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psychiatry Flashcards

1
Q

symptoms of depression

A 
A SAD FACES
appetite (loss/gin)
sleep (insomnia/hypersomnia)
anhedonia
dysphoria
fatigue
agitation or retardation
concentration (diminished ability of)
esteem (feeling of guilt or worthlessness)
suicide/self harm
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2
Q

symptoms of mania

A 
FIDGET
flight of ideas
insomnia
distractability
grandiose ideas and inflated self esteem
energy
 - enhanced libido  -often leading to disinhibition 
    and inappropriate behaviour
 - impaired judgement/poor decision 
      making/gross over spending
talkativeness - rapid pressured speech
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3
Q

symptoms of mania

A 
FIDGET +/- psychosis
flight of ideas
insomnia
distractibility
grandiose ideas and inflated self esteem
energy (enhanced libido, impaired judgment/poor decision making/gross over spending
talkativeness - rapid, pressured speech
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4
Q

management of depression

A 
SSRI - citalopram
SNRI  -venlafaxine
if psychotic symptoms - lorazepam, olanzapine
electroconvulsive therapy
pscychotherapy
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5
Q

management of BPAD

A

acute with agitation - rapid acting antipsychotic (olanzapine) or benzodiazepine (lorazepam)
without agitation - mood stabiliser (lithium, valporate, carbamazepine, lamotrogine)
depression - lithium
CBT
psychotherapy

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6
Q

define bipolar affective disorder

A

Bipolar disorder is a recurrent and sometimes chronic mental illness marked by alternating periods of abnormal mood elevation and depression associated with a change or impairment in functioning.

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7
Q

what are the first rank symptoms of schizophrenia

A

auditory hallucinations
delusions of thought interference
passivity phenomenon/delusion of control
delusional perception

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8
Q

what are some second rank symptoms of schizophrenia

A

hallucinations
negative symptoms (apathy, anergia, anhedonia)
change in personal behaviour (loss of interest, aimlessness, social withdrawal)
incoherent/irrelevant speech
catatonia - stupor, waxy flexibility, mutism, negativism

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9
Q

how is schizophrenia diagnosed

A

at least 1 first rank symptom or 2 second rank symptoms clearly present for at least the majority of the time for the past month

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10
Q

management of schizophrenia

A

first episode - benzodiazepine e.g. lorazepam
long term
atypical antipsychotics (mixed dopamine and serotonin antagonist) e.g. clozapine, olanzapine, haloperidol
CBT
family therapy
dynamic psychotherapy

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11
Q

define a specific phobia

A

anxiety provoked by specific situation or objects which are perceived to be more dangerous than they actually are and leads to anticipatory anxiety and avoidance

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12
Q

define a delusion

A

a belief that is not true/unlikely and cannot be explained by the persons cultural or religious beliefs

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13
Q

management options for specific phobias

A

phobic learning history
Stimulus exposure > anxiety >relaxation > decreased anxiety
Fear & Avoidance Hierarchy (FAH)
Subjective Units of Distress Scale (SUD)

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14
Q

manage of social phobia

A

CBT
SSRI
MAOI
short term: benzos, propranolol

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15
Q

define generalised anxiety disorder

A

Anxiety is free floating, not restricted to any circumstance.

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16
Q

drug management of generalised anxiety disorder

A

sertraline
venlafaxine
pregablin

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17
Q

non drug treatments for generalised anxiety disorder

A

relaxation training
exposure therapy
CBT
physical exercise

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18
Q

define panic disorder

A

several severe attacks of autonomic anxiety within a month

characterised by fear of death/suffocating and an urgent desire to flee

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19
Q

management of panic disorder

A

SSRI (fluoxetine)
CBT
anxiety and relaxation training

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20
Q

symptoms of anxiety

A

restlessness
sense of dread
difficulty concentrating

sweating
dry mouth
chest pain

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21
Q

define agoraphobia

A

an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape

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22
Q

management of agoraphobia

A

SSRIs
anxiolytics
CBT
behaviour therapy

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23
Q

define PTSD

A

a delayed response disorder that arises within 6 months of experiencing stressful event/trauma of an exceptional threatening or catastrophic nature
characterised by flashbacks and nightmares

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24
Q

Management of PTSD

A

trauma focused CBT
SSRI
tricyclics
EMDR (eye movement desensitisation and reprocessing)

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25
symptoms of PTSD
flashbacks nightmares hyperarousal - anxiety, irritability, insomnia, numbness and emotional detachment
26
define OCD
recurrent intrusive thoughts, images, ruminations, and impulses that are ego syntonic (acknowledged as unreasonable or excessive, and there are attempts to resist) resulting in compulsions (ritualistic motor acts)
27
management of OCD
CBT ERP - exposure response prevention SSRI clomipramine (a TCA)
28
types of personality disorders
``` paranoid schizoid schizotypal antisocial borderline (emotionally unstable) histrionic narcissistic avoidant dependent OCD ```
29
borderline personality disorder
Instability of interpersonal relationships, self-image, and impulsivity; intense anger and affective instability; recurrent suicidal behaviour/gestures; impulsive behaviour with potential for self-harm.
30
antisocial personality disorder
Disregard for and violation of rights of others beginning at age 15; impulsivity; deceitfulness; lack of remorse; engages in acts that are illegal or show disrespect for social norms
31
management of personality disorders
dialectical behaviour therapy patient communication and relationship management strategies low dose anti psychotics e.g. haloperidol SSRI psychotherapy
32
define learning disability
life long condition with 3 aspects: 1) reduced ability to understand new/complex information or to learn a new skill 2) reduced ability to cope independently 3) a condition which started before age 18 with a lasting effect on the individual's development
33
causes of learning disability
genetics: down's. fragile x infective: rubella (antenatal), meningitis, encephalitis (post natal) trauma: birth asphyxia, head trauma
34
mental health disorders associated with learning diabilities
``` depression schizophrenia anxiety delirium and early onset dementia ADHD ```
35
triad of impairments in autistic spectrum disorder
qualitative impairment in reciprocal social interaction poor communication restricted, stereotyped and repetitive repertoire of interests and activates
36
physical health impairments associated with learning difficulties
GORD epilepsy hearing and vision impairment heart abnormalities
37
describe the spectrum of substance misuse
recreational use acute intoxication ( recovery is usually complete, impaired judgment, euphoria/dysphoria, reduced/heighted consciousness) harmful substance use (damage to the physical or mental health of the user) dependence syndrome
38
define dependence syndrome
use of the substance takes on a much higher priority for a given individual than other behaviours that once had greater value - the desire to take such substance is often strong and overpowering
39
diagnosis of dependence syndrome
3 or more of the following 5: desire or sense of compulsion difficulty in controlling substance taking behaviour evidence of tolerance neglect of alternative pleasures or interests use despite clear evidence of overtly harmful consequences
40
withdrawal symptoms of benzodiazepines
``` agitation irritability diaphoresis nausea hallucinations ```
41
withdrawal symptoms of opiods
``` rhinitis lacrimation diaphoresis diarrhoea tachycardia ```
42
symptoms of delirium tremens
``` cognitive impairment hallucinations tremor tachycardia fever ```
43
substances that cause psychosis
alcohol, cannabis, ecstasy, cocaine
44
symptoms of psychotic disorder
vivid hallucinations misidentifications paranoid delusions delusions of reference
45
management of opioid withdrawal
methadone | buprenorphine
46
management of amphetamines withdrawal
no effective pharmacological treatment | CBT and contingency management
47
define medically unexplained symptoms
symptoms for which no medical cause can be found either due to it being unknown, uncertain or disputed does not necessarily imply the cause is psychological e.g. stress headaches
48
define somatoform MUS
any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general medical condition
49
define malingering MUS
Malingering is falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job
50
define factitious MUS
they know they are producing the symptoms but they do not know why
51
management of MUS
CBT | anti depressants
52
red flags in perinatal depression
change in mental state/new symptoms new thoughts of self harm new or persistent expression of incompetency as a mother
53
define tokophobia
``` primary = fear of childbirth that pre-dated pregnancy secondary = fear after a traumatic or distressing delivery ```
54
consequences of post natal depression
poor mother child relationship may lead to delayed cognitive, social and emotional development, poor language skills
55
presentation of postpartum psychosis
mostly affective: elation and depression delusions and hallucinations confusion and perplexity wide fluctuations in intensity of symptoms
56
risk factors for antenatal depression
maternal anxiety life stress domestic violence unintended pregnancy
57
risk factors for postnatal depression
history of depression lack of support poor relationship with partner
58
Define ADHD
neurodevelopmental disorder in which symptoms of inattention, hyperactivity and impulsivity significantly interfere with daily functioning
59
Presentation of ADHD in children/adolescence
academic impairment poor social interaction smoking/alcohol/drug use
60
presentation of ADHD in adults
chaotic, disorganised lifestyle | conflicts at work (late, mistakes, etc.)
61
management of ADHD
stimulants (DA and NA reuptake inhibitors) 1st line = methylphenidate 2nd line = Dexamphetamine both available as immediate or slow releases non-stimulants (NA Reuptake Inhibitor) Atomoxetine
62
define bulimia nervosa
recurrent episodes of binge eating, with compensatory behaviours and overvalued ideas about ‘ideal’ body shape and weight
63
define anorexia nervosa
wt loss leading to a body weight at least 15% below the normal or expected weight for age and height
64
what are the types of detentions under the mental health act
``` emergency detention (72hrs) short term detention (28 days) compulsory treatment order (6 months) ```
65
differential for depression
delirium/dementia dysthymia BPAD negative symptoms schizophrenia
66
MoA of SSRIs and TCA
SSRI: Inhibition of reuptake of serotonin at the serotonin reuptake pump of the synaptic cleft therefore increasing circulation levels TCA: Stops the reuptake of monoamines by binding to monoamine pump at pre-synaptic cleft The reduced reuptake of norepinephrine and/or serotonin combats depression
67
side effect of antipsychotic
metabolic syndrome (wt gain, insulin resistance, dyslipidaemia), seizures myocarditis, Extra pyramidal side effects (dystonia, parkinsonism, akathisia, tardive dyskinesia) due to antagonizing dopamine D2 receptors

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