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NP- Phase 3a Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is an illusion?

A

misconception of a real external stimulus

affect driven

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2
Q

what is a hallucination?

A

disorder of perception

  • experienced in the ABSENCE of external stimuli
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3
Q

types of hallucination

A
  • 2nd person auditory- talking to them
  • 3rd person auditory- talking about it
  • visual
  • olfcatory
  • hypnogogic (occur on falling asleep)
  • hyponopompic (occur on waking up)
  • autoscopic- visualising yourself
  • reflex- stimulation in one modality produces hallucination in another
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4
Q

what is a pseudo-hallucination?

A

perceptual experience which originates in space of own mind

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5
Q

what is a delusion?

A
  • disorder of thought

- a belief that if firmly held, not affected by rational argument or evidence, not a conventional belief

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6
Q

what is a persecutory delusion?

A

believing that you are going to be/ are being intentionally harmed

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7
Q

what are grandiose delusions?

A

inflated self-importance- e.g. belief that you are a god

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8
Q

what are delusions of reference?

A

certain events/ actions can have special significance (e.g. believing that black cars are following you)

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9
Q

what is a nihilistic delusion?

A

delusion of nothingness- believes they have no money, nothing inside of them etc

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10
Q

what is an ertomanic (De Clerambaults) delusion?

A

belives they are of a high social standing/ everyone is in love with them

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11
Q

what is a morbid jealousy/ orthello delusion?

A

delusion that a sexual partner is unfaithful, can lead to violence

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12
Q

what is a delusion of misidentification (Capgras)

A

delusion that a close relative has been replaced by an imposter

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13
Q

what is a cotard delusion?

A

belief they are dead/ do not exist

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14
Q

what is a folie a deux delusion?

A

shared delusion with someone else

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15
Q

what is an ekboms delusion?

A

delusion of infestation

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16
Q

what is psychosis?

A

a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

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17
Q

what is neurosis?

A

symptoms of stress (depression, anxiety, OCD etc) but no radical loss of touch with reality

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18
Q

what is passivity phenomena?

A

feeling that ones actions/ thoughts are not their own and are controlled by someone else

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19
Q

what is somatic passivity?

A

belief that they are a recipient of bodily sensations from an external force- e.g. someone else is making their arm hurt

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20
Q

what is catatonia?

A

significantly excited/ inhibited motor activity

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21
Q

what is stupor?

A

loss of activity with no response to stimuli

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22
Q

what is psychomotor retardation?

A

slowing of thoughts/ movements

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23
Q

what are some types of thought alienation?

A

o Thought Insertion
o Thought Withdrawal - someone/thing removing thoughts from head
o Thought Broadcast - thoughts made available to others
o Thought Echo
o Thought Block - abrupt stop in middle of thought - may not be able to continue idea

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24
Q

what is concrete thinking?

A

lack of abstract thinking

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25
Q

what is loosening of association?

A

lack of logical association between thoughts- incoherent speech

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26
Q

what is circumstantiality ?

A

going into ridiculous detail to make a point

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27
Q

what is perseveration?

A

repetition of a word, theme or action beyond the point of it being relevant/ appropriate

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28
Q

what is confabulation?

A

giving a false account to fill gap in memory

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29
Q

what is tangeliality?

A

wandering off topic

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30
Q

what is flight of ideas?

A

rapidly skipping from one thought to a distantly related idea

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31
Q

what is echolalia?

A

meaningless repetition of another persons spoken words

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32
Q

what are clang associations?

A

ideas that are linked by rhyme or the similarity of words

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33
Q

what is pressure of speech?

A

rapid speech with unusual associations

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34
Q

what is anhedonia?

A

inability to experience pleasure from activities that would normally cause this

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35
Q

what is incongruity of affect?

A

patients emotional response is grossly out of tune with the situation/subject- e.g. smiling when talking about death

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36
Q

what is a flat affect?

A

no emotion

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37
Q

what is blunting of affect?

A

reduced emotional expression/ response

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38
Q

what is Belle indifference?

A

relative lack of concern about the nature/ implication of the patients symptoms

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39
Q

what is depersonalisation?

A

detached from body- world has become vague/ dream like

can observe themselves

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40
Q

what is derealisation

A

external world feels unreal

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41
Q

what is conversion?

A

manifestation of mental illness as a physical order disease

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42
Q

what is dissociation?

A

disruptions in aspects of conciousness, identity, memory

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43
Q

what are mannerisms?

A

repeated involuntary movements that are goal directed

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44
Q

what is akathisia?

A

feeling of inner restlessness- rocking., marching on spot etc

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45
Q

what is tardive dyskinesia?

A

involuntary, repetitive jerky movement of head/ neck

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46
Q

what are pharmacokinetics?

A

what the body does to the drug

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47
Q

what are pharmacodynamics?

A

what a drug does to the body

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48
Q

what are ‘positive’ symptoms?

A

an excess or a distortion of normal functioning (delusions, hallucinations, disorganised speech/ behaviour, catatonic behaviour)

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49
Q

what are negative symptoms?

A

decrease/ loss of functioning (e.g. decreased emotions, loss of interest, flat affect, alogia)

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50
Q

what are some positive symptoms that can be seen in Schizophrenia?

A

delusions (usually persecutory), hallucinations, formal thought disorder

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51
Q

what are some negative symptoms that can be seen in Schizophrenia?

A

impairment of motivation and loss of volition

loss of awareness of socially appropriate behaviour/ social withdrawal

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52
Q

what are the first rank symptoms in schizophrenia?

A
  • 3rd person auditory hallucinations
  • delusional perception- delusions of passivity, influence or control
  • thought disorders- withdrawal, insertion, broadasting
  • passivity phenomenia
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53
Q

ICD-10 classification in schizophrenia

A

One or more of

  • 3rd person auditory hallucintion
  • Thought echo, insertion, withdrawal, broadcasting
  • Delusional perception
  • Passivity phenomena

Or two or more of

  • Any persistent hallucination
  • Catatonic behaviour - stupor, waxy flexibility
  • negative symptoms
  • breaks in train of thought
  • impaired sight
  • neologisms (making up words)
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54
Q

subtypes of schizophrenia

A

Paranoid- auditory hallucinations, no thought disorders, grandiose delusions

Hebephrenic- thought disorder and flat affect

catatonic- subject may be immobile

residual- 1 year of chronic negative symptoms which much have been preceded by at least one clear psychotic episode in the past

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55
Q

investigations in schizophrenia

A
  • U&E’s- rule out drug cause
  • LFT, FBC- rule out alcohol as a cause
  • serological test- rule out syphilis
  • CT head- brain lesion
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56
Q

what 4 things are assessed in a psychosis risk assessment?

A
  • risk to self
  • risk to others
  • risk from others
  • risk of criminal damage to property
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57
Q

epidemiology of Schizophrenia

A
  • 15/100,000
  • slightly more common in men
  • age of onset- late-teens/ mid- twenties, can be a bit later in women
  • increased prevalence in lower socio-economic classes
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58
Q

what are some motor symptoms seen in schizophrenia?

A
  • catatonic rigidity (maintaining a fixed position and resisting being moved)
  • catatonic posturing (adopting an unusual position for a period of time)
  • catatonic negativism (patients resist all instructions to move)
  • catatonic excitement (excitable motor activity with no external stimulus)
  • catatonic stupor (presentation of akinesis, mutism and extreme unresponsiveness)
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59
Q

how is schizophrenia caused?

A

excess dopamine

overactivity of neurones- mesolimbic- results in hallucinations and delusions

under activity fo neurones- mesocortical- blunted, anhedonia, apathy

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60
Q

what do mesolimbic and mesocortical mean?

A

mesolimbic= positive symptoms

mesocortical= negative symptoms

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61
Q

what are some extra-pyramidal side effects of the treatment of schizophrenia?

A
  • acute- acute dystonic reaction (muscle spasms)
  • few weeks- Parkinsonism
  • 6-60 days- akasthesia (inner restlessness)
  • long term use- tardive dyskinesia
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62
Q

how are the extra-pyramidal side effects of schiophrenia treatment treated?

A

procycladine

propanolol +/- cyproheptadine

tetrabenazine

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63
Q

in schizophrenia what is procycladine used for?

A

EPSE- treatment of acute dystonia/ parkinsonism

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64
Q

in schizophrenia what is propanolol/cyproheptadine used for?

A

EPSE- treatment of akathesia

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65
Q

in schizophrenia what is tetrabenazine used for?

A

EPSE- treatment of tardive dyskinesia

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66
Q

what 1st generation antipsychotics are used in schizophrenia?

A

haloperidol

chloropromazine

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67
Q

what are some atypical/ new antiphyscotics used in schizophrenia?

A

olanzapine, risperidone, quetiapine, clozapine

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68
Q

what are the main dopamine and serotonin receptors?

A

Dopamine- D2

serotonin- 5HT2a

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69
Q

what does dopamine inhibit?

A

prolactin

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70
Q

what are some symptoms of hyperprolactinaemia?

A
  • galactorrhoea
  • amenorrhoea
  • infertility
  • sexual dysfunction
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71
Q

which antipsychotics can cause weight gain?

A
  • all atypical

- clozapine/ olanzapine

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72
Q

side effects of clozapine

A
  • weight gain
  • agranulocytosis- high risk of infection
  • reduced seizure threshold
  • sedating
  • postural hypotension
  • extreme salivating
  • cardiomyopathy
  • toxic megacolon
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73
Q

which pathway causes excess proclactin?

A

tuberoinfundibulnar

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74
Q

which pathway causes movement disorders?

A

nigrostriatal

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75
Q

schizophrenia- signs and symptoms of neuroleptic malignant syndrome?

A
  • reduced activity
  • fever, altered mental status, muscle rigidity, autonomic dysfunction
  • signs- elevated creatine Kinase, raised WCC, metabolic acidosis
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76
Q

schizophrenia- what drugs can cause neuroleptic malignant syndrome?

A

haloperidol

chloropromazine

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77
Q

what is schizoaffective disorder?

A

presentation of both schizophrenic and mood (depressed/ mania) symptoms that present in the same episode of illness

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78
Q

what are the 3 ‘phases’ of schizophrenia?

A
  • prodromal- withdrawn
  • active- severe symptoms- positive
  • residual phase- cognitive symptoms
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79
Q

what is generalised anxiety disorder (GAD)?

A

anxiety that is generalised and persistent- not isolated to any specific environmental circumstance

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80
Q

what are some risk factors of GAD?

A
  • early/ middle age
  • more common in females
  • divorced/ separated
  • live alone
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81
Q

what are clinical features are needed for a diagnosis of GAD?

A

3 of:

  • restlessness
  • irritability
  • easily fatigued
  • difficulty concentrating
  • muscle tension
  • sleep disturbance

+4 symptoms of someone with anxiety (imagine typical patient- palpitations, increased HR, sweating, difficulty concentrating, numbness etc)

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82
Q

investigations in GAD

A
  • exclude physical illness- hyperthyroid, pheochromocytoma, cardiac disease
  • medication review- salbutamol, theophylline, corticosteroids
  • rule out withdrawl symptoms of alcohol and benzodiazepines
  • exclude PTSD, OCD, depression, schizophrenia, dementia, personality disorder
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83
Q

how is GAD managed?

A

1- lifestyle- exercise etc

2- low intensity psychological support, guided self help

3- CBT, medication

4- specialist input

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84
Q

what medications are used in GAD?

A

rapid response- benzodiazepines (lorazepam etc)

long-term- SSRI sertraline, clomipramine

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85
Q

what is a panic attack?

A

period of intense fear characterised by a group of symptoms that develop rapidly

dont last longer than 20-30 minutes

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86
Q

what is panic disorder?

A

recurrent panic attacks not secondary to substance misuse, medical conditions, another psychiatric disorder

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87
Q

what comorbidities can correlate with panic disorder?

A

agoraphobia
anxiety
bipolar

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88
Q

differential diagnosis of a panic attack

A
  • anxiety/ anxiety related disorders
  • substance/ alcohol misuse and withdrawal
  • mood disorder
  • psychiatric disorder secondary to a medical condition
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89
Q

management of panic disorder

A

1- recognition

2- primary care treatment- CBT, SSRI- sertraline, clomipramide

3- review and consideration to alt. treatment

4- review and referral to specialist mental health

5- care in specialist mental health services

90
Q

what is agoraphobia?

A

anxiety/ panic symptoms associated with places or situations where escape may be difficult/ embarrassing- this leads to avoidance of situation

91
Q

management of agoraphobia

A
  • SSRI’s
  • benzodiazepines
  • pshycological- exposure techniques, cognitive methods
92
Q

what is OCD?

A

obsessive compulsive disorder

obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the persons mind

compulsions are repetitive behaviours that the person feels a drive to perform

i.e.- the OBSESSION is being clean whereas the COMPULSION is washing their hands regularly

93
Q

Treatment of OCD

A
  • CBT- exposure and response prevention

SSRI- fluoxetine/ sertraline

TCA- Clomipramine

94
Q

difference between OCPD and OCD

A

OCPD= obsessive compulsive personality disorder- they’re okay with it

OCD- egodystonic (they do not like the obsessions and complusions)

95
Q

risk factors of PTSD

A 
low education 
lower social class
female
afro Caribbean/ hispanic 
FH 
previous traumatic events
96
Q

clinical features of PTSD

A
  • re-experiencing- flashbacks, nightmares etc
  • avoidance- avoiding people, situations and circumstances resembling the event
  • hyperarousal- sleep problems, hypervigiilance for threat, exaggerated startle response
  • emotional numbing
97
Q

treatment of PTSD

A
  • psychological- CBT, EMDR (eye movement desensitisation and reprocessing)
  • pharm- SSRI- sertralline
  • sleep disturbance- mirtazapine
98
Q

PTSD- diagnosis

A

ICD 10
symptoms arise within 6 months of event
symptoms present for at least 1 month

99
Q

what are neuroses?

A

class of functional mental disorders with chronic distress, in the absence of delusions and hallucinations

100
Q

what are the common causes of delirium?

A

PINCH ME

Pain
Infection/ intoxication
Nutrition (B12/thiamine def.)
Constipation
Hypoxia/hydration

Medication/drugs/substance abuse
Environmental

101
Q

clinical features of delirium

A
  • acute
  • fluctuating
  • inattention
  • reduced comprehension
  • disorientation
  • anterograde amnesia
  • labile affect
  • visual hallucination
  • paranoid delusions
102
Q

what are the 3 subtypes of delirium?

A
  • hypoactive
  • hyperactive
  • mixed
103
Q

differential diagnosis of delirium

A
  • dementia
  • alcohol withdrawal
  • mania
  • post-ictal
  • psychosis
  • anxiety
104
Q

how can delirium and dementia be determined from eachother?

A
  • onset- delirium= acute, dementia= gradual
  • pathology- delirium= outside brain, dementia= brain
  • course of disease- delirium= can improve, dementia= progressively worse
  • attention- delirium= impaired consciousness/ innattention, dementia= preserved conciousness
  • fluctuations- delirium= throughout day, dementia= minor
  • aetiology- delirium= secondary to something, dementia= normally primary except for lewy body and vascular
  • treatable?- delirium= yes, dementia= no
105
Q

investigations in delirium

A
  • bloods- FBC, U&E, LF, glucose, TFT
  • blood cultures (MC&S)
  • Blood gases
  • ecg
  • CT/ LP
  • CXR
106
Q

Management of delirium

A
  • treat precipitating course
  • support- sleep hygiene, side room, adequate lighting, clocks and calendars etc
  • sedation- haloperidol (if the pt does not have parkinsons!)- if they do, give lorazepam
107
Q

how long must symptoms of depression be present for a diagnosis?

A

everyday for 2 weeks

108
Q

what are the 3 core symptoms of depression?

A
  • low mood
  • low energy (anergia)
  • loss of enjoyment (anhedonia)
109
Q

give some clinical features of depression (pneumonic)

A

DEADSWAMP

Depressed mood most of day
Energy low
Anhedonia
Death thoughts (suicidal)

Sleep disturbance (insomnia)
Worthlessness/ guilt 
Appetite/ weight change
Mentation decreased (lack of concentration)
Psychomotor agitation/ retardation
110
Q

what are the criteria for defining depression?

A
  • mild- 2 core + 2 other clinical features
  • moderate- 2 core + 3+ other
  • severe- 3 core, 4+ others
111
Q

risk factors of depression

A
  • biopsychosocial
  • genetic
  • childhood experiences- abuse, loss of parent, lack of care
  • social- marriage problems, socio-economic status
  • chronic disease
  • personality- anxiety, obsessionality
112
Q

how is depression assessed?

A
  • PHQ-9= patient health questionnaire

- HADs= Hospital Anxiety and Depression scale

113
Q

management of mild depression

A
  • lifestyle- activity, sleep hygiene, reduce stress, CBT
114
Q

management of moderate depression

A

lifestyle, anti-depressants, CBT

115
Q

management of severe depression

A

specialist mental health assessment (consider inpatient admission), ECT- electroconvulsive therapy

116
Q

pharmacological management of depression

A

1st line- SSRI- fluoxetine, citalopram, sertraline

2nd- alterate SSRI

3rd:

  • NaSSA- mirtazapine
  • SNRI- velafaxine/ duloxetine

4th line:

  • TCA’s- amitryptilline, clomipramine
  • anti-cholinergic/ muscarinic
  • MAOIs- moclobemide
117
Q

what medication used in depression can cause QT prolongation?

A

Citalopram

118
Q

what medication used in depression can cause drowsiness and weight gain?

A

Mirtazapine (NaSSA)

119
Q

what 2 hormones are reduced in depression?

A

serotonin and noradrenaline

120
Q

what medication classes are used in the treatment of depression?

A
  • SSRI- selective serotonin reuptake inhibitor
  • SNRI- serotonin noradrenaline reuptake inhibitor
  • MOAI- monoamine oxidase inhibitors
  • TCA- tricyclic antidepressants
  • NaSSA= Noradrenergic and Specific Seritonergic Antidepressants
121
Q

summarise postpartum depression (presentation, screening, treatment etc)

A
  • peaks at 3 months
  • Edinburgh post natal depression scale to screen
  • Tx- reassurance and support, CBT, SSRI’s (sertraline/ paroxetine), tricyclics
122
Q

what are pharmacokinetics?

A

what the body does to the drug (absorption, distribution, elimination)

123
Q

what are pharmacodynamics?

A

what the drug does to the body

124
Q

what are the 4 key neurotransmitters in the brain

A

dopamine
serotonin
acetylcholine
glutamate

125
Q

treatment of neuroleptic malignant syndrome

A

bromocriptine- reduces dopamine blockade (dopamine agonist)

dantrolene (reduced muscle spasms)

126
Q

what can cause serotonin syndrome?

A

serotonergics (SSRI’s, MAOI’s, ecstasy)

127
Q

symptoms of serotonin syndrome

A

increased activity- clonus, hyperreflexia, tremor, muscle rigidity, dilated pupils

autonomic dysfunction- tachycardia and an unstable BP

acute onset

128
Q

what is seen in the bloods of a pt with serotonin syndrome?

A

elevated CK and WCC

derranged LFT’s

metabolic acidosis

129
Q

treatment of serotonin syndrome

A

cyproheptadine (5HT-2a antagonist)

benzodiazepines

130
Q

what are the features of dependence?

A
  • compulsion to drink
  • tolerance
  • difficulties controlling consumption
  • physiological withdrawal
  • neglect of alternatives
  • persistent use despite harm
131
Q

risk factors for dependence

A
  • men
  • low education
  • unemployment
  • younger age of usage
  • mental illness
  • peer pressure
  • low self esteem
  • high stress
  • FH
  • genetic susceptibility
132
Q

assessment of alcoholism

A

CAGE- ever been asked to Cut down?, do you get Annoyed when people criticise your drinking, do you feel Guilty? Eye-opener- i.e. drinking first thing in the morning etc?

audit

133
Q

what is the TWEAK assessment in alcoholism?

A 
Tolerance (>6 drinks, 2 points)
Worried (yes= 2 points)
Eye-opener ( 1 point)
Amnesia (1 point)
Cut Down (1 point)

> 3= problem with alcohol use

134
Q

consequences of alcoholism

A
  • liver damage
  • pancreatitis
  • diabetes
  • cancer
  • CNS disturbances- peripheral neuropathy

+ loads more

135
Q

how will a pt with alcoholism present on examination?

A
  • acute- vomiting, nausea, sweating, unsteady gait, ataxia, agitation
  • chronic- clubbing, hepatomegaly, spider naevi, palmar erythema, gynecomastia, dupuytrens
136
Q

investigations in alcoholism

A
  • raised MCV- macrocytic anaemia
  • B12 and folate deficiency
  • derranged LFT’s
137
Q

management of alcohol dependance

A
  • acomprosate to reduce cravings
  • disulfiram
  • naltrexone
  • CBT
138
Q

management of alcohol withdrawal

A
  • chlordiazepoxide
  • IV pabinex 5 dayss
  • thiamine 100mg
139
Q

symptoms of alcohol withdrawal

A
  • symptoms develop 6-12 hours after cessation
  • tremors
  • sweating
  • nausea/ vomiting
  • hyperacusis (sound sensitivity)
  • mood disturbance- anxiety
  • autonomic hyperactivity
140
Q

investigations in alcohol withdrawal

A
  • raised MCV- macrocytic anaemia
  • deranged LFTs- GGT, AST/ALT
  • thrombocytopenia- reduced platelets
141
Q

what is delirium tremens?

A
  • fatal form of alcohol withdrawal

- altered consciousness and marked cognitive impairment

142
Q

symptoms of delirium tremens

A
  • vivid hallucinations and illusions in any sensory modality
  • lilliputian- visual hallucinations of small humans/ animals
  • formications- insects crawling on skins
  • paranoid delusions
  • marked tremor
  • autonomic arousal- heavy sweating, raised pulse, raised BP
143
Q

what triad of symptoms is seen in Wernicke’s encephalopathy?

A
  • delirium
  • ocular signs (opthalmoplegia, mystagmus)
  • wide based gait ataxia
144
Q

how is Wernicke’s treated?

A

IV Pabrinex and chlordiazepoxide

145
Q

what causes Wernicke’s encephalopathy?

A

thimaine deficiency- most commonly seen in alcoholics

146
Q

what can untreated Wernicke’s lead to?

A

Korsakoff’s syndrome

147
Q

what is Korsakoff’s syndrome?

A

chronic state of thiamine deficiency

148
Q

triad seen in Korsakoff’s

A
  • anterograde amnesia
  • confabulation
  • psychosis
149
Q

treatment of Korsakoff’s

A

same as Wernicke’s- IV pabrinex and chlordiazepoxide

150
Q

symptoms of opiate intoxication

A
  • drowsiness
  • mood change
  • bradycardia
  • HTN
  • pupillary constriction
  • respiratory depression
  • decreased body temp
151
Q

symptoms of opiate withdrawal

A
  • muscle cramps
  • low mood
  • insomnia
  • agitation
  • diarrhoea
  • shivering
  • flu-like symptoms
152
Q

complications of opioid misuse

A
  • viral infection secondary to sharing needles- hiv, HEP b/c
  • bacterial infection- infective endocarditis, septic arthritis
  • overdose- respiratory depression and death
153
Q

management of:

  • opoid misuse
  • opioid dependance
A
  • misuse= IV naloxone

- if dependence- methadone and buprenophrine

154
Q

diagnostic criteria for anorexia

A
  • weight <85% predicted
  • BMI <17.5kg/m2
  • intense fear of gaining weight or becoming fat with persistent behaviour that interferes with weight gain
  • feeling fat when underweight
155
Q

clinical signs of anorexia

A
  • general- fatigue, decreased cognition, cold intolerance, altered sleep cycle
  • dental caries
  • CV- bradycardia, low BP, QT prolongation
  • dermatological- lanugo hair (fine downy hair), yellow skin, dry and brittle hair
  • GI- constipation
  • sexual health- subfertility and amenorrhoea
  • haemaotlogical- low WCC, low hb, low platelets
  • endocrine- low glucose etc
156
Q

what is the SCOFF questionarre?

A 
>2 indicates anorexia nervosa/ bulimia 
Sick (making yourself)
Control of eating lost
One stone loss in 3 months
Feel fat 
Food (dominates your life)
157
Q

red flags for anorexia

A
  • BMI <13 or below 2nd centile
  • weight loss >1kg/ week
  • temp <34.5
  • BP <80/50
  • Sa02 <92%
  • long QT, flat T
  • muscle weakness
158
Q

what is re-feeding syndrome?

A

drop in phosphate due to the rapid initation of food after >10 days of malnutrition

159
Q

clinical signs of re-feeding syndrome

A
  • rhabdomyolysis
  • respiratory/ cardiac failure
  • low bp
  • arrythmia’s
  • seizures
160
Q

management of re-feeding syndrome

A
  • slow re-feeding
  • thiamine/ vitamin B
  • monitor for low phosphate and potassium, high glucose and magnesium
161
Q

management of anorexia

A
  • restore nutritional balance
  • treat complications of starvation
  • involve family
  • admit if severe
  • psychological therapies
162
Q

what psychological therapies are offered to adults and children with anorexia?

A
  • Adults- ED-CBT (eating disorder focused CBT), MANTRA (Maudsley anorexia nervosa treatment for adults)
  • children- first line -anorexia focused family therapy, 2nd line- CBT
163
Q

what is bulimia?

A

recurrent episodes of binge eating with a preoccupation with the control of body weight.

regular use of mechanisms to overcome binging- vomiting, starvation, laxatives, excessive exercise

164
Q

clinical signs of bulimia

A

same as anorexia plus:

  • oesophagitis (due to vomiting)
  • Russell’s sign
  • oedema
  • gastric dilation
  • CM (due to laxatives)
  • metabolic alkalosis
165
Q

what is Russell’s sign?

A

callouses/ scars (excoriations) on the back of the knuckles and hands, due to repeated contact of the fingers with teeth during self-induced vomiting episodes

seen in bulimia

166
Q

management of bulimia

A
  • support
  • referral to EDU
  • SSRI’s- fluoxetine- can reduce binging and purges
167
Q

what is bipolar?

A

manic depression

requires at least 2 episodes, of which one must be mania/ hypomania for diagnosis

168
Q

what are the 3 subtypes of bipolar?

A

bipolar 1= mania+ depression, psychotic symptoms

Bipolar II= hypomania- more episodes of depression and no psychosis

Cyclothymia= cyclic mood swings with subclinical features

169
Q

features of mania (>1 week)

A
  • extreme uncontrollable elation
  • overactivity
  • pressure of speech
  • impaired judgement
  • extreme risk taking behaviour
  • social disinhibition
  • inflated self-esteem and grandiosity
  • psychotic symptoms
170
Q

features of hypomania (4+ days)

A
  • elevated mood
  • increased energy
  • increased talkativeness
  • poor concentration
  • mild reckless behaviour
  • overfamiliarity
  • sexual disinhibition
  • increased confidence
  • decreased sleep
171
Q

aetiology of bipolar disorder

A
  • female (commonly post-partum)
  • asylum seekers
  • LGBTQ+
  • traumatic life events
  • FH of depression, bipolar, suicide
  • substance/ alcohol abuse
  • serious/ chronic illness
172
Q

treatment of acute mania in bipolar

A

severe/ life threatening= ECT (electroconvulsive therapy)

lithium (max 2 weeks)

additional antiphyscotics/ benzo’s required:

  • risperidone
  • olanzapine
  • haloperidol
173
Q

long term treatment of bipolar

A

1st line:

  • lithium
  • check TSH, U&E’s and hydration status every 6 months

2nd line:

  • valporate// lamotrigine
  • CBT

ECT in severe mania

174
Q

what is lithium toxicity and describe its course?

A
  • levels >1.0mmol/L
  • sudden onset
  • course- tremor, hyperreflexia, seizures, heart block

also nausea, vomiting, ataxia, muscle weakness, nystagmus, dysarthria, impaired consciousness, hypotension, coma

175
Q

side effects of lithium in bipolar disorder

A
  • thirst, polyuria, polydipsia
  • weight gain
  • fine tremor
  • hypothyroidism
  • impaired renal function
  • T wave flattening/ inversion
176
Q

definition of personality disorders

A

a severe disturbance in the characterological condition and behavioural tendencies of an individual, usually involving several areas of the personality and nearly alway associated with considerable personal and social disruption

177
Q

what is required for a diagnosis of a personality disorder?

A

inhibition of functioning ! (work/relationships/ day to day life)

178
Q

risk factors for a personality disorder

A
  • sexual/ physical/ emotional abuse
  • neglect
  • bullied
  • early childhood trauma
  • truanting
  • deliberate self harm
179
Q

management of personality disorders

A
  • non pharmacological- dialectical behavioural therapy (DBT)
    CBT
    interpersonal therapy (IPT)

benzo’s can be used in short-term management

180
Q

what are the 3 clusters of personality disorders?

A

A- eccentric= paranoid (delusional), schizoid (socially withdrawn), schizotypical (distorted reality)

B- Flamboyant= borderline, dissocial, narcissistic, histrionic

C- Fearful/ anxious= avoidant, dependent, anakastic

181
Q

features of a cluster A paranoid personality disorder

A
  • sensitive/ easily offended
  • suspicious
  • self entitlement
  • unsubstantial conspirational explanations
  • distrusts loyalty
  • bears grudges
  • guarded/ defensive
182
Q

features of a cluster A schizoid personality disorder

A
  • no pleasure from activities
  • emotional coldness
  • indifferent to praise or criticism
  • little interest in sexual experiences
  • fantasises
  • solitary activities
  • indifferent/ solitary/ humourless
183
Q

features of a cluster A schizotypical personality disorder

A
  • social and interpersonal deficits
  • daydreaming
  • unusual perceptions
  • vague, circumstantial and suspicious
  • excess social anxiety
  • eccentric/ bizarre lifestyle
184
Q

features of a cluster B borderline personality disorder

A
  • act without regard to consequences
  • quarrelsome
  • anger outburst
  • self image uncertainty
  • unstable relationships
  • self harm
  • manipulative
185
Q

features of a cluster B dissocial personality disorder

A
  • unconcerned by feelings of others
  • irresponsibility
  • incapacity to maintain relationships
  • low tolerance to frustration, anger and violence
  • incapacity to feel guilt
  • prone to blame others
  • impulsive
186
Q

features of a cluster B narcissistic personality disorder

A
  • persuasive grandiosity
  • lack of empathy
  • preoccupied with fantasies
  • requires excessive admiration (sense of entitlement)
  • special and unique
  • envious of others
  • egotistical/ arrogant
187
Q

features of a cluster B histrionic personality disorder

A
  • self dramatisation
  • easily influenced
  • shallow and liable affectivity
  • preoccupied with physical attractiveness
  • inappropriately seductive
  • attention seeking
  • shallow/ vein/ dramatic
188
Q

features of a cluster C avoidant personality disorder

A
  • tense and apprehensive
  • inferiority complex
  • preoccupied with sense of rejection and criticism
  • unwillingness to get involved
  • avoidance of social and occupational activities
  • need for security
189
Q

features of a cluster C dependent personality disorder

A
  • allowing others to make important life decisions
  • subordination
  • unwilling to make demands
  • uncomfortable or helpless alone
190
Q

features of a cluster C anakastic (OCPD) personality disorder

A
  • rigid conformity to rules
  • perfectionism
  • inflexibility
  • everything has to go to their plan
191
Q

what is the difference between an avoidant and schizoid personality disorder?

A

schizoid voluntarily withdraw from social situations

avoidant- desire compannonshship but cant- afraid of rejection

192
Q

what are some secondary causes of insomnia?

A
  • narcolepsy
  • sleep apnoea
  • circadian rhythm disorders
  • parasomnia
  • stress
  • psych- depression, bipolar, GAD, PTSD
193
Q

management of insomnia

A
  • CBT
  • sleep hygiene advice- limit caffiene and alcohol, exercise, less screen use etc
  • short acting benzo’s- lorazepam, nitrazepam
194
Q

how is a patients suicide risk assessed?

A

SAD PERSONS

Sex (males)
Age (peaks at young and old)
Depression

Previous attempts 
Ethanol abuse (alcohol)
Rational thinking loss (schizo)
Support network less
Organised plans (note etc)
No significant others
Sickness

0-2- keep watch
3-4- send home but check up on
5-6- consider hospitalisation
7-10- definitely hospitalise

195
Q

how is a violent patient treated?

A

haloperidol (or lorazepam)

196
Q

for Section 3 of the mental health act, state the:

  • duration
  • reason
  • who it needs to be approved by
  • evidence required
A
  • duration= 6 months (can be renewed)
  • reason= treatment
  • approved by= 2 doctors (one s12) and 1 AMHP
  • evidence= mental disorder, safety and protection of themselves and others and appropriate treatment is available
197
Q

for Section 2 of the mental health act, state the:

  • duration
  • reason
  • who it needs to be approved by
  • evidence required
A
  • duration= 28 days (not renewed)
  • reason= assessment (treatment can be given without consent)
  • approved by= 2 doctors (one s12) and 1 AMHP
  • evidence= patient suffering from a mental disorder, detained for safety of themselves and others
198
Q

for Section 4 of the mental health act, state the:

  • duration
  • reason
  • who it needs to be approved by
  • evidence required
A
  • duration= 72 hours
  • reason=emergency order- used when waiting for 2nd doctor would cause undesirable delay
  • approved by= 1 doctor, 1 AMHP
  • evidence= mental disorder, safety of themselves and others, not enough time for 2nd doctor to attend
199
Q

for Section 5 (4)of the mental health act, state the:

  • duration
  • reason
  • who it needs to be approved by
  • evidence required
A
  • duration= 6 hours
  • reason= pt admitted but wanted to leave
  • approved by= nurse holding power
  • evidence= cannot be coercively treated
200
Q

for Section 5(2) of the mental health act, state the:

  • duration
  • reason
  • who it needs to be approved by
  • evidence required
A
  • duration= 72 hours
  • reason= allows time for section 2 or 3 to be completed
  • approved by= doctor holding power
  • evidence= cannot be coercively treated
201
Q

what is a section 135?

A

police section; used to detain a patient when they are in their own home, detained in order to complete section 2 or 3

202
Q

what is a section 136?

A

police section; used to detain a patient when they are in a public place, detained in order to complete section 2 or 3

203
Q

what are the 5 principles of the mental capacity act and who does it apply to?

A

anyone over 16

5 principles:

  • assume capacity
  • individual supported to make own decision
  • unwise decisions do not mean lack of capacity
  • best interests
  • least restrictive practice
204
Q

what does the capacity assessment test?

A
  • does the person have impairment or disturbance of mind or brain?

is the patient able to:

  • understand
  • retain
  • weigh up
  • communicate decision
205
Q

what is an IMCA?

A

independent mental capacity advocate

206
Q

what is an advanced statement?

A

written document stating the patients wishes should they lack capacity in the future

however this is not a legally binding document

207
Q

what are advanced decisions/ directives?

A

LEGALLY BINDING

stipulates person’s refusal of certain medical interventions/ must be signed when person has capacity

208
Q

what is the court of protection?

A

makes decisions if no lasting power of attorney

209
Q

what is a last power of attorney?

A

person to make decisions for the patient if they lack capacity in the future

210
Q

what are DOLS?

A

Deprivation of Liberty Safeguards

allows deprivation of someones liberty who lacks capacity in a hospital environment if it is in the patients best interest

211
Q

DD for dementia

A
  • the 4 types
  • Picks
  • Creutzfeldt-Jacob disease
  • Huntingtons
  • HIV
  • neurosyphillis
  • Wilson’s disease
  • normal pressure hydrocephalus
  • alcohol-induced dementia
212
Q

DD for psychosis

A
  • types of schizophrenia
  • persistent delusional disorder
  • schizoaffective disorder
  • puerperal psychosis
213
Q

DD for mood (affective) disorder

A
  • hypomania
  • mania
  • bipolar
  • persistent mood disorder
  • cyclothymia
  • baby blues
  • post natal depression
214
Q

What dietary restrictions are required for a pt taking a MOAI?

A

aged cheese
beer
red wine
smoked meat/ fish

215
Q

what medication can cause a hypertensive crisis and how is this treated?

A

MOAI’s

tx- phentolamine

216
Q

what are the ‘baby blues’?

A
  • type of depression
  • 3-7 days after birth
  • tearful, anxious, irritable
  • tx- reassurance and support
217
Q

what is puerperal psychosis?

A
  • occurs 2-3 weeks after giving birth
  • severe mood swings and disordered perception
  • requires hospital admission, antidepressants, and ECT
218
Q

features of alzehimers dementia

A
  • most common
  • difficulty remebering things (names, conversations etc)
  • apathy and depression
  • impaired communication, poor judgement, disorientation, confusion
  • aphasia, apraxia, agnosia
219
Q

features of vascular dementia

A
  • stepwise progression (due to multiple infarcts)
  • impaired judgement, decision making, planning and organisation
  • localising signs
220
Q

features of lewy body dementia

A

Parkinsons+ dementia

  • memory loss
  • visual hallucinations
  • parkinsonian movement features
  • fast onset
221
Q

features of frontotemporal dementia

A
  • change in personality- disinhibition, pacing, etc

- difficulty with language

222
Q

cognitive screening tools used in dementia

A
  • MMSE
  • MOCA
  • AMT
  • 6-CIT
  • Addenbrookes

NP- Phase 3a Medicine (22 decks)

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