Psychiatry Flashcards

Question

What is mood incongruence? Give examples

Answer 1

Symptoms experienced are conflicting with the person's current mood. e.g. Laughing when your dog dies Believing you have superpowers despite going through a major depressive episode

Answer 2

Mild chronic depression. Symptoms are not severe enough to meet criteria for a mild depressive disorder.

Answer 3

Mild, Moderate, Severe, Psychotic (Delusions/Hallucinations) - Should be used to classify a single depressive episode. Further episodes = Recurrent depressive disorder, with an episode of X Mild - 5 SIGECAPS (At least 1 core) - Minor functional impairment Moderate - Functional impairment between mild and severe Severe - Most symptoms present, Severe functional impairment that interferes with normal function +/- psychotic symptoms

Answer 4

``` Hypothyroidism, Cushing syndrome Dysthymia Cyclothymia Bipolar disorder Schizophrenia GAD PTSD Postnatal depression OCD Eating disorder Bereavement Normal sadness Drugs side effects ```

Answer 5

Antidepressants - SSRI, TCAs ,MAOi ECT CBT Counselling

Answer 6

``` Pregnancy Patient Preference Previous Treatment experience Suicidality Past history of elevated mood Age and Physical Health ```

Answer 7

10-25 years | Understand contributing factors can also lead to premature death -e.g. Co-mobitdities

Answer 8

Women (X2)

Answer 9

Innate and enduring characteristics characteristics of an individual which shapes their attitudes, thoughts and behaviours in response to situations.

Answer 10

Enduring patterns of thinking and feeling about oneself and others that significantly and adversely affect how and individual functions in various aspects of life. Characteristics cause difficulties for themselves or relationships with others. Abnormalities must not be caused by any other condition. Out keeping with social & cultural norms.

Answer 11

Cluster A - Odd/Eccentric Cluster B - Dramatic, Emotional & Erratic Cluster C - Fearful & Anxious MAD BAD SAD

Answer 12

Paranoid Schizoid Schizotypical

Answer 13

``` Histrionic Narcissistic Antisocial (dissocial) Emotionally Unstable Borderline Emotionally Unstable Impulsive ```

Answer 14

Avoidant Dependent Anankastic (OCD)

Answer 15

Suspicious of others - interprets motives as malevolent Sensitive Pervasive distrust Jealousy (Partners fidelity)

Answer 16

Pattern of detachment from social relationships Excessive introspection & fantasy Wants nothing to do with social interaction

Answer 17

Strange/Odd behaviour Strange Appearance, belief & thinking Interpersonal discomfort NO PSYCHOTIC EPISODE

Answer 18

Violates rights of others/ Callous lack of concern No respect for authority Aggression and Irritability

Answer 19

``` Flamboyant Attention seeking Seductive Excessively emotional / Self-dramatisation Manipulating behaviour Egocentric ```

Answer 20

Grandiosity Lack of empathy Heighten importance of self Need for admiration

Answer 21

Unstable self-image Unstable relationships Splitting views of individuals - All good or All Bad

Answer 22

Inability to control anger | Unpredictable affect and behaviour

Answer 23

Very timid & shy Low self-esteem Avoids social contact - Uncomfortable Afraid or rejection

Answer 24

Passive allow others to direct their lives Lacks self-confidence See themselves as hopeless or stupid Clingy

Answer 25

Pharmacological Intervention A & B - Antipsychotics C - Antidepressants Mood stabilisers - Li or Anticonvulsants to control affective instability or impulsivity Psychodynamic therapy DCT CBT Substance abuse treatment program referral

Answer 26

Substance misuse Self-Harm and suicide Depressive disorder

Answer 27

``` Substance misuse Affective disorders Psychotic disorders Anxiety disorders (Phobia & Panic) Dementia ```

Answer 28

Perfectionist Preoccupied with trivial details Inflexible Feelings of excessive doubt or caution

Answer 29

Clinical Interview Urine drug screen MRI/CT scan of brain Questionairres for differentials - PHQ-9, GAD-7, GAD2, SAPAS(Standardised Assessment of Personality Abbreviated Scale)

Answer 30

1. Establish Patients intent. 2. Assess the seriousness and perceived seriousness of attempt. 3. How the patient feel about the attempt

Answer 31

1. Current Episode of self harm - Before Event, During Event, After Event 2. Previous Episodes of self-harm 4. Screen for Mental health conditions - Depression / Psychosis / Anorexia/ Alcohol Dependency 3. Past psychiatric history and remainder of normal history taking- PMH, DH FH, SH SH Needs to be focused on more!!

Answer 32

``` Location of cuts How many cuts? How deep? Feeling when they saw blood? Perceived outcome of cutting? Feelings at moment of cutting? ```

Answer 33

``` Type of medication? How they got medication? How much medication was taken? What did you take with the medication? Perceived outcome of taking the medication? How long have you been planning taking medication? Action after taking medication? How they got to hospital? ```

Answer 34

Trigger? Planned or impulsive? Any Final Acts? Preparative acts - Will, Note, Money transfers etc... Any precautious steps taken not to be discovered? Influenced by drugs or alcohol?

Answer 35

``` Method? Alone? Location? Actions after self harming? Did they think self-harm would kill them? Thoughts at the time? ```

Answer 36

Did you call anyone? Currently feel suicidal? If you were to go home today, what would you do? Any preventative factors against future self harm? Willingness for treatment?

Answer 37

``` Living situation Relationships & Dependants Occupation Drug & Alcohol Use ADLs ```

Answer 38

Are thoughts to harm ever not your own? Do you feel that there are voices telling you to self-harm that others cannot hear? How do they know these voices are not their own worries?

Answer 39

Act of intentionally killing oneself with the primary aim of dying

Answer 40

Act of intentionally killing oneself with the primary aim of dying, but failing to do so.

Answer 41

Act that looks like suicide but doesn’t result in death as a cry for help, attention, revenge or expression of despair.

Answer 42

Deliberate Self Harm (DSH) Act of intentionally injuring oneself not intended to cause death but to gain relief from psychological stress / pain.

Answer 43

Gender - M>F Age - 15 -44 Marital status - Single, divorced, widowed Unemployed Occupations- Farmers, doctors, Vets, pharmacists Socioeconomic status- G4 & 5 Poor/no level of social support - elderly, prisoners, refugees Personal reasons - Abuse as a child, access to means Sense of hopelessness/feeling of entrapment

Answer 44

Hx of DSH Mental disorder Physical illness (Chronic) / significant pain. FH of DSH

Answer 45

``` Mood Disorders Psychosis and Schizophrenia Anxiety Disorders Eating Disorders Dementia ```

Answer 46

Primary Mood disorders | Secondary Mood disorders (Organic)

Answer 47

Unipolar Depressive Disorder - Mild, Moderate, Severe, Psychotic Dysthymia Bipolar Bipolar Affective Disorder - B1 & B2 Cyclothymia

Answer 48

A mood disorder that doesn't result from another medical or psychiatric condition

Answer 49

Mood disorder that results from another medical or psychiatric condition - e.g. anaemia, hypothyroidism, substance missuse

Answer 50

MUST HAVE HAD 1 OR MORE EPISODES OF MANIA OR HYPOMANIA

Answer 51

A patient that has had more than one episode of depressive disorder. Current episode - classified for a single episode

Answer 52

Episodes of major depression and mania - Full blown mania lasting at least 7 days - Major depression at least 2 weeks - Symptoms of mania severe enough that hospitalisation is required

Answer 53

Episodes of major depression and hypomania -No full blown manic or mixed episodes (No history)

Answer 54

Recurrent episodes of mild elation and mild depressive symptoms that aren't sufficiently severe or prolonged to meet criteria for BPD Hypomanic and depressive symptoms don't meet B2 Criteria "Mild chronic bipolar affective disorder. "

Answer 55

Genetics Change in neurorecptors functions Neurochemical imbalances - Depletion of nAd, serotonin, dopamine Organic causes Environmental factors - Life events Neurological abnormalities - loss of volume in frontal and temporal lobes

Answer 56

Increases the levels of monoamines in synaptic cleft + elevates mood.

Answer 57

Neurological, Endocrine, Metabolic, Neoplastic, Drugs

Answer 58

>1.5 mmol/L

Answer 59

Lamotrigine, Carbamazepine, Valproate

Answer 60

Slowing down of thought Reduction of physical movements in an individual Can be visible and be observed in speech and affect.

Answer 61

1. ASSUME a person has CAPACITY unless proved otherwise. 2. Don't treat people as incapable of making unless ALL PRACTICABLE STEPS have been been taken to help make a decision 3. Don't treat a person as unable to make a decision just because they seem to make an UNWISE DECISION 4. Always take decisions in THE BEST INTERESTS of a person who lacks capacity 5. Before making a decision consider if the act can be acheived in a LEAST RESTRICTIVE way of a persons right and freedom of action

Answer 62

1. UNDERSTAND information RELEVANT to the decision 2. RETAIN information for a sufficient period to make decisions. 3. Use & WEIGH UP information as part of a process of making the decision 4. COMMUNICATE their decision

Answer 63

Hallucinations | Illusions

Answer 64

Stream of thought Possession of thought Content of thought Form of thought

Answer 65

State of psychological and physical symptoms brought about by a sense of apprehension at a perceived threat.

Answer 66

Genetic factors Neurochemical abnormalities - GABA inbalance Environmental factors - Stressful events

Answer 67

1. Initial trigger + Risk factors leads to 2. Fearful thoughts 3. Emotions of fear and anxiety 4. Body fight and flight system kicks in 5. Symptoms of anxiety occur 4a. Behavioural changes are taken to avoid panic.

Answer 68

TCAs, SSRI, CBT, Benzodiazepines.

Answer 69

Rapid onset of severe anxiety, lasts 20-30 minutes. Associated cognitions- Fear of symptoms Anxiety occurrence - Episodic (Occur recurrently and unexpectedly) Associated behaviour- Escape

Answer 70

Secondary Agoraphobia -Panic attack makes person avoidant of leaving the house to reduce risk of having a panic attack

Answer 71

Persistent and excessive worry about a number of activities or events. (>- 6M, Most days) Uncontrollable and irrational worry Anxiety and worry are associated with symptoms (3+) It is neither situational or episodic. (Phobia, Panic Disorder)

Answer 72

``` Concentration difficulty Restlessness Irritability Muscle tension Sleep disturbance (Falling asleep, staying asleep) Being easily fatigued ```

Answer 73

Auditory hallucinations - Thought echo, 2nd Person, 3rd person, voices arguing or commenting. Thought Allienation (X3) -Thought Withdrawal, insertion, broadcasting Somatic passivity Delusional perception Made feelings, impulses or actions (volition, affect, impulse)

Answer 74

Attribution of a new meaning usually in sense of self reference to a normally perceived object Combines memory+ delusional significance e.g. person thinks he's from royal decscent because he remembers a spoon as boy that had a crown on it.

Answer 75

Belief that one's thoughts or actions are influenced or controlled by an external agent.

Answer 76

At Least 1: Delusions, Hallucinations or disorganised speech Time period: >24H but LESS THAN 30 days n.b. - good consideration when considering a differential of delirium

Answer 77

Neuropsychiatric syndrome A sudden state of severe confusion and rapid changes in brain function and mental abilities.

Answer 78

Alcohol/benzo withdrawal suspected catatonia C/I to antipsychotics and extremely agitated NOTE- Can make delirium worse

Answer 79

A symptom or feature of mental illness characterised by radical changes in personality, impaired functioning, and a distorted or nonexistent sense of objective reality. Person loses contact with reality. Loss of function Lack on insight

Answer 80

Hallucinations Delusions Confused and disturbed thoughts

Answer 81

Rule out organic causes - FBC, UE, Urine drug screen, LFTs, Kidney function, Glucose, Folate & Vitamin B Levels (12,1,3), TFTs, Blood culture ESR, ANA - (Autoimmune)

Answer 82

Biological Psychological Social

Answer 83

A false sensory perception experienced without external stimulus.

Answer 84

Auditory - False perceptions of sound Visual - False visual perceptions of sound Tactile - False perceptions of touch (Formication) Gustatory - False perceptions of taste Olfactory - False perceptions of smell

Answer 85

Can't see - Blurred vision Can't pee - Urinary retention Can't spit - Dry mouth Can't shit - Constipation

Answer 86

``` Low socioeconomic status Lone Parent Teenage pregnancy Unwanted pregnancy Low social support Poor family relationships ```

Answer 87

``` Postnatum depression Baby Blues Postpartum (puerperal) psychosis Perinatal OCD Perinatal PTSD ```

Answer 88

Eating disorder chartered by restriction of caloric intake leading to: Low body weight Intense fear of gaining weight Body image disturbance

Answer 89

BMI BN >21 AN<18.5 (15%+ below expected) BN - Normal/Overweight AN- Underweight

Answer 90

1. Structured eating plan with oral nutrition 2. Psychotherapy - AN Family therapy 3. Fluid Repletion of any loss electrolytes-K, Ca2, Mg2+, Na, +- SSRI Depression (Fluoxetine) In extreme cases - NG feeding, oral feeding. Feeding as a treatment for MHA assessment Education on nutrition to challenge over-valued ideas.

Answer 91

``` CBC UE LFTs - UP ALT, AST TFTs - Low T3 Urinalysis ECG ``` Possible additionals - Hormone levels (Test, estradiol), Bone density

Answer 92

Prevents long term psychiatric and physical complications of AN

Answer 93

``` Muscle loss Hypotension Bradycardia Orthostatic HTN Amenorrhea Lack of libido Halitosis Electrolytes - HypoNA, Mg, Po Fatigue/Low energy Dry scaly skin Brittle hair Peripheral neuropathy Infertility Constipation Anaemia, Leukopenia, Thrombocytopenia Brain atrophy - Ataxia, confusion Cardiac symptoms - Oedema (CHF) ```

Answer 94

``` Genetic/Hormonal -Abnormalities in signals that convey hunger & satiety Social/Environment -Peer groups -Popular culture/Social media -Thin societal beauty standard ```

Answer 95

``` Young women Adolescence and puberty obsessive and perfectionist traits Exposure to western media Middle & upper socioeconomic status Athletes ```

Answer 96

Restricting - Person doesn't regularly engage in binge eating or purge behaviour No variability in diet Weight loss via dieting, exercise, fasting Binge-eating purging (Eating large amounts, then self inducing vomiting or purge) Binge/Purge - Person regularly engages in binge eating or purge behaviour

Answer 97

(Evacuating behaviour) Self inducing vomiting, misuse of laxatives, diuretics, diet pills

Answer 98

``` Refuse to eat infront of others Specific food rituals - v.small pieces, food order Purging Exercise Weight

Answer 99

Loss of appetite - Secondary to drugs Depression/OCD GI Disorders (Crohns, UC, malabsorption syndrome) Brain Tumours

Answer 100

Eating disorder characterised by recurrent episode of binge eating, followed by binge compensatory behaviour.

Answer 101

Eating amount of food definitely larger than most people would eat X2 the normal amount of food ingested.

Answer 102

At least ONCE weekly for 3 months

Answer 103

``` Female gender Personality disorder FH of obesity Childhood Hx of obesity Exposure to media pressure History of sexual abuse ```

Answer 104

CBT & Psychotherapy Nutritional and meal support SSRI -Fluoxetine / SNRI-Venlafaxine

Answer 105

FBC UE - Hypokalemia, other electrolytes decreases LFTs Pregnancy test (Always be consider for change in symptoms) Urinalysis - (possible ketones / poor glycemic ctrl) Serum creatinine - UP

Answer 106

``` Sleep Interest - Lack of interest (Anhedonia) Guilt Energy Concentration Appetite Psychomotor retardation Suicidal Ideation ``` Diurnal mood variation (Feel worst on waking and gradual improve)

Answer 107

``` CBT DBT Interpersonal Family therapy Mindfulness based therapy Cognitive analytical therapy ```

Answer 108

``` Psychotic symptoms Alcohol use Early onset Level of social support Age ```

Answer 109

Delusions of 'nothingness' and refer to rotting death or decay. They are consistent (congruent) with depressed mood

Answer 110

``` Hypothyroidism Cushing's syndrome Parathyroid disease Renal failure Folate deficiency Cerebral tumours Alcohol or drug misuse ```

Answer 111

Mirtazapine

Answer 112

``` Paranoid schizophrenia Hebephrenic schizophrenia Catatonic schizophrenia Undifferentiated schizophrenia Residual schizophrenia Simple schizophrenia ```

Answer 113

Mental illness that affects how a person thinks, feels, and behaves. Functional Psychosis disorder Fragmentation of thinking Lifetime Risk - 1 in 100

Answer 114

Symptoms that tend to represent a change in behaviour or thought. Usually sudden with onset

Answer 115

Negative symptoms usually involve a decline in normal functioning. Usually insidious

Answer 116

``` Thought echo (hearing your own thoughts out loud)* Thought insertion or withdrawal* Thought broadcasting* 3rd person auditory hallucinations* Delusional perception * Passivity and somatic passivity* Odd behaviour/Chaotic behaviour Thought disorder Lack of insight ``` * Schneider’s First Rank symptoms [Thought Disorder]

Answer 117

``` Blunted affect Apathy Social isolation Poverty of speech Poor self-care ```

Answer 118

``` Obstetric complications FH of schizophrenia Migrant status Cannabis use Childhood abuse Psychological stress Increased paternal age of birth (>55) ```

Answer 119

Loss of motivation

Answer 120

Poverty of speech - Struggling to give answers to brief questions.

Answer 121

Paranoid Schizophrenia Characterised by paranoid delusions and auditory hallucinations.

Answer 122

Care Programme Approach

Answer 123

4 Stages Assessing health and social needs Creating a care plan Appointing a key worker to be the first point of contact Reviewing treatment

Answer 124

Typical Atypical Typical antipsychotic drugs act on the dopaminergic system, blocking the dopamine type 2 (D2) receptors. Atypical antipsychotics have lower affinity and occupancy for the dopaminergic receptors, and a high degree of occupancy of the serotoninergic receptors 5HT-2A Extrapyramidal (motor) S/E - Typical More More withdrawal symptoms - Atypical

Answer 125

1. At least 2 of: Hallucinations, delusions, disorganised speech, catatonic behaviour/ -ve symptoms occurring for 1 Month + and continuous problems over a 6M period. At least one +ve Symptom [DSM-5] 2. No other cause for psychosis such as drug intoxication or withdrawal, brain disease (including dementia/delirium/epilepsy), or extensive depressive or manic symptoms A first-rank symptom or persistent delusion present for at least one month [ICD-10]

Answer 126

MSU to rule out UTI causing delirium Urine drug screen to rule out drug intoxication CT scan if an organic neurological cause is suspected HIV testing if applicable Syphilis serology if applicable Bloods including FBC, TFTs, U+Es, LFTs, CRP and a fasting glucose

Answer 127

Dopamine - Excess causes overactivity in mesocorticolimbic system & causes +Ve symptoms Serotonin - Increased activity Glutamate - Decreased activity

Answer 128

Risperidone/Olazanpine + IM Lorazapam - Extreme agitation, aggression/violence + Procyclidine (To reduce) extrapyramidal effects

Answer 129

``` Schizoaffective disorder Substance induced-psychosis Dementia w/psychosis BAD w/Psychosis Hyperthyroidism Hyperparathyroidism Delusional disorder Brief psychotic disorder Poisoning - CO2, heavy metal ```

Answer 130

Chronic mental illness characterised by the symptoms of schizophrenia & mood symptoms at the same time. Mood symptoms present for a great portion of psychotic disturbance =Schizophrenia (Psychosis) + Mood Disorder (Mood symptoms)

Answer 131

Delusions of persecution | Delusions of grandeur.

Answer 132

Stopping of voluntary movement or staying still in an unusual position (motor immobility) Wave flexibility - Able to stay in the same position for hours

Answer 133

``` War Physical Assault Sexual/physical abuse Rape Kidnapping Crashes - Car/Plane Natural disasters ```

Answer 134

Enhance the inhibitory effect of GABA Increase the frequency of chloride channel opening Sedation, hypnotic, anxiolytics, anticonvulsant,muscle relaxant insomnia, irritability, anxiety, tremor, loss of appetite, tinnitus, perspiration, perceptual disturbances, seizures

Answer 135

Lithium levels should be performed weekly and after each dose change until concentrations are stable. 12 hours after the last dose (If acute) Lithium blood level should be checked every 3 months TFTs & Renal func should be checked every 6 months.

Answer 136

Memory Loss (Retrograde)

Answer 137

Reduces seizure threshold, making seizures more likely ``` S/E hypersalivation agranulocytosis myocarditis / PE neutropaenia constipation Smoking cessation can cause a rise in clozapine blood levels ``` Last resort treatment - Once patient is resistant to other (2+) antipsychotics. FBC Moniotring prior to treatment & ECG

Answer 138

``` Clozapine Olanzapine Quetiapine Risperidone Apiprazole - Best side effect profile (Good for high prolactin) ```

Answer 139

Haloperidol Chloropromzaine Zuclopentixol

Answer 140

``` Nausea/vomiting, diarrhoea fine tremor nephrotoxicity ECG: T wave flattening/inversion Weight gain Leucocytosis ```

Answer 141

Cotard syndrome. Delusional disorder (Nihilistic delusion subtype)

Answer 142

Monoamine oxidase inhibitors- due to the risk of serotonin syndrome.

Answer 143

``` Fever Confusion Seizures Renal and hepatic impairment Arrhythmia, Increased muscle tone Hypersecretion of sweat. ``` To avoid this, patients should be given a 14-day washout period between MAOIs and SSRIs.

Answer 144

Symptoms: 6-12 hours - tremor, sweating, tachycardia, anxiety Seizures: 36 hours Delirium tremens: 72 hours -coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Answer 145

Lowering of WBC count. (Primarily Neurtrophils) Clozapine can cause this side effect.

Answer 146

Duloxetine Venlafaxine Inhibiting the reuptake increases the concentrations of serotonin and noradrenaline in the synaptic cleft

Answer 147

``` 0-4 no depression identified 5-9 mild depression 10-14 moderate depression 15-19 moderately severe depression 20-27 severe depression ``` MAX - 27

Answer 148

Paroxetine Increased risk of congenital malformations

Answer 149

``` Efforts to avoid discovery Planning suicide Leaving a written note Final acts - sorting out finances Violent methods for dying ```

Answer 150

Reduced BMI Bradycardia Hypotension Enlarged salivary glands

Answer 151

most things low G's and C's raised: GH, Gluc, Salivary glands, Cortisol, Cholesterol, Carotinaemia/Xanathaemia (Increased Beta-Carotene) ``` hypokalaemia Low sex hormones- FSH, LH, oestrogens and testosterone Raised cortisol and GH impaired glucose tolerance hypercholesterolaemia hypercarotinaemia low T3 ```

Answer 152

Repetition of someone’s speech. including the question that was asked.

Answer 153

The formation of new words.

Answer 154

When ideas or words are repeated several times despite an attempt to change the topic.

Answer 155

Wandering from a topic without returning to it.

Answer 156

Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, the person does eventually return the original point.

Answer 157

short history, rapid onset biological symptoms e.g. weight loss, sleep disturbance patient worried about poor memory reluctant to take tests, disappointed with results mini-mental test score global memory loss (dementia characteristically causes recent memory loss)

Answer 158

Antimuscarinic: dry mouth, blurred vision, urinary Retention, constipation Sedation, weight gain Raised prolactin may result in galactorrhoea due to inhibition of the dopaminergic tuberoinfundibular pathway impaired glucose tolerance neuroleptic malignant syndrome: pyrexia, muscle stiffness reduced seizure threshold (greater with atypicals) prolonged QT interval (particularly haloperidol)

Answer 159

Stroke | VTE

Answer 160

Parkinsonism acute dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis) akathisia (severe restlessness) tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

Answer 161

procyclidine (anticholinergic drug)

Answer 162

They may increase the chance of congential heart defects and malformations in children. Especially 1st Trimester use

Answer 163

Long QT Syndrome CI: Patients with pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval

Answer 164

Sertraline

Answer 165

``` Strong family history Gradual onset Low IQ Premorbid history of social withdrawal Lack of obvious precipitant ```

Answer 166

Expression of rapidly shifting thoughts in an individual. e.g leaps from one topic to another but with some link between them. Feature of Mania

Answer 167

Persistently elevated mood state with psychotic symptoms. >7 Days severe functional impairment Psychotic symptoms -delusions of grandeur or auditory hallucinations

Answer 168

Benzodiazepines: Chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure.

Answer 169

False sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating. Grievers Can be auditory and visual.

Answer 170

Denial, Anger, Bargaining, Depression, Acceptance

Answer 171

Prolonged grief lasting >6M to >12M

Answer 172

Induced Psychosis ``` C – Cataracts U – Ulcers S – Striae, Skin thinning H – Hypertension, Hirsutism I – Immunosuppression, Infections N – Necrosis of femoral heads G – Glucose elevation P- Psychosis O – Osteoporosis, Obesity I – Impaired wound healing D – Depression/mood changes ``` [Glucocorticoid Excess]

Answer 173

- Most days for >2 wks - Cause distress / interfere with functioning (usually by wasting time) + must have ALL the following features: FORD CAR ``` F = Failure to resist: if long term, resistance may be minimal O = Originate from person's mind RD = Repetitive + Distressing: at least 1 recognised as excessive / unreasonable CAR = CARrying out obsession / compulsion is not itself pleasurable ```

Answer 174

Admission and Assessment section. 28 Days - Non renewable AMHP (Approved MH practitioner) + 2 Doctors (Section 12 Trained) Treatment t can be given against patient wishes.

Answer 175

Treatment section 6 Months - Renewable Patients who have already been assessed under S2 or known service user. AMHP (Approved MH practitioner) + 2 Doctors (Section 12 Trained

Answer 176

Emergency Admission Section 72 Hours Hold 1 Doctor + AMHP For assessment

Answer 177

A patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Answer 178

Allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

Answer 179

Section 135 a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety Section 136 Someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety 24 hours hold, whilst a Mental Health Act assessment is arranged Place of safety - Police station

Answer 180

diabetes, cardiovascular disease and COPD

Answer 181

Hypomania -> Routine referral to CMHT Mania/Severe depression - Urgent CMHT referral.

Answer 182

Psychotic Symptoms Olanzapine- Antipsychotic Lithium - Mood stabiliser / Valproate (Not in childbearing women) Depression Psychotherapy Fluoxetine - Antidepressent management In acute mania episode STOP ANTIDEPRESSANTS

Answer 183

Severe depressiive illness Prolong or severe manic episode Catatonia Only for rapid and short term improvement of severe symptoms after other treatments have proved ineffective

Answer 184

Always assess suicide risk and Identify any safeguarding issues, learning disabilities or cognitive impairments. Mild Discuss presenting problems Active monitoring and follow up (2 weeks) ``` Moderate Low intensity psychosocial intervention - IAPT (Improving access to psychological therapies) -Individual guided self help -Computer CBT -Group CBT SSRI/SNRIs ``` ``` Severe SSRI/SNRIs High intensity IAPT (Referral or Self referral) -Couples therapy -Behavioural activation -Interpersonal therapy ```

Answer 185

``` Persistent eleveated mood Irritability Pressured speech Flight of ideas poor attention insomnia loss of inhibitions increased appetite ```

Answer 186

``` Psychodynamic CBT -Individual -Interpersonal -Group based ``` Behavioural activation Couples therapy Counselling

Answer 187

FILLLLLL [Pass Med]

Answer 188

Slowly reducing the drug dose of a current drug whilst slowly increasing the dose of a new drug.

Answer 189

Fluoxetine

Answer 190

Not enough or poor quality sleep Chronic: Acute:

Answer 191

Excessive daytime sleepiness

Answer 192

Doing strange things in your sleep

Answer 193

Person has belief something often terrible but of great importance is going to occur but don't know what it is. Mood state real interpretation delusional

Answer 194

Misinterpretation of the significance of something that's usually perceived. i.e - Traffic lights change from Red to Green == I AM GOD Perception real interpretation delusional

Answer 195

Delusional interpretation of a normal memory. i.e - I was given a chocolate bar by my mum when I was younger == That's when I noticed a chip was implanted in me. Memory real interpretation delusional

Answer 196

Primary - Delusion is ultimately un-understandable. Not occurring due to another psychopatholocial cause - i.e mood disorders Secondary - Delusions are understandable when detailed psych history/exam is taken . Occurs due to other morbid psychological phenomena (mood disorder, perceptual disturbances)

Answer 197

An apparent attempt at suicide, in which the aim is not death.

Answer 198

Noradrenergic and specific serotonergic antidepressant. Inhibit the inhibitory presynaptic A2-receptors on both noradrenergic and serotonergic neurons, hence increasing NA and 5-HT signallin. It doesn't affect reuptake transporters. Fewer side effects and interactions than many other antidepressants and so is useful in older people with polypharmacy. S/E - Sedation and Increased appetite.

Answer 199

Trauma-focused cognitive behavioural therapy or EMDR trauma-focused cognitive behavioural therapy (CBT) watchful waiting may be used for mild symptoms lasting less than 4 weeks

Answer 200

Present Longer than 1M (DSM-5) Re-experiencing- Flashbacks, nightmares, repetitive and distressing images Avoidance - People, situations or circumstances resembling or associated with the event Hyperarousal - hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating Emotional numbing - lack of ability to experience feelings, feeling detached from other people. Anger issues/ substance misuse

Answer 201

Thyroid - lithium inhibits thyroid hormone release is poorly understood. Cause Hypothyroidism Also cause hypercalcemia -bones, stones, abdominal groans, psychiatric overtones

Answer 202

Auditory Visual Hallucinations are more common in 'Organic Disorders'

Answer 203

Bio Antipsychotics - Risperdone (1st Line) Clozapine - Last resort AS (treatment resistance to 2 other tried antipsychotics) ``` Psyco CBT (Cope w/stress / voices) DBT Psychoeducation Family therapy ``` Social Housing/Finances Education/Employment Social activities

Answer 204

Bio Antipsychotics - Risperdone (1st Line) Clozapine - Last resort AS (treatment resistance to 2 other tried antipsychotics) ``` Psyco CBT (Cope w/stress / voices) DBT Psychoeducation Family therapy ``` Social Housing/Finances Education/Employment Social activities

Answer 205

Non-pharmacological de-escalation Offer oral lorazepam 1-2mg Lorazepam 1-2mg IM (Repeat every 30-60 min) Be-aware benzo induced respiratory depression - Treat w/ Flumazenil (GABA-A receptor antagonist)

Answer 206

``` Male Young Divorced Mental illness Chronic illness Substance misuse ```

Answer 207

You see a stranger and believe they are your brother

Answer 208

You see your brother but believe it is a stranger impersonating him.

Answer 209

You believe someone (usually famous) is in love with you

Answer 210

Mild - 2/3 symptoms present - managing most activities Moderate - 4 or more symptoms present - Struggling to do anything but essential activities Severe (With or without psychotic symptoms) - Multiple and marked symptoms - Psychotic symptoms (if present) - All activities impossible

Answer 211

6-9 months following recovery due to high risk relapse

Answer 212

Lithium, Sodium Valproate, Carbamazepine

Answer 213

Amitriptyline | Clomipramine

Answer 214

[FILL] Nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort

Answer 215

``` Lorazepam Diazepam (Valium) Zoldipem (Ambien) Librium (Chlorodiazepoxide) Heminevrin (Clomethiazole) Xanax (Alprozalam) ```

Answer 216

Re-titrate the clozapine dose again slowly.

Answer 217

DEPOT Injection

Answer 218

Clinical Features Neuromuscular excitation - Hyperreflexia, myoclonus, rigidity) Autonomic nervous system excitation- Hyperthermia Altered mental state Management Supportive IV fluids Cyproheptadine Chloropromazine

Answer 219

Elderly. Increases falls risk

Answer 220

Real physical symptoms that arise from or are influenced by the mind and emotions rather than a specific organic cause Symptoms - Somatic symptoms - Sweating, Palpitations, Tachycardia, tremor, drowsiness etc.. e.g. of Psychosomatic disorder - Somitisation disorder

Answer 221

Clomipramine (TCA) | Mirtazipine (Antipsychotic)

Answer 222

Abnormal condition of mind that results in difficulties in determining what is real and what’s not. Symptoms - Hallucinations - Delusions

Answer 223

Raised ICP ``` Headache Nausea Arrhythmia Retrograde memory loss Anterograde memory loss ```

Answer 224

DBT - Dialectical BT

Answer 225

PPI Medication - Increased risk of GI bleeding in px taking SSRIs

Answer 226

Sudden onset of palpitations Chest pain Choking sensations Dizziness Feelings of unreality (depersonalisation/derealisation) Secondary fear of dying, losing control or going made.

Answer 227

Excessive fear of being in a situation where a person can't freely escape or where help may not be available if something goes wrong. Leads to - Avoidance - Restriction in activities Can be enclosed spaces/Open spaces (crowds)

Answer 228

Dysthymia - chronic but mild symptoms of depression that can be associated with physical illness or other [2 years duration ] Atypical depression - Depression that occurs with symptoms opposite to that expected. E.g. Patient increased sleep and increased appetite. Post-Partum dépression Psychotic depression

Answer 229

Mental disorder in which the affected person holds the delusional belief that they are dead, do not exist. V.Rare

Answer 230

1. Felt low, depressed or hopeless | 2. Had little interest or pleasure in doing things

Answer 231

Capgras Syndrome

Answer 232

Individual has a delusional belief that their partner is cheating on them without any proof.

Answer 233

De Clerambault (Ergotomania)

Answer 234

``` Catatonia Stupor Refractory to antidepressants High risk of suicide Psychotic features Food refusal, severe weight loss or dehydration Previous successful response to ECT ```

Answer 235

``` Dental Erosion Abdo Pain Bloating Lethargy Heartburn Sore throat Halitosis ```

Answer 236

CBT/interpersonal psychotherapy (IPT). Management in <18 BN- Family focused therapy – first line 18 sessions over six months encouraging regular eating and reducing bulimic behaviours CBT-ED – 18 sessions over six weeks if family therapy is ineffective. Management Adults Bulimia focused guided self-help programme Individual eating disorder focused CBT (CBT-ED) – 20 sessions over 20 weeks if self-help is ineffective.

Answer 237

A -10 - 15% B - 0.5% C -50 -75%

Answer 238

Hypersalivation (Sialorrhoea) Hyoscine Others - Letheragy, Tachy, Hypotension, confusion

Answer 239

Pinpoint pupils, Severe respiratory depression, Pulmonary oedema, Stupor, Pallor

Answer 240

``` Dilated Pupils Epiphora (eyes watering), Rhinorrhoea (nose running), Agitation Perspiration Piloerection (erection or bristling of hairs) Tachycardia Vomiting Shivering Yawning ```

Answer 241

Restart Clozapine at starting dose of 12.5mg. Titrate upwards accordingly.

Answer 242

<70 = Learning Disability <50 =Moderate <35= Severe disability

Answer 243

Paroxitine

Answer 244

Stop the antidepressant.

Answer 245

Patient presenting with Intense, long-standing pain without somatic explanation. RESTRICTED TO PHYSICAL PAIN and not somatic (Somatisation disorder)

Answer 246

Patient presenting with various physical complains that are not explained by a somatic process. Diffusie, odd mix of symptoms that can't be explained with a unifying diagnosis. [e.g pain, GI, sexual, neurological]

Answer 247

1 - Inattention: Easily distracted, no listening, forgetful, easily losing things, unable to sustain attention for prolonged periods. 2 - Hyperactivity: Fidgety, restlessness, difficult to engage in quite activities 3 - Impulsiveness: interrupts others, can't wait, excessive talking, blurts out answers M>F

Answer 248

Person assumes that an innocent, neutral character is responsible or is as guilty as the patient, for the patient's actions. e.g A cheater accusing an innocent person of doing the same thing.

Answer 249

Not accepting a diagnosis or reality.

Answer 250

Person who obsesses over a thoughtcrimes, idea or object as a way of coping with a stressor.

Answer 251

Patient distinguishes between two groups of people. Those the patient loves and trusts versus those that the patient doesn't love or trust. People are considered good or bad and patient only cooperates with those people that the patient considers's good. Characteristic of borderline personality disorder.

Answer 252

Individual takes out their feelings on a neutral person. e.g. Patient displacing their feelings out on innocent people who aren not involved in the patient's situation.

Answer 253

Combat-related trauma. Trauma-focused CBT prioritised instead.

Answer 254

Borderline-type More difficulties with relationships, self-harming and feelings of emptiness. Impulsive-type More difficulties with impulsive behaviour and feelings of anger.

Answer 255

Fabrication of imaginary experiences due to loss of memory. 'Confusing real events with those from their imagination' Common in patients with cognitive imparirement (e.g. dementia. Individuals are able to maintain superficial conversations through fabrication of events.

Answer 256

Shared delusional disorder where 2 co-dependent people develop a paired delusion. Separating the 2 individuals.

Answer 257

Comprehensive psychosocial assessment of needs and risks (Care plan) - Identify needs of patient (Mental illness, social situation) - Form a crisis plan

Answer 258

1. Fear of heights 2. Fear of pain 3. Fear of getting married 4. Fear of being out in public

Answer 259

Reducing current medication gradually over two weeks STOP - WASHOUT Period/Abstinence (4-7 days) Start new SSRI

Answer 260

Set of psychological disorders where emotional state is distorted or inconsistent. Interfere with ability to function normally.

Answer 261

Anticholinergics

Answer 262

Typical AntiPsychotics | e.g. haloperidol

Answer 263

Stop typical antipsychotic and switch to atypical one. e.g. Haloperidol to Olanzipine

Answer 264

Experiencing symptoms of depression > 6 Months

Answer 265

Form of counselling which employs various techniques to induce behavioural changes that will stay with the patient in the long term.

Answer 266

Talking therapy exploring patient’s understanding, concepts and reactions towards a certain problem, gradually building behavioural changes to challenge the concepts and manage the problem.

Answer 267

Phase sensitive learning that is rapid and apparently independent of the consequences of behaviour. Learning occurring at a particular age or stage

Answer 268

Learning process that occurs through associations between an environmental stimulus and naturally occurring stimulus.