinguish between pseudo-dementia and dementia.

A

Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.

72
Q

What is delirium?

A

Delirium is an acute confusional state often with changes in consciousness. It is a medical emergency but is often reversible.

73
Q

Give 3 causes of delirium.

A
  1. Infection e.g. UTI. 2. Dehydration. 3. Iatrogenic e.g. medication changes or surgery. 4. Constipation. 5. Urinary retention.
74
Q

Patients with what psychiatric disorder may be more prone to delirium?

A

Patients with dementia - bidirectional relationship.

75
Q

How can you treat delirium?

A

Treat the underlying cause and consider environmental support. Antipsychotics can be used in extreme cases if the patient is suffering from hallucinations.

76
Q

Give 5 potential causes of depression.

A
  1. Drugs e.g. beta-blockers, opioids. 2. Metabolic e.g. anaemia, B12/folate def, cancer. 3. Infective e.g. post-viral, UTI. 4. Inflammatory e.g. temporal arteritis. 5. Intracranial e.g. post-stroke, Parkinson’s, Delirium, Dementia.
77
Q

Give 3 treatment/management strategies for depression.

A
  1. Antidepressants e.g. SSRI’s. 2. Talking therapies. 3. Social inclusion and community support. 4. ECT.
78
Q

What type of depression often responds poorly to antidepressants?

A

Vascular depression.

79
Q

What is Charles Bonnet Syndrome?

A

A condition characterised by visual hallucinations.

80
Q

What is the recovery model?

A

A non-pharmacological, psychosocial approach to treatment e.g. supporting housing, living, money, social inclusion, therapy, counselling, family work.

81
Q

What is formulation?

A

A meaningful narrative - summarising a patients condition. The 5 P’s demonstrates a good formulation model.

82
Q

Give examples of psychosocial therapies.

A
  1. Psychotherapy. 2. CBT. 3. Counselling. 4. Cognitive analytic therapy. 5. Interpersonal therapy. 6. Dialectic behaviour therapy. 7. Family therapy.
83
Q

What questions should you ask when taking a developmental history.

A
  1. Pre and post-natal: maternal substance use, birth, milestones. 2. Who was the main carer? 3. Life events and early childhood adverse experiences. 4. Teenage years: drug/alcohol use, changes in academic level, bullying.
84
Q

What is attachment disorder?

A

When a child is unable to develop relationships with parents/carers.

85
Q

How do you manage and treat a patient who has had a subarachnoid haemorrhage?

A
  1. Nimodipine (CCB). Early intervention, support and close monitoring is essential.
86
Q

What are DOLS?

A

Deprivation of Liberty Safeguards are a part of the MCA (2005). They are a set of rules that apply when a patient can’t make decisions about how they’re cared for.

87
Q

When do DOLS apply?

A
  1. When a patient is in a hospital or care home. 2. When the staff keep the patient under continuous supervision. 3. The patient or the family members are unhappy about the care/limitations of the care.
88
Q

Describe the treatment for bipolar disorder.

A
  1. Mood stabilisers e.g. Lithium, sodium valporate or aripiprazole. 2. Psychological therapies e.g. CBT.
89
Q

What do you need to monitor for when treating a patient with Lithium?

A

Kidney function and Thyroid function.

90
Q

Give examples of the following anti-depressants: - SNRI. - MAOI. - SSRI. - Tri-cyclic. - Tetra-cyclic.

A
  1. SNRI: Duloxetine. 2. MAOI: Isocarboxazid, Phenelzine. 3. SSRI: Sertraline, Citalopram, Fluoxetine. 4. Tri-cyclic: amitriptyline. 5. Tetra-cyclic: Mirtazapine.

Phase 3a (22 decks)

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