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Systems > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Affective/Mood Disorders

A

Disorders of mental status and function where altered mood is a core feature

  • Depression
  • Mania
  • Bipolar disorder

Primary problem or secondary to other disorder (e.g. cancer, dementia, drug misuse, medical Tx - steroids)

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2
Q

Affective disorder features

A
  • Persistence of symptoms (>2 weeks)
  • Pervasiveness of symptoms
  • Degree of impairment
  • Presence of specific symptoms
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3
Q

Depression

A

Mental state characterised by:

  • Low mood
  • Loss of interest/enjoyment
  • Neurovegetative disturbance
  • Reduced energy causing social/occupational dysfunction
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4
Q

Depression Aetiology

A

Genetic-environment interaction

  • F > M
  • Stressors: unemployment, financial, relationships

Medical causes

  • Traumatic brain injury
  • Post-natal
  • TH abnormalities
  • Chronic conditions: cancer, stroke, diabetes, heart disease, arthritis, MS
  • Delirium
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5
Q

IC-10 Depression

  • Criteria
  • Severity
A

> 2 weeks
No mania
No psychoactive substance or organic mental disorder

General criteria:

  • Depressed mood (abnormal)
  • Loss of interest/pleasure
  • Decreased energy or increased fatigue

Additional criteria

  • Loss of confidence
  • Guilt
  • Thoughts of suicide
  • Decreased concentration
  • Agitation/retardation
  • Sleep disturbance
  • Change in appetite

Mild: total 4
Moderate: total 6
Severe (automatic severe if psychosis): total 8

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6
Q

Somatic syndrome

A

Cluster of depressive syndromes

  • Anhedonia
  • Lack of emotion
  • Waking 2 hours early
  • Worse in morning
  • Psychomotor changes
  • Marked loss of appetite/weight
  • Marked loss of libido
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7
Q

Depression measurement tools

A
  • SCID
  • SCAN
  • HDRS
  • BDI-II
  • HADS
  • PHQ-9
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8
Q

Depression management

A

Antidepressants (continue for further 6 months after successful)

  • SSRIs
  • TCAs
  • Monoamine oxidase inhibitors

Psychological treatments:

  • CBT
  • Interpersonal therapy
  • Psychotherapy
  • Family therapy

Physical treatments:

  • Electrocompulsive therapy (ECT)
  • Psychosurgery
  • DBC
  • VNS
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9
Q

Mania

A

Pathological mental state that causes unreasonable euphoria, very intense moods, hyperactivity and delusions

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10
Q

Mania features

A
  • Grandiose ideas
  • Disinhibition
  • Loss of judgement
  • Elated
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11
Q

IC-10 Hypomania

A
  • No psychosis
  • Mild elevation of mood for several days
  • Increased energy
  • Marked feeling of wellbeing
  • Increased sociability, talkativeness and overfamiliarity
  • Increased libido
  • Decreased sleep
  • Irritability
  • Reduced concentration
  • Creativity
  • Mild overspending
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12
Q

IC-10 Mania

A

Elevated hypomania symptoms

  • With or without psychosis
  • Severe enough to disrupt ordinary work and social activities
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13
Q

Mania measurement tools

A

Admission - safety

SCID, SCAN, YMRS (young mania rating scale)

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14
Q

Mania management

A

Antipsychotics

  • Olanzapine
  • Risperidone
  • Quetiapine

Mood stabilisers

  • Sodium valproate
  • Lamotrigine
  • Carbamazepine

Lithium
Benzodiazepines
ECT

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15
Q

Bipolar disorder

A

Repeated (2+) episodes of depression AND mania

  • Genetic link (young)
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16
Q

Cognitive Behavioural Therapy (CBT)

A

Focuses on how our thoughts relate to our feelings and behaviours

  • Identify, assess and change
  • Challenge unrealistic/unhelpful thoughts
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17
Q

Behavioural Activation

A

Focuses on avoided activities (depression)

- Activity scheduling

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18
Q

Interpersonal Therapy

A

Focuses on interpersonal events

  • Link depressive symptoms with IP event
  • Goal -> reduce symptoms and improve IP function
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19
Q

Motivational Interviewing

A

Promotes behaviour change in wide range of health care settings

  • More effective than advice giving/commanding
  • Indication: unmotivated patient
  • Prochaska and DiClemente stages of change: pre-contemplation, contemplation, planning/determination, action, maintenance
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20
Q

Phobic anxiety disorders

A

Stress response in a particular circumstance
- +/- anticipatory anxiety

  • Agoraphobia (leaving home)
  • Social phobia
  • Specific/isolated phobia (spiders, germs)
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21
Q

Anxiety disorders symptoms

A

Psychological arousal:

  • Nervousness
  • Fearful anticipation
  • Irritability

Autonomic arousal:

  • Palpitations
  • Sweating
  • Blushing (social)

Muscle tension:

  • Tremor
  • Headache

Hyperventilation, SOB
Sleep disturbance

Panic attack

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22
Q

Phobic anxiety disorder management

A
  • Education and advice
  • CBT
  • Antidepressants: SSRIs
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23
Q

Generalised anxiety disorder (GAD)

A

Stress response which occurs persistently (several months)
- Not confined to situation/object

  • Aetiology: stressor acting on predisposed personality (genetic and environmental factors)
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24
Q

Generalised anxiety disorder (GAD) Management

A
  • Counselling
  • Relaxation training
  • Antidepressants
  • CBT
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25
Q

Obsessive Compulsive Disorder (OCD)

A

Recurrent obsessions

  • Thoughts: unpleasant, distressing, not willed
  • Acts: not helpful, seen to prevent harm to self/others
  • Anxiety worsens with incompletion of tasks

Genetic: SHT receptor genes

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26
Q

OCD Management

A
  • Education and explanation
  • Antidepressants: SSRIs, TCAs
  • CBT
  • Psychosurgery
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27
Q

Post-Traumatic Stress Disorder (PTSD)

A

Delayed reaction to a stressor of exceptional severity
- E.g. combat, assault, disaster, or witness to above

Vulnerability factors:

  • Mood disorder
  • Previous trauma
  • Lack of social support
  • Female

Susceptibility partly genetic

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28
Q

Post-Traumatic Stress Disorder (PTSD) Features

A
  1. Hyperarousal
    - Persistent anxiety
    - Irritability
    - Insomnia
    - Poor concentration
  2. Re-experiencing phenomena
    - Intense, intrusive images
  3. Avoidance of reminders
    - Emotional blunting
    - Anhedonia
    - Cue avoidance
    - Recall difficulties
    - Diminishes interests
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29
Q

Post-Traumatic Stress Disorder (PTSD) Management

A

Screened (1/12 after)

Trauma-focused CBT

Eye Movement Desensitisation and Reprocessing (EMDR)

Medication: antidepressants (SSRIs, TCAs)

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30
Q

Legal Aspects

A 
Mental Health (Care and Treatment) (Scotland) Act 2003 
- Power to provide compulsory care for people with mental disorder (detention)

Adults with Incapacity (Scotland) Act 2000

Criminal Procedure (Scotland) Act 1995

31
Q

Detention criteria and duration

MH(C&T)(S)A2003

A

For any mental disorder with significant impairment of decision-making or risk to health and treatment is available.

  • Emergency - up to 72 hours
  • Short-term - up to 28 days
  • Compulsory Tx order - up to 6 months
  • Nurses - up to 3 hours
32
Q

Criminal Procedure (Scotland) Act 1995

A

Unfitness for trial

Diminished responsibility

  • Acquitted of offence if unable to appreciate nature of conduct due to mental disorder
  • Murder -> culpable homicide

Forensic sections

  • Assessment Order
  • Treatment Order
  • Compulsion Order
  • Restriction Order
33
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

- Antidepressant

A

Fluoxetine
- Block presynaptic serotonin reuptake

  • Side effects: GI upset, sexual dysfunction, anxiety, insomnia, fatigue, dizziness
  • Activation syndrome (agitation)
  • Discontinuation syndrome (flu-like)
34
Q

Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

- Antidepressant

A

Duloxetine
- Dual (serotonin and noradrenaline) reuptake inhibitor

Like TCA’s but less side effects.
Good for neuropathic pain

Side effects: increase DBP, nausea, QT prolongation, sexual dysfunction, discontinuation syndrome

35
Q

Tricyclic antidepressants

A

Amitriptyline
- Dual reuptake inhibitor

Side effects: antihistaminic, anticholinergic, antiadrenergic, QT prolongation, OD

36
Q

Monoamine Oxidase Inhibitors

- Antidepressant

A

Bind irreversibly to monoamine oxidase
- Prevent amine inactivation and increase synaptic levels of noradrenaline, dopamine, serotonin

  • Good for resistant depression
  • Side effects: hypotension, weight gain, dry mouth, sedation, sexual dysfunction, sleep disturbance
  • Hypertensive crisis
  • Serotonin syndrome
37
Q

Lithium

- Mood stabilisers

A

Testing and monitoring (3 months):

  • U&E
  • TSH
  • Pregnancy test
  • Serum: 0.6-1.2 (toxicity)

Side effects: GI, thyroid, renal, hair loss, acne, neurological

38
Q

Valproic acid (Depakote)

  • Mood stabilisers (anticonvulsant)
A

Another form of sodium valproate

  • Test (LFTs, FBC) and monitor
  • Side effects: thrombocytopenia, platelet dysfunction + similar to lithium
39
Q

Carbamazepine (Tegretol)

  • Mood stabilisers (anticonvulsant)
A
  • Test (LFTs, FBC, ECG) and monitor

- Side effects: rash, drug interactions, GI, neurological (sedation, dizziness, ataxia, confusion), AV conduction delays

40
Q

Lamotrigene (Lamictal)

  • Mood stabilisers (anticonvulsant)
A
  • Test (LFTs) and monitor

- Side effects: rash, drug interactions, GI, neurological

41
Q

Anxiolytics

A

Indications: anxiety, substance-related, insomnias

Buspirone
Benzodiazepines

42
Q

Typical antipsychotics

A

D2 dopamine receptor antagonists

  • Haloperidol
  • Loxapine
  • Fluphenazine
43
Q

Atypical antipsychotics

A

Serotonin-dopamine 2 antagonists
- Affect ^ in 4 dopamine pathways

  • Risperidone - extrapyramidal symptoms
  • Olanzapine
  • Quetiapine
  • Aripiprazole
  • Clozapine

Check bloods - fasting lipids and BG, LFTs, FBC

44
Q

Harmful alcohol use

A

Pattern of use causing damage to physical or mental health

- Use >1 month or repeatedly over 12 months

45
Q

Alcohol dependence syndrome

A

3 or more for >1 month or over 12 months

  • Craving
  • Difficulty controlling
  • Increased tolerance
  • Psychological withdrawal
  • Persistence despite harm
46
Q

Alcohol withdrawal symptoms

A
  • Tremor
  • Weakness
  • N+V
  • Anxiety
  • Seizures
  • Confusion
  • Agitation
  • Insomnia
  • Death
47
Q

Delirium Tremens

A
  • Profound, fluctuating confusion
  • Disorientation, impaired consciousness
  • Memory impairment
  • Psychosis
  • Tremor
  • Agitation
  • Sleeplessness
  • Autonomic over-activity
48
Q

Complications of alcohol misuse

A

Physical

  • Alcoholic fatty liver, acute alcohol hepatitis
  • Accident
  • Cancer
  • Seizures
  • Thiamine deficiency

Mental

  • Mood disorder
  • Sleep disruption
  • Alcoholic hallucinosis
  • Suicidal behaviour
  • Aggression

Relationships
Employment
Financial
Legal

49
Q

Alcoholism screening tools

A

CAGE (2 or >)

  • Cut down
  • Annoyed (criticised)
  • Guilty
  • Eye-opener

AUDIT
FAST
PAT

50
Q

Alcoholism Investigations

A
  • LFTs: GGT elevated
  • FBC: MCV elevated (macrocytosis)
  • Nutrient status
  • Imaging: cortical atrophy, ventricular enlargement
  • EEG
51
Q

Alcoholism Management

A

Education

  • Psychological: CBT, BA, group therapy
  • Social work
  • Community support: ADA
  • Medication: thiamine supplementation, benzos, Antabuse (deterrent), anti-craving
52
Q

Wernicke’s encephalopathy

A

Acute thiamine (B1) deficiency

  • Acute confusion
  • Ataxia
  • Ophthalmoplegia
  • Nystagmus

Management: supplementation (parenteral, oral)

53
Q

Korsakoff’s psychosis/

Acute amnesic syndrome

A

Thiamine deficiency

  • Marked impairment of anterograde memory (learning)
  • Disorientation
  • Cognitive impairment
  • Personality change, apathy, loss of initiative

Management: supplementation

54
Q

Physical aspect of addiction

  • Tolerance mechanisms
A

Reduced responsiveness to a drug caused by previous administration of many types of drugs. Develop dependence to prevent withdrawal symptoms.

Dispositional (less drug reaches active site)

  • Decreased absorption/ metabolism (-> active) rate
  • Increased metabolism (-> inactive)/excretion

Pharmacodynamic (drug has less action at active site)

  • Down-regulation of receptors
  • Reduced signalling of receptors
  • Other compensatory mechanism
55
Q

Psychological aspect of addiction

  • Reward pathway
A

Some drugs utilise reward pathway and increase dopamine levels
- May be a genetic variation for strength of reward centre

56
Q

Cocaine

  • Effects
  • Side effects
  • Withdrawal symptoms
A

Monoamine reuptake inhibitor
- Increases dopamine, serotonin and noradrenaline

Smoked, injected, snorted

  • Stimulant, euphoriant
  • Anaesthetic
  • Hypersensitive, alert, energy
  • Confidence, impaired judgement
  • Decreased appetite, tiredness
  • Anger (cocaethylene)

Side effects:

  • Damage to nose/airways
  • Seizures, stroke, confusion, paranoid psychosis
  • Respiratory failure
  • Cardiac arrhythmia, MI, hypertension

Withdrawal:

  • Depression
  • Irritability, agitation
  • Craving
  • Hyperphagia/somnia
57
Q

Amphetamine (speed)

A

Snorted, Swallowed, Injected

  • Stimulant
  • Similar to cocaine
58
Q

Heroin

A

Opioid agonist

Snorted, Smoked, Injected.

  • Analgesia
  • Emotional analgesia
  • Pin-point pupils, pruritis, sweating
  • Decreased libido, menstrual irregularities
  • Reduced cough reflex

Side effects:

  • N+V
  • Headache
  • Phlebitis (vein)
  • Endocarditis
  • Injection injuries and BBVs
  • Anorexia
  • Constipation
  • OD: respiratory depression

Withdrawal:

  • Craving
  • Insomnia, yawning
  • Muscle pain, cramps
  • Increased secretions (salivary, nasal, lacrimal)
  • Dilated pupils
  • Piloerection
59
Q

Naxolone

A

Opiate antagonist

60
Q

Methadone

A

Heroin substitute (longer half-life)

  • Decriminalises drug use
  • Normalise life
  • Reduces IV misuse
61
Q

Opiates

A
  • Heroin (dihydrocodeine)
  • Methadone
  • Benzos
  • Codeine
  • Morphine
62
Q

Schizophrenia

A

Severe mental illness affecting thinking, emotion and behaviour

ICD-10:
1 for > 1 month 
- Alienation of thought: echo, insertion, withdrawal, broadcasting
- Delusions
- Hallucinatory voices

Or 2 of

  • Hallucinations
  • Breaks in train of thought
  • Catatonic behaviour - excitement -> stupor
  • Negative symptoms
63
Q

Schizophrenia symptoms

A

Positive

  1. Hallucinations
    - 5 senses
    - Clarity of true perception
    - No external stimulus
    - Located in external space
  2. Delusional beliefs
    - Grandiose
    - Paranoid
    - Hypochondriacal
    - Self-referential
  3. Disordered thinking

Negative - worse prognosis

  • Apathy
  • Lack of interest
  • Lack of emotions - blunting, incongruity
64
Q

Schizophrenia aetiology

A

Unknown

Likely to be combination of physical, genetic, psychological and environmental factors

65
Q

Schizophrenia differential diagnosis

A
  • Delirium
  • Acute organic brain
  • Depressive/manic episode (severe)
  • Schizoaffective disorder
66
Q

Schizophrenia management

A
  • Education
  • Antipsychotic medication
  • CBT
  • Family therapy
67
Q

Personality disorder

A

Rigid/unhealthy patterns of thinking, functioning (emotions) and behaving.
- Interaction of genes and environment

68
Q

Cluster A personality disorders

A

Odd, eccentric thinking/behaviour

  • Paranoid
  • Schizoid
  • Schizotypal
69
Q

Cluster B personality disorders

A

Dramatic, overly emotional/ unpredictable thinking + behaviour

  • Borderline
  • Antisocial
  • Histrionic
  • Narcissistic
70
Q

Borderline Personality Disorder

A
  • Unstable and intense relationships - fear of being alone, distress when strained
  • Impulsive/risky behaviour
  • Unstable/fragile self-image
  • Problems controlling emotion
  • Ongoing feelings of emptiness

Management

  • Mentalization-Based Treatment (MBT)
  • Dialectical Behaviour Therapy (DBT)
71
Q

Antisocial Personality Disorder

A
  • Persistent criminal conduct and remorselessness
  • Difficulty with empathic concerns
  • Antisocial behaviours
  • Difficulty controlling impulse/anger

Management
- CBT

72
Q

Cluster C personality disorders

A

Anxious, fearful thinking + behaviour

  • Avoidant
  • Dependent
  • Obsessive compulsive
73
Q

Personality Disorder management

A
  • Group psychotherapy
  • Community mental health team
  • Medication: antidepressants, mood stabilisers, antipsychotics, anti-anxiety
74
Q

Psychiatric disorders in child

- Aetiology

A
  1. Genetics
    - Intra-uterine and perinatal factors
  2. Biological processes
    - White matter connectivity
    - Grey matter gyrification
  3. Life experiences (environmental factors)
    - Psychological: toxic stress, attachment
    - Social: emotion and empathy sharing

Systems (9 decks)

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