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Psychiatry Flashcards

1
Q

Name 5 perceptual symptoms

A 
illusion 
hallucination 
delusion 
delusional perception 
over valued idea
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2
Q

PHENOMENOLOGY

What is a mental disorder

A

Any disorder or disability of the mind excluding substance abuse - drugs and alcohol

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3
Q

PHENOMENOLOGY

Define psychosis

A

Severe mental disturbance charecterised by loss of contact with external reality

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4
Q

PHENOMENOLOGY

Define neurosis

A

Relatively mild mental illness in which there is no loss of connection with reailty

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5
Q

PHENOMENOLOGY

Define phenomenology

A

Study of signs and symptoms describing abnormal states of mind

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6
Q

PHENOMENOLOGY

Define illusion

A

False perception of a real external stimulus

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7
Q

PHENOMENOLOGY

Define hallucination

A

Perception in the absence of an external stimulus

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8
Q

PHENOMENOLOGY

What are the different types of auditory hallucinations

A

2nd person - Voices speak directly to the patient
You are a bad person

3rd person - Runnin commentary
Voices discuss what the patient has been doing

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9
Q

PHENOMENOLOGY

In terms of hallucinations what are the main sesnses

A 
Visual 
auditrory 
tactile 
gustatory 
olfactory
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10
Q 
PHENOMENOLOGY
In terms of halluciantions what are.. 
i) Reflex 
ii)Extracampine 
iii) Hypnagoic 
iiii)Hypnopompic
A

i) Stimulus in one sensory modality produces a sensory experience in another

ii) Hallucination that is outside the limits of the sensory fields
Eg: Hears voices talking in paris when they are in Sydney

iii) Occur when subject is falling asleep
iiii) Occur when subject is waking up

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11
Q

PHENOMENOLOGY

What are disorders reflex hallucinations commonly found in and give an example

A

Canabis and LSD poisoning

Eg: writing on a piece of paper but you can feel the scratching on the heart

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12
Q

PHENOMENOLOGY

What is Charles bonnet syndrome and what conditions can it be seen in

A

Visual hallucinations caused by the brain’s adjustment to significant visual loss.
Patient understands that the hallucinations aren’t real

  • Macular degeneration
  • Diabetic retinopathy
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13
Q

PHENOMENOLOGY

Define pseudo-hallucination

A

A perception in the absence of an external stimulus experienced in one’s subjective inner space of the mind rather than external sensory objects - Patients have insight

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14
Q

PHENOMENOLOGY

Define over-valued idea

A

A false or exaggarated belief held with conviction but not with delsuional intensity
This idea although resonable dominates their life and causes distress

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15
Q

PHENOMENOLOGY

Define delusion

A

False belief that is firmly maintained in spite of inconvertible evidence to the contrary.
It’s out of keeping with the patient’s social and cultural background

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16
Q

PHENOMENOLOGY

What are primary and secondary delusions

A

Primary - Direct result of psychopathology

Secondary - Arise from some other morbid experience or in response to other primary psychiatric condition

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17
Q 
PHENOMENOLOGY
In terms of delusions what are...
i) Persecutory 
ii) Grandiose 
iii) Nihilisitc 
iv) Guilt
A

i) Belief that someone is trying to inflict harm on them
ii) Belief that the patient is powerful / crucially important beyond truth
iii) Belief involving intense feeling of emptiness, patient denies the existence of their body and mind
iv) Ungrounded feelings of remorse for situations

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18
Q

PHENOMENOLOGY

Name 2 delusional misidentification syndromes

A

Capgras

Fregoli

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19
Q

PHENOMENOLOGY

What are Cpagras delusions

A

Delusions that a close friend / relative has been replaced by an imposter

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20
Q

PHENOMENOLOGY

What are fregoli delusions

A

Delusion that a stranger is someone they know is in disguise

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21
Q

PHENOMENOLOGY

What are cotard delusions

A

Nihilisitic delsuions that body parts are misssing/person is dead / parts are rotting

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22
Q

PHENOMENOLOGY

What is a delusional perception

A

A primary delusion of 2 componenets
Normal perception is sunject to delusional interpretation
Eg: Traffic light changed red so that means I am son of God

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23
Q

PHENOMENOLOGY
What is thought alienation?
What are the 3 components of this?

A

Sx of psychosis in which a patient feels their thoughts are no longer in their control

Thought insertion

though withdrawal

Thought broadcast - Delusional belief that thoughts are accesible to others without expressing them

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24
Q

PHENOMENOLOGY

What is concrete thinking

A

Loss of ability to understand abstract concepts and metaphorical ideas
Leads to a strictly literal form of speech

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25
Q 
PHENOMENOLOGY
In terms of thought disorders, what is....
i) Flight of ideas 
ii) Pressured speech 
iii) Poverty of speech alogia
A

i) Thoughts follow eachother rapidly causing abrupt leaps between topics. Connection between successive thoughts due to chance factor
ii) Rapid speech without pauses that is difficult to interrupt
iii) Speech lacking i content or amount

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26
Q 
PHENOMENOLOGY
In terms of thought disorders what is...
i) circumstantiality 
ii) Preservation
iii) thought block
A

i) Irrelevant wandering in a conversation - going around the point
ii) Repetition of a word, theme or action beyond that point at which it was relevant
iii) sudden interruption in the train of thought, leaving a blank

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27
Q

PHENOMENOLOGY

What is loosening of associations

A

A lack of logical association between sequential thoughts often leading to incoherent speech, impossible to follow train of thought

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28
Q 
PHENOMENOLOGY
In terms of thought disorders 
What is... 
i) neologisms 
ii )incoherence / word salad 
iii) povery of thought
A

i) making up new words
ii) confused mixture of seemingly random words and phrases
iii) Subjective expereince of being devoid of thoughts

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29
Q

PHENOMENOLOGY

What is passivity phenomena

A

Feeling that ones actions / thoughts are not their own but are controlled by someone else

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30
Q

PHENOMENOLOGY

What is somatic passivity

A

Delusional belief that one is a passive recipient of bodily sensations from an external agency e.g. the devil is making my arms itch

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31
Q

PHENOMENOLOGY

What is psychomotor retardation and what conditions would you find it in?

A

Slowing of thoughts and movements with decreased spontaneous movements

Parkinons disase
depression

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32
Q

PHENOMENOLOGY

Define anhedonia

A

Inability to experience pleasure form activities usually found enjoyable

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33
Q

PHENOMENOLOGY

Define apathy

A

Lack of interest, enthusiasm or concern

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34
Q

PHENOMENOLOGY

Define incongruity of affect

A

Emotional responses which don’t match the situation

Eg: smiling even though they’re upset when someone dies

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35
Q

PHENOMENOLOGY

Define blunting of affect

A

A limited range of normal emotional responsiveness

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36
Q

PHENOMENOLOGY

Define depersonlisation

A

When a person feels detached from themselves

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37
Q

PHENOMENOLOGY

Define derealisation

A

Person expereinces detachment from the world around them

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38
Q

PHENOMENOLOGY

Define obsession

A

Repetitive irrationsl thoughts / impulses which are intrusive and persistent despite efforts to resist.
Insight preserved - Recgonised as own thoughts

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39
Q

PHENOMENOLOGY

Define compulsions

A

Repetitive purposeful behaviour performed in response to an obsession to reduce anxiety

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40
Q

PHENOMENOLOGY

Define catatonia

A

Abnormality of movement and behaviour arising from a disturbed mental state
Eg: Echolalia

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41
Q

PHENOMENOLOGY

Define conversion

A

Development of features suggestive of physical illness without a physical cause

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42
Q

PHENOMENOLOGY

Define belle indifference

A

A suprising lack of concern for / denial of apparently severe functional disability

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43
Q

PHENOMENOLOGY

Define mannerism

A

Repeated involuntary movements

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44
Q

PHENOMENOLOGY

Define confabulation

A

Giving a false account to fill in a gap of memory

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45
Q

PHENOMENOLOGY

What is made, acts and feelings

A

Something is making you act something out, feel something, or drive you to do something

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46
Q

MENTAL HEALTH ACT 1983

What are the main principles of the MHA? (5)

A 
Minimise impact of of mental illness on individual 
Maximise patient and others safety 
Minimise restrictions on liberty 
Effectiveness of treatment 
Respect for pateints wishes and feelings
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47
Q

MENTAL HEALTH ACT 1983

What is the MHA and where does it apply to?

A

Provides legal framework for assessment and treatment of people with a mental disorder

England
Wales

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48
Q

MENTAL HEALTH ACT 1983

What does an individual have to show in order to be sectioned

A
  • Evidence of MH disorder
  • Evidence they’re a risk to themselves or others and treatment is in the interests of safety
  • Appropriate treatment must be available
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49
Q

MENTAL HEALTH ACT 1983

i) What is a S12 approved Dr
ii) What is an AMPH

A

i) Doctor with expertiese in treatment and assessment of mental health disorders
ii) Health proffesional with specialist non medical skills in mental health assessment and law

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50
Q

MENTAL HEALTH ACT 1983

Who can remove a section?

A

Consultant psychiatrust

MH review tribunal if patient disagrees with section

Nearest relative can make an order to discharge patient from hospital with 72hr written notice

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51
Q

MENTAL HEALTH ACT 1983

What is the: Purpose, duration, location and proffesionals involved in a Section 2?

A

P - Admission for assesment but treatment can be given without consent

D - 28d (Non-renewable)

L - Anywhere in community

P - 2Drs (1x S12), 1 AMHP

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52
Q

MENTAL HEALTH ACT 1983

What is the: Purpose, duration, location and proffesionals involved in a Section 3?

A

P - Admission for treatment

D - 6 months (Renewable)

L - Anywhere in community

P - 2 doctors (1 x S12) + AMHP

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53
Q

MENTAL HEALTH ACT 1983

What is the: Purpose, duration, location and proffesionals involved in a Section 4?

A

P - Emergency order
Waiting for second doctor would lead to undesirable delay

D - 72hrs

L - Anywhere in community

P - 1 S12 doctor and AMHP

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54
Q

MENTAL HEALTH ACT 1983

Where can you apply a section 5 and what cannot be done to a patient on a section 5?

A

Voluntary patient in hospital that wants to leave - Not A+E

Cannot co-ervively treat a patient but provides legal framework to restrain

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55
Q

MENTAL HEALTH ACT 1983

What is the: Purpose, duration, location and proffesionals involved in a Section 5 (2)?

A

P - Drs holding power allowing for S2/3 assesment

D - 72hrs

Proffesionals - 1 Dr
Usually the one in charge of their care

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56
Q

MENTAL HEALTH ACT 1983

What is the: Purpose, duration, location and proffesionals involved in a Section 5(4)?

A

P - Nurses holding power until Dr can attend to assess

D - 6hrs

Proffesionals - 1 registered nurse

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57
Q

MENTAL HEALTH ACT 1983
What are the 2 police sections and what are their differences?
what is the duration and purpose of these?

A

S135 -
Court order to access patient’s home and move to place of safety for MHA Assesment.
Applied through magistrates court by social worker - Required to accompany police

S136 -
D - >72hrs
Allows police to arrest a person suspecte dof having a mental disorder in a public space and moved to a place of safety

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58
Q

SOMATISATION DISORDER
What is somatisation disorder?

How many years do symptoms have to be present for a diagnsis?

A

Psychiatric disorder in which patients experience psychological distress in the form of multiple and incosistent MUS

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59
Q

SOMATISATION DISORDER

What is a patient with somatisation disorder reluctant to do?

A

Accept reassurance despite negative test results

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60
Q

SOMATISATION DISORDER

How does a patient with a somatisation disorder present?

A
  • No specific and atypical sx
  • Patient refuses to accept -ve results
  • discrepancy between subjective and objective findings
  • Results in multiple needless Ix and operations
  • Sx move from one system to another once diangostic possibilities have been exhausted
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61
Q

SOMATISATION DISORDER

What is the management of a patient with somatisation disorder

A

Rule out organic illness

Communicate dx and reassure patient of continuing care
- 1 regular doctor

Psychotherpay
- CBT / Group therapy

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62
Q

PUBLIC HEALTH APPROACH TO MH

What is the primary prevention for MH issues?

A

Preventing problems from occuring

Education of MH issues
Encouraging conversations

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63
Q

PUBLIC HEALTH APPROACH TO MH

What is the secondary prevention for MH issues?

A

Early interventions before the problem starts to emerge to resolve it

  • IAPTT
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64
Q

PUBLIC HEALTH APPROACH TO MH

What is the tertiary prevention for MH issues?

A

Making sure an ongoing problem is well managed to avoid crises and reduce its harmful consequences

  • Monitoring medications
  • Making sure physical health problems are addressed / checked
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65
Q

PSYCHIATRIC TREATMENTS

What is ECT and what is the puropse of it?

A

Treatment that involves sending an electric current through the brain under GA

  • Stimulate development of new neurones
  • Increases serotonin and dopamine
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66
Q

PSYCHIATRIC TREATMENTS

Name some inidcations for ECT therapy?

A 
Severe life threatening depression 
psychotic depression 
treatement resisitant schizophrenia 
catatonia 
severe long lasting mania
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67
Q

PSYCHIATRIC TREATMENTS

What are the short term effects of ECT?

A

Drowsy / confused
headache
retrograde amnesia
muscle ache

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68
Q

PSYCHIATRIC TREATMENTS

what are the logn term effects of ECT?

A

Apathy
Imapired memory
difficulty concetrating

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69
Q

PSYCHIATRIC MANAGEMENT

What is the biopsychosocial formulation and what are the 5P’s

A

An approach to understanding a patient and describing their sx

Presenting
Predisposing factors (what increases a pts risk of developing a mental illness)
- Precipitating factors (potential trigger to the onset of current problem)
- Perpetuating factors (what maintains the problem once it’s been established)
- Protective factors (strengths that reduce the severity of problems)

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70
Q

PSYCHIATRIC MANAGEMENT

Give examples of what might come under the 5Ps (excluding presenting).

A

Predisposing = genetics, life events, temperament

Precipitating = abuse, drug misuse, loss of family

Perpetuating = drug abuse, lack of social support, financial difficulties

Protective = family support, children, marriage

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71
Q

ORGANIC DISORDERS

What is an organic disorder

A

Describes reduced brain function due to illnesses that are not psychoatric in nature
Aetiology is in CNS

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72
Q

ORGANIC DISORDERS

What is delirium?

A

Transient acute metal confusional state

characterised by disturbance of consciousness, perception, sleep-wake cycle, emotion + cognition

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73
Q

ORGANIC DISORDERS

What are the 2 states of delirium?

A

Hyperactive

Hypoactive

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74
Q

ORGANIC DISORDERS

What is the aetiology of delirium?

A

DELIRIUM
D - Drugs (Anti-Ach/BDZs)

E - Environment / electrolytes
Uraemia / LF / Gluocse

L - Lack of drug (withdrawal)
Opiates /levodopa/alcohol

I - Infection

R - Retention (stool/urine)
Reduced sensory input -blind / deaf

I - Intracranial isses
Stroke / post-ictal / Meningitis

U - Underhydration / Undernutrition

M - Myocardical

S - Subdural / sleep deprived / Surgery

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75
Q

ORGANIC DISORDERS

What are some metabolic causes of delirium?

A
  • Hypo/hyperthyroid
  • Hypo / hyperglycaemia
  • Hypercortisolaemia
  • Substance misuse
  • Withdrawal (incl. delirium tremens)
  • Opioids, anticholinergics, Parkinson’s meds, steroids, BDZs, interactions
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76
Q

ORGANIC DISORDERS

What are some high risk factors for delirium?

A
  • > 65y, men, previous delirium
  • Pre-existing cognitive deficit (dementia, PD, stroke)
  • Sensory impairment (hearing/visual)
  • Significant illness (hip #, cancer)
  • Poor nutrition
  • Hx of alcohol excess
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77
Q

ORGANIC DISORDERS

Describe the 2 sub-types of delirium?

A
  • Hyperactive = agitated/aggressive, hallucinations, delusions, wandering + restless
  • Hypoactive = withdrawn, quiet, lethargic, lacks concentration, slow
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78
Q

ORGANIC DISORDERS

What is a suitable screening tool for delirium?

A

4AT (≥4 = likely) –

  • Alertness
  • AMT4 (age, DOB, hospital name, year)
  • Attention (list months backwards)
  • Acute change or fluctuating course
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79
Q

ORGANIC DISORDERS

What other cognitive tools can be used in the assessment of delirium/dementia?

A
  • GP-COG (GP assessment of cognition)
  • 6-CIT (6-item cognitive impairment test)
  • AMT (abbreviated mental test)
  • MOCA (Montreal Cognitive Assessment, <26/30)
  • MMSE
  • ACE-III
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80
Q

ORGANIC DISORDERS

What bedside assesments can you do on a confused patient?

A 
Hydration status 
O2 stats 
BP 
Temp 
Blood glucose 
ABG 
VBG
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81
Q

ORGANIC DISORDERS

What is involved in a confusion screen?

A 
FBC 
B12 + FOlate 
U+E
Ca2+
TFT
LFT 
Gluocse 
INR + Clotting 
CRP / ESR 
Toxicology
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82
Q

ORGANIC DISORDERS
What non invasive tests can also be used in a patient with suspected delirium?

What referrals could be considered?

A

CXR
CT head
ECG

Referral to memory clinic or old age psychiatrist

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83
Q

ORGNAIC DISORDERS

What is required for a delirium diagnosis?

A

Acute mental change from baseline - fluctuating

  • Impaired attention
  • Disorientation in time, place and person
  • Cognitive imapirement
  • Sleep wake abnormality
  • Disorganised thinking
  • Medical cause
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84
Q

ORGANIC DISORDERS

What is the mainstay of treatement for delirium?

A

Treat underlying vause
Capacity assessment
Maximise orientation
Make environment safe and comforting

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85
Q

ORGANIC DISORDERS

How long can a recovery from delirium take?

A

3-6 months

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86
Q

ORGANIC DISORDERS

What is the management for a patient with delirium?

A 
Reorientate: Clocks and calendars 
Continuity of care - Frequent reassurance
Consistency of staff members 
Avoid multiple rooms/ward moves
Sleep hygiene 
Discourage napping 
Bright light exposure during daytime 
Good lighting environment 
Encourage visits from family 
Mobilize and encourage exercise 
Tx sesnory imapirements - glasses / hearing aids
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87
Q

ORGANIC DISORDERS
Sometimes conservative de-escalation is inadequate and medications may be required. What is the pharmacological management and what are the CI to this?

A

Oral Haloperidol
Extremely agitated patients – small doses
CI: Lewy body dementia / Parkinsonism / Prolonged QT interval

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88
Q

ORGANIC DISORDERS

What are the differential dx for a patient with suspected delirium diagnosis

A

dementia
anxiety
thyroid disease
temporal lobe epilepsy

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89
Q

DEMENTIA
What is dementia?
What time frame is required in order to make a diagnosis?

A

Clinical neurodegenerative syndrome defined by progressive loss of higher mental function, affecting multiple cognitive domains with an impact on the general functioning of the patient

> 6m for diagnosis

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90
Q

DEMENTIA
What is mild cognitive impairement?
What is the timeline required for a review of a patient presenting with mild cognitive impairement?

A

Cognitive impairement without fucntional impairement

Review in 6m to 1 year

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91
Q

DEMENTIA
Where does subcortical dementia affect?
Name some examples

A

Basal ganglia
Thalamus

PD
Huntingtons
Alcohol related

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92
Q 
DEMENTIA 
What are the differences between delirium and dementia?
i) onset + deterioration 
ii)course
iii) consciousness 
iv) sleep wake cycle 
v) other presentations
A 
Delirium 
acute onset - reversible 
flucutating course 
altered level of consciousness 
altered sleep-wake cycle 
delusions/ illusions/ hallucinations 
Dementia 
chronic lllness - irreversible 
progressive course 
consciousness preserved 
normal sleep wake cycle
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93
Q

DEMENTIA

What are some risk factors for dementia development?

A 
Age > 65 
family hx 
Gentics 
downs syndrome 
smoking 
diabetes 
obesity 
Head trauma 
- Repetitive injury (boxing)
CVD
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94
Q

DEMENTIA

What is the gene associated with dementia?

A

Apoliprotein E-E4

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95
Q

DEMENTIA

Name some factors for dementia prevention

A

Healthy behaviours

  • excericse
  • diet
  • low alcohol
  • no smoking

Engaging in lesiure activities
Socially active
Cognitive active

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96
Q

DEMENTIA

What are some diangostic features of dementia?

A

Multiple cognitive deficits resulting in ADL impairement

  • memory
  • orientation
  • language
  • reasoning

Clear cosnisousness

BPSD

  • insominia
  • daytime drowsiness
  • nocturnal restlesness
  • depression / anxiety
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97
Q

DEMENTIA

What are some general investigations for dementia?

A
  • Full Hx + collateral with full physical exam + MSE

- Check for reversible causes with confusion screen ± CXR ± CT head

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98
Q

DEMENTIA

Describe the ranges for no, moderate and severe cognitve imapirement scores in an MMSE

A

none = 24 - 30

Mod = 18 - 23

Severe < 17

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99
Q

DEMENTIA

What score on a ACE-III indicates dementia

A

<82 with abnormla scores in more than 2 domains

  • attention
  • orientation
  • memory
  • language
  • visuospatial
  • fluency
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100
Q

DEMENTIA

What investigations are invovled in a dementia screen?

A 
FBC / U+E / LFT / CRP / TFT
Thaimine 
B12 / Folate 
Syphillis serology 
Cortisol 
Glucose 
MRI - SDH / NPH
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101
Q

DEMENTIA

Name some potentially treatable causes of dementia?

A 
Substance misuse 
Hypothyroid
Hyperparathyroid 
Cushings 
Addisons 
Depression 
NPH 
Vit B12/Foalte def
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102
Q

DEMENTIA

What biological and psychological treatment can be used in dementia?

A

Bio

  • Risperidone (agitation)
  • Memantine (Aggression)

Psycho

  • CBT (Depression)
  • Art therapy
  • Counselling
  • mental stimulation eg: puzzles
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103
Q

DEMENTIA

Why is the use of risperidone not encouraged?

A

Increased risk of stroke

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104
Q

DEMENTIA

What social treatements can be used in dementia?

A
  • OT assessment to remain independent (pendent, labels on cupboards, key safe, carers, handrails)
  • Carers assesment
  • Physio assessment
  • Encourage family visits + photos
  • Animal/pet therapy, music, arts + crafts
  • Care plans + advanced directives before worsens
  • Lasting power of attorney
  • Need to iform DVLA
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105
Q

ALZHEIMERS

What is the pathophysiology of alzheimers?

A

Accumulation of
- Extracellular beta amyloid plaques
- Intracellular Tau containing neurofibrillary tangles
Leads to degeneration of cerebral cortex with cortical atrophy + loss of Ach

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106
Q

ALZHEIMERS

What condition has increased rates of alzheimers

A

Down’s syndrome - develop at 50

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107
Q

ALZHEIMER’S
What genes have been implicated to…

i) familial early-onset Alzheimer’s?
ii) late onset Alzheimer’s?

A

i) APP gene, presenilin 1 + 2 (autosomal dominant)

ii) Apolipoprotein E (ApoE)

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108
Q

ALZHEIMERS

Name some risk factors for alzheimers development?

A 
Family hx 
Age - >65 
Genetics - ApoE 
Low intelligence / education 
Depression 
CVD - HTN 
Diabetes 
Hypercholeterolaemia 
Smoking
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109
Q

ALZHEIMERS

Name a protective factor for alzheimers

A

High intelligence

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110
Q

ALZHEIMERS

What is the clinical presentation of alzheimers

A

4 A’s
Amnesia
- loss of STM
- poor disorientation about time

Aphasia / Dysphasia

  • word finding problems
  • speech muddles / disjointed

Apraxia
Inability to carry out skilled tasks despite normal motor function
- button clothes
- pick up pen

Agnosia
Failure to recognise people / items

Executive fucntion imapired

  • planning
  • visuospatial impairment
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111
Q

ALZHEIMERS

Name some non-cognitive presentations of alzheimers

A

Psychosis

  • delsuions
  • hallucinations

Mood

  • depression
  • anxiety

Behavioural

  • apathy
  • agitation
  • wanderign
  • aggression
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112
Q

ALZHEIMER’S DISEASE
On CT/MRI head in Alzheimer’s disease, what are the…

i) macroscopic pathological changes?
ii) microscopic or histological pathological changes?

A

i) Diffuse cerebral atrophy (shrunken brain), increased sulcal widening, enlarged ventricles
ii) Neuronal loss, neurofibrillary tangles, beta-amyloid plaques

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113
Q

ALZHEIMER’S DISEASE

What is the pharmacological management of Alzheimer’s?

A

slow rate of decline + allow functioning at higher level

  • AChEi (donepezil, rivastigmine) for mild–mod
  • NMDA antagonist (memantine) for mod–severe
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114
Q

VASCULAR DEMENTIA
What is vascualr dementia and what is it charecterised by?
What are the risk factors?

A

Subcortical dementia - cumilative effect of small multiple infarcts charecterised by a stepwise deterioration

CVA / TIA 
HTN 
DM 
Hypercholeterolaemia 
Smoking 
Hx of PVD 
IHD
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115
Q

VASCULAR DEMENTIA

What is the clinical presentation of vascular dementia?

A

Stepwise deterioration with short periods of stability then sudden decline

Specific sx - depends on location of focal brai damage
memory issues
focal neurologicla signs if caused by stroke eg:UMN signs

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116
Q

VASCULAR DEMENTIA

What is the management of vascualr dementia?

A 
Prevent further decline 
Lifestyle changes
- weight loss 
- healthy diet 
- smoking cessation 
- alcohol consumption decrease

Pharmacological
- atorvastatin

Optimise co-morbidities

  • DM
  • HTN
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117
Q

LEWY BODY DEMENTIA

What is lewy body dementia and what might it be confused with?

A

Presence of lewy bodies in basal ganglia and cerebral cortex
presents between 50-80y/o

Delirium

  • fluctuating consciousness
  • hallucinations
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118
Q

LEWY BODY DEMENTIA

How do differentiate between parkinsons disease and lewy body dementia?

A

dementia before movement signs - LBD

Movement before dementia signs = PD

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119
Q

LEWY BODY DEMENTIA

What is the clinical presentation of lewy body dementia?

A 
fluctuating cognition 
visual hallucinations 
Parkinsonsism 
REM sleep disorder 
narrow based gait 
autonomic dysfunction 
- fluctuating BP 
- falls
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120
Q

LEWY BODY DEMENTIA

What is the management of LBD?

A

Conservative management

1st line - Rivastigme

last line - Memantine

Sleep disturbance
- clonazepam

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121
Q

LEWY BODY DEMENTIA

Why should antipsychotics be avoided in LBD pateints?

A

Irreversible parkinsoism
Impaired consciousness
NMS

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122
Q

LEWY BODY DEMENTIA

Name 1 effect of levodopa usage

A

Psychosis

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123
Q

FRONTOTEMPORAL DEMENTIA

What is the clinical presentation of FTD?

A

Behavioural chnages

  • Disinhibition
  • Withdrawal
  • Emotional unconcern
  • Behavioural stereotypies (humming)

executive imapirement

poor insight

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124
Q

FRONTOTEMPORAL DEMENTIA
What is the inheritence pattern for FTD?

What condition is FTD linked to?

A

AD

MND

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125
Q

FRONTOTEMPORAL DEMENTIA

What are the investigations and the results of the Ix of a patient suspected of having FTD?

A

MRI - Frontal atrophy

SPEC scan - lack of perfusion in fronto-temporal lobes

126
Q

PSEUDO-DEMENTIA

What conditions can present with pseudo-depression

A

Depression
Anxiety
Bipolar

127
Q

PSEUDO-DEMENTIA

What leads to pseudo-dementia presentation

A

Conditions cause an impairement in concentration
cognitive imapirement occurs secondary to mental illness

Patients tend to give “I don’t know answers”

128
Q

ENDOCRINE - PSYCHIATRY

Name 5 endocrine causes of psychosis

A 
Hyper/hypothyroidism 
cushings 
hyperparathyroidism 
addison's disease 
Metabolis - Uraemia / Na+ imbalance
129
Q

ENDOCRINE - PSYCHIATRY

Name 5 causes of depression

A 
Hypothyroidism 
Cushing's disease 
Addison's disease 
Parathyroid disease 
Vit deficiency - B12/Folate
130
Q

ENDOCRINE - PSYCHIATRY

Name 1 endocrine cause of mania

A

Hyperthyroidism

131
Q

ENDOCRINE - PSYCHIATRY

Name 1 endocrine cause of anxiety

A

Hyperthyroidism

132
Q

ADDICTIVE BEHAVIOURS

Name the 5 stages of the behavioural model of change

A 
Pre-contemplation 
Contemplation 
Determination 
Action 
Relapse 
Maintenance
133
Q

ADDICTIVE BEHAVIOURS

Define addiction

A

Compulsive substance taking behaviour with psychological withdrawal state

134
Q

ADDICTIVE BEHAVIOURS

Define addictive behaviour

A

Behaviour which is both rewarding and reinforcing

135
Q

ADDICTIVE BEHAVIOURS

Define dependence

A

Inability to control the intake of substance one is addicted to

136
Q

ADDICTIVE BEHAVIOURS

Define withdrawal

A

Psychological state when substance is stopped with negative symptoms

137
Q

ADDICTIVE BEHAVIOURS

Define tolerance

A

Pharmacological cocnept describing requiring larger doses to gain the same effect

138
Q

ADDICTIVE BEHAVIOURS

Name some features of dependence

A

Withdrawal

Cravings

Continued use despite harm

Tolerance

Primary / Salience

Loss of control

Narrowed repitoire

Rapid reinstatement

139
Q

ADDICTIVE BEHAVIOURS
What is Primary / salience?
Give an example?

A

Obtaining / using substance becomes so important other interests are neglected

Not eating to save money for drugs

140
Q

ADDICTIVE BEHAVIOURS

Give an example of continued use despite harm

A

Injecting heroin despite abscess formation

141
Q

ADDICTIVE BEHAVIOURS
What is narrowed repitoire?

Give an example

A

Less variation in types of substances used

Drinking at the pub to drinking cheapest alcohol at home

142
Q

ADDICTIVE BEHAVIOURS

What is rapid reinstatement

A

User relapses after period of abstenience

Risk of returning to previous dependence pattern quicker

143
Q

ADDICTIVE BEHAVIOURS

Name the 4 questions involved in the CAGE questionnaire

A

C - Have you ever felt you need to CUT down
A - Have people ANNOYED you by critscising your drinking
G - Have you ever felt bad or GUILTY about your drinking
E - Do you have an EYE-OPENER first thing in the morning to steady the nerves of a hangover

144
Q

ADDICTIVE BEHAVIOURS

What does AUDIT stand for

A

Alcohol use disorders identification test

145
Q

ADDICTIVE BEHAVIOURS

How do you calculate the units of an alcoholic drink

A

Strength(ABV) x volume (L) = units

146
Q

ADDICTIVE BEHAVIOURS

How many ml of alcohol is in 1 unit

147
Q

ADDICTIVE BEHAVIOURS

Name some causes of alcohol misuse

A 
Genetic factors 
chronic illness 
occupation 
social reinforcement 
anxiety 
traumatic life event
148
Q

ADDICTIVE BEHAVIOURS

Name a protective factor for alcohol misuse

A

Acetaldehyde dehdrogenase deficiency

149
Q

ADDICTIVE BEHAVIOURS
What drugs can interact with a patient with an alcohol disorder

What is their MOA

What are the effects

A

Metronidazole
Chlorporpamide

They inhibit acetaldehyde dehydrogenase

Headache / sweating / nausea

150
Q

ADDICTIVE BEHAVIOURS

How is alcohol intake cardioprotective

A

Increases HDL level

Reduces platelet aggregation

151
Q

ADDICTIVE BEHAVIOURS

Name some negative cardiac effects of alcohol

A 
Increased BP 
Arrhythmias --> AF 
Alcohol related cariomyopathy 
IHD 
CVA 
Stroke
152
Q

ADDICTIVE BEHAVIOURS

Name some negative heaptic effects of alcohol

A

Hypoglycaemia
fatty liver
cirrhosis
induction of drug metabolising enzymes

153
Q

ADDICTIVE BEHAVIOURS

Name some negative GI effects of alcohol

A

Gastritis
Pancreatitis
Mallory-weiss tear
reflux oesophagitis

154
Q

ADDICTIVE BEHAVIOURS

Name some negative GU effects of alcohol

A

Sexual desire increased - ST
Erectile dysfunction - LT
(Due to vasodialtion)

Damage to leydig cells

  • loss of libido
  • infertility
  • loss of male body hair
155
Q

ADDICTIVE BEHAVIOURS

Name some negative Neuropsychiatric effects of alcohol

A 
Painful peripheral neuropathy 
Imapired memory 
depression 
SDH 
Korsakoff sundrome 
Alcoholic dementia
156
Q

ADDICTIVE BEHAVIOURS

Name some negative endocrine effects of alcohol

A

Diabetes - due to cirrhosis

Issues with metabolisation of oestrogen –> testosterone leads to femininisation of patients
- loss of body hair
testicualr atrophy

157
Q

ADDICTIVE BEHAVIOURS

Outline the general approach to alcohol misuse management

A

Manage co-morbidities
Psychological support
Location for withdrawal
Medication to maintain abstenince

158
Q

ADDICTIVE BEHAVIOURS

What factors are invovled in the psychologicla support of a patient with alcohol misuse disorder

A
  • Support groups - AA
  • Motivational interviewing
  • FRAMES principle
159
Q

ADDICTIVE BEHAVIOURS

What factors indicate that a hospital admission for a detox

A 
previous withdrawal seizure 
suicidal ideation 
co-existing drug addiction 
history of DT 
No social support
160
Q

ADDICTIVE BEHAVIOURS

What are the indications for a home detox

A
  • No hx of DT
  • Good family support
  • No psychological complications (depression)
  • No physical complications
161
Q

ADDICTIVE BEHAVIOURS

What tests are used to screen for drug or alcohol abuse

A

breath test - Blood alcohol content
Blood test - Elevated MCV or GGT
Urinary tests
Hair testing

162
Q

ADDICTIVE BEHAVIOURS
What is disulifram

What is its MOA

Why is it useful

A

Antebuse - aversive drugs

Inhibits acetaldehyde dehydrogenase - prevents acetaldehyde breakdown leading to adverse effects if alcohol is ingested. Acetaldehyde reaction and histamine release

163
Q

ADDICTIVE BEHAVIOURS
Name some adverse effects of disulfiram

Which patients should not be given disulfiram

A

Hangover S/E

Flushing 
nausea 
headache 
Increased temp 
Increased pulse 
reduced BP

Do not give to impulse patients or pateits with LD - Fatal if mixed with alcohol

164
Q

ADDICTIVE BEHAVIOURS
Name 2 anti-craving medications for patients with alcohol abuse

What increases the effects of these medications working

A

Acamprosate

Naltrexone

Counselling

165
Q

ADDICTIVE BEHAVIOURS
What is acamprosate’s MOA

How long can it be prescribed for

A

Inhibits glutamate helping to reduce cravings
Helps patients seekign to maintain abstenence

Up to 6m or longer if there is a benefit

166
Q

ADDICTIVE BEHAVIOURS

What are the adverse effects and contra-indications of acramposate

A

Adverse effects

  • GI disturbance
  • Sexual impotence
  • Flucutations in libido
  • Rash

Contra-indications

  • Pregnant
  • Breast feeding
  • Severe heaptic/renal impairement
167
Q

ADDICTIVE BEHAVIOURS

What is naltrexone and who is it recommended for

A

Opiod antagonist

Recommended for patients wishing to reduce alcohol intake
- reduces positive reward of alcohol

168
Q

ADDICTIVE BEHAVIOURS
Describe a pateints presentation:
- 6/12 hrs after last drink

  • 24 hrs after last drink
  • 72 hrs after last drink
A 
Insomnia 
fine tremor 
anxiety 
N+V
Sweating 
palpitations 
raised BP 
Fatigue

Hallucinations
coarse tremor
seizures

Delirium tremens

169
Q

ADDICTIVE BEHAVIOURS

What is the management of alcohol withdrawal

A

Chlordiazepoxide
- reducing regime over 7-10 days

IV Pabrinex

Prophylactic oral thiamine

170
Q

ADDICTIVE BEHAVIOURS

What are the risks of frequent detoxing

171
Q

ADDICTIVE BEHAVIOURS

Name some public health strategies to help prevent alcohol abuse

A 
Increasing tax on alcohol 
restricting alcohol advertisement 
Drinkaware 
Know your limits campaign
Keep alcohol out of site - behind counter 
School alcohol education
172
Q

ADDICTIVE BEHAVIOURS

What are the features of opiate withdrawal

A

Everything runs

  • sweaty
  • rhinorrhoea
  • diarrhoea
  • cold
  • high BP
  • dialted pupils
173
Q

ADDICTIVE BEHAVIOURS

What are some harm reduction strategies for opiate users

A
  • needle injection

- screening for HBV / HNV / HIV

174
Q

ADDICTIVE BEHAVIOURS

What are some detoxification methods for opiate users

A
  • Methadone
    Long acting - 24hr half life
  • Bupronorpheine
    Parial opiate
175
Q

ADDICTIVE BEHAVIOURS

What are the short term complications of opiate usage

A 
VTE 
PE 
Bacterial infection secondary to injection - IE
Overdose 
   - Respiratory depression 
   - Resp acidosis
176
Q

ADDICTIVE BEHAVIOURS

What are the long term complications of opiate usage

A 
dependence 
craving 
crime 
constipation - chronic usage 
Infections - sepsis/HIV
Abscess
177
Q

ADDICTIVE BEHAVIOURS

What are the common injection sites for opiate usage

A 
Antecubital fossa
groin 
neck 
feet 
fingers
178
Q

PERSONALITY DISORDERS

What is the only personality disorder that can be diagnosed at 18

A

EUPD - As long as there is evidence that the patient has fully undergone puberty

179
Q

PERSONALITY DISORDERS

What are cluster A,B and C disorders

A

A = Abnormal / angry
Odd/eccentric

B = Bad
dramtic/erratic

C = Critical / Criers
Anxious/fearful

180
Q

PERSONALITY DISORDERS

What is a schizoid personality

A

SchizoiD - Distant

Detached in emotions and relationships

181
Q

PERSONALITY DISORDERS

What is a paranoid perosnality

A

distrustful and suspicious
Hypersensitive to critcism
Pre-occupied with percieved conspiricies against them

182
Q

PERSONALITY DISORDERS

What is a schizo-T-ypal personality

A

T - Tries to make friends
Magical / odd beliefs
Inappropriate behaviour and strange speech causes others to see them as strange
Similar to schizo - but better grasp on reality

183
Q

PERSONALITY DISORDERS

Describe an EUPD personlity

A

unstable relationships
unstable emotions - mood swings
Instability in self image
Impulsive

184
Q

PERSONALITY DISORDERS

Describe a historonic personality disorder

A

H - Hungry for attention

attention seeking
display a lot of emotions

185
Q

PERSONALITY DISORDERS

Describe a narscissistic perosnality disorder

A

big egos
lack of emapthy
need admiration
can’t handle criticism

186
Q

PERSONALITY DISORDERS

Describe a dissocial personality disorder

A

Little to no regard for others
legal issues - aggresive
inability to obey social norms

187
Q

PERSONALITY DISORDERS

Describe an obsessive - compulsive personality (Anankastic)

A

Order + control
Hyper focused
Perfectionist
Unlike OCD these actions are pleasurable and desirable as opposed to anxiety inducing

188
Q

PERSONALITY DISORDER

Describe a dependant personality disorder

A

submissive - strong psychological need to be cared for
clingy
lack initiatvie

189
Q

PERSONALITY DISORDER

Describe an avoidant perosnality disorder

A

Strong feeling of inadequacy and fear of social situation
Avoid situations where they can be criticised
Self impose isolation whilst craving acceptance

190
Q

PERSONALITY DISORDER

What is EUPD

A

Personality disorder affecting mood regualation and interpersonal relationships

191
Q

PERSONALITY DISORDER

Name some risk factors for EUPD

A 
women 
trauma 
insecure attachement 
domestic violence 
neglect 
family hx
192
Q

PERSONALITY DISORDER

How would a patient with EUPD present

A 
Intense usntable relationships 
low self esteem 
emotional dysregualtion 
fear of abandonment 
chronic feeling of emptiness
impulsive behaviour 
thoughts of self harm
193
Q

PERSONALITY DISORDER

What is the gold standard treatement for EUPD and what does it involve

A

DBT

Learn individualised techniques for managing their emotional state as an Alternative self harm

  • Self soothing techniques
  • Distraction techniques
194
Q

PERSONALITY DISORDER

Name reasosns that an EUPD patient would self harm

A 
releive psychic pain 
feel concrete pain 
decrease anxiety 
feel in control 
express anger
195
Q

PERSONALITY DISORDER

What are the differential diagnoses for EUPD

A 
Bipolar 
Autism 
ADHD 
Psychosis 
PTSD
196
Q

PSYCHOSIS

Name some presentations of psychosis

A 
schizophrenia 
manic depression 
bipolar 
schizoaffective disorder 
substance induced 
post partum 
brief psychotic disorder
197
Q

PSYCHOSIS

what is psychosis

A

A break from reality charecterised by delsuions, hallucinations and disorganised speech

198
Q

PSYCHOSIS

How is psychosis different from neuroses

A 
Whole of personality is affected 
Patient lacks insight 
loss of control with reality 
hallucinations 
delusions 
Managed with physical methods
199
Q

PERSONALITY DISORDER

Which personalities are classified as cluster A

A

Schzoid
paranoid
schizotypal

200
Q

PERSONALITY DISORDER

Which personalities are classified as cluster B

A

EUPD
Historonic
Narcisstic
Dissocial

201
Q

PERSONALITY DISORDER

Which personalities are classified as cluster C

A

Obsessive complusive - Anankastic
dependent
avoidant

202
Q

PSYCHOSIS

What are some indicators of an impending psychotic break

A

social isolation
worsening self care
paranoia
gradual shifts in thinking and perceptions

203
Q

PSYCHOSIS

What is schizophrenia

A

syndrome charecterised by disturbances in thinking, perception, affect and behaviour. Preserved consciouness and cognitive skills

204
Q

PSYCHOSIS

Name 5 risk factors for schizophrenia

A 
family hx 
cannabis usage 
Inner city living 
Intrauterine infection - CMV
Illicit substanes - cocaine 
maternal poor health / malnutrition 
Pregnancy/birth complications - hypoxia 
traumatic childhood
205
Q

PSYCHOSIS

What are the first rank symptoms of schizophrenia

A

hallucination - 3rd person auditory
delusional perception
passivity phenomena
thought alienation

206
Q

PSYCHOSIS

What are some secondary symptoms of schizophrenia

A 
delusions 
thought disorders 
- loosening of associations 
- thought blocking 
catatnoic behaviour 
negative symptoms
207
Q

PSYCHOSIS

What are the negative symptoms of schizophrenia

A 
blunting of affect 
anhedonia 
flat affect 
alogia - poverty  of speech 
avoilition - poor motivation
208
Q

PSYCHOSIS

Name 4 poor prognostic factors for schizophrenia

A 
family hx
gradual onset 
Low IQ 
Prodromal phase of social withdrawal 
lack of precipitating factor
209
Q

PSYCHOSIS

How is schizophrenia diagnosed

A

one 1st rank symptom for 1 month or longer
OR
two 2nd rank symptoms acutely for 1 month, with evidence of disturbance of functioning for 6 months.

210
Q

PSYCHOSIS

What is the rule of 1/4s for schizophrenia

A 
Prognosis for treatment
25%
- have another episode 
- improve a lot 
- little improvement 
- resistant
211
Q

PSYCHOSIS

What is the non-pharmacologicla treatment of schizophrenia

A 
CBT 
Family interventions 
Offer support for carers 
Offer support with:
- finances 
- accommodation 
- employement
212
Q

PSYCHOSIS

What is schizoaffective disorder

A

disorder with features of schizophrenia and mood disorders

213
Q

PSYCHOSIS

What are the diagnostic features for schizoaffective disorders

A

Presence of schizophrenia symptoms concurrent with the mood symptoms (depression or mania), and lasting for a considerable part of a 1-month period.

214
Q

PSYCHOSIS

What are some features of psychosis

A 
hallucinations 
delusions 
disorganised thinking and speech 
- flight of ideas 
Alogia 
tangeatality 
word salad
215
Q

PSYCHOSIS

What is a delusional disorder

A

Delusional disorder is distinguished from schizophrenia by the presence of delusions without any other symptoms of psychosis (eg, hallucinations, disorganized speech or behaviour, negative symptoms).
No psychosocial impairement

216
Q

PSYCHOSIS

What is a erotomanic delusional disorder

A

patients believe that another person is in love with them

- stalking is common

217
Q

PSYCHOSIS

What is a jealous delusional disorder

A

Patients believe that their spouse or lover is unfaithful. This belief is based on incorrect inferences supported by dubious evidence

218
Q

NEUROSES

What is GAD

A

Persistent uncontrolled worry about a number of different events with no identifiable cause present for 6m
Associated with an impairement in normal daiy function, somatic, cognitive and behavioural sx

219
Q

NEUROSES

Name 6 risk factors for GAD

A 
Female 
family hx 
child abuse and neglect 
emotional trauma 
substance abuse 
physcial health problems 
environmental stress 
- reduncency 
- divorce
220
Q

NEUROSES

What investigations are required in an individual suspected of having GAD?

A 
History + MSE + Risk assesment 
GAD - 7 
Hospital anxiety and depression scale questionnaire 
Exclude organic causes 
- FBC / U+E / LFT
221
Q

NEUROSES

How would a patient with GAD present

A

Generalised persisitent free floating worry for 6m - present for more days than not
Worry not due to other mental disorder or substane abuse
4 other sx must be present with 1 being from the autonomic range of sx

222
Q

NEUROSES

Descibe autonomic sx for GAD

A

Sweating
palpitations
trembling
dry mouth

223
Q

NEUROSES

describe physical sx for GAD

A

Difficulty breathing
chest pain
nausea

224
Q

NEUROSES

Descibe Brain/mind sx for GAD

A 
dizzy 
poor concentration 
fear of loosing control 
derealsation 
depersonalisation
225
Q

NEUROSES

Describe tension sx for GAD

A

Muscle tension
aches
restesness

226
Q

NEUROSES

Describe general sx for GAD

A

Tingling
hot flushes
Easily startled

227
Q

NEUROSES

What are the psychiatric differential diagnoses for a patient with GAD

A 
Depression 
mixed anxiety and depression 
Normal worries 
excess caffiene 
drug and alcohol problems
228
Q

NEUROSES

What is the clinical presentation of hypoglycaemia

A 
HE IS TIRED 
He - Headache 
IS - Irritability / Sweating
T - Tachycardia 
I - Irritability 
R - Restlesness 
E - Excessive hunger 
D - Dizziness
229
Q

NEUROSES

What are the medical differential diagnoses for a patient wth GAD

A 
Arrhthmias 
COPD 
Asthma 
Hyperthyroidism 
Hypoparathyroidism 
Hypoglycaemia 
Anaemia
230
Q 
NEUROSES 
What medications are associated with inducing anxiety like sx
- CVS 
- Resp 
- CNS 
- Endo
A

CVS

  • Anti-hypertensves
  • Anti - arrhythmics

Resp

  • Bronchodilators (Salbutamol)
  • Theophylline
  • corticosteroids

CNS

  • Anti - Ach
  • Antipsychotics

Endo
- Levothyroxine

231
Q

NEUROSES

Describe the stepwise management of GAD

A
  1. Patient education + active monitoring
    - manage co-morbidites
    - excercise
    - environmental stressors
  2. Low intesity psychological intervetions
    - individual / guided self help
    - psychoeducation groups
  3. High intensity psychologicla interventions
    - CBT
    - Applied relaxation
    OR/AND
    - Pharmacological
  4. Specialist referral
232
Q

NEUROSES

What is the pharmacological treatment of GAD

A

1st - SSRI - Sertraline
2nd - alternative SSRI or SNRI
3rd line - Pregabalin

233
Q

NEUROSES

What is a good progonostic factor for GAD

A

Stable pre-morbid personality

234
Q

NEUROSES

What is a panic attack

A

period of intense fear charecterised by a group of sx that develop rapidly - peak is reached in 10 mins
- Attacks can be spontaneous or situational

235
Q

NEUROSES

What is a panic disorder

A

Recurrent panic attacks not secondary to substance abuse, medical conditions or another psychiatric disorder

236
Q

NEUROSES

What are the physical sx of a panic attack

A 
papitations 
chest pain 
choking 
tachypnoea 
dry mouth 
urgency of urination 
dizziness 
blurred vision 
sweating 
chills 
hot flushes
237
Q

NEUROSES

Why does paraesthesia occur durign a panic attack

A

Hypocalcaemia due to hyperventialtion

238
Q

NEUROSES

What is agraphobia

A

Anxiety like sx associated with palcrs or situations where escape may be difficult / embarassing leading to avoidance

239
Q

NEUROSES

What is the management of panic disorder

A

Acute - Reasurrance +/- BDZs

Chronic
1st line - recognise and diagnose

2nd line:
- CBT 
Pharmacotherapy 
- 1st line: SSRI --> Sertraline 
-2nd line:  Clomipramidine
240
Q

NEUROSES

What is a simple phobia

A

Recurring excessive and unreasoanble psychological / autonomic sx on anxiety in anticipated presence of feared object or situation leading to avoidance

241
Q

NEUROSES

What is the management of simple phobia

A

Beahvioural:

  • Exposure therapy
  • graded exposure

Cognitive

  • Education
  • Anxiety management
  • coping strategies

Pharmacological

  • Not used generally
  • BDZs in severe cases
242
Q

NEUROSES

What is social phobia

A

Sx of anxiety - psychological and physical restricted to certain social situations leading to avoidance

243
Q

NEUROSES

What is the presentation of a social phobia

A

Soamtic sx

  • Blushing
  • trembling
  • dry mouth
  • sweating
  • fear of humiliation

Avoidance of situation

  • difficulty developing relationships
  • educational and vocational problems
244
Q

NEUROSES

What is the mangement of social phobia

A

Psychological
1st line - CBT
- Graded exposure therapy

Pharmacological
1st line - SSRI / SNRI
- sertraline / escitalopram
- Venelafaxine

Other sx
- Beta blockers

245
Q

NEUROSES

What is PTSD

A

Severe psychological disturbance following trauamtic event

Sx arise within 6m of truamatic event and be present for 1m imapring fucntioning

246
Q

NEUROSES

What can be seen on neuroimaging of a PTSD patient

A

Reduced hippocampal volume

247
Q

NEUROSES

What are the risk factors for PTSD

A 
Low education 
Afro-carribean 
female sex 
low self esteem 
previous traumatic event 
Percieved life threat
248
Q

NEUROSES

Name 5 protectiva factors for PTSD

A 
High IQ 
Higher social class 
Caucasian 
Male gener 
Good fmaily support
249
Q

NEUROSES

What is the presentation of PTSD

A

Re-experiencing

  • flashback
  • nightmares

Avoidance

  • avoiding people
  • sitaution connected to event

Hyperarousal

  • Hypervigilent
  • sleep issues
  • exaggarated stratle
  • Irritability
  • difficulty concentrating

Emotional numbing
- feeling detached

Inability to recall

250
Q

NEUROSES

What is the management of PTSD

A

1st line

  • Trauma focused CBT
  • EMDR

2nd line

  • SSRI –> Sertraline
  • SNRI - Venelafaxine
251
Q 
NEUROSES 
What is the management for these other factors in a patient with PTSD 
- Sleep issues 
- Anxiety 
- Intrusive thoughts
A
  • Mitarzapine
  • BDZs
  • Antidepressants
  • Propanolol
  • Lithium
  • Valporate
252
Q

NEUROSES

What is OCD

A

Chronic condition charecterised by obsessions and compulsions which imapct functional imapirement

253
Q

NEUROSES

What are obsessions

A

Intrusive distressing thoughts and urges that cause anxiety

Patient can recognise thoughts are their own

254
Q

NEUROSES

What are compulsions

A

Repetitive actions or behaviours which patient feels compelled to perform to reduce anxiety

255
Q

NEUROSES

Name 4 risk factors for OCD

A 
Family hx 
substance misuse 
anxiety / depression 
Age : 10 - 21 
childhood abuse and neglect
256
Q

NEUROSES

What is the management of OCD

A

1st line - CBT

2nd line
- High intensity CBT + ERP
OR
SSRI / Clomipiramine - If patient does not engage with therapy

3rd line
- High intensity CBT
AND
- SSRIq

257
Q

AFFECTIVE DISORDERS

What are the 3 core sx of depression ad how long must sx be present for to diagnose

A

Low mood
Low energy
Anhedonia

Nearly everyday for 2 weeks

258
Q

AFFECTIVE DISORDERS

Name 5 other sx of depression

A 
DEAD SWAMP 
D - Depressed mood 
E - Energy low / Early morning wakening 
A - Anhedonia 
D - Dead thoughts 
      Suicidal 
S - Sleep disturbance 
W - Worthlesness 
A - Appetite chnage 
M - Mentation decreased 
P - Psychomotor agitation / retardation
259
Q

AFFECTIVE DISORDERS

What is the criteria for different severities of depression

A

Mild - 2 core and 2 other
Moderate - 2 core and 4 others
Severe - 3 core and 5 others

260
Q

AFFECTIVE DISORDERS

What are the risk factors for depression

A

BIOPSYCHOSOCIAL
Bio
- Genetics
- Monamine theory

Psychosocial
- Childhood experiences (Abuse / loss of parent )
- Social circumstances (Marital status / adverse life events)
- Physicla illness
Peronality traits - Anxiety / Impulsivity

261
Q

AFFECTIVE DISORDERS

Name 2 Investigations used for a depression diangosis

A

PHQ-9

HADs

Rule out organic cause

262
Q

AFFECTIVE DISORDERS

What is the management of mild depression

A

NO MEDICATION

Low intensity psychological intervention - IAPT

Group based CBT

Lifestyle interventions

  • Sleep hygeine
  • Physical activity
263
Q

AFFECTIVE DISORDERS

What is the management of moderate depression

A

Lifestyle changes

Anti-depressants

High intensity psychological therapies - CBT

264
Q

AFFECTIVE DISORDERS

What is the pharmacological management of depression

A

1st line - SSRI

2nd line - Alternative SSRI

3rd line
- SNRI

265
Q 
POSTPARTUM DISORDERS
What are baby blues  
-  risk factors 
- duration 
- presentation
- Management
A

First baby

Occurs 3 - 7 days after primiparous birth

Tearful
Anxious about baby
Irritable
Poor conentration

Reasurrance and support

266
Q 
POSTPARTUM DISORDERS
What is postnantal depression 
-  risk factors
- screening tool  
- duration 
- presentation
- Management
A

N/A

Occurs within 1m of delivery and peaks at 3m

Edinburugh postnantal depression scale

Usual features of depression including

  • Marital tension
  • Fears about babys health
  • Maternal deficinecies

Reasurance and support
- Most resolve in <6m

CBT
SSRI
- Sertraline and Paroxitine

267
Q

POSTNATAL DISORDERS

Which SSRI should be avoided in pregnancy

A

Fluoxetine

268
Q 
POSTPARTUM DISORDERS
What is peurperal psychosis 
- duration 
- presentation
- Management
A

Sx develop within 2-3 weeks post birth

Manic depression or psychosis

  • severe mood swings
  • disordered perception (auditory hallucinations)
Hspital admission 
Medication 
- Mood stabaliser 
- Antidepressants 
- Antipsychotics if psychotic sx are present
269
Q

AFFECTIVE DISORDERS

What is bipolar disorder and how is it charecterised

A

Cyclical mood disorder that flucutated between epsidoes of acute mania and depression

Charecterised by at least 2 epsidoes - one of which muct be mania/ hypomania

270
Q

AFFECTIVE DISORDERS

Describe Bipolar 1

A

Mania + Depression

PSYCHOTIC SYMPTOMS

271
Q

AFFECTIVE DISORDERS

Describe Bupolar 2

A

Hypomania + Depression

NO PSYCHOSIS

272
Q

AFFECTIVE DISORDERS

What is cyclothymia

A

Cyclical mood swings with subclinical features of depression or mania

273
Q

AFFECTIVE DISORDERS

Describe a manic episode

A

Lasts > 7 days

  • Functional impairement
  • psychotic features

DIG FAST
Distractability
Irritability
Grandiosity

Fast speech
Activity - Increased goal directed activity
Sleep / Sexual desire
Talkability

274
Q

AFFECTIVE DISORDERS

Descibe a hypomanic episode

A

lasts > 4 days

No functional impairement
No psychotic features

275
Q

AFFECTIVE DISORDERS
What is the management of an acute manic episode
- with agitation
- without agitation

A

IM Benzodiazepine

Oral monotherapy with antipsychotic

276
Q

AFFECTIVE DISORDERS

What is the management of a depressive episode is a bipolar patient

A

SSRI - Fluoxetine

Lithium

277
Q

AFFECTIVE DISORDERS

What is the long term management of bipolar

A

1st line - Lithium

2nd line - Valporate

278
Q

AFFECTIVE DISORDERS

What is the driving regulations for a newly diangosed bipolar patient

A

No driving for 3m until DVLA assesment

279
Q

AFFECTIVE DISORDERS

Describe the diagnostic criteria for anorexia

A

Weight <85% predicted

BMI < 17.5kg/m2

Intense fear of gaining weight

Body image distorsion - Feeling fat when underweight

280
Q

AFFECTIVE DISORDERS

Describe the 5 componenets of the SCOFF questionnaire

A

S –Do you make yourselfSICKbecause you feel uncomfortably full?
C– Do you worry you have lostCONTROLover how much you eat
O– Have you recently lost more thanONE STONE(6kgs) in a three month period
F– Do you believe yourself to beFATwhen other say you are thin?
F– Would you sayFOODdominates your life?

2 or more –> High sensitivity

281
Q

AFFECTIVE DISORDERS

Describe the CVS effects of anorexia

A 
Hypotension 
Bradycardia 
Hypothermia 
QT prolongation 
Arrhythmias
282
Q

AFFECTIVE DISORDERS

Descibe the endocrine effects of anorexia

A

Hypoglycaemia
Hypo - K+ / Na+ / PO43-
Swelling of parotid and submandibular glands
Low T3/T4

High - Gs and Cs 
Cortisol 
Beta-carotene 
Cholesterol 
GH
283
Q

AFFECTIVE DISORDERS

Descibe the dermatological effects of anorexia

A

Lanugo hair
Brittle hair
Yellow ting to skin

284
Q

AFFECTIVE DISORDERS

Descibe the GU effects of anorexia

A

Amenorrhoea
Infertility
Breast atrophy

285
Q

AFFECTIVE DISORDERS

What are the red flags for anorexia

A 
BMI < 13 
Weight loss > 1 kg/week 
Temperature < 35.5 
BP < 80/50 
Long QT 
Flat T waves 
weakness in muscles
286
Q

AFFECTIVE DISORDERS

What are the investigations required for an anorexic patient

A 
Bloods 
- FBC 
-U+E
- TFTs 
Calcualte BMI 
ECG - bradycardia and prolonged QT 
BP 
DEXA scan - after 1 year of being underweight 
Temp
287
Q

AFFECTIVE DISORDERS
What is the management of anorexia
- child
- adult

A

Child
1st line - Anorexia based family therapy
2nd line - CBT

Adult
ED - CBT
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

288
Q

ANOREXIA

What is re-feeding syndrome

A

Drop in phosphate due to rapid initiation of food after > 10 days of undernutition

289
Q

ANOREXIA

What is the management of re-feeding syndrome

A 
Slowly re-feed 
Thiamine and Vitamin B complex 
Monitor U+E's 
- Low phosphate 
- Low potassium 
- high glucose 
- high Mg
Regualr ECGs
290
Q

ANOREXIA

What is the presentation of re-feeding syndrome

A 
Rhabdomylysis 
respiratory failure 
cardiac failure 
Low BP 
Arrhythmias 
Seizures
291
Q

BULIMIA

What is bulimia

A

Repeated episodes of over eating followed by compensatroy behaviour

292
Q

BULIMIA

Name 4 methods of compensatory behaviour

A

vomiting
starvation
laxatives
excessive excercise

293
Q

BULIMIA

What is the diagnostic criteria for bulimia

A

Periodsof binging

Lack of control

294
Q

BULIMIA

Name the metabolic disorders caused by bulimia and the compensatory behaviours associated

A

Metabolic:

Acidosis - Laxatives

Alkalosis - Vomiting

295
Q

BULIMIA

What can continued use of laxatives lead to

A

Cardiomyopathy

296
Q

BULIMIA

What is the management of bulimia in adults and children

A

Adults
1st line - Bulimia nervosa guided self help
2nd line - Individual CBT - ED

Children
1st line - Bulimia nervosa focused fmaily therapy

297
Q

BULIMIA

What is thr pharmacological management of Bulimia

A

High dose fluoxetine

- reduced binging and purges

298
Q

LEARNING DISABILITY

What is a learning disability

A

Global impairement in intellectual function in development period leading to an impairement of adaptive function

299
Q

LEARNING DISABILITY

What is a learning difficulty

A

Localsied impairement of intellectual fucntioning during developementla period leading to impairement of specific adaptive function

300
Q

LEARNING DISABILITY

Describe the categorisation of IQ and it’s relevance to learning disability

A

IQ:

< 70 –> Mild

35 - 50 –> Moderate

34 - 21 –> Significant

<20 –> Profound

301
Q

SUICIDE

What are the risk factors for suicide

A 
male sex
Hx of self harm or suicide 
Substance misuse 
Hx of mental illness 
Hx of chronic illness 
older age 
divorced 
low self esteem
302
Q

SUICIDE

Name 5 protective factors for suicide

A 
married 
active religious beliefs 
social support 
good employement 
Children
303
Q

LITHIUM TOXICITY

What shoudl a patient takin lithium avoid

A

NSAIDs
ACEi
Diuretics

304
Q

WERNICKE’S KORSAKOFF SYNDROME

What is the cause and presentation of wernicke’s

A

cause:
Thiamine deficiency - B1

presentation:
ataxia 
encephalopathy 
ocular abnormalities 
- opthalmoplegia 
- gaze paresis 
- ptosis
305
Q

WERNICKE’S KORSAKOFF SYNDROME

What is the management of wernicke’s

A

IV Thiamine - Pabrinex

IV Glucose - After thiamine has stabalised if not can lead to metabolic acidosis due to lactic acid build up

306
Q

WERNICKE’S KORSAKOFF SYNDROME

What is the presentation of Korsakoff syndrome

A

Retrograde amnesia
Anterograde amnesia
confondibulation

307
Q

WERNICKE’S KORSAKOFF SYNDROME

Describe the pathophysiology of Korsakoff’s

A

Affects limbic system
Affects Mamillary bodies to cause irreversible deficits in anterograde and retrograde memory
Mamillary bodies are part of limbic system – Memory / emotion / behaviour

308
Q

NEUROLEPTIC MALIGNANT SYNDROME

What are the causes of NMS

A

Antipsychotics

Withdrawal of dopaminergic drugs

309
Q

NEUROLEPTIC MALIGNANT SYNDROME

Hownlogn does it take for NMS to set in

310
Q

NEUROLEPTIC MALIGNANT SYNDROME

What is the presentation of NMS

A

REDUCED ACTIVITY

Hyperthermia - > 38
BP fluctuation
Muscular ridgidity

311
Q

DELIRIUM TREMENS

What is the presentation of delirium tremens

A

occurs 72 hours after last drink

  • altered consciousness
  • liluptian hallucinations
  • Formication
  • paranoid delusios
  • marked tremor
  • heavy sweating
  • raised pulse / BP
  • fever

Phase 3A (12 decks)

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