Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

KT > Psychiatry > Flashcards

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is panic disorder?

A

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

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

What are panic attacks?

A

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

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

What are the differentials of panic disorder?

A 
Agoraphobia
Specific phobia
Social anxiety disorder
PTSD
Substance induced anxiety disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for panic disorders?

A

SSRIs and CBT

TCA (imipramine and clomipramine) if SSRIs are ineffective

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

What is PTSD?

A

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

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

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

What are the differentials of PTSD?

A 
Depression
Specific phobia
Panic disorder
Adjustment disorder
Psychosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

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

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

What are the differentials of social phobia?

A 
Phobias
Panic disorder
Agoraphobia
GAD
PTSD
Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for social phobia?

A

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

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

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

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

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

What is a compulsion?

A

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

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

What is the epidemiology of OCD?

A

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

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

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

How is OCD assessed?

A

Yale-Brown obsessive compulsive scale (YBOS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the differentials of OCD?
Obsessive compulsive personality disorder Body dysmorphic disorder Panic disorder Autism spectrum disorder
26
How is OCD treated?
SSRIs (fluoxetine, paroxetine) or clomipramine CBT involving exposure and response prevention Psychoeducation and social support
27
What are some organic causes of anxiety?
``` Phaeochromocytoma Hyperthyroidism Hypoparathyroidism Caffeine Stimulant use Medication - salbutamol, theophylline, steroids ```
28
What is bipolar?
Recurrent episodes of altered mood and activity involving upswings and downswings At least 2 episodes with at least 1 being a manic / hypomanic episode
29
What is mania?
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
30
What is hypomania?
``` 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 ```
31
What is cyclothymia?
Doesn't meet levels of mood disturbance to diagnose with mania / hypomania / depression
32
What is the epidemiology of bipolar disorder?
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
33
What is the aetiology of bipolar disorder?
Strong genetic component Abnormalities in HPA Smaller prefrontal lobes and enlarged amygdala and globes pallidus Prolonged psychological stressors during childhood Early postpartum
34
What are the risk factors for bipolar?
``` 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 ```
35
What are the differential diagnoses for bipolar?
Substance abuse - especially amphetamines or cocaine Mood abnormalities secondary to endocrine dysfunction or epilepsy Schizophrenia Schizoaffective disorder Personality disorders ADHD
36
How is an acute manic episode treated?
1) Haloperidol, olanzapine, quetiapine or risperidone 2) Lithium or valproate Benzodiazepines in short term Lorazepam and antipsychotics for rapid tranquillisation ECT
37
How is a depressive episode in bipolar disorder treated?
Quetiapine, olanzapine, lamotrigine or combination or olanzapine and fluoxetine
38
What is the long term therapy for bipolar disorder?
Mood stabilisers Antipsychotics Cognitive therapy for depressive disorder Psychoeducation Family therapy and support Work and education help Motivational interviewing to minimise substance abuse
39
What does a psychiatric assessment for children involve?
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
40
What child psychiatric problems have a higher prevalence in boys?
``` Autistic disorders Hyperactive disorders Attachment disorders Conduct / oppositional disorders Juvenile delinquency Completed suicide Tic disorders Nocturnal enuresis Anorexia nervosa and bulimia nervosa ```
41
What child psychiatric problems have a higher prevalence in females?
Specific females Diurnal enuresis Deliberate self harm Depression post puberty
42
What are examples of emotional disorders?
``` Anxiety disorders Phobias Depression Obsessive-compulsive disorder Somatisation ```
43
What are examples of developmental disorders?
Learning disability Autism spectrum disorder Specific learning disorder Enuresis / encopresis
44
What are examples of behavioural disorders?
Conduct disorders Hyperactivity disorder Oppositional defiant disorder
45
What are examples of disorders of social functioning?
Elective mutism Reactive attachment disorder Disinhibited attachment disorder
46
What is the aetiology of ADHD?
``` Genetic loading Social adversity Parental alcohol abuse Dietary constituents Exposure to tranquilisers ```
47
What are the clinical features of ADHD?
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
48
What does the diagnosis of ADHD require?
At least 6 months of short attention span, distractibility, overactivity and impulsivity
49
What are the differential diagnoses of ADHD?
``` Learning / language disorder Oppositional defiant disorder Depression Bipolar Anxiety Autism spectrum disorders ```
50
What disorders can co-exist with ADHD?
``` Mood disorders Disruptive behavioural disorders Conduct disorders Autism spectrum Oppositional defiant disorder Anxiety disorder Tics Developmental coordination disorder Specific learning difficulties / language delay ```
51
How is ADHD treated?
``` 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 ```
52
When is autism diagnosed?
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
53
What are the differential diagnoses of autism?
ADHD Learning disability Deafness Childhood schizophrenia
54
How is autism treated?
Behavioural management
55
What are the risks of using antipsychotics in dementia?
CVA | Pneumonia
56
What are the risks of using memory enhancers for older people?
Bradycardia
57
What is dementia?
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
58
What brain functions are involved in dementia?
``` Memory and orientation Thinking processes Learning Language Calculation Comprehension Judgement Emotion Behaviour Motivation ```
59
What are the risk factors for dementia?
``` Age Genetics Cerebrovascular risk factors Diabetes Obesity Lack of education History of depression ```
60
How can dementia present?
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
61
What are the types of dementia?
``` 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 ```
62
What are some reversible causes that can present as dementia?
``` Alcoholism B12 / folate deficiency Hypothyroidism Space occupying lesion Carbon monoxide poisoning Syphilis Hydrocephalus ```
63
What are the risk factors for Alzheimer's disease?
``` Increasing age Down's syndrome Apolipoprotein e4 Diabetes Smoking Hypertension ```
64
What factors are protective against Alzheimer's disease?
Apolipoprotein e2 allele Higher level of premorbid education Higher level of physical activity in middle age NSAIDs
65
What are the clinical features of Alzheimers?
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
66
What are the vascular risk factors for vascular dementia?
``` High BP High cholesterol High lipids Smoking Diabetes mellitus ```
67
What are the clinical features of vascular dementia?
Early: emotional, personality, language and executive impairments Late: memory impairments Increased depression Often retain insight
68
What are the symptoms of dementia with lewy bodies?
Fluctuating memory and cognitive performance Falls Incontinence Hallucinations Delusions Parkinsonian features - bradykinesia, rigidity, gait disorder, tremor
69
What is the neuropathology of fronto-temporal dementia?
Neuronal loss Gliosis Protein inclusions consisting of tau, TDP-43 or FUS
70
What are the clinical features of fronto-temporal dementia?
``` 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
What investigations would you do for dementia?
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
How is dementia managed?
``` Community treatment Non-pharmacological approaches: - behavioural - psychological - occupational therapy - sensory stimulation - day centres Pharmacological approaches: - antipsychotics, antidepressants - acetylcholinesterase inhibitors - memory enhancers ```
73
What pharmacological treatment is used for Alzheimers?
Mild: acetylcholinesterase inhibitors e.g. donepezil, rivastigmine Moderate: memantine with/without AchE inhibitors
74
What pharmacological treatment is used for vascular dementia?
Aspirin | Acetycholinesterase inhibitors
75
What pharmacological treatment is used for dementia with lewy bodies?
Acetylcholinesterase inhibitors
76
How can fronto-temporal dementia be treated?
No treatment | SSRIs to manage behaviour / impulsiveness
77
What is depression?
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
What is major depressive disorder?
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
What is sub-threshold depression?
Presence of 2-4 depressive symptoms including depressed mood or anhedonia which last longer than 2 weeks
80
What is persistent depressive disorder?
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
What are the risk factors for depression?
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
What are the clinical features of depression?
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
What are the examination findings in depression?
``` Depressed affect Downcast gaze, furrowed brow Psychomotor slowing Speech latency Expressions of guilt or self-blame ```
84
How can depression be screened for?
PRIME-MD PHQ-9 Edinburgh postnatal depression scale Cornell scale
85
What investigations should be done for depression?
Exclude other causes of symptoms TFT, metabolic panel, FBC Serum vitamin B12, folate 24h urinary cortisol (elevation suggests Cushings disease)
86
What are the differentials of depression?
``` 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
What is the management of depression?
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
How is severe depression treated?
ECT | Psychotherapy
89
What is severe depression?
Psychotic, suicidal, catatonic or have severe psychomotor retardation impeding ADLs or severe agitation
90
What is treatment resistant depression and how is it managed?
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
What is the diagnosis of anorexia nervosa?
``` 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
What are the clinical features of anorexia nervosa?
``` Preoccupation with food Dietary restriction Self-conscious about eating in public Vigorous exercise Constipation Cold intolerance Depression and obsessive-compulsive symptoms ```
93
What are the physical signs of anorexia nervosa?
``` 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
What are the differential diagnoses of anorexia nervosa?
Organic causes of low weight Depression Psychotic disorder with delusions around food Substance or alcohol abuse
95
What is the MARSIPAN checklist?
Management of really sick patients with anorexia nervosa
96
What is bulimia nervosa?
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
What are the clinical symptoms and signs of bulimia nervosa?
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
What are the differential diagnoses of bulimia nervosa?
``` Depression Hyperthyroidism Type 1 diabetes mellitus Crohn's disease / UC OCD ```
99
How is an eating disorder treated?
Refeeding, weight management and physical health Psychological - CBT, interpersonal psychotherapy, focal psychodynamic therapy Medication if other comorbidities
100
What is a section 2?
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
What is a section 3?
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
What is a section 4?
Emergency application only requiring 1 doctor | Allows detainment for assessment only up to 72h
103
What is a section 5(2)?
Allows a person to be held for up to 72h for assessment only who is already in hospital
104
What is a section 5(4)?
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
What is a section 136?
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
What is a section 17?
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
What is a section 37?
Allows a person convicted of imprisonable offences to be detained and treated in hospital
108
What is a section 41?
Restricts discharge of dangerous patients detained under section 37 by requiring permission from Home Secretary
109
What are the key assessment points for capacity?
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
What is the definition of incapacity?
Impairment or disturbance of mental function | Person lacks capacity to understand, retain, use or weigh up information and communicate a decision
111
What is a personality disorder?
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
What are the risk factors for personality disorder?
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
What are adverse childhood experiences significantly associated with?
Depression, suicide attempts Alcoholism, drug abuse, smoking Sexual promiscuity, STIs, domestic violence Obesity, physical inactivity
114
What are the 3 clusters of personality disorders?
``` 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
What are the features of borderline personality disorder?
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
What investigations may be done for personality disorder?
``` SAPAS MCM-III MRI / CT brain Urine drug screen PRIME-MD PHQ-9 ```
117
How are cluster A personality disorders managed?
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
How are cluster B personality disorders managed?
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
How are cluster C personality disorders managed?
``` 1st line: patient communication and relationship management strategies Add psychotherapy Add pharmacotherapy - fluoxetine, sertraline, venlafaxine - gabapentin, pregabalin - phenelzine ```
120
What are the differentials of personality disorders?
``` Mood disorder Psychotic disorder Anxiety disorder Substance-related disorder Personality change due to medical condition ```
121
What can trigger a personality disorder crisis?
``` Drug or alcohol misuse Relationship problems Financial problems Anxiety, depression or other mental health problems Important events Stressful situations Loss ```
122
What is psychotherapy?
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
What is psychoanalytic / psychodynamic psychotherapy?
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
What is CBT?
Usually 1:1 but can be groups Identify problematic patterns of thought and behaviour Commonly used for anxiety, depression, OCD and eating disorders
125
What type of patients will CBT not suit?
``` Autism Psychotic patients Acute mania Acute depression Severe learning difficulties ```
126
What is cognitive analytic therapy?
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
What is mentalisation-based therapy and dialectical behavioural therapy?
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
What is EMDR?
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
What is counselling?
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
What is psychosis?
Group of symptoms characterised by mood, thoughts, feelings and emotions which are disconnected from reality
131
What is the diagnosis of schizophrenia?
Co-occurrence of at least 2 of following symptoms for at least 1 month: - delusions - hallucinations - disorganised speech - disorganised / catatonic behaviour - negative symptoms
132
What is the ICD-10 diagnosis of schizophrenia?
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
What are the subtypes of schizophrenia?
Paranoid - delusions and auditory hallucinations Catatonic - psychomotor disturbances, rigidity and posturing Hebephrenic Residual Simple - negative symptoms without preceding over psychotic symptoms
134
What is the epidemiology of schizophrenia?
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
What is the aetiology of schizophrenia?
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
What are the clinical features of schizophrenia?
``` 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
What is a delusion?
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
Describe the mental state exam in schizophrenia
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
What investigations should be done for schizophrenia?
``` 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
What are the differentials of schizophrenia?
``` 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
How is psychosis managed?
``` 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
What are the potential benefits of atypical antipsychotics?
Less extrapyramidal side effects less tardive dyskinesia Less hyperprolactinaemia Beneficial effect on negative symptoms, cognition, resistant symptoms and affect symptoms
143
What is the consequence of atypical antipsychotics?
``` Metabolic syndrome Central obesity Hypertension Dyslipidaemia Raised fasting plasma glucose ```
144
What factors have a good prognosis for schizophrenia?
``` Female Married Family history of affective disorder Good premorbid function Acute onset Life event at onset Early treatment Affective symptoms ```
145
What factors have a bad prognosis for schizophrenia?
``` Male Single Family history schizophrenia Premorbidly schizoid Slow onset Longer duration untreated pyschosis Negative symptoms Obsessions High expressed emotions Substance misuse ```
146
What mental health disorders increase suicide risk?
Depression - anhedonia, low mood, fatigue Psychosis Alcohol dependency Anorexia
147
What is hazardous substance use?
Pattern of substance use that increases risk of harmful consequences to the user
148
What is harmful substance use?
Pattern of psychoactive substance use that is causing damage to health and adverse effects on family and society
149
What is dependence?
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
What is a withdrawal state?
Physical and psychological symptoms occurring on absolute or relative withdrawal of substance after repeated use
151
Give examples of opiates
Heroin Morphine Methadone
152
What effects do opiates give?
Intensely pleasurable buzz or rush Peace, detachment CNS depression
153
Give examples of stimulants and the effects they give
Cocaine Amphetamines Brief high with euphoria, increased energy and concentration Depression / tiredness after use
154
Give examples of hallucinogens and the effects they give
``` Ecstasy GHB GBL LSD, magic mushrooms Stimulant, hallucinogenic ```
155
What effects does cannabis give?
Euphoria, relaxation Hallucinations Increased appetite Decreased temperature
156
What are the signs of cannabis intoxication?
``` Impaired motor coordination Euphoria Sensation of slowed times Social withdrawal Increased appetite ```
157
What are the withdrawal signs of cannabis intoxication
Irritability Insomnia Anorexia Mild nausea
158
What are the signs of opiate withdrawal?
Early: agitation, anxiety, muscle aches, increasing tearing, insomnia, runny nose, sweating Late: abdominal cramping, diarrhoea, dilated pupils, goose bumps, nausea and vomiting
159
What are the signs of benzodiazepine intoxication?
``` Slurred speech Incoordination Unsteady gait Nystagmus Impairment in attention or memory Stupor or coma Behavioural changes Mood lability Impaired judgement ```
160
What are the signs of benzodiazepine withdrawal?
``` Autonomic hyperactivity Increased tremor Nausea Insomnia Transient visual, tactile or auditory hallucinations Psychomotor agitation Anxiety Grand mal seizures ```
161
What are the signs of acute alcohol intoxication?
``` Slurred speech Impaired coordination and judgement Labile affect Hypoglycaemia Stupor Coma ```
162
How can we screen for alcoholism?
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
What are the signs of alcoholism on examination?
``` Jaundice Spider naevi Palmar erythema Gynaecomastia Peripheral neuropathy ```
164
What is Wernicke's encephalopathy?
Acute condition characterised by ophthalmoplegia, ataxia and global confusional state Caused by thiamine deficiency
165
What is Korsakoff's syndrome?
Marked deficits in anterograde and retrograde episodic memory and apathy Confabulation to cover gaps in memory
166
What is foetal alcohol syndrome?
``` Decreased muscle tone Poor coordination Developmental delay Heart defects Facial abnormalities ```
167
What are the symptoms of alcohol withdrawal?
``` Malaise Nausea Autonomic hyperactivity Tremulousness Labile mood Insomnia Transient hallucinations or illusions ```
168
What are the signs of delirium tremens and how is it treated?
Global confusion, agitation, disorientation, hallucinations, fever, autonomic hyperactivity Treat with lorazepam
169
What does disulfiram do?
Blocks alcohol metabolism as its an irreversible inhibitor of acetylaldehyde dehydrogenase If alcohol is consumed it causes flushing, headache, anxiety and nausea
170
What can be used for detoxification / maintenance of opioid withdrawal?
``` Methadone Lofexidine Naltrexone to prevent relapse Loperamide for diarrhoea Paracetamol and ibuprofen for muscle aches ```

KT (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions