psychiatry Flashcards
symptoms of depression
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
symptoms of mania
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 speechsymptoms of mania
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
management of depression
SSRI - citalopram SNRI -venlafaxine if psychotic symptoms - lorazepam, olanzapine electroconvulsive therapy pscychotherapy
management of BPAD
acute with agitation - rapid acting antipsychotic (olanzapine) or benzodiazepine (lorazepam)
without agitation - mood stabiliser (lithium, valporate, carbamazepine, lamotrogine)
depression - lithium
CBT
psychotherapy
define bipolar affective disorder
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.
what are the first rank symptoms of schizophrenia
auditory hallucinations
delusions of thought interference
passivity phenomenon/delusion of control
delusional perception
what are some second rank symptoms of schizophrenia
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
how is schizophrenia diagnosed
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
management of schizophrenia
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
define a specific phobia
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
define a delusion
a belief that is not true/unlikely and cannot be explained by the persons cultural or religious beliefs
management options for specific phobias
phobic learning history
Stimulus exposure > anxiety >relaxation > decreased anxiety
Fear & Avoidance Hierarchy (FAH)
Subjective Units of Distress Scale (SUD)
manage of social phobia
CBT
SSRI
MAOI
short term: benzos, propranolol
define generalised anxiety disorder
Anxiety is free floating, not restricted to any circumstance.
drug management of generalised anxiety disorder
sertraline
venlafaxine
pregablin
non drug treatments for generalised anxiety disorder
relaxation training
exposure therapy
CBT
physical exercise
define panic disorder
several severe attacks of autonomic anxiety within a month
characterised by fear of death/suffocating and an urgent desire to flee
management of panic disorder
SSRI (fluoxetine)
CBT
anxiety and relaxation training
symptoms of anxiety
restlessness
sense of dread
difficulty concentrating
sweating
dry mouth
chest pain
define agoraphobia
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
management of agoraphobia
SSRIs
anxiolytics
CBT
behaviour therapy
define PTSD
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
Management of PTSD
trauma focused CBT
SSRI
tricyclics
EMDR (eye movement desensitisation and reprocessing)
symptoms of PTSD
flashbacks
nightmares
hyperarousal - anxiety, irritability, insomnia, numbness and emotional detachment
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)
management of OCD
CBT
ERP - exposure response prevention
SSRI
clomipramine (a TCA)
types of personality disorders
paranoid schizoid schizotypal antisocial borderline (emotionally unstable) histrionic narcissistic avoidant dependent OCD
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.
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
management of personality disorders
dialectical behaviour therapy
patient communication and relationship management strategies
low dose anti psychotics e.g. haloperidol
SSRI
psychotherapy
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
causes of learning disability
genetics: down’s. fragile x
infective: rubella (antenatal), meningitis, encephalitis (post natal)
trauma: birth asphyxia, head trauma
mental health disorders associated with learning diabilities
depression schizophrenia anxiety delirium and early onset dementia ADHD
triad of impairments in autistic spectrum disorder
qualitative impairment in reciprocal social interaction
poor communication
restricted, stereotyped and repetitive repertoire of interests and activates
physical health impairments associated with learning difficulties
GORD
epilepsy
hearing and vision impairment
heart abnormalities
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
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
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
withdrawal symptoms of benzodiazepines
agitation irritability diaphoresis nausea hallucinations
withdrawal symptoms of opiods
rhinitis lacrimation diaphoresis diarrhoea tachycardia
symptoms of delirium tremens
cognitive impairment hallucinations tremor tachycardia fever
substances that cause psychosis
alcohol, cannabis, ecstasy, cocaine
symptoms of psychotic disorder
vivid hallucinations
misidentifications
paranoid delusions
delusions of reference
management of opioid withdrawal
methadone
buprenorphine
management of amphetamines withdrawal
no effective pharmacological treatment
CBT and contingency management
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
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
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
define factitious MUS
they know they are producing the symptoms but they do not know why
management of MUS
CBT
anti depressants
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
define tokophobia
primary = fear of childbirth that pre-dated pregnancy secondary = fear after a traumatic or distressing delivery
consequences of post natal depression
poor mother child relationship may lead to delayed cognitive, social and emotional development, poor language skills
presentation of postpartum psychosis
mostly affective: elation and depression
delusions and hallucinations
confusion and perplexity
wide fluctuations in intensity of symptoms
risk factors for antenatal depression
maternal anxiety
life stress
domestic violence
unintended pregnancy
risk factors for postnatal depression
history of depression
lack of support
poor relationship with partner
Define ADHD
neurodevelopmental disorder in which symptoms of inattention, hyperactivity and impulsivity significantly interfere with daily functioning
Presentation of ADHD in children/adolescence
academic impairment
poor social interaction
smoking/alcohol/drug use
presentation of ADHD in adults
chaotic, disorganised lifestyle
conflicts at work (late, mistakes, etc.)
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
define bulimia nervosa
recurrent episodes of binge eating, with compensatory behaviours
and overvalued ideas about ‘ideal’ body shape and weight
define anorexia nervosa
wt loss leading to a body weight at least 15% below the normal or expected weight for age and height
what are the types of detentions under the mental health act
emergency detention (72hrs) short term detention (28 days) compulsory treatment order (6 months)
differential for depression
delirium/dementia
dysthymia
BPAD
negative symptoms schizophrenia
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
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
