Psychiatry Flashcards
1
Q
When to modify hx taking?
A
distressed, low cognition, no language, concerns about risk/safety, urgent issues, time, carer
2
Q
What is phenomenolgy?
A
descriptive psychopathology (objectivity about abnormal states of mind); elicit, identify and interpret symptoms of psychiatric disorders; understand the mental experiences of the patient and try to be empathetic
3
Q
5 Ps for helping with hx taking?
A
presenting problem, predisposing factors, precipitating factors, perpetuation factors and protective factors
4
Q
Other questions to ask in hx other than the normal ones?
A
Mood, sleep, appetite, risks of harm to self or others
5
Q
Questions to ask around drugs and alcohol?
A
what, injected?, which veins, what is meant by social drinking, what time start in morning, drink everyday
6
Q
PMH questions?
A
med conditions, admissions, surgery, head injuries, deliberate self-harm, SEs from meds
7
Q
FH questions?
A
mental health, suicides, drug/alcohol abuse, forensic encounters; if recent death and note reaction to this
8
Q
Personal history (EE-OR)?
A
o Early life and development – pregnancy/birth complications, serious illnesses, bereavements, abuse (emotional, physical, sexual), childhood separation, describe childhood home environment, religion
o Educational history – school, academic achievements, friends/bullied?, school conduct/truancy
o Occupational history – job titles and duration, reasons for change (work satisfaction, relationships with colleagues, use longest job for indicator of normal before deterioration)
o Relationship history – duration, gender of partner, children, quality and abuse (communication, aggression, jealousy or infidelity), sex problems (menstruation, contraception, pregnancies)
9
Q
Forensic hx?
A
arrests, imprisoned, juvenile crime, length of sentence, against person/property, prison experience
10
Q
Premorbid personality questions?
A
how would you and friends describe you before; what do you enjoy; how do you cope
11
Q
How common is mental health in the general population?
A
1 in 4
12
Q
RFs?
A
inequalities in health (socioeconomic, refugees 5x more common), age, gender and sexual identity
13
Q
Causes of RFs?
A
problems behind the illness, social determinants (poverty, isolation, migration unemployment, trauma, abuse, education, racism/discrimination, institutional care, homelessness)
14
Q
Definition of primary prevention?
A
stop it in first place
15
Q
Definition of secondary prevention?
A
intervene early when problem emerges
16
Q
Definition of tertiary prevention?
A
manage ongoing problem and reduce its harm
17
Q
Examples of primary prevention?
A
population wide campaigns, campaigns for at risk groups, screening questions to find at risk, physical exams, legislation, action to reduce harmful consequences
18
Q
Mental state examination parts?
A
ABSolutely MAD PIC - appearance and behaviour, speech, mood and affect, disorders of thought content, perception, insight, cognition
19
Q
Appearance and behaviour questions?
A
- General health and posture, tattoos, clothing, cuts, hygiene and tidiness
- Distinctive features
- Manner and report, hallucination response
- Motor activity high or low (tics, chorea, repeated movements)
- Antipsychotic side-effects (tremor, bradykinesia, akathisia [restlessness], tardive dyskinesia [rolling tongue/licking lips], dystonia [muscle spasm])
- Mannerisms
- Gait abnormalities
- Self-harm
20
Q
Speech questions?
A
- Tone, rate and volume
- Look at PPS first lecture
- Circumstantiality
- Loosening of association – incoherent speech as lack of association of thoughts to speech (disorder of form of speech)
- Perseveration – inappropriate repetition
- Flight of ideas
- Pressure of speech – rapid and strays from topic
21
Q
Mood and affect questions?
A
- Mood = self-explanatory (subjective view of mood from patient and objective is what you think)
- Affect = more to do with how mood is making the patient seem sometimes with reaction to certain cues (unreactive, labile, irritable etc)
22
Q
Disorders of thought content questions?
A
• Negative thoughts
• Ruminations (preoccupations of the mind)
• Obsessions
• Depersonalisations (feel cut out from world) and derealisation (feel like world and people in it are lifeless and not real)
• Abnormal beliefs:
o Overvalued ideas
o Ideas of reference (thinking other people are talking about them but not at delusional intensity)
o Delusions – secondary can be explained by another morbid experience
• Concrete thinking – taking things literally
• Content (obsession, preoccupation, delusions), form (circumstantial, tangential, looseness of association) and stream (poverty, racing, perseverative, thought insertion/withdrawal/broadcast; disorders of continuity of thought or tempo)
• Think of main categories = disorders of tempo, continuity, possession (thought alienation and obsessions and compulsions)
• Disorder of memory – confabulation and dissociative amnesia (sudden from periods of trauma, lasts a few days)
• Disorder of emotion – anhedonia, apathy (lack of emotion), incongruity of affect (seen mood not related to actual emotion), blunting of affect, conversion (unconscious mechanism of symptom formation, in conversion hysteria, psych conflict into somatic symptom, motor or sensory), la belle indifference (lack of concern about their disability – not bothered about no legs)
23
Q
Perception questions?
A
- Seen/heard anything others can’t hear (5 senses = auditory, visual, tactile [usually in drug abuse], gustatory, olfactory); changes in intensity, quality, spatial form and distortion of experience of time (differentiate normal from abnormal)
- Illusions – misinterpretations of normal things
- Hallucinations
- Pseudo-hallucinations – internal perceptions with preserved insight (like a voice in head saying not doing good)
24
Q
Insight questions?
A
- How patient sees their own condition
- Identifies abnormal mental phenomena
- Willing to seek help
- Appreciates risk of non-compliance, impact of illness on others
25
Cognition questions?
```
• Ability of pt to perform tasks
• Memory – of list of objects etc
• Orientations – in time, place, person
• Attention and conc – count backwards
• Dyspraxia – draw pentagons
• Receptive dysphasia – follow a command
• Expressive dysphasia – name object
• Frontal lobe functioning tests:
o Approximation (height of landmark)
o Abstract reasoning (next shape in sequence)
o Verbal fluency
o Proverb interpretation
```
26
Main 3 classification categories for psych?
LD, PD and mental illness
27
Hierarchal classification categories for DSM-IV-TR?
o Personality disorders
o Anxiety disorders (GAD, panic, OCD, PTSD and adjustment disorder)
o Mood disorders (bipolar, affective disorder and psychotic depression)
o Psychotic disorders (schizophrenia)
o Organic disorders (delirium, dementia, drug abuse)
28
Overview of risk assessment in psych?
• Assess risk of self-harm and harm to others
o How likely is event to happen
o How bad will it be
o Collaborate with the pt and review plan
o Use past behaviour as a guide for future risk
o Any new risks let someone know
29
Suicide risk assessment questions?
method, belief in lethality, plan to avoid discovery, note and planning for death after (bank acc etc), how do they feel (anger it didn’t succeed and will they do it again) now, protective factors, risk factors
30
Questions and things to note with harm to others?
```
o Document any acts of violence of intimidation towards others
o Any isolation put in place
o Compliance with meds
o Life events
o Stressful incidents recently
o Change in meds
```
31
Self-neglect and accidental harm questions?
```
o Malnutrition
o No healthcare
o Bad living conditions
o Falls that can be prevented (frailty)
o Wandering
o Overdose
o Vulnerability to crime
```
32
Psychosis definition?
misperception of thoughts and perceptions by the patient
33
Psychosis examples?
```
o Schizophrenia
o Schizoaffective disorder
o Delusional disorder
o Brief psychotic episodes
o Psychotic depression
o Bipolar affective disorder
o Drug-induced psychoses
```
34
Definition of schizophrenia?
more permanent than episodes of relapse of mania/psychosis
35
When does schizophrenia usually begin?
Adolescence/early 20s
36
Negative, positive and cognitive symptom examples of schizophrenia?
positive (hallucinations and delusions), negative (poor motivations, low speech, low function, socially withdrawn, self-neglect, blunted affect [same emotions but how they express this is less]) and cognitive
37
1st rank symptoms of schizophrenia?
o 3rd person auditory hallucinations (people talking about you, running commentary)
o Thought echo (hear own thoughts out loud)
o Thought block
o Delusional perception (real perception exaggerated to something else or jumping to conclusions from an unrelated thing e.g. a jumper means that someone is watching me)
o Thought insertion/withdrawal (thoughts interfered with e.g. like in big brother); all of these known as thought alientation
o Passivity (actions, feelings or impulses controlled by someone/something else) or somatic passivity (body movements controlled by someone else)
o Primary delusions – something they strongly believe in (an idea etc); mood, perception or sudden idea
38
2nd rank symptoms of schizophrenia?
o Other symptoms that can be present in schizophrenia but also other disorders
o Catatonic behaviour
o 2nd person auditory hallucinations (talking to you e.g. telling you that you’re the messiah)
o -ve symptoms
o Other hallucinations
o Thought disorder
39
Diagnosis for schizophrenia?
first rank symptom/persistent delusion/at least 2+ secondary symptoms; present for 6 months (using DSM-IV-TPR); no drug intoxication, withdrawal, overt brain disease, prominent affective symptoms
40
2 types of delusions?
```
o Persecutory (out to harm the person)
o Delusions of reference (paranoia people or news is talking about them)
```
41
Thought disorder examples?
o Loosening of associations
o Neologisms (new words or words used in special way – THINK OF SAM ABOUT TO DO SOMETHING DUMB)
o Concrete thinking (can’t deal with out of box thinking)
o Word salad (jumbled nonsense)
o Perseveration – keep persisting with a word/phrase and can’t help it
42
Subtypes of schizophrenia and what they consist of?
o Paranoid – delusions (persecution or grandeur) and hallucinations evident
o Catatonic – psychomotor disturbances, rigidity, posturing (strange posture), echolalia (LIKE IN ENGLISH LIT – copying speech), echopraxia (copying behaviours), waxy flexibility (limbs feel like wax – sustained abnormal position), logoclonia (repetition of last syllable of word), negativism (unreasonable resistance to movement and aversion), palilalia (repetition of word with increasing intensity), verbigeration (repetition of meaningless words/phrases)
o Hebephrenic – early onset and poor prognosis, irresponsible and unpredictable, disorganised/disordered, giggling and mannerisms, delusions and hallucinations
o Residual – negative and cognitive mainly and chronic
o Undifferentiated – negative
43
Main RFs for schizophrenia?
o Genetics and later age of parents
o Neurodevelopmental factors (winter births, obstetric complications, developmental delay, temporal lobe epilepsy, bad academia, smoking cannabis in adolescence, severe bullying/abuse)
o Life events and bad socio-economic factors
o Neurotransmitters – high dopamine/serotonin and low glutamate increase risk
44
Treatment and management of schizophrenia?
o Antipsychotics – atypical have fewer motor side effects than typical; lowest dose needed should be used; use clozapine if more than one anti-psychotic is ineffective
o Therapies – CBT, family therapy, art therapy and self-help forums and groups
o Social support – to maximise independence and get back working; always think of psychosocial factors (homelessness etc)
o Adjust diet, smoking
o If need to tranquilise then use benzodiazepine
45
Good prognostic factors for schizophrenia (FINDING PLANS)?
```
o Female
o In relationship/s
o No negative symptoms
o aDheres to medications
o Intelligence
o No stress
o Good premorbid personality
o Paranoid subtype
o Late onset
o Acute onset
o No substance misuse
o Scan (CT head) normal
```
46
What is hypomania and S+Ss?
(4+ days) – elevated mood (euphoric, dysphoric, angry), increased energy, more talkative, poor conc, mild reckless, sociability, increased libido, increased confidence, decreased need to sleep, change in appetite
47
What is mania and S+Ss?
(more than 1 week) – extreme elation (uncontrollable), overactive, pressure of speech (can’t interrupt their flow but can in hypomania), impaired judgement, extreme risk taking/high libido, v grandiose ideas about self and strange (more normal in hypomania but still v self confident), social disinhibition, psychosis, mood congruent/incongruent
48
Types of bipolar affective disorder?
```
o Depressive
o Manic (like schizophrenia)
o Hypomanic (less severe and without psychosis – circumstantiality [take ages to get to point])
o Mixed (depressive and manic)
```
49
What is bipolar 1 disorder?
1+ episodes of manic/mixed episodes and 1+ major depressive episodes
50
What is bipolar 2 disorder?
recurrent major depressive and hypomania but not manic – easy to miss should treat with mood stabilisers not antidepressants
51
What is cyclothymic/persistent mood disorder?
not quite bipolar 2 but very close over 2 yearsish; more mild; mood swings and some periods of hypomania/depression; highs and lows for 6 months with only 2 months consecutive no symptoms
52
S+Ss of bipolar?
think of everything being high functioning and out of control mind and body-wise:
o High psychomotor
o Exaggerated optimism
o High self-esteem
o Low social inhibition (high libido, high spending, dangerous driving)
o High sensory awareness
o Rapid thinking and speech (fast and furious speech and thoughts)
o Manic symptoms can be 4 monthsish and depressive is longer
o Can be mixed with schizophrenia and the subtypes and ADHD or substance misuse
o Secondary delusions
53
RFs for developing bipolar?
o Genetics
o Small prefrontal and large amygdalas
o Childhood abuse
o Postpartum
54
Management and treatment of bipolar?
o Anti-manic drugs (also for prophylaxis) – lithium and valproate (like for epilepsy)
o Atypical anti-psychotics (also for prophylaxis) – orlanzapine, risperidone, aripiprazole, quetiapine
o Benzodiazepines for acute behavioural disturbance and lorazepam and antipsychotics for rapid tranquillisation
o Use antidepressants with anti-manics
o Electrocompulsive therapy (ECT) – stimulation to brain under anaesthesia
55
What is a personality disorder?
deeply engrained and long-lasting abnormal behaviour that can cause distress (similar to some mental illnesses but PDs not temporary and not treatable)
56
Cluster A PD?
Paranoid, schizoid, schizotypal
57
Cluster B PD?
Borderline/EUPD, histrionic, narcissistic, antisocial
58
Paranoid PD S+Ss?
cold sensitive, distrust and suspicious (friends and spouse), won’t confide, bears grudges, takes everything negatively, grandiose sense of personal rights; cold and calculating; meds not recommended
59
Schizoid S+Ss?
(sad and withdrawn): socially withdrawn, low emotional range, low pleasure, won’t confide, not bothered about praise or criticism, insensitive to social norms; daydream; no meds
60
Schizotypal S+Ss?
(hallucinations and inappropriate dot joining): struggles socially and interpersonally, ideas of reference, magical thinking, unusual perceptions, tangential and circumstantial thinking, suspicious, socially anxious, eccentric; hallucinations 2 weeks before mood; schizophrenia symptoms with mood disorder; antipsychotics and SSRIs and lithium for bipolar types
61
Borderline S+Ss?
(both schizophrenic and bipolar): self-damaging impulsivity, unstable mood and intense interpersonal relationships/attachment issues, identity confusion, anhedonia (won’t feel pleasure in things meant to feel pleasure), recurrent suicidal/self-harm behaviour to relieve psychic pain, tries to avoid real life, transient paranoid ideation (feelings of grandeur and persecution and sometimes paranoia of others); emotional insensitivity and chronic feelings of emptiness; sometimes uncontrollable anger; most likely to have other co-morbidities like anxiety, depression, PTSD, substance misuse and past trauma
Self injury causes (prevalent) – feel something when numb, reduce anxiety, feel in control, express anger, keep away bad memories
62
Histrionic S+Ss?
(blonde, dumb valley girl): shallow and excessive emotions, attention-seeker, suggestable, immature, inappropriate sexual seductiveness, narcissism, grandiosity, exploitable actions
63
Narcissistic S+Ss?
grandiose, lack of empathy, need for praise
64
Antisocial PD S+Ss?
(like a young ADHD kid – most likely to be in secure psychiatric units): disregard for rights/safety of others, irresponsible, can’t maintain relationships, irritable, low threshold for frustration and aggression, no guilt, deceitful, impulsive, no personal safety, blames others
65
Cluster C PD?
avoidant, dependent, anankastic/OCD
66
Avoidant S+Ss?
feeling tense/anxious, socially inhibited, won’t join in unless know is liked by others, restricts lifestyle to keep physical security; antidepressants
67
Dependent S+Ss?
needs taken care of, fear of separation, too much advice to make decisions, won’t disagree in case argument, won’t express opinion first as low self-confidence, lengths to gain support from others, always thinking about being left alone; CBT
68
Anankastic/obsessive compulsive PD?
(perfectionist and stickler for the rules): excessive doubt, rigid and stubborn, must stick to rules, perfectionism, always must be productive and takes over life, must be socially norm, obsessional thoughts and impulses
69
Treatment for PDs?
some mood stabilisers for symptomatic but CBT and DBT (dialectical behavioural therapy) is usually more helpful; medium-term outcome = bad but long-term is better
70
Adjustment disorder characteristics and treatment?
lasts less than 6 months few weeks after change in life; symptoms (depression, anxiety, autonomic arousal); support (vent feelings, CBT, problem solving; some SSRI and SNRI)
71
Abnormal grief reaction S+Ss?
delayed onset of grief, prolonged and higher intensity; with difficult relationship with deceased, sudden death or constraints to grieving
72
Normal grief stages?
shock and disbelief, anger, guilt and self-blame, sadness and despair, acceptance
73
Examples of exceptional stress?
PTSD and acute stress reactions?
74
PTSD S+Ss and treatment?
over 1 month symptoms from weeks to months after event; autonomic system and hypothalamic-pituitary-adrenal axis and noradrenaline; symptoms = intrusive thoughts and reimagining, avoidance, detachment, high arousal and heightened senses; treatment = trauma-focussed CBT, EMDR (eye movement desensitisation reprogramming – asked to recall upsetting moments and then directed to do eye movements and exercises to reprogram how feel about event), antidepressants, PIES (proximity, immediacy, expectancy and simplicity)
75
Acute stress reaction S+Ss and treatment?
starts within minutes to hour and last less than 3 days; symptoms = dazed, confused, intense anxiety, autonomic arousal, intense sadness or depression and heightened senses; reorientate and brief CBT
76
Pathophysiology of anxiety disorders?
Low levels of GABA and remodelling of amygdala (heightened stimulation) and frontal cortex
77
What can worsen anxiety?
alcohol and benzodiazepines
78
Define panic disorder?
o Episodic severe panic attacks can happen whenever (last a few mins)
o >4 panic attacks in a >4 week period
79
S+Ss panic attack?
palpitations, tachycardia, choking feeling, chest pain, nausea, dizziness, paraesthesia, dry mouth, chills and hot flushes, derealisation and depersonalisation, fear of losing control, feeling of impending doom
80
Treatment for panic disorder?
SSRIs, CBT, tricyclics, NOT BENZODIAZEPINES
81
What is generalised anxiety disorder?
o Last 6 months or longer; generalised, persistent and excessive worry
82
GAD S+Ss?
subjective apprehension, high vigilance, restless, insomnia (difficulty falling asleep), motor tension, autonomic hyperactivity
83
GAD treatment and management?
CBT and SSRIs and benzodiazepines for no longer than 4 weeks; also SNRIs, buspirone and pregabalin; psychotherapy
84
3 elements of phobic disorder?
phobia, avoidance of anxiety situations and severe anxiety
85
Treatment for rare phobias?
Benzodiazepines
86
What is agoraphobia
fear and avoidance of places cannot escape from easily
87
What is an obsession?
thoughts, images, impulses, ruminations (continuous pondering) or doubts and infiltrate everything think about; unpleasant, irrational, intrusive, thought as own thoughts
88
What are compulsions?
repetitive and purposeful physical/mental behaviours in response to an obsession (neutralise discomfort), need to be differentiated from superstitions and rituals; patient realises behaviour is unreasonable
89
Examples of compulsions?
```
o Hand-washing
o Counting and checking
o Touching and rearranging
o Hoarding
o Arthimomania (counting)
o Onamatomania (say a forbidden word)
o Folie du pourquoi (asking questions to facts that don’t need to be asked)
```
90
OCD S+Ss?
concerned with contamination, concerned with harm (leaving gas on), obsessions without overt compulsive acts, hoarding; More than an hour per day of obsessions/compulsions; Avoidance of stimuli is common and sometimes resistance
91
RFs for OCD?
conditioning as a child by parents; defence from cruel and aggressive fantasies in mind; traumatic event where had a disease as a child (PANDAS – paediatric autoimmune neuropsychiatric disorders associated with streptococci)
92
What is body dysmorphic disorder/dysmorphophobia
| (BDD) and S+Ss?
o Imagined defect in appearance
o Time consuming behaviours: mirror gazing, comparing features to others, excessive camouflaging of area, skin picking, seeking reassurance, surgery request
93
BDD treatment and management?
psychoeducation so understand their disorder; CBT with medication and patient told to try and avoid compulsion in CBT when exposed to it; SSRIs or clomipramine; sometimes psychosurgery and deep brain stimulation
94
S+Ss of anankastic PD?
obsessive-compulsive personality disorder; rigidity of thinking, perfectionism, preoccupation with the rules, excessive cleanliness and order, emotional coldness
95
Atypical antipsychotic examples?
```
o Amisulpride
o Aripiprazole
o Clozapine
o Lurasidone
o Olanzapine
o Paliperidone
o Quetiapine
o Risperidone
```
96
Clozapine SEs?
side effect of agranulocytosis, seizures and weight gain; most effective; offered only when 2+ treatments tried, in treatment resistance
97
Olanzapine SEs?
weight gain
98
Risperidone SEs?
galactorrhoea SE; only one indicated in older people with dementia and behavioural disturbance (lower stroke risk and glycaemic loss of control)
99
General SEs of atypical antipsychotics?
Parkinsonism (e.g. rest tremor, postural tremor)
Akathisia (severe restlessness)
Acute dystonia (sustained muscle contractions – laryngeal, oculogyric crisis, buccolingual and scoliosis [basically mainly in top of body])
Tardive dyskinesia (involuntary movements of the tongue, lips, face, trunk, and extremities)
o Other side-effects
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)
100
Physiology of antipsychotics?
Most antipsychotics work by blocking dopamine D2/3 receptors to reduce input it is thought; can be taken orally but some as depot injections like risperidone; low meso-cortical pathway and overactive mesolimbic (reward/pleasure centre) in psychosis
101
When are antipsychotics used?
For schizophrenia, psychoses, acute mania and sometimes violent or agitated behaviour with benzodiazepine; if have negative symptoms then can have neuroleptic dysphoria/neuroleptic malignant syndrome (tremor, muscle cramps, fever, autonomic instability, delirium, raised CK, give DA agonists bromocriptine) when give dopamine agonist; Low dose for tourette’s
102
Antipsychotic length taken?
Taper over 2-3 weeks; usually continue meds for 5 years to prevent relapse
103
Typical antipsychotic examples?
```
o Haloperidol
o Trifluperazine
o Chlorpromazine
o Pericyazine
o Levomepromazine
o Flupentixol
```
104
Antimanic/mood stabilising drug examples?
Lithium, lamotrigine, valproic acid and carbamazepine
105
What is lithium used for?
acute mania, control aggression, schizoaffective disorder, prophylaxis in recurrent affective disorder, resistant depression
106
How does lithium work?
affects all systems associated with electrolytes, 5HT, dopamine, acetylcholine and noradrenaline
107
Checks done when on lithium?
thyroid and renal before and every 6 months checked and serum lithium as well
108
Lithium CIs?
avoided in renal, cardiac, thyroid and Addison’s; dehydration and diuretics = toxicity; also NSAIDs, CCBs and some antibiotics
109
When to stop lithium?
toxicity and OD stop it and fluid therapy (normal bad SEs incl tremor and muscle twitching)
110
What is lamotrigine for?
bipolar depression
111
Valproic acid and carbamazapine SEs?
nausea, drowsiness, gastric irritation, diarrhoea, dizziness
112
What to check when taking valproic acid and carbamazapine?
check bloods every 6 months as could be agranulocytosis
113
Give types of hypnotics and anxiolytics?
Benzodiazepines, zopiclone, zolpidem, quinazoliones; Some antidepressants (mirtazapine), antihistamines and some antipsychotics (clozapine) used as hypnotics; H1 antihistamines as anxiolytics
114
What are benzodiazepines for?
– flumazenil given (for muscle relaxants, anticonvulsants, insomnia, alcohol withdrawal)
115
Withdrawal S+Ss from benzos?
Resp depression, tremors, seizures, anxiety
116
Benzo SEs?
drowsiness, ataxia, amnesia, dependence, disinhibition
117
Benzo physiology?
GABA agonist
118
Benzo examples?
Midazolam
Diazepam – long-acting
Lorazepam – short-acting
Chlordiazepoxide – long-acting
119
What are zopiclone and zolpidem?
Hypnotics
120
What are zopiclone and zolpidem used for?
Sleep and sedatives
121
Example of a quinazolinone?
chloroqualone
122
What is a quinazolinone?
hypnotic
123
Examples of H1 antihistamines?
hydroxyzine, chlorpheniramine, diphenhydramine
124
What are H1 antihistamines used for?
anxiolytics for GAD
125
Examples of stimulants?
o Methylphenidate and atomoxetine
126
What are stimulants used for?
ADHD and narcolepsy
127
Stimulant SEs?
low appetite and weight loss, anxiety, agitation, insomnia
128
Types of antidementia drugs?
Cholinesterase inhibitors, glutamate receptor antagonist
129
Cholinesterase inhibitor examples?
donepezil, rivastigmine galantamine
130
Glutamate receptor antagonist example?
memantine
131
SEs from antidementia drugs?
GI disturbance, dizziness, drowsiness, cramps, incontinence, dyspnoea and syncope
132
What is serotonin discontinuation syndrome and what are the S+Ss?
```
stop taking them:
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
```
133
SEs from SSRIs?
gastro SEs mainly with bleeding (especially with aspirin) and hyponatraemia in older; sexual dysfunction, headaches, anorexia, nausea, indigestion, anxiety
134
Why shouldn't you give SSRIs with triptans/MAOIs?
serotonin syndrome (neuromuscular abnormalities, altered mental state, autonomic dysfunction – use cyproheptadine)
135
Examples of SSRIs?
```
o Fluoxetine
o Zimeldine
o Citalopram
o Sertraline
o Paroxetine
```
136
Physiology of SNRIs?
block pre-synaptic alpha-2 receptors, increasing monoamine output
137
Examples of SNRIs?
o Mirtazapine and mianserin, venlafaxine and duolxetine
138
SEs and physiology of tricyclics?
dry mouth, tremor, tachycardia, constipation, fatigue and weight gain; anticholinergic effects, alpha-1 adrenergic antagonism, antihistaminergic
139
Examples of tricyclics?
o Imipramine
o Amitriptyline
o Dothiepin
o Lofepramine
140
What are norepinerphine reuptake inhibitors for and some examples?
(for ADHD):
o Atomoxetine
o Methylphenidate
reboxetine
141
Antidepressants physiology?
increase NA and 5-HT function; stress neurotoxic as causes glutamate release and affects neuronal neuroplasticity; depressed have more BDNF
142
MAO-A reversible inhibitor example?
Moclobemide
143
MAO-i examples?
phenelzine and tranylcypromine and iproniazid
144
MAOi physiology?
inhibit breakdown of serotonin by MAO-A
145
MAOi CIs?
don’t take with high tyramine foods (cheese, red wine) as can cause hypertension or headaches
146
Other non-category antidepressants?
agomelatine, trazadone, maprotiline, nefazodone; St John’s Wort (acts like MAO inhibitor but herbal)
147
When are antidepressants taken?
• Moderate or severe episode of depression; take at least 4 weeks to work; phobic disorder, panic disorder, PTSD, generalised anxiety, bulimia and OCD
148
What is ECT?
• ELECTROCONVULSIVE THERAPY (ECT) – modified cerebral seizure
149
What is ECT used for?
severe depressive illnesses, prolonged/severe mania, catatonia, moderate resistant depression; depressive and/or psychomotor retardation most likely to respond; when all other treatment options failed (for fast and short-term improvement when sitch is life threatening)
150
What is involved in the process of ECT?
= patient fasts for 4 hours then anaesthesia, muscle relaxant and preoxygenation then place electrodes then seizure for 20-60 seconds and EEG then monitor
151
ECT CIs?
raised ICP, stroke, MI and angina
152
ECT SEs?
mainly memory and cognition = orientation problems, new learning, retrograde amnesia, anaesthetic complications, dysrhythmias, confusion, headaches
153
What is transcranial magnetic stimulation?
prefrontal cortex stimulation using magnetic field; daily 30 min session or 2-4 weeks
154
When is transcranial magnetic stimulation used?
severe depression
155
When is deep brain stimulation used?
PD
156
What is deep brain stimulation?
thin electrode into brain
157
What types of neurosurgery are there?
bilateral anterior capsulotomy, anterior cingulotomy for severe treatment-resistant depression and OCD
158
What is malingering?
give fake reasons for symptoms for monetary gain (secondary gain)
159
What is conversion disorder?
pt not bothered by symptoms
160
What is somatic symptom disorder?
experience real but unidentifiable symptoms in somatic pathway (bit like fibromyalgia)
161
What is Munchausen disorder?
patient complains of symptoms for primary gain (medical attention and attention from loved ones); often those with severe PD; sometimes can be by proxy
162
What is hypochondriasis?
patient worried about disease even though don’t have one; must have lasted over 6 months and can be associated with other psych
163
What is dysmorphophobia?
patient worried about something wrong with morphology of self and causes social anxiety
164
What is Korsakoff's syndrome?
like more acute version of wernicke’s encephalopathy; symptoms = anterograde amnesia (can’t make new memories), retrograde amnesia (can’t remember past) and confabulation (making up new memories)
165
What is delusional misidentification syndrome?
Capgras’ = delusional belief that person known to them has been replaced with a imposter of them, Fregoli’s = delusion that strangers the person meets are the patient’s persecutors in disguise
166
What is delusional parasitosis/Ekbom's syndrome?
think insects colonising body (esp under skin and eyes)
167
What is Folie a deux?
delusional belief shared by two or more people but only one has psychotic illness but is more dominating and intelligent over the others who aren’t
168
What is De Clerambault's syndrome/erotomania?
delusional belief that someone is in love with them and makes inappropriate advances and can get angry when rejected
169
What is Othello syndrome?
morbid/pathological jealousy, patient usually convinced partner is unfaithful and always trying to find evidence; can sometimes occur from Parkinson’s disease dopamine agonists
170
What is Cotard's syndrome?
nihilistic delusions where pt thinks parts of body rotting/decaying or stopped existing, also that they are dead or eternally alive
171
What is Couvade's syndrome?
pregnant symptoms (abdo swelling, spasms, nausea and vomiting etc) in expectant fathers
172
What is Ganser's syndrome?
approximate, absurd and inconsistent answers to simple questions (colour of snow = green); clouding of consciousness, somatic symptoms, true/pseudo-hallucinations
173
What is Somatoform disorder?
pain severe enough to disrupt patient’s life (like somatic symptom disorder)
174
What is a reflex hallucination?
normal sensory stimulus causes a hallucination
175
What is an extracampine hallucination?
hallucination outside limits of sensory field
176
What is a hypnagopic and hypnopompic hallucination?
occur when the subject is falling asleep or waking up respectively
177
What is an autoscopic hallucination?
see self in a hallucination externally
178
What is first person auditory hallucination?
hear own thoughts out loud
179
What is a haptic hallucination?
tactile feel
180
What is an elementary hallucination?
simple, unstructured sounds
181
What is a gustatory hallucination?
in mouth in absence of food/drink
182
What is functional vs organic?
organic is something that can be physically seen and functional is the symptom/sign
183
Give the different types of delusions?
* Persecutory – person feels persecuted even though lack of evidence of it
* Grandiose
* Self-referential
* Love
* Infidelity
* Nihilistic – pt denies existence of their body
* Poverty
* Misidentification
* Religious
* Hypochondriacal
* Guilt
184
What is idealisation?
dealing with emotional conflict by attributing overly positive attributes to others
185
What is reaction formation?
intrapsychic conflict dealt with by thoughts and behaviours that are opposite to their own
186
What is projecting?
blames other people for their own wrongdoings etc
187
What is rationalising?
reassures self why things that are wrong are ok to happen
188
What is sublimation?
channelling potentially threatening and bad feelings and impulses into a socially acceptable outlet (bit like fighting in arguments out on the street after having been in prison like in the Louie Theroux doc)
189
S+Ss oppositional defiant disorders (ODD)?
6 months+; rebellious and won’t listen to authority
190
Conduct disorder S+Ss?
like ODD but also violent to people and animals; worse prognosis if younger diagnosis
191
What is antisocial PD?
socio/psychopath label; hurts others; 18+ years old; low moral values and societal norms; low empathy and impulse control
192
What is intermittent explosive disorder?
intense anger in brief and spontaneous and out of proportion bursts; 6+ age; twice per week for 3 months
193
What is impulse control disorder?
difference between this and like it is that these urges are compulsion
194
Two types and descriptions of impulse control disorders?
o Pyromania – fire compulsion (not arsonist)
| o Kleptomania – stealing compulsion
195
Treatment of conduct disorders and disruptive impulse control?
CBT, social skills training, anger management, parent management training (for parents of the children)
196
What is depersonalisation and derealisation defined?
• Depersonalisation (feeling of detachment)/derealisation (world around isn’t real) disorders – emotionally and physically numb; weak sense of self; deadpan speech; relationship trouble; altered sense of time
197
What is dissociative amnesia?
localised (traumatic event); generalised (not remember any of past, comes in attacks); continuous (only remember present moment)
198
What is dissociative identity disorder?
(multiple personality disorder) – covert (sudden ways in which they perceive and think about themselves; think are a different person but can be aware of this afterwards; when different identity bit like being trapped in that body [bit like being trans]); overt (acts like different person; takes over mind and often not aware/blackout periods; more than 2 distinct identities)
199
What is bruxism and S+Ss?
• Clenching jaw – tooth fracture; tongue deformation; temporomandibular joint disorder
o Nocturnal – grinding and clicking, gets better through day and worse at start
o Diurnal – no waking pain and increases through day; no grinding or clicking; stress and chewing
200
Bruxism complications?
• Improperly aligned teeth, stress, dehydration, meds and MDMA can cause
201
Bruxism treatment and management?
behaviour modification, mouth guards, dental plates, muscle relaxants, avoid stimulants and depressants, avoid chewing, do stress-relieving activities
202
Social complications from LD?
* More vulnerable (easy to abuse) and lower intellectual ability (IQ<70) and struggles with ADLs
* Impairment to social/adaptive functioning (can’t cope with new sitch’s and info easily); lower life expectancy
203
RFs for LD?
development in womb/genetic problems
204
Examples of learning difficulties?
```
o Auditory processing disorder
o Dyscalculia
o Dysgraphia
o Dyslexia
o Language processing disorder
o Non-verbal learning disabilities
o Visual perceptual/motor deficit
o ADHD
o Dyspraxia executive functioning (higher brain functioning = organisation and planning etc)
o Cognition/memory
```
205
LD S+Ss?
poor task performance/cognition; congenital syndromes and challenging behaviour (aggression and self-aggression, withdrawal and destructive behaviour); can have other associated physical/psychological problems (psych problems, epilepsy, incontinence, visual/hearing impairment)
206
LD management?
• GP – should have annual physical and mental health check and check meds (Cardiff health check used)
207
Down's syndrome outlined?
o Multiple malformations, medical conditions and cognitive impairment
o Different severities
o Trisomy 21 – risk factors = FH and maternal age
o 1/1000 affected
208
Down's S+Ss?
```
Single palmar crease
Hypotonia
Flat face/round head
Protruding tongue
Broad hands
Upward slanted palpebral fissures and epicanthic folds (medial corner of eye and lid fold problems)
Speckled irises
Intellectual impairment
Short stature
Pelvic dysplasia
Cardia malformations
Hypoplasia of middle phalanx of 5th finger
Intestinal atresia
High-arched palate
```
209
Complications from Down's?
cardiac, feeding, vision, hearing, thyroid and haematological problems
210
Other more rare complications from Down's?
heart septal defects/tetralogy of Fallot, otitis media, sinusitis, OSA, cataracts, glaucoma, GORD, dental problems, coeliacs, hyperflexibility, scoliosis, hypothyroidism, LD, behavioural problems, seizures, AD, infections, AML, ALL, polycythaemia
211
ASD S+Ss?
deficits in social communication and interaction; restricted/repetitive patterns of behaviour, interests or activities
212
ASD diagnosis?
difficult; team of doctor, psychologist and speech and language therapist; use either autism diagnostic observation schedule (ADOS) or developmental, dimensional and diagnostic interview (3di)
213
Main 3 types of ASD?
Impaired reciprocal social interaction, impaired imagination, poor range of activities and interests
214
Impaired reciprocal social interaction features (ASD)?
(think of bit like a robot and low emotions):
• Can’t read emotions
• Abnormal response to being hurt
• Impaired imitation/learning of certain things (waving bye at a door if no one leaves)
• Repetitive play
• Bad at making friends as low empathy
215
Impaired imagination features (ASD)?
(prefers to be alone and socially awkward):
• Very quiet in infancy and not many facial expressions
• Avoids gaze, stiffens with interaction with family (tactile defensiveness)
• Not interested in fantasy
• Odd speech
• Difficulty in keeping up social interactions
216
Poor range of activities and interests features (ASD)?
(bit like stereotypical autism):
• Stereotyped movements (flicking, spinning, head banging)
• Preoccupation with objects and unusual attachments to strange objects
• Distress over minor or trivial things
• Insists on routine
• Fixation on order
217
Complication from ASD?
Seizures
218
ASD treatment and management?
early intensive behavioural intervention, parent training and education, social skills training, drugs (risperidone for aggression, melatonin or sometimes t3 for sleep, SSRIs for repetitive behaviour), gluten free can help but unproven; if under 3 refer to ASD and above 3 to paeds if concerned about language and motor skills
219
What does Fragile X/Martin Bell syndrome affect?
o Behavioural, developmental and physical problems
| o No shortening of life expectancy
220
Pathophysiology of fragile X?
o Disorder of repeat expansion Xp28
221
S+Ss Fragile X?
```
Learning difficulties (low IQ) and delayed milestones
Emotional and behavioural mood swings
Anxiety and autism (tactile defensiveness)
High forehead
Large testicles
Facial asymmetry
Large jaw and long ears
Connective tissue problems
```
222
Fragile X diagnosis?
DNA blood sample 3 times
223
Fragile X treatment and management?
speech therapy, specialist education, behavioural therapy
ADHD = dextroamphetamine
Anxiety = SSRIs
Psychosis = aripiprazole
Anticonvulsants = anti-manics/benzodiazepines
Genetic counselling
Minocycline = dampens anxiety and eases severity of traits (MAIN ONE USED)
224
Williams syndrome S+Ss?
Heart disease
Failure to thrive
Characteristic facial appearance
Hearing loss
Intellectual/LD
ADHD common
Sociable but sometimes don’t know social norms
Speech and language delay
Non-social anxiety (insecure and loud noises and pain etc)
Weak in – relational/conceptual language (irony etc), reading comprehension, pragmatism (common sense), grammar structure
225
Williams syndrome management?
speech-language intervention, support and advocacy
226
What is global developmental delay?
o When a child takes longer to reach a learning milestone/development in any skill area
o Someone with another condition may have this
o Some can be short-term and overcome with therapy
o Others can be more significant and need lifelong aid and lead to LD
227
Definition of depression?
• Definition (IC-10) – 2+ symptoms present every day for at least 2 weeks: low mood, anhedonia (associated with low emotional reactivity and motivation), decreased energy (anergia); not from substance abuse or illness
228
Symptoms of depression?
low conc and attention, low self-esteem and confidence, ideas of guilt and worthlessness, feeling hopeless for the future, self-harm thoughts, change in libido, guilt, diurnal mood variation, low sleep (early waking and low mood in morning) and appetite (weight loss and food refusal)
229
Severity rating for depression?
number of symptom (mild = 2-3, moderate = 4 plus loss of functioning), severity of symptoms, degree of distress and affect on ADLs (SAND – Symptom no. ADLs affected, Number of symptoms, Distress experienced); associated with psychosis (mood congruent, nihilistic, guilty delusions, derogatory voices) = always severe
230
Beck's cognitive triad?
(-ve and pessimistic thoughts) – the self, the world and the future
231
Delusions in depression?
usually nihilistic, hypochondriacal, concerning illness or death
232
Atypical depression S+Ss?
initial anxiety-related insomnia, oversleeping, increased appetite, relatively bright and reactive mood (think of opposite to what would expect in other symptoms)
233
Depression associated with?
anxiety disorders, eating disorders, PD and substance misuse
234
Differentials of depression?
with normal sadness after bereavement or during an illness; psychotic depression with negative schizophrenia; depressive retardation with chronic schizophrenia; with drug or alcohol withdrawal
235
Aetiology of depression?
monoamine neurotransmitter availability in synaptic cleft (adrenaline and noradrenaline) is reduced in depressed patients and antidepressants increase availability; hypercortisolaemia in severe depression; cytokines and limbic system can contribute
236
Rfs for depression?
psychosocial, recent adverse event, childhood stress/abuse, women after childbirth, illnesses and medications (acne isotretinoin and steroids, antihypertensives, beta blockers, benzodiazepines)
237
Scores used for depression?
PHQ9, hospital anxiety and depression scores used
238
Depression increasing risk of?
CV and gastro deaths
239
Management and treatment of depression?
treat comorbidities, assess self-harm/suicide risk
o Mild – self-help groups, structured physical activity groups, guided self-help, computerised CBT
o Doesn’t work – individual CBT, interpersonal therapy
o Moderate to severe – give antidepressants, continue these for at least 6 months to reduce relapse but also up to 5 years, taper slowly out to prevent withdrawal
o Resistant depression – antidepressant with mood stabiliser (lithium), atypical antipsychotic or another antidepressant
o ECT – severe cases for psychosis and if food and fluids refused
240
What is post-natal depression and the problems surrounding it?
within first year post-natal; can affect child; suicide can be common; likely if other mental health problems and normal factors surrounding mother; same as depression but most women don’t seek help as don’t want baby going into care
241
Post-natal depression assessment?
past mental health, substance misuse, attitude of pregnancy, relationships, social network, domestic violence, housing and physical wellbeing
242
What is post-partum psychosis?
not very common; depressive, manic, delusions, hallucinations and odd beliefs about baby
243
Personality of people with eating disorders?
anxious, obsessive compulsive, depressive and low self-esteem; anorexia usually constricted affect and emotional expressiveness; bulimia usually impulsive
244
Aetiology of eating disorders?
altered 5-HT brain serotonin for appetite, mood and impulse control
245
Early childhood of people with eating disorders?
abuse; overprotective/controlling; food, body-shape and eating overvalued; troubled family relationships; ridiculed coz of size/weight; culture
246
Anorexia nervosa restrictive and bulimic definitions?
o Restrictive (low food intake and exercise) and bulimic (binge-eating with laxative and vomiting) subtypes
247
Anorexia diagnosis?
fear of fatness, deliberate weight loss, distorted body image, BMI<17.5/<85% predicted, amenorrhoea, loss of sexual interest and prepubertal development arrest
248
What is the SCOFF questionnaire?
sick, loss of control, one stone in 3 months, considered fat and food dominates life
249
Anorexia S+Ss?
preoccupation with food (dieting, food plans), public eating self-consciousness, vigorous exercise, constipation, cold intolerance, depressive and obsessive compulsive symptoms
o Physical signs: emaciation (abnormally thin/weak), dry and yellow skin, fine lanugo hair, bradycardia and hypotension, anaemia and leucopenia, repeated vomiting (hypokalaemia, alkalosis, pitted teeth, parotid swelling, scarring of dorsum of hand (russell’s sign)
250
Anorexia differentials?
diabetes, depression, psychotic disorders, substance/alcohol abuse
251
Anorexia management and treatment?
people often don’t think anything is wrong and like the way they look; monitor physical health; adolescents = family interventions first; adults = CBT, IPT, focal psychodynamic therapy and family therapy; severe = nasogastric feeding under mental health act; hospitalise if severe/raid weight loss or BMI<13.5, significant suicide risk and chronic starving/purging; risedronate,
252
Bulimia nervosa diagnosis?
morbid fear of fatness; craving for food and binge-eating (>2000kcal per session), purging (vomiting, laxative use, diuretics, enemas, omitting insulin if diabetic, fasting, excessive exercise); preoccupation with weight
253
Bulimia S+Ss?
normal or excessive weight, loss of control in binging, intense self-loathing, depression; multi-impulsive bulimia = alcohol and drug misuse, deliberate self-harm, stealing/sexual disinhibition, poor impulse control mainly
o Physical signs: amenorrhoea, hypokalaemia (dysrhythmias, renal damage), signs of excessive vomiting (mallory-weiss tear etc)
254
Bulimia rare causes?
kleine-levin and kluver-bucy syndromes
255
What is binge-eating disorder and its treatment?
o Binge-eating without purging – so become obese
| o Treat by psychotherapy and some meds like orlistat if severe and sometimes even gastric banding or bypass surgery
256
3 categories for psychosexual disorders?
Function, preference and identity; lots of legal and social implications
257
Disorders of sexual function men examples?
erectile dysfunction, ejaculatory failure
258
Disorders of sexual function women examples?
low libido, vaginismus (inability to allow penetration), dyspareunia (painful intercourse), lack of sexual enjoyment and orgasmic dysfunction
259
Disorders of sexual function assessment?
examine both partners and identify nature of problem; couple’s attitudes to sex and reason why came to you
260
Disorders of sexual function aetiology?
main past trauma etc, poor relationship with partner, physical conditions (neuro, diabetes, hypothyroidism, pelvic surgery), sexual dysfunction physical, psych conditions (depression, substance misuse, anxiety), prescribed drugs (beta-blockers, diuretics, antipsychotics, benzodiazepines, antidepressants, recreationals)
261
Disorders of sexual function management and treatment?
oral phosphodiesterase inhibitors (sildenafil) for ED; low-dose antidepressants for premature ejaculation; ED = vacuum pumps, penile bands and intracavernosal drugs like alprostadil; cognitive based therapies; education and dispelling sexual myths; sex/couples therapy
262
Other name for disorder of sexual preference?
paraphilias
263
What is not involved in disorder of sexual preference?
homosexuality
264
what are examples of disorders of sexual preference?
```
o Give sexual excitement
o Variations of sexual act:
Paedophilia
Fetishism (inanimate object)
Transvestism (cross-dressing)
Bestiality
Necrophilia
```
265
Management of disorders of sexual preference?
behaviour therapy and sometimes antiandrogens in paedophiles
266
Variations of the sexual act examples?
Exhibitionism – indecent exposure; either those with aggressive personality traits or antisocial personality disorders or inhibited temperament where penis = flaccid
Voyeurism – observe sexual acts
Frotteurism – rubbing genital against stranger in crowd
Sadomasochism – inflicting pain on other (sadism) or having it on self (masochism)
267
Another name for disorders of sexual identity?
gender dysphoria
268
S+Ss of transsexuality?
o Often starts in childhood – cross-dressing, cross-gender roles in games and fantasy, past-times thought of for opposite sex, homosexual men more likely to be open about it then heterosexuals
o Most are men
269
When can you seek gender reassignement surgery?
psychologically stable, adopted cross-gender role for at least 2 years, accepts surgical treatment not cure, will participate in pre-surgical psychotherapy
270
Most common abused illicit substances?
• Cannabis is most abused illicit substance then coke, MD, amphetamines and amyl nitrate (poppers)
271
Acute intoxication definition?
after use = disturbance in consciousness, cognition, behaviour and affect
272
Harmful use of substance abuse definition?
damage to health and effects on family and society
273
Dependence definition (CAN'T STOP)?
Compulsion, Aware of harms but persist, Neglect of activities, Tolerance, Stopping causes withdrawal, Time preoccupied with substance, Out of control of use, Persistent
274
Withdrawal state definiton?
physical and psychological symptoms after stop after prolonged and/or high use
275
Psychotic disorder defintion?
psychosis during or immediately after taking illicit substances
276
Amnesic disorder definition?
memory and cognitive impairments
277
Residual and late onset psychotic disorders S+Ss?
effects on behaviour, affect, personality or cognition that last after drug effect
278
RFs for substance misuse?
peer pressure, desire for pleasurable effect, prescribed drug misuse, psych illness (impulsivity/anxiety/borderline/PD), can exacerbate depression and anxiety and psychosis; use a multi-disciplinary team in these circumstances
279
Withdrawal S+Ss?
late-onset (7-10 days later) and bad symptoms = mydriasis (pupil dilation), abdo cramps, diarrhoea, agitation, restlessness, piloerection (‘goose-flesh), tachycardia
280
Management and treatment of substance misuse?
can be offered rewards (goods/services) if -ve drug test or harm reduction; CBT, motivational interviewing, self-help groups; needle exchange for those at infection risk
281
Examples of opiates?
heroine, morphine, methadone
282
Opiates S+Ss of tolerance and withdrawal?
flu-like,, sweating and yawning) develop quickly
283
Opiates detoxification and treatments for this?
lasts between 4-12 weeks; methadone (opioid agonist) or buprenophrine (partial opioid agonist) first-line as less euphoric and long half-life compared to abusive opioids; lofexidine is used where milder abuse and for shorter detox
284
Opiates progression after detoxification entails?
from maintenance (getting off illicit substances just to prescribed), detoxification and abstinence
285
What is naltrexone?
opioid antagonist used to prevent relapse as blocks their effects
286
What is naloxone used for?
used for overdose (miosis, respiratory depression)
287
Examples of hallucinogens?
o Magic mushrooms, LSD, MD, GHB, GBL
288
Examples of stimulants?
cocaine, amphetamines, methamphetamine, naphyrone, mephedrone, amyl nitrate
289
Cocaine S+Ss?
effects resemble hypomania (restlessness, increased energy, no fatigue and hunger) and last 20 minutes; hallucinations and paranoid psychoses, pre-withdrawal = dysphoria, insomnia and depression
290
Amphetamines, methamphetamine, naphyrone, mephedrone, amyl nitrate S+Ss?
```
o Amphetamines (speed) – similar to cocaine
o Methamphetamine – similar but more potent and long-lasting
o Naphyrone and mephedrone – close to amphetamines but legal highs but now class B drugs
o Amyl nitrate – fatal if swallowed and toxic
```
291
Cannabis S+Ss?
euphoric, relaxed, hallucinations, high appetite and low body temp; lung disease, low sperm, flashbacks and psychosis, depression
292
Benzodiazepines risks?
dependence, dangerous withdrawals and tolerance
293
Solvents S+Ss?
sniffed and red rash around mouth; euphoria followed by drowsiness; psychological dependence common; weight loss, nausea, vomiting, polyneuropathy, low cognition; can have fatal SEs (bronchospasm, arrythmias, aplastic anaemia, organ damage)
294
What is phencyclidine and S+Ss?
aka PCP; euphoria, analgesic, psychosis, impaired consciousness
295
What is Khat and S+Ss?
somali and yemen; excitement and euphoria
296
Define a unit of alcohol?
10mL/8g
297
Units per week/day?
* Units per week – 14 and 2 drink-free days per week
| * Units per day – 4 for men and 3 for women
298
S+Ss acute alcohol intoxification?
bit like cerebellar dysfunction; slurring, low coordination, labile affect, hypoglycaemia, stupor and coma
299
S+Ss acute alcohol withdrawal?
mainly shaking and feeling fluey (1/2 days after) – malaise, nausea, autonomic hyperactivity, labile mood, insomnia, transient hallucinations or illusions, seizures, delirium tremens (hyperadrenergic state – emergency)
300
RFs alcohol abuse?
medical inpatients, mental illness and 2+ drink drive offences
301
CAGE questionnaire?
ever tried Cutting down?, people Annoyed you by suggesting it?, felt Guilty about drinking?, ever needed an Eye-opener (early morning drink)?; then use FAST alcohol test
302
Signs of alcohol abuse?
liver disease signs, peripheral neuropathy, macrocytosis, raised GGT, ALT and AST and CDT
303
Aetiology of alcohol abuse?
genetic, occupation (high risk), cultural (Scottish and irish), cost to drink, avoiding withdrawal, chronic illness
304
Complications of alcohol abuse?
wernicke’s encephalopathy (ataxia, nystagmus, acute confusion, ophthalmoplegia – like have cerebellar dysfunction); peripheral neuropathy; ED; cerebellar degeneration; dementia; depression; suicide; severe anxiety; insomnia; foetal alcohol syndrome
305
Management and treatment of alcohol abuse?
rapid detailing sedation to control withdrawal and seizures; delirium tremens treated with lorazepam or antipsychotics; rehydration with electrolytes (pabrinex) and thiamine; motivational interviewing on what treatment and why to stop; psych therapies (self-help groups, meds like disulfiram [can’t metabolise so feel ill], acamprosate [reduces cravings], naltrexone [reduces opioid effects])
306
Basis of psychological therapies?
educating person about their condition – reflecting on previous life events/relationships; good rapport developed; teach skills around problems
• Choice of therapy guided by patient, cost and illness
307
Types of counselling techniques?
non-directive (pt shares), problem solving, cognitive, behavioural, CBT; 6-10 sessions over 8-12 weeks
308
Types of therapies?
supportive e.g. counselling, cognitive and behavioural e.g. CBT, psychodynamic psychotherapies e.g. IPT, psychoanalysis
309
What is CBT?
challenge automatic and -ve thoughts to modify underlying core beliefs; for anxiety, depression, eating disorders and some PD
310
What is rational behavioural therapy?
form of cognitive therapy to teach recognition of beliefs and how cause patient harm
311
What are behavioural therapies and what concepts do they use (ABC)?
based on learning theory to condition desirable behaviours by reinforcement; graded-exposure to objects/situations that cause anxiety; reciprocal inhibition uses a response that combats the symptom at the time; behaviour activation is doing activities they avoid; behavioural management therapy uses ABC Antecedents to target behaviour, Behaviour targeted and Consequence where A and C are manipulated to alter behaviour; couples therapy as well
312
What are psychodynamic therapies?
based on learning theory to condition desirable behaviours by reinforcement; graded-exposure to objects/situations that cause anxiety; reciprocal inhibition uses a response that combats the symptom at the time; behaviour activation is doing activities they avoid; behavioural management therapy uses ABC Antecedents to target behaviour, Behaviour targeted and Consequence where A and C are manipulated to alter behaviour; couples therapy as well
313
What is transference therapy?
pt re-experiences emotions from important relationships with therapist
314
What is counter-transference therapy?
therapist has strong emotions to pt
315
When are therapeutic communities used?
severe borderline PD and involves group and individual sessions
316
What is interpersonal psychotherapy for and what is it?
depression and eating disorders; focuses on interpersonal aspects; role transitions, interpersonal disputes, deficits in number and quality of relationships, grief
317
What is dialectical behavioural therapy and when is it used?
for borderline; similar to CBT but also group skills training to give coping strategies alternative to self-harm; mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness
318
What are mentalisation-based treatments and what for?
borderline psychodynamic principles; can deduce mental states of behaviour of themselves and others; based on attachment theory
319
What are eye movement desensitisation and reprocessing for and what is it?
for PTSD; recall the past event and focus on external stimulus; usually get patient to use lateral eye movements (Saccadic eye movement)
320
What are exposure therapies for?
phobias, OCD, PTSD
321
What are the 4 aspects of mental capacity?
(4 rule – understand, retain, weigh-up and communicate) – understand info relevant to decision; retain, use and weigh info to come to decision; communicate decision
322
Some principles when lacking capacity?
* Should always try to get people to make decisions for themselves if have capacity and their views if not
* Repeat capacity as can change and sometimes wait on a decision if lack it temporarily (psychotic episode)
323
What happens when no capacity?
o Professional always acts in best interests; consult family/carers and friends and independent mental capacity advocate (IMCA) if this not available
324
What is an LPA?
o LASTING POWER OF ATTORNEY – person appointed on their behalf to make decisions for them when they lack capacity (property, financial, personal incl healthcare welfare)
325
What is an advance decision?
o ADVANCE DECISIONS – make a decision in advance for certain decisions; can only refuse treatments not demand it
326
What are deprivation of liberty safeguards and when are they used?
for people in hosp or carehomes who = deprived of liberty, lack capacity and not sectioned; can only authorise if person is over 18 and if doesn’t interfere with advanced directive or with the LPA, person has mental health disorder, person not detained under MHA and doesn’t need it (only if requires it for the treatment), in person’s best interests; renewed annually and the person can appeal
327
What is fitness to plead and when is it used?
jury can decide if they can mount defence against charges: understand the charge, distinguish between guilty and not guilty, instruct lawyers, follow court evidence, challenge jurors; can still have trial of the facts if unfit to plead and if facts proven then flexibility of the case
328
What is men's rea?
if the person can be criminally responsible and has a ‘guilty mind’; not if: age under 10, lack criminal intent, automatism (epilepsy, sleepwalking and concussion), mental disorders
329
What is diminished responsibility?
murder to manslaughter due to ‘abnormality of mind’ at the time
330
What is testament capacity?
will only valid if: understand will making, appreciate his/her property, be aware who has a reasonable claim to estate
331
Basic outlines of sectioning?
pt has severe enough mental health disorder to be kept in hospital for their/others safety, for under longer periods must have appropriate medical intervention, can’t be detained for LD unless aggressive or serious conduct
332
What is a section 12?
approved doctor; can be police, psychiatrists and GPs; need at least 1 sectioned 12 approved doctor to section someone for anything; also need an approved mental health professional (mainly social care worker) and a mental disorder/disability of mind (not drugs/alcohol)
333
Aspects to bear in mind when sectioning?
• Respect for patients’ past and present wishes; respect for diversity; minimise liberty restrictions; involve pts in planning, developing, delivering care, treatment; avoidance of discrimination; public safety
334
What is a section 2?
kept for 28 days for admission of assessment, 2 doctors (one S12 approved), AMHP; evidence needed = pt has mental disorder needing detention in hosp for assessment, for health and safety of themselves or others
335
What is a section 3?
up to 6 months for treatment (can be renewed so much longer) – must have a responsible clinician; pt has mental disorder which means medical treatment in hosp, in interests of health and safety of them/others, appropriate treatment plan and diagnosis and treatment availability
336
What is a section 4?
emergency and lasts 72 hours (when can’t get both doctors but has to section 12 approved); same reasons for section as 2 but don’t have enough time to get a 2nd doctor
337
What is a section 5(2)?
pt already admitted but wanting to leave; doctor’s holding power 72 hours (not s12 approved); allows time for 2 or 3; can’t be coercively treated
338
What is a section 5(4)?
same as 5(2) but for nurse and only 6 hours
339
What is a section 135/136 for police?
135 court order to remove pt from home; 136 = in public; get them to place of safety (local psych unit/police cell) for further assessment; last for 72 hours
340
What is a community treatment order?
must make themselves available for examination and to be given treatment for up to 72 hours at a time (section 4)
341
Who can remove a section?
pt’s legal closest relative or at a tribunal
342
What is CAHMS for?
ages 4-18 and community based
343
What is psychomotor retardation?
decreased spontaneous movement and slowing of voluntary (essentially opposite to catatonia/stupor)
344
What is incongruity of affect?
pt thought doesn’t affect outcome of mood (schizophrenia)
345
What is blunting of affect?
less emotional sensitivity reaction
346
What is Belle indifference?
lack of concern/denial of severe functional disability
347
What is Creutz-feldt Jakob disease (CJD)?
communicable disease; 85% sporadic; can be transmitted in neurosurgery
348
CJD S+Ss?
myoclonus, visual disturbances, cerebellar, pyramidal and extrapyramidal signs; cognitive and functional impairment; incubation 4-30 years; CJD lasts a few months and neurological whereas nvCJD (from cows) can also be psychiatrics
349
Management and diagnosis for CJD?
no cure so management and tonsil biopsy for helping to diagnose
350
Types of fronto-temporal dementia?
behavioural variant FTD (main one), progressive non-fluent aphasia, semantic dementia
351
Proteins involved in fronto-temporal dementia?
tau, FUS and TDP-43 proteins
352
S+Ss behavioural FTD?
loss of inhibition, inappropriate social behaviour, loss of motivation, repetitive behaviours, loss of control, difficulty planning, lack of insight, loss of awareness of hygiene
353
S+Ss semantic FTD?
loss of vocab, can’t find right word, can’t recognise people, memory preserved, slow aphasia; best prognosis
354
Investigations FTD?
o Bloods = dementia screen, ammonia, ESR, toxicology (if encephalopathy)
o If parkinsonism – screen for caeruloplasmin and serum copper for Wilson’s
355
HIV encephalopathy S+Ss?
in 16% with AIDS; first conc and memory and depression then intellect; slow movements
356
Neurosyphilis S+Ss?
dorsal column loss, dementia and meningovascular involvement
357
Wilson's disease S+Ss?
young adults seen as neuropsychiatric; severe depression common also behaviour and psych
358
Wernicke-Korsakoff's syndrome causes?
thiamine deficiency from alcohol abuse; neuronal loss in cerebral cortex, hypothalamus and cerebellum; also chronic subdural haematoma
359
Wernicke-Korsakoff's syndrome S+Ss?
N+V, confusion, fatigue, weakness, apathy, diplopia and eye drooping, anterograde and retrograde amnesia, disorientation, polyneuropathy, low reflexes, gait abnormal, low bp, maybe cachectic
360
Treatment for wernicke-korsakoff's syndrome?
oral thiamine
361
Psychosis S+Ss?
• Can’t: think clearly, respond with appropriate emotion, communicate effectively, understand reality and behave appropriately
362
When does psychosis happen?
schizophrenia, depression, bipolar, puerperal psychosis, drug/alcohol abuse
363
Psychosis treatment and management?
• Reduce symptoms, initiate treatment, maximise ability to ADL, prevent relapse; may have to initiate immediate tranquilisation
364
What is neurosis?
less severe than psychosis (internal struggles and mental/physical disturbances)
365
What are positive and negative symptoms of psychosis?
• Positive symptoms = symptoms before psychosis that pt doesn’t have and -ve symptoms is opposite to this
366
Acute and transient psychosis what is it and how is it treated?
disorder most affecting females; around 17 days and onset acute; good response to antipsychotics; better postepisodic functioning than after schizophrenia psychosis episode
367
Frontal lobe syndrome S+Ss?
deterioration in personality and behaviour; lack of spontaneous activity, loss of attention, memory unimpaired, perserveration and change of affect; signs = go no go (ask patient to hold up two fingers when you hold one), visual grasp, letter fluency and motor test
368
Somatic symptom disorder S+Ss?
• Chronic and many physical complaints; multiple, recurrent and changing symptoms; happens before age 30 and more in women; can affect ADLs; symptoms = SOB, palpitations, chest pain, vomiting, abdo pain, joint pain, headaches, dizziness, vision changes and dysuria (basically think how old person is)
369
Somatic symptom disorder treatment?
antidepressants
370
What is neuroleptic malignant syndrome and S+Ss?
• Rare but life-threatening reaction to neuroleptic drugs – fever, muscle-rigidity, altered mental state, autonomic dysfunction
371
Treatment for neuroleptic malignant syndrome?
Bromocriptine
372
What is ADHD?
o Persistent patten of inattention and/or hyperactivity and impulsivity than normal; combined, predominantly inattention or predominantly hyperactivity-impulsivity
373
Risks from ADHD?
self-harm, substance misuse, anxiety, academic underachievement
374
Management of ADHD?
o Watchful waiting (10 weeks) first to see if can adjust life (reduce certain food groups); only give drugs to those not responsive to therapy (parent-training) and moderate/severe
375
What is tourette's?
neuropsychiatric condition with motor and vocal tics; fluctuating; can be associated with OCD
376
What are tics?
sudden, purposeless, repetitive, non-rhythmic, stereotyped movements/vocalisations; persist more than 1 year
377
Features other than tics for tourettes?
echolalia (copying others), palilalia (repeating own words), coprolalia (dirty words), copropraxia (obscene gestures), echopraxia and difficulty concentrating
378
Factors to modify in ADHD?
o Education, reduce stress etc, behavioural and psychosocial factors good to modify
379
Drugs for moderate to severe ADHD?
riseridone, sulpiride; haloperidol for treatment of tics
380
What is enuresis?
Bedwetting with no pathology
381
S+Ss enuresis?
excess urine, poor sleep arousal, reduced bladder capacity; primary nocturnal enuresis = more than 5 with/without daytime
382
RFs enuresis?
male, daytime incontinence, FH, obesity, sleep apnoea, spina bifida, Down’s, stress
383
Enuresis questions for hx?
frequency, pattern, time, wake after, daytime, soiling, fluid intake, reason for consultation
384
When to refer for enuresis?
severe daytime, recurrent UTIs, abnormal renal US, physical/neuro problems, not responded after 6 months
385
Management and treatment of enuresis?
avoid caffeine and reward good toileting; alarm training; desmopressin and imipramine for resistant cases
386
Asperger's definition?
lies in ASD; high functionality than autism; difficulties understanding and processing language; usually obsessed with complex subjects; poor imagination; solitary but socially aware
387
What is separation anxiety disorder and S+Ss?
fear affecting when think about separating from home or people attached to; usually ends aged 2; may have physical (headache, nausea and vomiting, nightmares); more than 4 weeks in children and 6 months in adults; anti-anxiety meds
388
What are the RFs for delirium (CHIMPS PHONED)?
```
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, recreational, their partner/neighbour/pets’, alcohol and smoking)
```
389
Order for looking into causes for a psychiatric diagnosis?
• Organic, then drugs, then psychosis, then depression then anxiety
390
General investigations for organic causes?
Basic bloods, imaging, blood-testing towards known effects of medication, dementia screens, blood testing of plasma levels of medication, urine drug screens
391
What basic bloods are tested?
FBC, U+E, LFT, glucose, TSH
392
What blood testing for known effects of medications are there example?
Prolactin for antipsychotics
393
What directed imaging is used?
X-ray, CT or MRI
394
What blood plasma levels of drugs examples are there?
Lithium, clozpine for compliance etc
395
What directed dementia screens are there (exclude delirium)?
FBC, U+E, LFT, ESR, TFT, B12/folate, glucose, syphilis, CT/MRI
396
What is a Lilliputian hallucination?
See small figures dotting around (in alcohol withdrawal)
397
When is an affective illusion seen?
Depression
398
What is a pareidolic illusion?
Like seeing a face in a cloud
399
Memory therapies and strategies for those with dementia?
Doll therapy (https://www.dementiauk.org/get-support/complementary-approaches/doll-therapy/), music/aromatherapy, occupational therapy, recreation therapy, nostalgia therapy, dementia cafes, day-care hospitals (have a lot of the therapies in there), memory nurses, trackers, increased security, training for abuse for carers to protect pts
400
What do you treat acute dystonia with?
Procyclidine
401
In what conditions would you refer to inpatients for pts stopping alcohol?
withdrawals in past, delirium tremens in past, epilepsy, drink over 30 units, score more than 30 on SADQ, need concurrent withdrawal from alcohol and benzos, regularly drink 15-30 units pre day and have significant LD or cognitive impairment or psych or physical comorbidity
402
When would you tend to get pseudo-hallucinations?
In non-psychotic illness like depression
403
How to differentiate between a personality disorder and traits of PD (the 3 Ps)?
usually disorder if it’s a problem for them or others, persistent through their life and perseverant in all aspects of their life (3 Ps – if not all Ps but some then can be traits of a PD)
404
What to use for short-term in mania/hypomania treatment?
Antipsychotics
405
Treatment for cyclothymia?
Primarily CBT but sometimes mood stabiliser trial
406
Stages of depression?
mild = 2 core and 2 others, moderate = 2/3 and 3 others plus loss of functioning, severe = all 3 core plus 4 other
407
What is dysthymia and S+Ss?
less severe depression; less ADLs affected; symptoms do not present for more than 2 weeks; very pessimistic and glass half empty personality
408
What is seasonal affective disorder and S+Ss?
time of year depression (cyclical); get more hungry and more sleepy as well as other 3 core symptoms of depression; more depressed in the evening
409
Give a focused alcohol history?
drinking pattern (everyday/weekends), time of day; what do they drink; when; how much per day; where, who with; what makes drink less/more in a day; spenditure on alcohol; compulsion?, how important is drinking to you, if you stop do you notice -ve change in mood/physical signs (sick/sweating/shakes), do have to drink more than used to, to feel the effects?, impact of drinking on jobs and ADLs, alcohol-related crime, previous attempts at abstinence, desire to stop drinking
410
What is dependence syndrome?
3+ of these S+Ss in the same year: strong desire to take, difficulties in controlling taking, withdrawal state if stop or use to stop withdrawal, tolerance evidence, neglect of pleasurable activities, keep using substance despite evidence to show its harm
411
What is substance tolerance?
A condition that occurs when the body gets used to a substance so that either more substance is needed to feel the effects or different substance is needed
412
Short term effects of heroine use?
the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. Nausea, vomiting, and severe itching may also occur. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage
413
Long-term effects of heroine use?
changes the physical structure13 and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed.14,15 Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.16-18 Heroin also produces profound degrees of tolerance and physical dependence
414
Define a legal high?
a drug that is taken for pleasure and has the same effect as an illegal drug, but has not been made illegal
415
SEs and risks of taking legal highs?
agitation, paranoia, drowsiness, coma, seizure, death; risks = don’t know what they contain, significant risk if mix with alcohol/other drugs, more likely to engage in risky behaviour, can dehydrate and overheat, long-term mental health problems, synthetic cannabinoids more likely to cause long-term depression and psychosis
416
Difference between learning difficulty and disability?
o a learning disability constitutes a condition which affects learning and intelligence across all areas of life
o a learning difficulty constitutes a condition which creates an obstacle to a specific form of learning, but does not affect the overall IQ of an individual
417
Types of abuse and neglect?
Physical, sexual, emotional, discriminatory, neglect, domestic, financial
418
Risks when overdosing on tricyclic antidepressants?
Seizures and death
419
Time to stop taking antidepressives after last depressive episode?
2 years
420
How long to wait for antidepressant effects seen?
4 weeks
421
Chemicals lacking and high in depression in the body?
low BDNF and low neuroplasticity and high glutamate release; MAO low
422
What is the neuroplasticity hypothesis for depression?
Low neuroplasticity in depressed so fewer neural pathways formed (antidepressants form more)
423
What is the salience hypothesis in psychosis?
associating something with importance; psychosis hypothesis where associate something with the wrong importance
424
What is the mesocortical pathway for?
executive function and cognitive control of emotions
425
What is the nigrostriatal pathway do in antipsychotics?
Contribute the movement component
426
What is the tuberoinfundibular pathway do in antipsychotics?
increase in prolactin
427
What is neuroleptic syndrome and S+Ss?
from antipsychotic use; pyrexia, muscle stiffness, raised CK, tremor, delirium; treat with DA agonists like bromocriptine
428
What long-acting benzodiazepine would you use for alcohol withdrawal?
Chlordiazepoxide
429
Give S+Ss and treatment for wernicke's syndrome?
ophthalmoplegia, gait ataxia, alteration of consciousness and give glucose with thiamine
430
When is family therapy used?
Mainly in CAMHS for eating disorders
431
What is family therapy?
sometimes observed by other therapists through black glass; systemic works with family’s strengths to help families think about different ways of helping
432
SEs of olanzapine?
side effect is weight gain, impaired glucose tolerance and increased appetite for sugary foods, drowsiness
433
Why is aripiprazole useful in certain situations?
can give this if hyperprolactinaemia as can bring prolactin levels down
434
What is a 117 (when thinking about a section 3)?
after discharge can get a 117 which gives discounts and support in social care
435
IQ for borderline LD?
70-85
436
IQ for mild, moderate, sever and profound LD?
50-69, 35-49, 20-35 and below 20
437
LD definition?
Onset in development and problems with intellectual and adaptive functioning and deficit in conceptual, social and practical domains
438
LD 3 criteria?
Deficits in intellectual (reasoning, problem-solving, abstract thinking etc - basically IQ) and adaptive (can't meet developmental and sociocultural standards) and this onset must be in the developmental period (0-18yrs)
439
Prenatal LDs?
Genetic (Down and Fragile X), inborn errors of metabolism, brain malformation (microcephaly), maternal disease (placental disease), environmental (fetal alcohol syndrome, other drugs/toxins/teratogens), infection, toxins, maternal health, nutrition
440
Perinatal LD?
Prematurity, birth anoxia
441
Post-natal LD?
Hypoxic ischemic injury
* Traumatic brain injury
* Infections
* Demyelinating disorders
* Seizure disorders (e.g., infantile spasms)
* Severe and chronic social deprivation including malnutrition
* Toxic metabolic syndromes and intoxications (e.g. lead/ mercury)
442
What is a challenging behaviour and some examples in LD?
Can get them locked up and hard to deal with; violence, aggression, hyperactivity, withdrawal, shouting/screaming, sexual aberrance, self-injuries
443
Examples of genetic and inherited LDs?
```
Downs [21] chromosomal
Turners
Klinefelter’s XXY
XYY syndrome
Tuberous sclerosis
Prader Willi and Angleman’s syndromes [15q deletion] genetic
15q duplication syndrome
22q11.5 deletion syndrome
Phenylketonuria [phenylalanine hydroxylase gene and enzyme dysfunction]
Hydrocephalus
Fetal alcohol syndrome
```
444
Treatment for severe depression?
give medication first then therapy; if with psychosis give with antipsychotics; benzodiazepines if extreme psychosis distress; sleeping agents if struggling to sleep
445
What delusions tend to be mood incongruent?
Psychotic
446
Organic differentials for mood changes?
MS, stroke, diabetes, brain tumour, hypothyroidism
447
Organic differentials for insomnia?
sleep apnoea, hyperthyroidism, GORD, pain
448
Organic differentials for confusion?
renal failure, cerebral arteritis, sepsis
449
Organic differentials for personality change?
MS, mass lesion, SLE
450
Organic differentials for hallucinations?
migraine, substance abuse, encephalitis, seizures
451
Organic differentials for behavioural change?
lyme, vascular infarct, Parkinson’s, subdural haematoma, mass lesion
452
Organic differentials for psychosis?
sensory loss, syphilis, dementia, Wilson’s
453
Organic differentials for irritability?
vitamin B12 deficient, drug withdrawal, substance misuse
454
Causes for Parkinson facies?
Antipsychotics and depression
455
Causes for abnormal pupils?
opiate
456
Argyll-Robertson pupil causes?
Neurosyphilis
457
Enlarged parotids causes?
Bulimia
458
Hypersalivation causes?
clozapine
459
Goitre causes?
Thyroid disease
460
Multiple forearm scars causes?
BPD
461
Needle tracks causes?
IVDU
462
Gynaecomastia causes?
Antipsychotics, alcoholic liver disease
463
Russell's sign causes?
Bulimia
464
Lanugo hair causes?
Anorexia
465
Piloerection causes?
opiate withdrawal
466
Excessive thinness causes?
anorexia
467
Primary definition?
directly from disordered mental states
468
Secondary definition?
reaction to something as a result of condition
469
Congruent/incongruent definition?
affect is aligned with mood or not
470
Form definition?
Type of experience from the symptom
471
Content definition?
Composition of symptom
472
Structural definition?
Observable structural abnormalities
473
Functional definition?
Outcome of an abnormality
474
ICD 10 classification hierarchy?
* Organic, including symptomatic, mental disorders
* Mental and behavioural disorders due to psychoactive substance use
* Schizophrenia, schizotypal and delusional disorders
* Mood [affective] disorders
* Neurotic, stress-related and somatoform disorders
* Behavioural syndromes associated with physiological disturbances and physical factors
* Disorders of adult personality and behaviour
* Mental retardation
* Disorders of psychological development
* Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
* Unspecified mental disorder
475
Schizoaffective disorder defintion?
symptoms of schizophrenia and mood disorders (antipsychotic and mood stabiliser)
476
Definition of schizophreniform disorder?
some traits of schizophrenia but doesn’t meet threshold for diagnosis
477
Anxiety disorder treatments?
symptom control (explain that symptoms cannot cause harm), meditation, exercise, progressive relaxation exercises (deep-breathing), CBT, behavioural therapy, hypnosis, medication
478
S+Ss of dementia in general?
restless, repetitive activity, rigid, fixed routine; sexual disinhibition, social gaffes, shoplifting, blunting; syntax errors, dysphasia, mutism; slow, muddled thinking; bad memory; illusions and hallucinations; irritable, depressed, emotional incontinence
479
4 As of Alzheimer's?
amnesia, aphasia, agnosia, apraxia
480
2 types of reactive attachment disorders?
reactive either: disinhibited (seek comfort from everyone even strangers) or inhibited (withdrawn and detached from everyone); can be diagnosed before 5yrs
481
3 core symptoms of conduct disorder?
defiance of will of authority, aggression, antisocial behaviour
482
What medication to control seizure threshold in LD?
Antipsychotics
483
CHANGE VIEW for explaining CBT?
change = thoughts and actions; homework = practice makes perfect; action = don’t just talk, do; need = pinpoint problem; goals = move towards them; evidence = CBT can work; view = events from other angle; I can do it = self-help approach; experience = test out beliefs; write it down = to remember progress
484
Types of behavioural psychotherapy?
relaxation therapy (muscle group relaxation can form part of this); systematic desensitisation; response prevention; exposure therapy; thought stopping therapy; aversion therapy; social skills training; token economy; modelling and role play therapy
485
Counselling definition?
2 people talking together to find a solution to a stressful situation/problem
486
Supportive psychotherapy definition?
only time therapist engages in a supportive and encouraging way (uses psychodynamic, interpersonal and CBT approaches)
487
Qualities of pt eligible for group therapies?
enter voluntarily, think it will be as good as individual, good verbal and conceptual skills
488
Illnesses indicated for group therapy?
PD, addictions, drug and alcohol misuse, victims of childhood abuse, difficulty in socialising, major medical illnesses
489
Who is play therapy offered for?
kids mainly 3-11yrs as can communicate better how they are feeling this way
490
Types of play therapy?
either directive (structured by therapist) or non-directive
491
What is art therapy?
using art materials for self-expression and reflection
492
Who is indicated for using art therapy?
mental health, LD, palliative care, disaster zones, prisons
493
Brain areas implicated in stress response?
amygdala, hippocampus, and prefrontal cortex
494
What effect does traumatic/acute stress have upon the structural and functional aspects of the brain?
Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors. Antidepressants have effets on the hippocampus that counteract the effects of stress. Findings from animal studies have been extended to patients with post-traumatic stress disorder (PTSD) showing smaller hippocampal and anterior cingulate volumes, increased amygdala function, and decreased medial prefrontal/anterior cingulate function. In addition, patients with PTSD show increased cortisol and norepinephrine responses to stress
495
What is a section 37?
A court decides instead of going to prison you go to hospital for treatment
496
What is a section 41?
A judge decides certain restrictions must be placed on the pt for public safety (it is a court order by the crown court)
497
What SSRI is licensed for neuropathic pain?
Duloxetine
498
Treatment of antipsychotic akathisia?
Reduce dose and use propanolol/diazepam
499
Why not give sodium valproate to child bearing age mothers?
Teratogenic
500
Treatment for neuroleptic malignant syndrome?
stop drug and treat symptoms with diazepam (tremors), dantrolene and bromocriptine (high temp)
501
Treatment for OCD?
Sertraline
502
Difference between OCD and OCPD?
OCPD enjoy it more and don’t see it as a problem unlike OCD where it is more unpleasant; ego-syntonic in OCPD and ego-dystonic in OCD
503
3 types of attachment styles and cause?
secure (type B), insecure avoidant (type A), insecure ambivalent/resistant (type C); due to early interactions with mother
504
Attachment in BPD?
insecurity in their sense of self and relationships; fear abandonment
505
What is refeeding syndrome?
potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphataemia.
506
Pathophysiology of refeeding syndrome?
* During prolonged fasting, hormonal and metabolic changes are aimed at preventing protein and muscle breakdown. Muscle and other tissues decrease their use of ketone bodies and use fatty acids as the main energy source. This results in an increase in blood levels of ketone bodies, stimulating the brain to switch from glucose to ketone bodies as its main energy source. The liver decreases its rate of gluconeogenesis, thus preserving muscle protein. During the period of prolonged starvation, several intracellular minerals become severely depleted. However, serum concentrations of these minerals (including phosphate) may remain normal. This is because these minerals are mainly in the intracellular compartment, which contracts during starvation. In addition, there is a reduction in renal excretion.
* Refeeding
* During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate.
507
NICE guidelines for refeeding?
• The NICE guidelines recommend that refeeding is started at no more than 50% of energy requirements in “patients who have eaten little or nothing for more than 5 days.” The rate can then be increased if no refeeding problems are detected on clinical and biochemical monitoring
508
What section is used for force feeding anorexic patients?
can force-feed anorexic as long as its treatment for the disorder using a section 63
509
Give an overview of CAMHS and AMHs?
• CAHMS is ages 4-18 and community based; deal with families; 50% mental health manifests at 14yrs;
o AHM – focussed around individual; FH; MHA common
o CAHMS – FH, early life (events, development); less pharma used; wider range of therapies (play and art therapy); young person and family always interviewed; schools give a good insight into social and academic progression, have to have young person’s and fam’s permission first tho; good to have a good connection with the schools
510
Questions to ask a child entering CAMHS?
Development – young person’s understanding? (do they know why they’re here, what do the want help with), if anxious then use play to express themselves; try and understand what matters to them; if under 16 then assume no capacity
511
Give an overview of the attachment timeline?
0-3 months = indiscriminate attachment, 3-6 months = preference for main caregivers, 6-12 months = only main caregiver, 12-24 months = increasingly able to separate from main caregiver
512
Treatments offered at CAMHS?
Treatments = CBT, EMDR, art therapy, meds, family therapy
513
Transition process of patients from CAMHS to GP/AMH?
17.5-18.5yrs; wither to GP/AMH; depends on severity and risk; risky process, careful and gradual planning, shared with family
514
Drug used in anxiety after sertraline for sleep and anxiety?
Promethazine
515
Antipsychotic mainly used in anxiety?
Quetiapine
516
Mild moderate and severe treatment length for PTSD?
6 months, 1yr, 18months to 2yrs
517
Ego-syntonic definition in OCD?
Behaviours that are acceptable
518
Ego-dystonic definition in OCD?
Behaviours that cause distress
