Psychiatry Flashcards
1
Q
What is neurosis?
A
Maladaptive psychological symptoms not due to organic causes or psychosis, usually precipitated by stress
2
Q
Give 3 cognitive signs/symptoms of anxiety
A
- Agitation
- “Impending doom”
- Poor concentration
- Insomnia
- Repetitive thoughts/activities
- Obsessive concern about self and bodily functions
3
Q
Give 3 somatic signs/symptoms of anxiety
A
- Tension
- Trembling
- Hyperventilation
- Headaches
- Sweating
- Palpitations
- Nausea
- “Butterflies in stomach”
- “Lump in throat”
4
Q
Give 3 behavioural signs of anxiety
A
- Reassurance seeking
- Avoidance
- Dependence
5
Q
Give 3 signs of anxiety in children
A
- Thumb-sucking
- Nail-biting
- Bed-wetting
6
Q
Give 3 risk factors for anxiety
A
- Genetic predisposition
- Stress
- Events
- Faulty learning
7
Q
What therapy is most commonly used for anxiety?
A
Cognitive behavioural therapy (CBT)
8
Q
What lifestyle change can help manage anxiety?
A
Regular (non-obsessive exercise)
9
Q
What medication can be given to treat the somatic symptoms of anxiety?
A
Beta-blockers
10
Q
What is the first line medication treatment for anxiety?
A
SSRI’s
11
Q
What is the definition of compulsions?
A
Senseless repeated rituals, normally a way to reduce an obsession
12
Q
What is the definition of obsessions?
A
Stereotyped, purposeless words, ideas or phrases that come into the mind
13
Q
Which therapy is most commonly used to manage OCD?
A
Cognitive behavioural therapy (CBT)
14
Q
What medications can be used to managed OCD?
A
Clomipramine (TCA) or SSRI’s
15
Q
What is a phobia?
A
Anxiety only/predominantly experienced in certain situations that are not dangerous
16
Q
What is agoraphobia?
A
Fear of leaving the house
17
Q
What is the treatment for phobias?
A
Behavioural therapy - graded exposure
18
Q
Give 3 symptoms of PTSD
A
- Vivid nightmares and/or flashbacks
- Autonomic - sweating, high HR and BP
- Panic attacks
- Avoidance of associations
- Hypervigilance
- Poor concentration
19
Q
Non-pharmacological management of PTSD
A
- CBT
- EMDR
- Hypnotherapy
20
Q
What does EMDR stand for?
A
Eye movement desensitisation and reprocessing (EMDR)
21
Q
What medications can be used to manage PTSD?
A
SSRIs, TCAs etc.
22
Q
What does AMHP stand for?
A
Approved mental health professional
23
Q
What is the purpose of a Section 2 detainment?
A
Assessment (although treatment can sometimes be given)
24
Q
How long can a Section 2 detainment last for?
A
28 days (cannot be renewed)
25
What evidence is required for a Section 2 detainment?
- Patient has a mental disorder that warrants detention in hospital for assessment
- Detainment is for the patients own health or safety, or protection of others
26
What is the purpose of a Section 3 detainment?
Treatment
27
How long can a Section 3 detainment last for?
6 months (can be renewed)
28
What professionals are required for a Section 2 detainment?
2 doctors (1 S12), 1 AMHP
29
What professionals are required for a Section 3 detainment?
2 doctors (1 S12), 1 AMHP
30
What evidence is required for a Section 3 detainement?
- Patient has a mental disorder that warrants detention in hospital for medical treatment
- Treatment is in the interest of the health and safety of the patient and others
- Appropriate treatment is available
31
What scenario is a Section 4 detainment used in?
Only in "urgent necessity" when waiting for a second doctor would lead to "undesirable delay"
32
How long can a Section 4 detainment last for?
72hrs
33
Which professionals are required for a Section 4 detainment?
1 doctor and 1 AMHP
34
What evidence is required for a Section 4 detainment?
- Patient has a mental disorder that warrants detention in hospital for assessment
- Detainment is for the patients own health or safety, or protection of others
- Not enough time for a second doctor to attend (risk)
35
What is a Section 136 detainment?
Police section - person suspected of having a mental disorder in a public place
36
What is a Section 135 detainment?
Police section - needs court order to access patients home and remove them to a place of safety (unit or cell)
37
What is a Section 5(4)?
Patient already admitted (psych or general) but wanting to leave - nurses holding power until doctor can attend
38
How long can a Section 5(4) last for?
6hrs
39
What is a Section 5(2)?
Patient already admitted (psych or general) but wanting to leave - doctors holding power
40
How long can a Section 5(2) last for?
72hrs - allows time for S2/S3 assessment
41
What is the prevalence of schizophrenia?
Approx. 1%
42
What is schizophrenia?
A severe psychiatric disorder characterised by chronic or recurrent psychosis, consciousness and intellectual capacity are usually maintained
43
What is the cause of schizophrenia?
Multiple factors -> dysregulation of dopaminergic activity
44
Give 3 positive symptoms of schizophrenia
- Hallucinations
- Delusions
- Disorganised thought
- Disorganised speech
45
Give 3 negative symptoms of schizophrenia
- Flat affect
- Avolition
- Alogia
- Apathy
- Anhedonia
- Emotional and social withdrawal
- Catatonia
46
What is avolition?
Lack of motivation
47
What is alogia?
Lack of ideas to talk about
48
What is anhedonia?
Lack of pleasure in things previously enjoyed
49
What is catatonia?
Behavioural syndrome characterised by abnormal movements and reactivity to the environment
50
Give 3 risk factors for schizophrenia
- Stress
- Psychosocial factors
- Frequent cannabis use
- Family history
51
Give 5 first rank symptoms of schizophrenia
- Hearing thoughts spoken aloud
- 3rd person hallucinations
- Commentary hallucinations
- Somatic/visual/tactile hallucinations
- Thought withdrawal or insertion
- Thought broadcasting
- Delusional perception
- Feelings/actions "made or influenced" by external agents
52
What is schizotypal disorder?
Thinking, behaviour and affect similar to in schizophrenia, but no definite characteristic anomalies seen
53
What is schizoaffective disorder?
Affective and schizophrenic symptoms present but don't justify a diagnosis of either schizophrenia or affective disorder alone
54
What percentage of people with schizophrenia attempt suicide?
Approx. 50%
55
What are first generation antipsychotics?
D2 agonists that cause extrapyramidal side effects
56
Give an example of a first generation antipsychotic
Chlorpromazine
| Haloperidol
57
What are second generation antipsychotics?
5HT2A and D2 agonists, lower risk of extrapyramidal side effects but more metabolic side effects
58
Give 5 common side effects of antipsychotics
- Extrapyramidal - tremor, slurred speech, dystonia
- Hyperprolactinaemia -> sexual dysfunction
- Weight gain
- Diabetes mellitus
- CVD - stroke, postural hypotension, long-QT
59
Give an example of a second generation antipsychotic
Risperidone
Quetiapine
Clozapine
60
What is the most concerning side effect of clozapine?
Agranulocytosis
61
Give 3 risk factors for depression
Biological - genetics, personality, chronic illness, medication (BB, steroids), substance misuse
Psychological - life events, lack of education
Social - lack of support, low socio-economic status
62
What are the 3 core symptoms of depression?
- Low mood
- Anhedonia
- Fatigue
63
Give 3 "typical" symptoms of depression
- Poor appetite
- Disrupted sleep - early waking
- Psychomotor retardation
- Decreased libido
- Agitation
- Feelings of worthlessness, guilt or self-reproach
- Suicidal thoughts
64
Management of mild depression
Low intensity psychological interventions (e.g. computerised CBT) and education
65
Management of moderate depression
Combination of an anti-depressant and high intensity psychological intervention (IAPT -> group or individual CBT)
66
Management of severe depression
Rapid specialist mental health assessment, consider admission and ECT -> medication and therapy
67
Which antidepressant should be given as first line for depression?
SSRI - fluoxetine, citalopram or sertraline
68
Which SSRI should be tried first if the patient is under 18?
Fluoxetine
69
Which SSRI should be tried first if the patient has IHD?
Sertraline
70
Which antidepressant should be given as second line for depression?
A different SSRI - fluoxetine, citalopram and sertraline
71
Which antidepressant should be given as third line for depression?
Mirtazapine (NaSSA) or venlafaxine (SNRI)
72
Which antidepressant should be given as forth line for depression?
Keep trying different antidepressants until one works, consider older antidepressants
73
Give 3 common side effects of SSRIs
- Nausea, GI upset
- Headache
- Agitation
- Sexual dysfunction
74
What food can interact with MAO-Is and to cause hypertension?
Cheese
75
What are the main triad of symptoms in serotonin syndrome?
- Neuromuscular abnormalities
- Altered mental state
- Autonomic dysfunction
76
What is delirium?
An acute, transient and reversible state of confusion, usually with an organic cause
77
What are the 3 different types of delirium?
- Hypoactive - drowsy and withdrawn, often ignored
- Hyperactive - agitated and upset
- Mixed/fluctuating
78
Give 3 causes of delirium
- Constipation
- Infection
- Metabolic disturbance
- Stroke
- Medications
- Post-op
- Environmental changes
- Alcohol
- Hepatic or renal impairment
79
Give 5 signs of delirium
- Confusion
- Disorientation in time and place
- Hallucinations
- Delusions
- Reduced movement
- Agitation
- Uncooperative with reasonable requests
- Withdrawal
80
What are the components of a confusion screen?
- Vital signs
- CT head
- Bloods - FBC, U&Es, LFTs, TFTs, Ca, glucose, cultures, haematinics, coagulation
- Chest x-ray
- Urinalysis
81
Management of delirium
- Treat any organic cause
- Optimize supportive surroundings and nursing care
- Avoids sedatives
- Low dose haloperidol (lorazepam if PD)
82
Give 3 causes/triggers of a manic episode
- Medications - steroids, illicit substances
- Infection, stroke, neoplasm, metabolic disturbances
- Life events
83
What is bipolar type I?
Equal ratio of both mania and depression episodes
84
What is bipolar type II?
More episodes of depression, only mild hypomania
85
What is rapid cycling bipolar?
More than 4 episodes of depression and mania in a year
86
What is cyclothymia?
A mild form of bipolar disorder
87
Give 3 signs and symptoms of hypomania
- Symptoms for 4+ days
- Mildly elevated mood
- Increased energy
- Poor concentration
- Mild reckless behaviour
- Sexual disinhibition
- Increased talkativeness
- Increased confidence
- Decreased need for sleep
88
Give 3 signs and symptoms of mania
- Symptoms for >1 week
- Extreme elation
- Overactivity
- Pressure of speech
- Impaired judgement
- Extreme risk-taking behaviour
- Social disinhibition
- Grandiosity
- Psychosis
- Mood congruence/incongruence
89
What investigations should you do if a patient appears manic?
- CT head
- EEG
- Screen for drugs/toxins/infection
90
Give the 1st and 2nd line management of an acute manic episode
1st line - SGA (risperidone, clozapine)
| 2nd line - valproate/lamotrigine or lithium
91
Give 1st and 2nd line management of a depressive episode in a patient with bipolar affective disorder
AVOID ANTIDEPRESSANTS
1st line - SGA (risperidone, clozapine)
2nd line - add lamotrigine or lithium
92
Give 1st and 2nd line medications for general maintenance of bipolar affective disorder
1st line - lithium (requires good compliance and monitoring)
| 2nd line - valproate, anticonvulsants
93
What is anorexia nervosa?
Compulsive need to control eating and body shape, BMI <17.5
94
Give 3 behaviours that may exist in someone with anorexia
- Voluntary avoidance of food
- Self-induced vomiting
- Excessive exercise
- Appetite suppressant use
- Diuretics use
95
When is anorexia most commonly diagnosed?
Mid-adolescence
96
Give 3 risk factors for anorexia nervosa
- Genetics
- Psychological - depression, anxiety, OCD, low self-esteem
- Development - relatives attitudes to food
- Sociocultural - social media, image-aware activities, substance abuse
97
How is anorexia managed?
- Aim to restore nutritional balance, slowly build up feeds
- Treat complications of starvation
- Explore comorbidities
- Involve family/carers
98
Give 2 differentials for a suspected eating disorder
- Other mental health disorder
- GI problem, e.g. IBD
- Hypothalamic tumour
99
What is bulimia?
- Recurrent episodes of binge eating
- Regular use of mechanisms to overcome fattening effects of binges
- BMI <17.5
100
Give a risk factor for bulimia that is not a risk factor for anorexia
Urbanisation
101
How should bulimia be managed?
- Support
- Food diary
- Treat medical complications
- Antidepressants
102
What is the average age of onset of bulimia?
18yrs old
103
Give 5 signs or symptoms of an eating disorder
- Amenorrhoea > 3mths
- Constipation, bloating, abdo pain
- Headaches
- Fainting, dizziness
- Fatigue
- Palpitations
- Cold intolerance
- Dry skin, hair loss
- Polyuria, polydipsia
- Sore throat, dental enamel erosion
- Lanugo hair
104
What questionnaire is used to assess for an eating disorder?
SCOFF questionnaire
105
Give 3 red flag signs in someone with a suspected/confirmed eating disorder
- BMI<13
- Weight loss >1kg/wk
- Temperature <34.5
- BP <80/50
- Pulse <40bpm
- Deranged U&Es
- Long QT
106
What is circumstantiality?
The inability to answer a question without giving excessive, unnecessary detail - differs from tangentiality in that the person does eventually return the original point.
107
What is tangentiality?
Wandering from a topic without returning to it
108
What are neoligisms?
New word formations, which might include the combining of two words
109
What are clang associations?
When ideas are related to each other only by the fact they sound similar or rhyme
110
What is word salad?
Completely incoherent speech where real words are strung together into nonsense sentences
111
What is Knights move thinking?
A severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another
112
What is flight of ideas?
Thought disorder where there are leaps from one topic to another but with discernible links between them - feature of mania
113
What is perseveration?
The repetition of ideas or words despite an attempt to change the topic
114
What is echolalia?
The repetition of someone else's speech, including the question that was asked
115
What is confabulation?
Giving a false account to fill a gap in memory
116
What is somatic passivity?
Delusional belief that one is a passive recipient of bodily sensations from an external agency
