Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3A Quiz > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the main methods by which antidepressants work ?

A

Increasing synaptic availability of N-AD/ Serotonin (5HT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do SSRI Works?

A

SSRIs work by increasing serotonin levels in the brain.

SSRIs inhibit serotonin reuptake by nerve cells so more serotonin is available to pass further messages between nearby nerve cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name some SSRIs?

A

Effective For Sadness Panic Compulsions

escitalopram
fluoxetine
sertraline
paroxetine
citalopram
fluvoxamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Non-pharmacological Tx for depression?

A 
Exercise
Counselling
Meditation- Yoga, Tai Chi
Social Clubs
Psychotherapy

Therapy is know to be as effective as anti-depressants in mild/moderate depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common Side effects of anti-depressants?

A 
Hyponatremia 
GI disturbance
Insomnia
Sexual dysfunction 
Weight gain
Dry mouth
Headaches 
Agitation/Restlesness/Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes for violent behaviour?

A

Psychiatric illness, substance misuse, personality disorder, physical illness
Adverse environments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What environmental changes may trigger violence in patients

A 
Overcrowding
Noise
Alienation
Claustrophobia 
Removal of privileges - due to bad behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define rapid tranqulisation?

A

Use of medication in controlling behaviour. Used as a last resort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Examples of antipsychotics

A 
Haloperidol
Olazapine
Quetiapine
Aripiprazole
Risperidone
Clozapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 Major criteria points for a depression diagnosis?

Time period for the criteria?

A

Persistent sadness or low mood; and/or
Loss of interests or pleasure (Anehdonia)
Fatigue or low energy (Anergia)

At least 1 of these, most days, most of the time for at least 2 weeks.

DSM-V

<5- SUBTHRESHOLD DEPRESSION

> 5 SIGECAPS + ONGOING FOR 2 WEEKS (MOST DAYS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of depression?

Time period?

A 
Sleep
Appetite
Concentration
Low confidence
Suicidality
Agitation
Slowing of movements
Guilt

Symptoms should be present for a month or more and every symptom should be present for most of every day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What area of the brain deals with initiating muscle contractions?

A

Basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should you consider when doing a Mental State Examination?

A 
Appearance 
Speech
Memory/mood
Thoughts
Perception
Orientation

Always Send Mail Through Post Office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MSE - Appearance

What things do you think about?

A
  • Eye contact and rapport
  • Clothing
  • Hygiene
  • Facial expressions
  • Motor behaviours
  • Signs of autonomic arousal
  • Affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define Affect?

A

How people convey their mood by their behaviour

e.g. reactive and appropriate - that is, laughs at a joke, or cries when sad.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MSE - Speech

What things do you think about?

A

Content
Volume
Form - Speech rate, rhythm, fluency of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MSE - Mood

What things do you think about?

A

Elevated / Depressed?

Ask the patient to describe their mood subjectively?

Enquire about other mood states such as anxiety and panic?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MSE - Perceptions

What things do you think about?

A

Hallucinations? - Type/Origin

Delusions?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define Delusion?

A

“A delusion is a false, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background; it is held with extraordinary conviction and subjective certainty.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MSE - Orientation/Cognition

What things do you think about?

A

Orientation- time, person and place
General knowledge - name of prime minister, recent news items etc.
Concentration and attention? - Spelling WORLD backwards or serial sevens
Recall - repeating the new information five minutes later
Registrations - ability to repeat new information such as a name and
address

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What’s the lifetime prevalence of mental illness?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

1 - What are the common types of mental disorder (6) ?

2 - Which is the most common?

A

1 - Affective disorders, dementia, psychoses, substance misuse, personality disorder, anxiety disorders (panic/OCD/PTSD)

2 - Affective (Mood) disorders

  • Depression
  • Bipolar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is bipolar depression also known as

A

Manic Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is mood congruence? Give examples

A

Symptoms experienced are in agreement with the person’s current mood.

e.g. Feeling suicidal when your dog dies
Believing you have superpowers when you are going through a manic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is mood incongruence? Give examples

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Define Dysthymia?

A

Mild chronic depression.

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the the 4 distinctions of depression

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some differential diagnoses for depression?

A 
Hypothyroidism, Cushing syndrome
Dysthymia
Cyclothymia
Bipolar disorder
Schizophrenia
GAD 
PTSD 
Postnatal depression
OCD
Eating disorder
Bereavement
Normal sadness
Drugs side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pharmacological treatment options for depression?

A

Antidepressants - SSRI, TCAs ,MAOi
ECT
CBT
Counselling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What factors affect choosing an antidepressant?

A 
Pregnancy 
Patient Preference
Previous Treatment experience
Suicidality
Past history of elevated mood
Age and Physical Health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

On average how much earlier do people with severe mental disorders die vs. gen population?

A

10-25 years

Understand contributing factors can also lead to premature death -e.g. Co-mobitdities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Generally whose is more likely to have mental health problems

Men or Women?

A

Women (X2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Define Personality

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a personality disorder?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the 3 classifications for personality disorders?

A

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

MAD BAD SAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What the CLUSTER A Personality disorders?

A

Paranoid
Schizoid
Schizotypical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What the CLUSTER B Personality disorders?

A 
Histrionic 
Narcissistic 
Antisocial (dissocial) 
Emotionally Unstable Borderline
Emotionally Unstable Impulsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What the CLUSTER C Personality disorders?

A

Avoidant
Dependent
Anankastic (OCD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Characteristics of Paranoid PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Characteristics of Schizoid PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Characteristics of Schizotypical PD?

A

Strange/Odd behaviour
Strange Appearance, belief & thinking
Interpersonal discomfort

NO PSYCHOTIC EPISODE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Characteristics of Antisocial PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Characteristics of Histrionic PD?

A 
Flamboyant 
Attention seeking
Seductive
Excessively emotional / Self-dramatisation
Manipulating behaviour
Egocentric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Characteristics of Narcissistic PD?

A

Grandiosity
Lack of empathy
Heighten importance of self
Need for admiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Characteristics of Borderline PD / EUPD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Characteristics of Emotionally Unstable Impulsive PD?

A

Inability to control anger

Unpredictable affect and behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Characteristics of Anxious/Avoidant PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Characteristics of Dependent PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the management for personality disorders?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which Personality Cluster has highest rate of suicide or violent deaths

A

Cluster B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Complications are personality disorders

A

Substance misuse
Self-Harm and suicide
Depressive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Differentials Personality disorders?

A 
Substance misuse 
Affective disorders
Psychotic disorders 
Anxiety disorders (Phobia &amp; Panic) 
Dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Characteristics of Anankastic (OCD) PD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Investigations for PD?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the main purposes for conducting a suicide risk assessment?

A
  1. Establish Patients intent.
  2. Assess the seriousness and perceived seriousness of attempt.
  3. How the patient feel about the attempt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Suicide Risk Assessment? - What areas do you need to cover

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

SH Needs to be focused on more!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Questions MUST ask about self-cutting?

A 
Location of cuts
How many cuts?
How deep?
Feeling when they saw blood?
Perceived outcome of cutting? 
Feelings at moment of cutting?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Questions MUST ask about OD?

A 
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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Suicide Risk Assessment BEFORE Questions?

A

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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Suicide Risk Assessment DURING Questions?

A 
Method? 
Alone? 
Location?
Actions after self harming?
Did they think self-harm would kill them?
Thoughts at the time?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Suicide Risk Assessment AFTER Questions?

A

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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What areas of a SH need to be addressed?

A 
Living situation 
Relationships &amp; Dependants 
Occupation
Drug &amp; Alcohol Use
ADLs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Possible Psychosis, Suicide Risk Assessment

What questions should you ask?

A

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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Define Suicide?

A

Act of intentionally killing oneself with the primary aim of dying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Define attempted suicide?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is Parasuicide?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is Deliberate Self Harm?

A

Deliberate Self Harm (DSH)

Act of intentionally injuring oneself not intended to cause death but to gain relief from psychological stress / pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are sociodenographic risk factors for suicide?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the clinical factors for suicide?

A

Hx of DSH

Mental disorder

Physical illness (Chronic) / significant pain.

FH of DSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the 5 Main categories for mental illness?

A 
Mood Disorders
Psychosis and Schizophrenia
Anxiety Disorders 
Eating Disorders
Dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How can all mood disorders be divided?

A

Primary Mood disorders

Secondary Mood disorders (Organic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the primary mood disorder categories?

A

Unipolar
Depressive Disorder - Mild, Moderate, Severe, Psychotic
Dysthymia

Bipolar
Bipolar Affective Disorder - B1 & B2
Cyclothymia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Define Primary mood disorder?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Define secondary mood disorder?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What criteria must be met for a mood disorder to be classed as bipolar?

A

MUST HAVE HAD 1 OR MORE EPISODES OF MANIA OR HYPOMANIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is recurrent depressive disorder?

A

A patient that has had more than one episode of depressive disorder.

Current episode - classified for a single episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Define Bipolar 1?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Define Biopolar 2?

A

Episodes of major depression and hypomania

-No full blown manic or mixed episodes (No history)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Define Cyclothymia?

A

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. “

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Aetiology behind mood disorders?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What effect does cocaine and amphetamines have?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are organic causes?

A

Neurological, Endocrine, Metabolic, Neoplastic, Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What blood level is lithium toxicity considered

A

> 1.5 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Name a fast acing sedative used in highly agitated and difficult to manage individuals

A

Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Name some anticonvulsants

A

Lamotrigine, Carbamazepine, Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Define psychomotor retardation

A

Slowing down of thought
Reduction of physical movements in an individual

Can be visible and be observed in speech and affect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the 5 principles of the mental capacity act

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What requirements must a person with capacity meet to make a decision?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the two types of sensory deceptions

A

Hallucinations

Illusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the 4 disorders of thought?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Define Anxiety

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Causes of anxiety disorders

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Describe the steps in the cognitive behaviour model for panic disorders

A
  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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the treatment options for panic disorders

A

TCAs, SSRI, CBT, Benzodiazepines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Describe the characteristics of a panic attack

Describe the features on cognition, behaviour and anxiety occurrence for panic disorders

A

Rapid onset of severe anxiety, lasts 20-30 minutes.

Associated cognitions- Fear of symptoms
Anxiety occurrence - Episodic (Occur recurrently and unexpectedly)
Associated behaviour- Escape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What lasting complications can arise from panic attacks

A

Secondary Agoraphobia

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is generalised anxiety disorder

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What are the symptoms associated with GAD? (6)

A 
Concentration difficulty
Restlessness 
Irritability
Muscle tension 
Sleep disturbance (Falling asleep, staying asleep) 
Being easily fatigued
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What diagnostic tool is used for Generalised anxiety disorder?

A

GAD-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Name First Rank Symptoms (Schneiders)?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Define Delusional perception?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Define Passivity?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the DSM-5 Criteria for BRIEF PSYCHOTIC EPISODE?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Define Delirium

A

Neuropsychiatric syndrome

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

In what circumstances should Benzodiazepines be used?

A

Alcohol/benzo withdrawal
suspected catatonia
C/I to antipsychotics and extremely agitated

NOTE- Can make delirium worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Define Psychosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the main symptoms of psychosis?

A

Hallucinations
Delusions
Confused and disturbed thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What are the investigations for psychosis?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What are the treatments for psychosis?

A

Biological

Psychological

Social

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Define Hallucination?

A

A false sensory perception experienced without external stimulus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Types of hallucinations?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Mneumonic for TCA Side Effects

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Risk Factors for interaction with perinatal psychiatry?

Perinatal - During Pregnancy up to 1 year postpartum

A 
Low socioeconomic status
Lone Parent 
Teenage pregnancy 
Unwanted pregnancy 
Low social support
Poor family relationships
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Main conditions associated with perinatal psych?

A 
Postnatum depression 
Baby Blues
Postpartum (puerperal) psychosis 
Perinatal OCD
Perinatal PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is Anorexia Nervosa? (AN)

A

Eating disorder chartered by restriction of caloric intake leading to:

Low body weight
Intense fear of gaining weight
Body image disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is key distinction between Bulimia Nervosa vs. AN

A

BMI
BN >21
AN<18.5 (15%+ below expected)

BN - Normal/Overweight
AN- Underweight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Treatment for AN?

A
  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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Investigations for AN?

A 
CBC
UE 
LFTs - UP ALT, AST
TFTs - Low T3 
Urinalysis 
ECG

Possible additionals - Hormone levels (Test, estradiol), Bone density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What can cause Metabolic alkalosis & Hypokalemia results.

A

Vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Why is early intervention important in AN?

A

Prevents long term psychiatric and physical complications of AN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What are the key signs and symptoms for AN?

A 
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)
122
Q

Aetiology of AN?

A 
Genetic/Hormonal 
-Abnormalities in signals that convey hunger &amp; satiety 
Social/Environment 
-Peer groups
-Popular culture/Social media
-Thin societal beauty standard
123
Q

Risk Factors for AN?

A 
Young women
Adolescence and puberty 
obsessive and perfectionist traits 
Exposure to western media 
Middle &amp; upper socioeconomic status  
Athletes
124
Q

What are the two types of AN?

A

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

125
Q

What is purging? Give examples

A

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

126
Q

Examples of restricting behaviour seen in AN?

A

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

127
Q

Differentials for AN?

A

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

128
Q

What is Bulimia Nervosa? (BN)

A

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

129
Q

What is binge eating?

A

Eating amount of food definitely larger than most people would eat

X2 the normal amount of food ingested.

130
Q

How long are binge-episodes typically?

A

At least ONCE weekly for 3 months

131
Q

Clinically Signs & Symptoms for BN?

A
132
Q

RF for Bulimia Nervosa?

A 
Female gender
Personality disorder 
FH of obesity
Childhood Hx of obesity
Exposure to media pressure
History of sexual abuse
133
Q

Treatment for BN?

A

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

134
Q

Investigation for BN?

A

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

135
Q

What are the SIGECAPS depression Symptoms?

A 
Sleep
Interest - Lack of interest (Anhedonia)  
Guilt
Energy
Concentration
Appetite 
Psychomotor retardation
Suicidal Ideation

Diurnal mood variation (Feel worst on waking and gradual improve)

136
Q

Examples of psychotherapy?

A 
CBT
DBT
Interpersonal 
Family therapy 
Mindfulness based therapy
Cognitive analytical therapy
137
Q

What factors can affect the prognosis of depression?

A 
Psychotic symptoms
Alcohol use 
Early onset 
Level of social support 
Age
138
Q

Define Nihilistic delusions?

A

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

139
Q

What are some organic/physical causes of depression?

A 
Hypothyroidism
Cushing's syndrome
Parathyroid disease
Renal failure
Folate deficiency
Cerebral tumours
Alcohol or drug misuse
140
Q

Which antidepressant is relatively safe in overdose?

A

Mirtazapine

141
Q

What are the different classifications of Schizophrenia?

6 ICD-10

A 
Paranoid schizophrenia
Hebephrenic schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Residual schizophrenia
Simple schizophrenia
142
Q

Define Schizophrenia

A

Mental illness that affects how a person thinks, feels, and behaves.

Functional Psychosis disorder
Fragmentation of thinking

Lifetime Risk - 1 in 100

143
Q

What are positive symptoms?

A

Symptoms that tend to represent a change in behaviour or thought.

Usually sudden with onset

144
Q

What are Negative symptoms?

A

Negative symptoms usually involve a decline in normal functioning.

Usually insidious

145
Q

Name positive symptoms for schizophrenia?

A 
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]

146
Q

Name negative symptoms for schizophrenia?

A 
Blunted affect
Apathy
Social isolation
Poverty of speech
Poor self-care
147
Q

Risk Factors for Schizophrenia?

A 
Obstetric complications
FH of schizophrenia
Migrant status 
Cannabis use
Childhood abuse
Psychological stress
Increased paternal age of birth (>55)
148
Q

Define Avolition?

A

Loss of motivation

149
Q

Define Alogia?

A

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

150
Q

Whats the most prevalent type of schizophrenia?

A

Paranoid Schizophrenia

Characterised by paranoid delusions and auditory hallucinations.

151
Q

What important to set out in the treatment for schizophrenia?

A

Care Programme Approach

152
Q

What’s involved in the care programme approach for schizophrenia?

A

4 Stages

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

153
Q

Two classes of antipsychotics? Whats the difference?

N.B- Always check lipids before starting antipsychotics

A

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

154
Q

What is required for a schizophrenia diagnosis?

[ICD -10 > DSM 5)

A
  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]

  1. 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]

155
Q

Investigations to rule out organic causes of schizophrenia?

A

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

156
Q

Which neurotransmitters are involved in the neuroreceptor hypothesis of schizophrenia?

A

Dopamine - Excess causes overactivity in mesocorticolimbic system & causes +Ve symptoms

Serotonin - Increased activity
Glutamate - Decreased activity

157
Q

1st Line Antipsychotic for acute psychotic episode (With schizophrenia)?

A

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

158
Q

Differentials of Schizophrenia?

A 
Schizoaffective disorder
Substance induced-psychosis
Dementia w/psychosis 
BAD w/Psychosis
Hyperthyroidism 
Hyperparathyroidism 
Delusional disorder 
Brief psychotic disorder
Poisoning - CO2, heavy metal
159
Q

Schizoaffective disorder?

A

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)

160
Q

What are the most common types of delusions?

[Expand]

A

Delusions of persecution

Delusions of grandeur.

161
Q

Define Catatonia?

A

Stopping of voluntary movement or staying still in an unusual position (motor immobility)

Wave flexibility - Able to stay in the same position for hours

162
Q

What are examples of traumatic events that could cause PTSD

A 
War 
Physical Assault 
Sexual/physical abuse 
Rape 
Kidnapping 
Crashes - Car/Plane 
Natural disasters
163
Q

Who tends to be at higher risk of PTSD.

Men/Women?

A

Women

164
Q

Benzodiazepines

ACTION?
INDICATIONS?
Symptoms of withdrawal?

A

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

165
Q

Lithium Monitoring Requirements?

A

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.

166
Q

Major side effect for ECT therapy?

A

Memory Loss (Retrograde)

167
Q

What are the downsides of clozapine treatment in schizophrenic patients?

A

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

168
Q

Name Some Atypical antispsychotics?

A 
Clozapine 
Olanzapine 
Quetiapine
Risperidone
Apiprazole - Best side effect profile (Good for high prolactin)
169
Q

Name some typical antispsychotics?

A

Haloperidol
Chloropromzaine
Zuclopentixol

170
Q

Lithium medication side effects?

A 
Nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity
ECG: T wave flattening/inversion
Weight gain
Leucocytosis
171
Q

What is the name of the condition in which a patient believes that they are either dead or non-existent?

A

Cotard syndrome.

Delusional disorder (Nihilistic delusion subtype)

172
Q

What type of medication should not be mixed with SSRIs?

A

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

173
Q

Symptoms of serotonin syndrome?

A 
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.

174
Q

Give a timeline for presentation of Alcohol Withdrawal to DT?

A

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

175
Q

Define Agranulocytosis?

A

Lowering of WBC count. (Primarily Neurtrophils)

Clozapine can cause this side effect.

176
Q

Name some SNRIs?

MOA?

A

Duloxetine
Venlafaxine

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

177
Q

What are the score ranges for depression in PHQ-9 Questionnaire?

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

MAX - 27

178
Q

Which SSRI should be avoided in pregnancy?

A

Paroxetine

Increased risk of congenital malformations

179
Q

What actions might make you think an individual is at increased risk of completing suicide in the future?

A 
Efforts to avoid discovery
Planning suicide
Leaving a written note
Final acts - sorting out finances
Violent methods for dying
180
Q

Clinical features of Anorexia Nervosa?

A

Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands

181
Q

Physiological abnormalities of AN?

A

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
182
Q

Define Echolalia?

A

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

183
Q

Define Neologism?

A

The formation of new words.

184
Q

Define Perseveration?

A

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

185
Q

Define Tangentiality?

A

Wandering from a topic without returning to it.

186
Q

Define Circumstantiality?

A

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

187
Q

What are factors suggesting diagnosis of depression over dementia?

A

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)

188
Q

Side effects of antipsychotics?

A

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)

189
Q

What two conditions have an increased risk with use of antipsychotics in elderly individuals?

A

Stroke

VTE

190
Q

What Extrapyrdimal S/E can antipsychotics cause?

A

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)

191
Q

How may Extrapyramidal S/E be managed?

A

procyclidine (anticholinergic drug)

192
Q

Why are SSRI advised against in Preganacy?

A

They may increase the chance of congential heart defects and malformations in children.

Especially 1st Trimester use

193
Q

What risk condition do you need consider when prescribing citalopram?

A

Long QT Syndrome

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

194
Q

Which SSRI is safer in patients who have had a myocardial infaction?

A

Sertraline

195
Q

Name some risk factors that may indicate a worse prognosis for schizophrenia?

A 
Strong family history
Gradual onset
Low IQ
Premorbid history of social withdrawal
Lack of obvious precipitant
196
Q

What is flight of ideas?

A

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

197
Q

Define Mania?

A

Persistently elevated mood state with psychotic symptoms.

> 7 Days
severe functional impairment
Psychotic symptoms -delusions of grandeur or auditory hallucinations

198
Q

What is the first line pharmacological treatment in patients with alcohol withdrawal?

A

Benzodiazepines: Chlordiazepoxide.

Lorazepam may be preferable in patients with hepatic failure.

199
Q

Define Pseudohallucinations?

Who may present with this symptom?

A

False sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating.

Grievers

Can be auditory and visual.

200
Q

What the 5 Stages of grief?

A

Denial, Anger, Bargaining, Depression, Acceptance

201
Q

Criteria for abnormal grief?

A

Prolonged grief lasting >6M to >12M

202
Q

What psychiatric symptom can occur as S/E of steroids?

A

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]

203
Q

ICD-10 Criteria for OCD?

A
  • 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
204
Q

Explain Section 2 of MHA(1983)?

A

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.

205
Q

Explain Section 3 of MHA(1983)?

A

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

206
Q

Explain Section 4 of MHA(1983)?

A

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

207
Q

Explain Section5(2) of MHA(1983)?

A

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

208
Q

Explain Section5(4) of MHA(1983)?

A

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

209
Q

Explain Section 135 & 136?

A

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

210
Q

What Co-morbidities are patients with bipolar at increased of?

A

diabetes, cardiovascular disease and COPD

211
Q

What steps for Primary care referral should be made patients with Bipolar disorder exhibiting symptoms.

A

Hypomania -> Routine referral to CMHT

Mania/Severe depression - Urgent CMHT referral.

212
Q

Management for Bipolar Disorder for acute episode

A

Psychotic Symptoms
Olanzapine- Antipsychotic
Lithium - Mood stabiliser / Valproate (Not in childbearing women)

Depression
Psychotherapy
Fluoxetine - Antidepressent management

In acute mania episode STOP ANTIDEPRESSANTS

213
Q

When is ECT Therapy indicated?

A

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

214
Q

Management for Mild, Moderate & Severe Depression?

A

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
215
Q

Mania/Hypomania symptoms?

A 
Persistent eleveated mood 
Irritability 
Pressured speech 
Flight of ideas 
poor attention 
insomnia 
loss of inhibitions
increased appetite
216
Q

Name some types of psychotherapy?

A 
Psychodynamic 
CBT 
-Individual 
-Interpersonal
-Group based

Behavioural activation
Couples therapy
Counselling

217
Q

Mania VS Hypomania

A

FILLLLLL [Pass Med]

218
Q

What is cross-tapering medications?

A

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

219
Q

What is the SSRI of choice in children/teenagers

A

Fluoxetine

220
Q

Define Insomnia? [FILLLL]

A

Not enough or poor quality sleep

Chronic:

Acute:

221
Q

Define Hypersomnia?

A

Excessive daytime sleepiness

222
Q

Define Parasomnia?

A

Doing strange things in your sleep

223
Q

What is a delusional mood (Atmosphere) ?

[PRIMARY DELUSION = TRUE DELUSION]

A

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

224
Q

What is delusional perception (APOPHANOUS)?

A

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

225
Q

What is a delusional memory (Retrospective delusions)?

A

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

226
Q

How can you tell between primary and secondary delusions?

A

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)

227
Q

What is parasuicide?

A

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

228
Q

What type of drug is Mirtazapine? (3 Marks)

Main S/E? (2 Marks)

A

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.

229
Q

PTSD Management

A

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

230
Q

PTSD Clinical Features?

4 Pillars

A

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

231
Q

What organ can Lithium cause issues?

A

Thyroid - lithium inhibits thyroid hormone release is poorly understood.

Cause Hypothyroidism

Also cause hypercalcemia -bones, stones, abdominal groans, psychiatric overtones

232
Q

Whats more common in psychiatric disorders

VISUAL OR AUDITORY HALLUCINATIONS?

A

Auditory

Visual Hallucinations are more common in ‘Organic Disorders’

233
Q

Schizophrenia Management?

A

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

234
Q

Schizophrenia Management?

A

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

235
Q

Necessary steps dealing with Aggressive/Violent patient?

A

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)

236
Q

Risk factors for completed suicides ?

A 
Male 
Young
Divorced 
Mental illness 
Chronic illness 
Substance misuse
237
Q

Fregoli’s illusion (Delusional Disorder / Schizophrenia).

Give an example?

A

You see a stranger and believe they are your brother

238
Q

Capgras syndrome (Delusional Disorder / Schizophrenia)

Give an example?

A

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

239
Q

Erotomania/De Clerambault’s (Delusional Disorder/ Schizophrenia)

Give an example?

A

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

240
Q

ICD-10 Classification of Mild, Moderate & Severe Depression?

A

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
241
Q

How long should you continue depression treatment following recovery?

A

6-9 months following recovery due to high risk relapse

242
Q

Name Mood Stabilisers?

A

Lithium, Sodium Valproate, Carbamazepine

243
Q

Name some Tricyclic antidepressants?

A

Amitriptyline

Clomipramine

244
Q

Anxiety features?

A

[FILL]

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

245
Q

Anxiety Management?

A

[FILL]

246
Q

OCD Mangement

A

[FILL]

247
Q

Name some benzodiazepine?

A 
Lorazepam 
Diazepam (Valium) 
Zoldipem (Ambien) 
Librium (Chlorodiazepoxide)
Heminevrin (Clomethiazole) 
Xanax (Alprozalam)
248
Q

If Clozapine does has been missed for 48 hours. What Action should be taken?

A

Re-titrate the clozapine dose again slowly.

249
Q

Non-Compliance with Antipsychotic medication?

What’s the alternative?

A

DEPOT Injection

250
Q

Symptoms of serotonin syndrome ?

Management of serotonin syndrome?

A

Clinical Features
Neuromuscular excitation - Hyperreflexia, myoclonus, rigidity)
Autonomic nervous system excitation- Hyperthermia
Altered mental state

Management
Supportive IV fluids
Cyproheptadine
Chloropromazine

251
Q

Who do you need to avoid given Z-Drugs (Zolpidem, Zopiclone)

A

Elderly. Increases falls risk

252
Q

Define Psychosomatic?

A

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

253
Q

What medications may be used in chronic insomnia alongside psychiatric symptoms?

A

Clomipramine (TCA)

Mirtazipine (Antipsychotic)

254
Q

Define Psychosis?

A

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

Symptoms

  • Hallucinations
  • Delusions
255
Q

MAIN Contraindication of ECT?

Side-Effects of ECT? (5 Marks)

A

Raised ICP

Headache 
Nausea 
Arrhythmia
Retrograde memory loss
Anterograde memory loss
256
Q

What form of psychotherapy is good for Bordline personality disorder?

A

DBT - Dialectical BT

257
Q

What is important to add if SSRI is being given to someone on NSAID Medication?

A

PPI Medication

  • Increased risk of GI bleeding in px taking SSRIs
258
Q

Common symptoms of panic attacks?

A

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

259
Q

Define Agoraphobia?

A

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)

260
Q

What are some subtypes of depression?

A

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

261
Q

What is Cotard’s syndrome?

A

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

V.Rare

262
Q

What are the 2 questions for quick screening of depression for further investigation (PHQ-2).

A
  1. Felt low, depressed or hopeless

2. Had little interest or pleasure in doing things

263
Q

NAME THE SYNDROME?

Individual believes that a closely related person (Sibling, friend, partner) has been replaced by an exact double

A

Capgras Syndrome

264
Q

What’s Othello Syndrome?

A

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

265
Q

NAME THE SYNDROME?

When an individual has delusions that someone is deeply in love with them and can’t live without them

  • Usually Famous people
A

De Clerambault (Ergotomania)

266
Q

Indications for ECT?

A 
Catatonia 
Stupor 
Refractory to antidepressants
High risk of suicide 
Psychotic features 
Food refusal, severe weight loss or dehydration 
Previous successful response to ECT
267
Q

Symptoms of Bulimia Nervosa (BN)?

A 
Dental Erosion 
Abdo Pain 
Bloating
Lethargy
Heartburn
Sore throat
Halitosis
268
Q

Treatment for BN

A

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.

269
Q

Incidence of:

A - Postpartum Depression
B - Postpartum Psychosis
C - Postpartum Blues

A

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

270
Q

What is the most common S/E of Clozapine?

Possible Tx

A

Hypersalivation (Sialorrhoea)
Hyoscine

Others - Letheragy, Tachy, Hypotension, confusion

271
Q

Classic symptoms of Opioid OD?

A

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

272
Q

Symptoms of Opioid withdrawal?

A 
Dilated Pupils 
Epiphora (eyes watering), Rhinorrhoea (nose running), Agitation
Perspiration 
Piloerection (erection or bristling of hairs)  
Tachycardia
Vomiting 
Shivering 
Yawning
273
Q

If Clozapine has been missed for 48H for whatever reason what actions should be taken?

A

Restart Clozapine at starting dose of 12.5mg.

Titrate upwards accordingly.

274
Q

What are IQ Ranges for learning disability

A

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

275
Q

Which SSRI is considered only in major depressive episodes?

A

Paroxitine

276
Q

Manic patient on an antidepressant and antipsychotic?

FIRST STEP DEALING WITH TREATMENT?

A

Stop the antidepressant.

277
Q

Define Pain Disorder?

A

Patient presenting with Intense, long-standing pain without somatic explanation.

RESTRICTED TO PHYSICAL PAIN and not somatic (Somatisation disorder)

278
Q

Define Somatisation?

A

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]

279
Q

What are the Core features of ADHD?

A

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

280
Q

Define Projection?

A

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.

281
Q

Define Denial?

A

Not accepting a diagnosis or reality.

282
Q

Define Fixation?

A

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

283
Q

Define Splitting?

A

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.

284
Q

Define Displacement?

A

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.

285
Q

What type of PTSD is EMDR not used?

A

Combat-related trauma.

Trauma-focused CBT prioritised instead.

286
Q

What are the 2 types of EUPD?

A

Borderline-type
More difficulties with relationships, self-harming and feelings of emptiness.

Impulsive-type
More difficulties with impulsive behaviour and feelings of anger.

287
Q

Define Confabulation ?

A

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.

288
Q

What is shared delusion (folie a deux) ?

Best first step in management?

A

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

Separating the 2 individuals.

289
Q

What is VERY IMPORTANT part of the long-term risk management in reducing future self-harm of a patient?

A

Comprehensive psychosocial assessment of needs and risks (Care plan)

  • Identify needs of patient (Mental illness, social situation)
  • Form a crisis plan
290
Q

Define the phobias?

  1. Acrophobia
  2. Algophobia
  3. Gamophobia
  4. Agoraphobia
A
  1. Fear of heights
  2. Fear of pain
  3. Fear of getting married
  4. Fear of being out in public
291
Q

When Switching SSRIs.

What actions should you take?

A

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

292
Q

Define Mood Disorder?

A

Set of psychological disorders where emotional state is distorted or inconsistent.

Interfere with ability to function normally.

293
Q

What class of drugs is used in the treatment of acute dystonia?

A

Anticholinergics

294
Q

Which antipsychotics tend to cause EPSE?

A

Typical AntiPsychotics

e.g. haloperidol

295
Q

If someone has tardive dyskinesia as a result of an antipsychotic (atypical)

WHAT SHOULD BE DONE IMMEDIATELY?

A

Stop typical antipsychotic and switch to atypical one.

e.g. Haloperidol to Olanzipine

296
Q

Adjustment Disorder vs Major depressive disorder

Main distinction?

A

Experiencing symptoms of depression > 6 Months

297
Q

What is Psychotherapy?

A

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

298
Q

What does CBT involved?

A

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.

299
Q

What is imprinting?

A

Phase sensitive learning that is rapid and apparently independent of the consequences of behaviour.

Learning occurring at a particular age or stage

300
Q

What is classical conditioning?

A

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

Phase 3A Quiz (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions