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Psychiatry Flashcards

1
Q

What are the symptoms of anxiety?

A

Brain and mind - dizziness, depersonalisation, fear of passing out / death / going mad
General - chills, flushing, tingling, numbness, pins and needles
Chest and abdo - SOB, choking, chest pain, nausea, stomach churning
Autonomic - palpitations, sweats, shakes, dry mouth

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2
Q

What is generalised anxiety disorder?

A

Generalised persistent excessive anxiety or worry about a number of events the individual finds difficult to control, lasting more days for at least 3 weeks.

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3
Q

What are the symptoms of GAD?

A 
Anxiety
Subjective apprehension
Increased vigilance
Feeling restless and on edge
Sleeping difficulties
Motor tension - tremor, hyperactive deep reflexes
Autonomic hyperactivity
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4
Q

What are the differentials of GAD?

A 
Panic disorder, social phobia, OCD, PTSD
Withdrawal from drugs or alcohol
Excessive caffeine consumption
Depression
Psychotic disorders
Organic causes - thyrotoxicosis, parathyroid disease, hypoglycaemia, phaeochromocytoma, carcinoid syndrome
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5
Q

How can generalised anxiety disorder be treated?

A 
Individual guided self help and psychoeducational groups
CBT or applied relaxation
SSRIs or SNRIs
Pregabalin is 2nd line
Benzodiazepine if acute crisis
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6
Q

What is panic disorder?

A

Recurrent unpredictable severe panic attacks that aren’t restricted to any particular situations

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7
Q

What are panic attacks?

A

Discrete periods of intense fear, impending doom or discomfort accompanied by sudden onset of characteristic symptoms

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8
Q

What are the symptoms of a panic attack?

A 
Crescendo of fear and autonomic symptoms
Palpitations, tachycardia
Sweating, trembling, breathlessness
Feeling of choking
Chest pain / discomfort
Nausea / abdo discomfort
Dizziness, paraesthesia
Chills and hot flushes
Derealisation / depersonalisation
Fear of losing control or dying
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9
Q

What are the differentials of panic disorder?

A 
Agoraphobia
Specific phobia
Social anxiety disorder
PTSD
Substance induced anxiety disorder
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10
Q

What is the treatment for panic disorders?

A

SSRIs and CBT

TCA (imipramine and clomipramine) if SSRIs are ineffective

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11
Q

What is PTSD?

A

Onset within 6 months of severe stressful experience that is of an exceptionally threatening or catastrophic nature

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12
Q

What are the clinical features of PTSD?

A

Persistent intrusive thinking or re-experiencing trauma
Avoidance of situations reminding of trauma
Numbing, detachment and estrangement from others
Irritability, hyper vigilance, exaggerated startle response
Increased arousal with autonomic symptoms
Insomnia

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13
Q

What are the differentials of PTSD?

A 
Depression
Specific phobia
Panic disorder
Adjustment disorder
Psychosis
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14
Q

What is the treatment for PTSD?

A

Eye movement densensitisation and reprocessing (EMDR)
Venlafaxine or SSRI e.g. paroxetine
Antipsychotics e.g. mirtazapine along with psychological therapies

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15
Q

What is social phobia?

A

Persistent fear of social situations in which individual is exposed to unfamiliar people or to possible scrutiny b others and fears they will be humiliated or embarrassed

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16
Q

What are the differentials of social phobia?

A 
Phobias
Panic disorder
Agoraphobia
GAD
PTSD
Hyperthyroidism
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17
Q

What is the treatment for social phobia?

A

CBT
Self-help
Graded self exposure
Drugs - SSRI e.g. escitalopram or sertraline

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18
Q

What is agoraphobia?

A

Fear of open spaces, crowds, difficulty escaping.
Fear of entering shops, public places and travelling alone
More common in women
Treat with graded exposure therapy

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19
Q

What is OCD?

A

Time consuming recurrent obsessions and/or compulsions present more days for at least 2 weeks, are distressing and interfere with activities

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20
Q

What is an obsession?

A

Unwelcome, persistent, recurrent, intrusive thought.
Ideas, images, impulses
Senseless and uncomfortable for the individual who attempts to suppress or neutralise them and recognises them as absurd and a product of their own mind

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21
Q

What is a compulsion?

A

Repetitive, purposeful, physical or mental behaviours performed with reluctance in response to an obsession

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22
Q

What is the epidemiology of OCD?

A

Onset during adolescence
Lifetime prevalence of 2-3%
Men and women equally affected

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23
Q

What is the aetiology of OCD?

A

Family history of OCD, tics or Tourettes syndrome
Parental overprotection
Biochemical abnormalities involving serotonin
Abnormality of cortico-striatal-thalamic circuit

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24
Q

How is OCD assessed?

A

Yale-Brown obsessive compulsive scale (YBOS)

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25
Q

What are the differentials of OCD?

A

Obsessive compulsive personality disorder
Body dysmorphic disorder
Panic disorder
Autism spectrum disorder

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26
Q

How is OCD treated?

A

SSRIs (fluoxetine, paroxetine) or clomipramine
CBT involving exposure and response prevention
Psychoeducation and social support

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27
Q

What are some organic causes of anxiety?

A 
Phaeochromocytoma
Hyperthyroidism
Hypoparathyroidism
Caffeine
Stimulant use
Medication - salbutamol, theophylline, steroids
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28
Q

What is bipolar?

A

Recurrent episodes of altered mood and activity involving upswings and downswings
At least 2 episodes with at least 1 being a manic / hypomanic episode

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29
Q

What is mania?

A

7 days of abnormally elevated or irritable mood that interferes with functioning and at least 3 of:

  • physical restlessness
  • pressured speech
  • flight of ideas
  • loss of normal social inhibition
  • decreased need for sleep
  • grandiosity
  • distractibility
  • reckless or foolhardy spending or behaviour
  • marked sexual indiscretions
  • psychotic symptoms
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30
Q

What is hypomania?

A 
Lesser degree of mania
Persistent mood elevation
Increased energy and activity
Increased sociability, talkativeness
Overfamiliarity, increased sexual energy
Decreased need for sleep
Decreased attention and concentration
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31
Q

What is cyclothymia?

A

Doesn’t meet levels of mood disturbance to diagnose with mania / hypomania / depression

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32
Q

What is the epidemiology of bipolar disorder?

A

Equally common in males and females
Peaks in early 20s and in 45-54yo
Greater prevalence in higher social classes
Black African and Afro-Caribbean more likely to present with mania and severe psychotic symptoms

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33
Q

What is the aetiology of bipolar disorder?

A

Strong genetic component
Abnormalities in HPA
Smaller prefrontal lobes and enlarged amygdala and globes pallidus
Prolonged psychological stressors during childhood
Early postpartum

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34
Q

What are the risk factors for bipolar?

A 
Family history
Onset of mood disorder before 20yo
Stressful life events
Previous history of depression
Lifetime history of substance misuse disorder
Presence of anxiety disorder
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35
Q

What are the differential diagnoses for bipolar?

A

Substance abuse - especially amphetamines or cocaine
Mood abnormalities secondary to endocrine dysfunction or epilepsy
Schizophrenia
Schizoaffective disorder
Personality disorders
ADHD

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36
Q

How is an acute manic episode treated?

A

1) Haloperidol, olanzapine, quetiapine or risperidone
2) Lithium or valproate
Benzodiazepines in short term
Lorazepam and antipsychotics for rapid tranquillisation
ECT

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37
Q

How is a depressive episode in bipolar disorder treated?

A

Quetiapine, olanzapine, lamotrigine or combination or olanzapine and fluoxetine

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38
Q

What is the long term therapy for bipolar disorder?

A

Mood stabilisers
Antipsychotics
Cognitive therapy for depressive disorder
Psychoeducation
Family therapy and support
Work and education help
Motivational interviewing to minimise substance abuse

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39
Q

What does a psychiatric assessment for children involve?

A

Current behavioural or emotional difficulties
Mood
Sleep
Appetite
Elimination
Relationships
Antisocial behaviours
School behaviour and academic performance
Daily routine
Family structure, interactions and separations
Signs of abuse or neglect

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40
Q

What child psychiatric problems have a higher prevalence in boys?

A 
Autistic disorders
Hyperactive disorders
Attachment disorders
Conduct / oppositional disorders
Juvenile delinquency
Completed suicide
Tic disorders
Nocturnal enuresis
Anorexia nervosa and bulimia nervosa
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41
Q

What child psychiatric problems have a higher prevalence in females?

A

Specific females
Diurnal enuresis
Deliberate self harm
Depression post puberty

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42
Q

What are examples of emotional disorders?

A 
Anxiety disorders
Phobias
Depression
Obsessive-compulsive disorder
Somatisation
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43
Q

What are examples of developmental disorders?

A

Learning disability
Autism spectrum disorder
Specific learning disorder
Enuresis / encopresis

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44
Q

What are examples of behavioural disorders?

A

Conduct disorders
Hyperactivity disorder
Oppositional defiant disorder

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45
Q

What are examples of disorders of social functioning?

A

Elective mutism
Reactive attachment disorder
Disinhibited attachment disorder

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46
Q

What is the aetiology of ADHD?

A 
Genetic loading
Social adversity
Parental alcohol abuse
Dietary constituents
Exposure to tranquilisers
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47
Q

What are the clinical features of ADHD?

A

Impaired attention
- failing to give close attention to detail
- difficulty sustaining attention on tasks or play
- doesn’t seem to listen when spoken to directly
- difficulty organising tasks
- avoids activities that require sustained attention
- loses things
- easily distracted
Hyperactivity
- fidgets with hands or feet
- squirms in seat
- leaves seat where remaining in seat is required
- climbs excessively or dangerously
- difficulty playing or engaging in leisure activities
Impulsivity
- blurts out answers before questions have been completed
- difficulties awaiting turn
- interrupts others

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48
Q

What does the diagnosis of ADHD require?

A

At least 6 months of short attention span, distractibility, overactivity and impulsivity

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49
Q

What are the differential diagnoses of ADHD?

A 
Learning / language disorder
Oppositional defiant disorder
Depression
Bipolar
Anxiety
Autism spectrum disorders
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50
Q

What disorders can co-exist with ADHD?

A 
Mood disorders
Disruptive behavioural disorders
Conduct disorders
Autism spectrum
Oppositional defiant disorder
Anxiety disorder
Tics
Developmental coordination disorder
Specific learning difficulties / language delay
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51
Q

How is ADHD treated?

A 
Medications:
 - stimulates e.g. methylphenidate, hydrochloride, dimesylate
 - non-stimulants e.g. atomoxetine
 - clonidine
Behavioural therapy
Parent training and family work
Classroom behavioural interventions
Treating comorbid conditions
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52
Q

When is autism diagnosed?

A

At least 3 of:

  • Pervasive failure to make social relationships
  • major difficulties / deficits with verbal / non-verbal communication
  • Deficits in developing, maintaining and understanding relationships
  • resistance to change with associated ritualistic behaviours
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53
Q

What are the differential diagnoses of autism?

A

ADHD
Learning disability
Deafness
Childhood schizophrenia

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54
Q

How is autism treated?

A

Behavioural management

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55
Q

What are the risks of using antipsychotics in dementia?

A

CVA

Pneumonia

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56
Q

What are the risks of using memory enhancers for older people?

A

Bradycardia

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57
Q

What is dementia?

A

A chronic irreversible decline in a wide range of brain activities in the presence of a clear consciousness resulting from various neuropathological changes that impair ADLs

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58
Q

What brain functions are involved in dementia?

A 
Memory and orientation
Thinking processes
Learning
Language
Calculation
Comprehension
Judgement
Emotion
Behaviour
Motivation
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59
Q

What are the risk factors for dementia?

A 
Age
Genetics
Cerebrovascular risk factors
Diabetes
Obesity
Lack of education
History of depression
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60
Q

How can dementia present?

A

Poor memory - initially short term
Disorientation in time, place and person
Behavioural change - difficult, apathetic, aggressive and/or restless, disinhibited, psychomotor agitation, lack of motivation
Emotional - lability of mood, anxiety, depression
Delusions / hallucinations

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61
Q

What are the types of dementia?

A 
Alzheimer's disease
Vascular dementia
Dementia with levy bodies
Frontotemporal dementia - Picks disease
Parkinson's dementia
Huntington's chorea
Dementia puglistica
Creutzfeldt-Jakob disease / prion disease
PSP 
Posterior cortical atrophy
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62
Q

What are some reversible causes that can present as dementia?

A 
Alcoholism
B12 / folate deficiency
Hypothyroidism
Space occupying lesion
Carbon monoxide poisoning
Syphilis
Hydrocephalus
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63
Q

What are the risk factors for Alzheimer’s disease?

A 
Increasing age
Down's syndrome
Apolipoprotein e4
Diabetes
Smoking
Hypertension
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64
Q

What factors are protective against Alzheimer’s disease?

A

Apolipoprotein e2 allele
Higher level of premorbid education
Higher level of physical activity in middle age
NSAIDs

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65
Q

What are the clinical features of Alzheimers?

A

Behavioural and psychological symptoms
Early: failing memory, disorientation in time, muddled efficiency with ADLs and changes in behaviour
Middle: global intellectual, aphasia, apraxia, agnosia, impaired visuospatial skills and executive dysfunction
Late: fully dependence, physical disorientation, incontinence

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66
Q

What are the vascular risk factors for vascular dementia?

A 
High BP
High cholesterol
High lipids
Smoking
Diabetes mellitus
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67
Q

What are the clinical features of vascular dementia?

A

Early: emotional, personality, language and executive impairments
Late: memory impairments
Increased depression
Often retain insight

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68
Q

What are the symptoms of dementia with lewy bodies?

A

Fluctuating memory and cognitive performance
Falls
Incontinence
Hallucinations
Delusions
Parkinsonian features - bradykinesia, rigidity, gait disorder, tremor

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69
Q

What is the neuropathology of fronto-temporal dementia?

A

Neuronal loss
Gliosis
Protein inclusions consisting of tau, TDP-43 or FUS

70
Q

What are the clinical features of fronto-temporal dementia?

A 
Apathy
Language difficulty
Change in personality
Lack of judgement 
Labile mood
Inappropriateness
Personality changes and social disinhibition or language impairment often precede memory impairment
71
Q

What investigations would you do for dementia?

A

History from patient and carer
Cognitive assessment
- MMSE, SMMSE
- ACE-R, ACE III, CAMCOG, MoCA, full neuropsychology testing
- frontal lobe assessment: trail making test, cognitive estimates, verbal fluency, sequencing
Blood screen
Physical / neuro exam
Brain scans - CT / MRI
Functional brain scans - SPECT, PET
Biomarkers in CSF - alpha synuclein (DLB), amyloid / tau (Alzheimers)

72
Q

How is dementia managed?

A 
Community treatment
Non-pharmacological approaches:
 - behavioural
 - psychological
 - occupational therapy
 - sensory stimulation
 - day centres
Pharmacological approaches:
 - antipsychotics, antidepressants
 - acetylcholinesterase inhibitors - memory enhancers
73
Q

What pharmacological treatment is used for Alzheimers?

A

Mild: acetylcholinesterase inhibitors e.g. donepezil, rivastigmine
Moderate: memantine with/without AchE inhibitors

74
Q

What pharmacological treatment is used for vascular dementia?

A

Aspirin

Acetycholinesterase inhibitors

75
Q

What pharmacological treatment is used for dementia with lewy bodies?

A

Acetylcholinesterase inhibitors

76
Q

How can fronto-temporal dementia be treated?

A

No treatment

SSRIs to manage behaviour / impulsiveness

77
Q

What is depression?

A

Persistent low mood, loss of interest and enjoyment, reduced energy causing varying levels of social and occupational disturbances
Need 3 core symptoms for at least 2 weeks: depressed mood, anhedonia, reduced energy

78
Q

What is major depressive disorder?

A

At least 5 depressive symptoms, including depressed mood or anhedonia, for at least 2 weeks. Symptoms cause functional impairment and aren’t better explained by substance abuse, medication side effects or other conditions

79
Q

What is sub-threshold depression?

A

Presence of 2-4 depressive symptoms including depressed mood or anhedonia which last longer than 2 weeks

80
Q

What is persistent depressive disorder?

A

At least 2 years of 3-4 dysthymic symptoms for more days than not.
Depressed mood, appetite change, sleep disturbance, low energy, low self-esteem, poor concentration, helplessness

81
Q

What are the risk factors for depression?

A

Prior history of depression
FHx of depression
Recent bereavement, stress or medical illness
Older age
Recent childbirth
Co-existing medical conditions e.g. diabetes, cancer, stroke, MI, HIV, chronic pain, PCOS and obesity
Medications e.g. corticosteroids, propranolol, interferon, oral contraceptives
Females

82
Q

What are the clinical features of depression?

A

Low mood

  • Low self-esteem
  • Feelings of guilt / psychosis
  • lack hope for future
  • suicide risk

Anhedonia
- reduced attention / concentration

Low energy / fatigue

  • changes in eating patterns
  • sleep changes
83
Q

What are the examination findings in depression?

A 
Depressed affect
Downcast gaze, furrowed brow
Psychomotor slowing
Speech latency
Expressions of guilt or self-blame
84
Q

How can depression be screened for?

A

PRIME-MD
PHQ-9
Edinburgh postnatal depression scale
Cornell scale

85
Q

What investigations should be done for depression?

A

Exclude other causes of symptoms
TFT, metabolic panel, FBC
Serum vitamin B12, folate
24h urinary cortisol (elevation suggests Cushings disease)

86
Q

What are the differentials of depression?

A 
Adjustment disorder with depressed mood
Substance / medication / alcohol abuse
Bipolar disorder
Grief reaction
Dementia
Anxiety disorder
Anorexia nervosa
Hypothyroidism, Cushings, vit B12 deficiency, OSA, drugs (glucocorticoids, interferon, levodopa, propranolol, oral contraceptives)
87
Q

What is the management of depression?

A

Biological:
- antidepressants: SSRIs e.g. sertraline, citalopram
2nd line: different SSRI, newer generation antidepressant or of a different class e.g. venlafaxine, TCA, MAOi
3rd line: augment with lithium, antipsychotic (aripiprazole, olanzapine, quetiapine, risperidone), or another antidepressant e.g. mirtazapine
Psychological: counselling, CBT, CAT, interpersonal therapy, family therapy, psychodynamic / psychoanalytic therapy
Social: lifestyle changes, exercise, smoking and alcohol, employment, family, motivational interviewing

88
Q

How is severe depression treated?

A

ECT

Psychotherapy

89
Q

What is severe depression?

A

Psychotic, suicidal, catatonic or have severe psychomotor retardation impeding ADLs or severe agitation

90
Q

What is treatment resistant depression and how is it managed?

A

Persistent depressive symptoms not responsive to 2 antidepressants for a minimum of 4-6 weeks at therapeutic dose.
Treat with mirtazapine and venlafaxine. Add antipsychotic. ECT or lithium

91
Q

What is the diagnosis of anorexia nervosa?

A 
BMI 15% below expected
Morbid fear of fatness / weight gain
Deliberate weight loss
Distorted body image
Amenorrhoea, delayed puberty
Loss of sexual interest and potency in men
92
Q

What are the clinical features of anorexia nervosa?

A 
Preoccupation with food
Dietary restriction
Self-conscious about eating in public
Vigorous exercise
Constipation
Cold intolerance
Depression and obsessive-compulsive symptoms
93
Q

What are the physical signs of anorexia nervosa?

A 
Emaciation
Dry and yellow skin
Fine lanugo hair on face and trunk
Bradycardia and hypotension
Anaemia and leukopenia
Consequences of repeated vomiting - hypokalaemia, alkalosis, pitted teach, parotid swelling, Russel's sign (scarring of dorsum of hand)
94
Q

What are the differential diagnoses of anorexia nervosa?

A

Organic causes of low weight
Depression
Psychotic disorder with delusions around food
Substance or alcohol abuse

95
Q

What is the MARSIPAN checklist?

A

Management of really sick patients with anorexia nervosa

96
Q

What is bulimia nervosa?

A

Intense cravings with repeated over eating binges then trying to prevent weight gain
Occurs at least once a week for at least 3 months

97
Q

What are the clinical symptoms and signs of bulimia nervosa?

A

Morbid fear of fatness
Craving for food and binge eating
Recurrent behaviours to prevent weight gain - vomiting, laxatives, diuretics, appetite suppressants
Preoccupation with body weight and shape
Amenorrhoea, hypokalaemia, excessive vomiting signs

98
Q

What are the differential diagnoses of bulimia nervosa?

A 
Depression
Hyperthyroidism
Type 1 diabetes mellitus
Crohn's disease / UC
OCD
99
Q

How is an eating disorder treated?

A

Refeeding, weight management and physical health
Psychological - CBT, interpersonal psychotherapy, focal psychodynamic therapy
Medication if other comorbidities

100
Q

What is a section 2?

A

Enables a person thought to be suffering from mental illness to be detained in a registered mental health unit in the interests of their own health and safety or to protect others
Up to 28 days for assessment if appropriate treatment is available
Application done by 2 professionals, 1 must be an approved doctor

101
Q

What is a section 3?

A

Enables a person with a known mental illness to be detained for up to 6 months for treatment
1 of the medical recommendations must be by an approved doctor

102
Q

What is a section 4?

A

Emergency application only requiring 1 doctor

Allows detainment for assessment only up to 72h

103
Q

What is a section 5(2)?

A

Allows a person to be held for up to 72h for assessment only who is already in hospital

104
Q

What is a section 5(4)?

A

Registered mental health nurse can hold a person who has been admitted to hospital for up to 6 hours if they are believed to be at serious risk to themselves or others

105
Q

What is a section 136?

A

Allows a police officer to convey a person in a public place behaving in a way to indicate that are suffering from a mental disorder to a place of safety so they can be examined by a medical officer and AMHP
Can be held for up to 24h

106
Q

What is a section 17?

A

allows patient to be discharged from detention with a community treatment order which requires them to continue with treatment and are liable to recall

107
Q

What is a section 37?

A

Allows a person convicted of imprisonable offences to be detained and treated in hospital

108
Q

What is a section 41?

A

Restricts discharge of dangerous patients detained under section 37 by requiring permission from Home Secretary

109
Q

What are the key assessment points for capacity?

A

Understand information relevant to decision
Retain that information
Use or weigh that information as part of process of making decisions
Communicate decision in any form

110
Q

What is the definition of incapacity?

A

Impairment or disturbance of mental function

Person lacks capacity to understand, retain, use or weigh up information and communicate a decision

111
Q

What is a personality disorder?

A

Deeply ingrained and enduring patterns of behaviour that are abnormal in a particular culture, lead to subjective distress and sometimes cause others distress
Manifest as problems in at least 2 of: cognitive-perceptual, affect regulation, interpersonal functioning or impulse control

112
Q

What are the risk factors for personality disorder?

A

History of abuse - physical, sexual, neglect
Family history of schizophrenia
Negative parenting interactions - harsh punishment, lack of parental affection
Emotional / disruptive disorder in childhood

113
Q

What are adverse childhood experiences significantly associated with?

A

Depression, suicide attempts
Alcoholism, drug abuse, smoking
Sexual promiscuity, STIs, domestic violence
Obesity, physical inactivity

114
Q

What are the 3 clusters of personality disorders?

A 
Cluster A (odd / eccentric)
 - paranoid
 - schizoid
 - schizotypal
Cluster B (flamboyant / dramatic)
 - borderline / emotionally unstable
 - histrionic
 - dissocial 
Cluster C (fearful / anxious)
 - dependent
 - anxious
 - obsessive-compulsive
115
Q

What are the features of borderline personality disorder?

A

Unstable and intense interpersonal relationships, self image and affect
Self-damaging impulsivity - spending, sex, substance abuse, reckless
Inability to control anger
Unpredictable affect and behaviour
Identity confusion
Chronic anhedonia
Recurrent suicidal or self mutilating behaviour
Transient psychotic symptoms may be pesent

116
Q

What investigations may be done for personality disorder?

A 
SAPAS
MCM-III
MRI / CT brain
Urine drug screen
PRIME-MD
PHQ-9
117
Q

How are cluster A personality disorders managed?

A

1st line: patient communication and relationship management strategies
Add low-dose antipsychotic e.g. aripiprazole, haloperidol
Add antidepressants e.g. fluoxetine, sertraline, venlafaxine
Add substance abuse treatment

118
Q

How are cluster B personality disorders managed?

A

1st line: patient communication and relationship management strategies
Borderline: Add psychotherapy, mood stabilisers or anticonvulsants (topirimate, valproate, lithium, lamotrigine)
Narcissistic / histrionic: substance abuse treatment
Antisocial: psychotherapy

119
Q

How are cluster C personality disorders managed?

A 
1st line: patient communication and relationship management strategies
Add psychotherapy
Add pharmacotherapy
 - fluoxetine, sertraline, venlafaxine
 - gabapentin, pregabalin
 - phenelzine
120
Q

What are the differentials of personality disorders?

A 
Mood disorder
Psychotic disorder
Anxiety disorder
Substance-related disorder
Personality change due to medical condition
121
Q

What can trigger a personality disorder crisis?

A 
Drug or alcohol misuse
Relationship problems
Financial problems
Anxiety, depression or other mental health problems
Important events
Stressful situations
Loss
122
Q

What is psychotherapy?

A

Helps a person to recognise unhelpful patterns and this gives more choice in the person’s interactions
Can treat any disease but particularly emotional maladjustments and mental disorders by psychological means

123
Q

What is psychoanalytic / psychodynamic psychotherapy?

A

Unstructured
1:1
Therapists observes and comments on what the patient says - noticing repeatable patterns, relationships and feelings
Aim is to make unconscious more conscious to. help people make more conscious choices about their behaviour, feelings and relationships to themselves and others

124
Q

What is CBT?

A

Usually 1:1 but can be groups
Identify problematic patterns of thought and behaviour
Commonly used for anxiety, depression, OCD and eating disorders

125
Q

What type of patients will CBT not suit?

A 
Autism
Psychotic patients
Acute mania
Acute depression
Severe learning difficulties
126
Q

What is cognitive analytic therapy?

A

Similar to CBT but more intense
Aims to identify different self-states and associated reciprocal role procedures
Patients are helped to observe and change thinking and behaviour related to these self-states

127
Q

What is mentalisation-based therapy and dialectical behavioural therapy?

A

Used for borderline personality disorders
MBT addresses disorganised attachments and individual’s failure to develop mentalising capacities as a result of early attachment experiences

128
Q

What is EMDR?

A

Helps with PTSD
Uses voluntary multi-saccadic eye movements to reduce anxiety associated with disturbing thoughts and helps process emotions associated with traumatic experiences

129
Q

What is counselling?

A

Briefer, discusses the here and now
Less challenging
Need less training
Method of relieving distress undertaken by means of a dialogue between 2 people. Aim is to help patient find their own solutions to problems while being supported to do so

130
Q

What is psychosis?

A

Group of symptoms characterised by mood, thoughts, feelings and emotions which are disconnected from reality

131
Q

What is the diagnosis of schizophrenia?

A

Co-occurrence of at least 2 of following symptoms for at least 1 month:

  • delusions
  • hallucinations
  • disorganised speech
  • disorganised / catatonic behaviour
  • negative symptoms
132
Q

What is the ICD-10 diagnosis of schizophrenia?

A

Minimum of 1 a-d or 2 e-h for at least 1 month

a) thought echo, insertion, withdrawal or broadcast
b) delusion of passivity or delusional perception
c) running commentary hallucination
d) persistent delusion of other kinds
e) persistent hallucinations in any modality
f) breaks in thought resulting in abnormal speech
g) catatonic behaviour e.g. posturing, wavy flexibility, negativism
h) negative symptoms not due to depression or medication

133
Q

What are the subtypes of schizophrenia?

A

Paranoid - delusions and auditory hallucinations
Catatonic - psychomotor disturbances, rigidity and posturing
Hebephrenic
Residual
Simple - negative symptoms without preceding over psychotic symptoms

134
Q

What is the epidemiology of schizophrenia?

A

Peak incidence in late teens / early adulthood
- 21-26 in males, 25-32 in females
More prevalent in urban areas
Increased risk in migrants

135
Q

What is the aetiology of schizophrenia?

A

Geentics
Neurodevelopmental hypothesis - factors interfering with early brain development increase risk
Social factors - socioeconomic deprivation, urbanity, migrant status, social isolation
Neurochemical changes - dopamine excess or overactivity in mesolimbic dopaminergic pathways
Adverse life events
Cannabis intoxication

136
Q

What are the clinical features of schizophrenia?

A 
Positive symptoms
 - delusions
 - hallucinations
 - formal thought disorder
Negative symptoms
 - avolition
 - anhedonia
 - poverty of speech
 - flat affect
 - social withdrawal
Cognitive symptoms
 - poor attention
 - poor memory
 - impairments in executive functioning
Mood
 - dysphoria
 - suicidality
- helplessness
137
Q

What is a delusion?

A

Fixed false belief help firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary and not shared by someone of similar age, educational, cultural, religious or social background

138
Q

Describe the mental state exam in schizophrenia

A

Appearance: unkempt, poor self care
Behaviour: preoccupied, distracted, restless, hostile
Speech: loosening of associations, word salad
Affect: blunted, perplexed
Delusions: paranoid, persecutory, grandiose
Perception: auditory, visual, tactile, olfactory
Cognition: attention deficits
Insight: impaired

139
Q

What investigations should be done for schizophrenia?

A 
Clinical diagnosis
CT / MRI head - normal
Serum HIV if risk of STIs
FBC - anaemia can cause fatigue and depression which can mimic negative symptoms
Urine drug screen
140
Q

What are the differentials of schizophrenia?

A 
Substance misuse
Psychosis due to another condition e.g. Wilson's disease
Personality disorder
Severe depression with psychotic symptoms
Manic episode with pyschotic symptoms
Schizoaffective disorder
Bipolar mood disorder
Delusional disorder
Brief psychotic episode
Organic cause
141
Q

How is psychosis managed?

A 
Biological:
 1) atypical antipsychotics
 2) typical antipsychotics
 3) clozapine 
4) Adjuncts: antidepressants, sedatives, mood stabilisers
Psychological: 
 - CBD
 - family interventions
 - psychoeducation
 - relapse prevention
Social:
 - occupational therapy
 - art therapy
 - life skills
 - practical support
ECT
142
Q

What are the potential benefits of atypical antipsychotics?

A

Less extrapyramidal side effects
less tardive dyskinesia
Less hyperprolactinaemia
Beneficial effect on negative symptoms, cognition, resistant symptoms and affect symptoms

143
Q

What is the consequence of atypical antipsychotics?

A 
Metabolic syndrome
Central obesity
Hypertension
Dyslipidaemia
Raised fasting plasma glucose
144
Q

What factors have a good prognosis for schizophrenia?

A 
Female
Married
Family history of affective disorder
Good premorbid function
Acute onset
Life event at onset
Early treatment
Affective symptoms
145
Q

What factors have a bad prognosis for schizophrenia?

A 
Male
Single
Family history schizophrenia
Premorbidly schizoid
Slow onset
Longer duration untreated pyschosis
Negative symptoms
Obsessions
High expressed emotions
Substance misuse
146
Q

What mental health disorders increase suicide risk?

A

Depression - anhedonia, low mood, fatigue
Psychosis
Alcohol dependency
Anorexia

147
Q

What is hazardous substance use?

A

Pattern of substance use that increases risk of harmful consequences to the user

148
Q

What is harmful substance use?

A

Pattern of psychoactive substance use that is causing damage to health and adverse effects on family and society

149
Q

What is dependence?

A

Cluster of behavioural, cognitive and physiological phenomena that develop after repeated substance use and typically include: (CANT STOP)

  • compulsion to take substance
  • aware of harm but persist
  • neglect of other activities
  • tolerance increased
  • stopping causing withdrawal
  • time preoccupied with use increases
  • out of control use
  • persistent wish to cut down
150
Q

What is a withdrawal state?

A

Physical and psychological symptoms occurring on absolute or relative withdrawal of substance after repeated use

151
Q

Give examples of opiates

A

Heroin
Morphine
Methadone

152
Q

What effects do opiates give?

A

Intensely pleasurable buzz or rush
Peace, detachment
CNS depression

153
Q

Give examples of stimulants and the effects they give

A

Cocaine
Amphetamines
Brief high with euphoria, increased energy and concentration
Depression / tiredness after use

154
Q

Give examples of hallucinogens and the effects they give

A 
Ecstasy
GHB
GBL
LSD, magic mushrooms
Stimulant, hallucinogenic
155
Q

What effects does cannabis give?

A

Euphoria, relaxation
Hallucinations
Increased appetite
Decreased temperature

156
Q

What are the signs of cannabis intoxication?

A 
Impaired motor coordination
Euphoria
Sensation of slowed times
Social withdrawal
Increased appetite
157
Q

What are the withdrawal signs of cannabis intoxication

A

Irritability
Insomnia
Anorexia
Mild nausea

158
Q

What are the signs of opiate withdrawal?

A

Early: agitation, anxiety, muscle aches, increasing tearing, insomnia, runny nose, sweating
Late: abdominal cramping, diarrhoea, dilated pupils, goose bumps, nausea and vomiting

159
Q

What are the signs of benzodiazepine intoxication?

A 
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impairment in attention or memory
Stupor or coma
Behavioural changes
Mood lability
Impaired judgement
160
Q

What are the signs of benzodiazepine withdrawal?

A 
Autonomic hyperactivity
Increased tremor
Nausea
Insomnia
Transient visual, tactile or auditory hallucinations
Psychomotor agitation
Anxiety
Grand mal seizures
161
Q

What are the signs of acute alcohol intoxication?

A 
Slurred speech
Impaired coordination and judgement
Labile affect
Hypoglycaemia
Stupor
Coma
162
Q

How can we screen for alcoholism?

A

CAGE questions
- have you tried to Cut down your drinking
- do people Annoy you by suggesting you cut down?
- have you felt Guilty about drinking?
- have you needed an Eye opener?
AUDIT
Collateral

163
Q

What are the signs of alcoholism on examination?

A 
Jaundice
Spider naevi
Palmar erythema
Gynaecomastia
Peripheral neuropathy
164
Q

What is Wernicke’s encephalopathy?

A

Acute condition characterised by ophthalmoplegia, ataxia and global confusional state
Caused by thiamine deficiency

165
Q

What is Korsakoff’s syndrome?

A

Marked deficits in anterograde and retrograde episodic memory and apathy
Confabulation to cover gaps in memory

166
Q

What is foetal alcohol syndrome?

A 
Decreased muscle tone
Poor coordination
Developmental delay
Heart defects
Facial abnormalities
167
Q

What are the symptoms of alcohol withdrawal?

A 
Malaise
Nausea
Autonomic hyperactivity
Tremulousness
Labile mood
Insomnia
Transient hallucinations or illusions
168
Q

What are the signs of delirium tremens and how is it treated?

A

Global confusion, agitation, disorientation, hallucinations, fever, autonomic hyperactivity
Treat with lorazepam

169
Q

What does disulfiram do?

A

Blocks alcohol metabolism as its an irreversible inhibitor of acetylaldehyde dehydrogenase
If alcohol is consumed it causes flushing, headache, anxiety and nausea

170
Q

What can be used for detoxification / maintenance of opioid withdrawal?

A 
Methadone
Lofexidine
Naltrexone to prevent relapse
Loperamide for diarrhoea
Paracetamol and ibuprofen for muscle aches

KT (6 decks)

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