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Phase 3a conditions list flashcards > Psychiatry - conditions > Flashcards

Psychiatry - conditions Flashcards

1
Q

What is a mood disorder?

A

Marked disruptions in emotions - severe lows (depression)/ highs (mania)

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2
Q

What two sets of diagnostic criteria are frequently used for psychiatric conditions?

A
  • ICD-10/11
  • DSM-5 (shitty American version)
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3
Q

What are the three core symptoms of depression?

A
  • Low mood
  • Anhedonia (lack of interest)
  • Anergia (lack of energy)
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4
Q

What are some other symptoms of depression (7)?

A
  • Weight change
  • Sleep changes
  • Reduced libido
  • Worthlessness/ guilt
  • Decreased concentration
  • Thoughts of self harm
  • Psychomotor sx (e.g. slow movements)
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5
Q

What sleep change is typical of depression?

A

Early morning wakening (typically 2-3 hours early) - although sleeping more/ less overall are both common

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6
Q

What 3 criteria should be fulfilled for a diagnosis of depression?

A
  • Impair daily function + cause distress
  • Symptoms most days for more than 2 weeks
  • Not due to substance use or grief
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7
Q

What are some risk factors for depression (8)?

A
  • Chronic pain
  • Post partum
  • Hypothyroid
  • Trauma + abuse
  • Bereavement (although this itself is not depression)
  • Divorce
  • Stress
  • Female
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8
Q

What group of people are a higher suicide risk when depressed?

A

Male

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9
Q

What are two theories that could lead to or worsen depression/ other psychiatric disorders?

A
  • Stress-vulnerability model = positive outcome more likely if stress minimised
  • Monoamine hypothesis = deficiency of catecholamines (e.g. norepinephrine) –> depression
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10
Q

How is depression initially assessed (3)?

A
  • Psychiatric: history, MSE, risk assessment
  • Bloods: FBC, U&E, LFTs, TFTs, Ca2+, B12/folate, glucose, CRP/ESR
  • Questionaries
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11
Q

What questionnaire is commonly used for depression?

A

PHQ-9

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12
Q

What scores are suggestive of different levels of depression in the PHQ-9?

A

Out of 27:
* <10 = mild
* 10-19 = moderate
* >19 = severe

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13
Q

What symptom can occur alongside severe depression?

A

Psychosis

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14
Q

What is psychosis?

A

Symptoms that occur when the mind has difficulty determining what is real and what is not

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15
Q

What are some symptoms of psychosis (3)?

A
  • Hallucinations
  • Delusions
  • Disorganised speech/thought
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16
Q

What is a delusion?

A

A false belief based in incorrect inference about reality

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17
Q

How is mild depression managed?

A

Psychotherapy - guided self help, CBT, group exercises/ mindfulness
Only give antidepressant if requested

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18
Q

How is more severe depression treated?

A
  • Offer antidepressant (SSRI/ SNRI)
  • Psychotherapy (less group activities than mild depression)
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19
Q

What PHQ-9 score should antidepressants be offered as first line?

A

16 or more
under 16 should only be given if requested

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20
Q

When should initial follow up appointments be arranged for depression after starting antidepressants?

A

2 weeks

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21
Q

Who should be seen 1 week after starting antidepressants?

A
  • 18-25 year olds
  • High risk of suicide
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22
Q

How soon should antidepressants begin to have a clinical effect?

A

Within 4-6 weeks

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23
Q

What should be done after 4-6 weeks of treatment if there has been no improvement in depression (3)?

A
  • Re-evaluate + manage risk factors for depression
  • Check compliance with medication
  • Consider differential diagnoses
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24
Q

How long after symptoms resolve should an antidepressant be taken for?

A

6 months

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25
Q

How frequently should those on long term antidepressants be seen?

A

Every 6 months

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26
Q

What treatment can be offered for extremely severe, life threatening depression?

A

ECT

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27
Q

What are the pharmacological options and order typically given for depression (6)?

A
  1. SSRI
  2. Another SSRI
  3. SNRI/ mirtazapine
  4. TCA
  5. MAOIs
  6. Treatment resistant depression –> lithium/ antipsychotics/ AEDs
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28
Q

When should a patient with depression be referred?

A

Treatment resistant depression/ very severe depression

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29
Q

Other than depression what are some other affective disorders (mood disorders) (6)?

A
  • Bipolar disorder
  • Dysthmia
  • Postnatal depression
  • Seasonal affective disorder
  • Premenstrual dysphoric disorder (PMDD)
  • Schizoaffective disorder
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30
Q

What is dysthymia?

A

Persistent (2-5 years) sub-threshold depressive symptoms

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31
Q

What is postnatal depression?

A

Depression within first year of giving birth, persisting beyond 2 weeks after birth

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32
Q

What severe symptoms can occur alongside postnatal depression?

A

Psychosis (postpartum psychosis)

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33
Q

What is the “baby blues”?

A

Depression that resolves within 2 weeks of giving birth

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34
Q

How is postnatal depression medically managed when mother is breastfeeding?

A

Sertraline/ paroxetine
low levels pass into breast milk

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35
Q

What is seasonal affective disorder (SAD)?

A

Depression usually during autumn/ winter with remission between

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36
Q

What is a specific treatment for SAD?

A

Light therapy

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37
Q

What is adjustment disorder?

A

Negative reaction to stress involving negative thoughts, strong emotions and changes in behaviour.
May occur with depressive symptoms

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38
Q

How long does adjustment disorder last?

A

Less than 6 months

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39
Q

What are some key differential diagnoses for low mood (4)?

A
  • Affective disorders (e.g. depression, bipolar, SAD…)
  • Hypothyroidism
  • Bereavement
  • Cancer/ terminal illness
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40
Q

What is bipolar disorder?

A

The presence of both depressive and (hypo)manic episodes

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41
Q

What is mania?

A

Abnormally elevated mood lasting for more than 1 week resulting in impairment in social and occupational functioning. Psychotic symptoms often present

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42
Q

What is hypomania?

A

Elevated mood lasting for more than 4 days that does not significantly impact on the persons functioning

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43
Q

What are the types of bipolar disorder (3)?

A
  • Type 1 = mania + depression
  • Type 2 = hypomania + depression
  • Cyclothymia = hypomania + subclinical depression
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44
Q

What criteria are needed for a diagnosis of each of the bipolar disorders?

A
  • Type 1 = manic episode, don’t need depressive episode
  • Type 2 = hypomanic AND depressive
  • Cyclothymia = hypomania and subclinical depression (much faster alternating) lasting 2 years
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45
Q

What are some symptoms of a manic episode (8)?

A
  • Elevated mood
  • Increased activity
  • Grandiose ideas
  • Decreased need for sleep
  • Easily distracted
  • Psychotic symptoms
  • Pressure of speech, flight of ideas
  • Changing appearance + overspending money
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46
Q

The lack of what features would point toward a hypomanic episode (3)?

A
  • Grandiosity
  • Psychosis
  • Lack of insight (so would have some insight)
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47
Q

What can precipitate a manic episode (3)?

A
  • Positive life events
  • Getting up early
  • Drugs/ alcohol
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48
Q

What are some risk factors for bipolar (4)?

A
  • Family history (first degree)
  • Trauma/ abuse
  • Stress
  • Substance abuse
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49
Q

What might be considered a typical person at risk of developing bipolar?

A

Female < 30 with family history of bipolar

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50
Q

What activities pose a risk to those in a manic episode (3)?

A
  • Reckless behaviour/ aggression
  • Sexual promiscuosity
  • Lack of self care for physical illnesses
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51
Q

What are some organic causes of bipolar disorder (3)?

A
  • Endocrine e.g. hyperthyroidism
  • Neurological - MS, CVA, epilepsy, tumour
  • Drugs - steroids, antidepressants
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52
Q

How is bipolar diagnosed (2)?

A
  • Clinical diagnosis
  • Bloods, imaging and other Ix used to rule out organic causes
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53
Q

How should bipolar be immediately managed (2)?

A
  • Manic episode = urgent referral
  • Hypomanic episode = routine referral
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54
Q

What is rapid cycling bipolar disorder?

A

Having 4 or more manic episodes in 1 year

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55
Q

What is the medication pathway to treat a manic episode (3)?

A
  • Antipsychotic (haloperidol, risperidone, quetiapine, olanzapine)
  • Offer second antipsychotic
  • Add sodium valproate/ lithium
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56
Q

What should be stopped during a manic episode?

A

Antidepressants - tapered and stopped

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57
Q

How is a depressive episode in bipolar managed with medication (3)?

A
  • Antipsychotics
  • Olanzapine + fluoxetine
  • Lamotrigine
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58
Q

What is the medication pathway for the long term management of bipolar?

A
  • Lithium
  • Sodium valproate
  • Olanzapine
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59
Q

How should lithium be monitored when started for bipolar disorder?

A

Concentration measured 12 hours after dose weekly until stable, then every 3 months

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60
Q

What non pharmacological options are there for those with bipolar disorder?

A
  • Education about bipolar and early warning signs (with involvement of family)
    CBT can be used - not particularly effective
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61
Q

What are some differential diagnoses for bipolar disorder (3)?

A
  • Unipolar depression
  • Schizophrenia
  • Emotionally unstable personality disorder (EUPD/BPD)
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62
Q

What is schizophrenia?

A

An acute mental health state resulting in psychosis (delusions and hallucinations) and dissociation from reality

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63
Q

What are 3 types of delusion?

A
  • Grandeur = belief of inflated self importance (e.g. that they are the queen)
  • Paranoid
  • Somatic = believe they have a terrible illness
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64
Q

What are some risk factors for schizophrenia (6)?

A
  • Family history (1st degree) = biggest factor
  • 16-30 years
  • Previous illicit drug user
  • Trauma + abuse
  • Traumatic birth
  • Emigrating
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65
Q

What broad groups are the symptoms of schizophrenia divided into (3)?

A
  • Positive symptoms
  • Negative symptoms
  • Cognitive impairment
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66
Q

What is a positive symptom in schizophrenia?

A

Those present in people during a psychotic episode

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67
Q

What is a negative symptom in schizophrenia?

A

Deficits of normal emotional responses

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68
Q

What are some examples of positive symptoms in schizophrenia?

A
  • Delusions
  • Hallucinations
  • Thought disorders
  • Disorganised speech/ behaviour
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69
Q

What types of hallucinations are common in schizophrenia?

A

Auditory (however talking to the voices is rare)
visual and olfactory hallucinations are rarer in schizophrenia

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70
Q

What types of disorganised speech sometimes occur in schizophrenia (6)?

A
  • Word salad - completely mixed up sentence
  • Neologism - made up word
  • Flight of thought - jumps from one idea to another with associations
  • Knights move thinking - jump from ideas with no associations
  • Pressure of speech - fast talking
  • Circumstantiality - take ages to get to the point
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71
Q

What type of thought disorders occur in schizophrenia (3)?

A
  • Insertion - thoughts put in mind
  • Withdrawal - thoughts taken from mind
  • Broadcasting - thoughts told against will
  • Passivity - lack of control over them
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72
Q

What negative symptoms can be present in those with schizophrenia (5)?

A
  • Alogia - impoverished level of thinking (poverty of speech)
  • Anhedonia - loss of pleasure
  • Apathy - lack of enthusiasm
  • Blunting of affect (emotionless)
  • Slowness of thought and movement
    AAABS
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73
Q

What other symptoms can be present in those with schizophrenia (5)?

A
  • Depression
  • Anxiety
  • Agitation
  • Withdrawal
  • Self harm
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74
Q

What are Schniders first rank symptoms for schizophrenia (more historical criteria) (4)?

A
  • Auditory hallucinations
  • Broadcasting, insertion, withdrawal of thoughts
  • Control (passivity) - others controlling actions + thoughts
  • Delusional perceptions
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75
Q

What are some differential diagnoses for psychosis (4)?

A
  • Psychological disorders
  • Delirium tremens
  • Drugs e.g. cannabis
  • Organic disorder e.g. epilepsy
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76
Q

What psychological disorders cause psychosis (5)?

A
  • Schizophrenia
  • Bipolar disorder
  • Brief psychotic disorder
  • Delusional disorder
  • Major depressive disorder
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77
Q

How long should a brief psychotic disorder last?

A

less than 1 month, often with a precipitating factor

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78
Q

What is delusional disorder?

A

Similar to schizophrenia but without significant hallucinations, though disorders or mood disorders

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79
Q

How is schizophrenia investigated (4)?

A
  • FBC + LFTs
  • Drug screening
  • EEG - for epilepsy
  • CT/ MRI - enlarged lateral ventricles
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80
Q

How long should symptoms of schizophrenia be going on for before a diagnosis is made?

A

28 days

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81
Q

What is important to tell people with a diagnosis of schizophrenia?

A

Can’t drive until well for 3 months

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82
Q

What is indicative of a poor prognosis for schizophrenia (4)?

A
  • Slower onset
  • Family history
  • Abuse history
  • Negative symptoms
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83
Q

What is late onset schizophrenia?

A

After age 45

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84
Q

What is the prognosis for later onset schizophrenia?

A

Better prognosis

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85
Q

What risks are associated with those with schizophrenia (3)?

A
  • Self neglect - exacerbate physical health conditions
  • Risk to others
  • Suicide - thoughts/ auditory hallucinations
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86
Q

How is schizophrenia managed pharmacologically?

A
  • Trial 2 atypical antipsychotics (risperidone, olanzapine, aripiprazole, quetiapine)
  • if no effect … clozapine
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87
Q

What non pharmacological treatments are offered to those with schizophrenia (3)?

A
  • CBT
  • Early warning signs education
  • Family therapy (they can recognise the signs)
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88
Q

What is schizoaffective disorder?

A

Schizophrenia + mood disorder (e.g. depression/ bipolar)

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89
Q

What “state” do some people with schizophrenia sometimes end up in?

A

Catatonia

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90
Q

What is catatonia?

A

Ceases in movements/ speech, sometimes with abnormal movements

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91
Q

Other than schizophrenia what is catatonia associated with (2)?

A
  • Major depressive disorder
  • Mania/ bipolar disorder
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92
Q

What is the most common anxiety disorder affecting 15% of people?

A

Specific phobias

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93
Q

How could a specific phobia be defined?

A

Irrational fear of particular thing/ situation

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94
Q

What is a symptom of specific phobias (2)?

A
  • Avoidance behaviours
  • Catastrophising
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95
Q

What are some examples of specific phobias (1)?

A
  • Agoraphobia = fear of public places/ unknown environment
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96
Q

How is a specific phobia treated (2)?

A
  • Exposure responce prevention
  • Consider SSRIs
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97
Q

What is the second most common anxiety disorder?

A

PTSD

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98
Q

What is PTSD?

A

Onset of symptoms such as flashbacks for more than 1 month after a particularly traumatic event

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99
Q

What is ‘PTSD’ that does not continue 1 month past the traumatic event known as?

A

Acute stress reaction

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100
Q

What are the 3 main symptoms of PTSD?

A
  • Flashbacks/ nightmares to event
  • Avoidance behaviour of things that remind them of the event
  • Hypervigilance - exaggerated responce to stimuli
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101
Q

What is the first line treatment for more mild PTSD?

A

Trauma focused CBT + exposure therapy

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102
Q

What is the gold standard treatment for chronic PTSD?

A

Eye movement desensitisation and reprocessing (EMDR)

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103
Q

What is a pharmacological treatment for PTSD?

A

SSRI or venlafaxine

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104
Q

Other than PTSD and phobias, what are some other anxiety disorders (3)?

A
  • Panic disorder
  • GAD
  • OCD
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105
Q

What 3 features are suggested in models that result in the development of panic/ anxiety disorders?

A
  • Stress
  • Loss of control
  • Genetics
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106
Q

What are some risk factors for the development of anxiety/ panic disorders (6)?

A
  • Genetics
  • Stimulant drugs
  • Palpitations
  • Hyperthyroid
  • Trauma/ abuse
  • Stress
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107
Q

How many panic attacks are required for a diagnosis of panic disorder?

A

4 or more within 1 month
usually last 10-30 min

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108
Q

Who is typically affected by panic disorder?

A

Female (20-30 years old)

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109
Q

What are 8 symptoms of a panic attack?

A
  • SoB
  • Chest pain
  • Lightheaded/ dizzy
  • Palpitations
  • Shaking
  • Sweating
  • Parasthesia
  • Fear of dying
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110
Q

What phobia do people with panic disorder often develop?

A

Agoraphobia - fear of unknown surroundings

111
Q

What questionnaire is used to diagnose panic disorder?

A

PHQ-PD

112
Q

How is panic disorder treated (4)?

A
  • Psychoeducation
  • CBT/ ERP = gold
  • SSRI
  • Beta blockers (propanolol)
113
Q

What is OCD?

A

Obsessive thoughts and recurrent ritualistic behaviour (for relief)

114
Q

What are the 2 symptoms/ features of OCD?

A
  • Recurrent unwanted intrusive thoughts
  • Behaviours that result from the obsessive thoughts believed to prevent a bad outcome
115
Q

How long should OCD be going on for to get a diagnosis?

A

More than 4 days per week for more than 2 weeks

116
Q

What are some common OCD behaviours (3)?

A
  • Handwashing
  • Checking lights/ locks
  • Cleaning
117
Q

Do patients with OCD have insight into their behaviours?

A

Yes they know it is unnecessary

118
Q

What is the cycle of emotions in OCD?

A

Obsession –> anxiety –> compulsion –> temporary relief

119
Q

What questionnaire can be used to help diagnose OCD?

A

Y-BOCS (Yale-brown OCD scale)

120
Q

How is OCD managed (3)?

A
  • Exposure and response prevention (+CBT)
  • 1st = SSRIs (for at least 12 weeks)
  • 2nd = clomipramine (TCA)
121
Q

What is generalised anxiety disorder?

A

Numerous worries cause anxiety throughout the day and in various situations

122
Q

How long should symptoms go on for a diagnosis of GAD?

A

6 months

123
Q

What are 3 key features of the anxiety in GAD?

A
  • Pervasive
  • Persistent
  • Non-specific
124
Q

What are some physiological reactions to anxiety (6)?

A
  • Decreased blood flow to gut
  • Smooth muscle contraction in gut
  • Increased blood flow to skeletal muscle
  • Dilation of pupils
  • Nausea
  • Increased HR/BP
125
Q

What are the 6 key signs/ symptoms of GAD?

A
  • Restlessness
  • Fatigue
  • Irritability
  • Poor concentration
  • Sleep disturbance
  • Muscle tension
126
Q

How is GAD investigated (2)?

A
  • Bloods
  • GAD-7 questionnaire
127
Q

How is GAD treated (4)?

A
  • Psychoeducation - explain the diagnosis
  • Guided self help + breathing techniques
  • CBT
  • Pharmacological Tx
128
Q

What drug treatments are offered to those with GAD in primary care (3)?

A
  • Sertraline = 1st
  • SSRI/SNRI (particularly duloxetine and venlafaxine)
  • Pregabalin
129
Q

What drug treatments are offered for GAD in secondary care?

A

Antipsychotics (e.g. quetiapine)

130
Q

What medications can be offered for symptom relief in those with GAD?

A

Beta blockers (e.g. propanolol)

131
Q

What medication is used for short term symptomatic relief of GAD?

A

Benzodiazapines e.g. diazepam

132
Q

Why should long term use of benzodiazepines be avoided (4)?

A
  • Addiction risk
  • Adverse effects on mood
  • Reduced motivation
  • Oversedation
133
Q

What percent of men and women have GAD?

A
  • Men = 2-4%
  • Women = 3-5%
134
Q

What is it known as when there is a focus/ exaggeration of physical symptoms?

A

Somatisation = symptoms

135
Q

What is concern of a serious illness known as?

A

Hypochondriasis = cancer

136
Q

What is a personality disorder?

A

A longterm, persistent pattern of inner experiences and behaviour that differs markedly from cultural expectations leading to distress/ impairment

137
Q

When do personality disorders typically develop in life?

A

Early adulthood/ adolescence

138
Q

What are some risk factors for personality disorders (2)?

A
  • Traumatic childhood without any strong connections with other people
  • Family member with personality disorder
139
Q

What theory has been suggested to contribute to the development of personality disorders?

A

Attachment theory - idea that children need one relationship with primary caregivers for their survival

140
Q

What areas of functioning do personality disorders affect (5)?

A
  • Interpersonal functioning
  • Affectivity
  • Cognition
  • Impulse control
  • Occupational/ social performance
141
Q

What questionnaire can be used to diagnose and distinguish different PDs?

A

Personality diagnostic questionnaire 4 (PDQ-4)

142
Q

Are behaviours/ emotions exhibited due to personality disorders easy to change?

A

No, they are deeply ingrained + enduring

143
Q

What are the 3 broad categories of personality disorders?

A
  • A = Suspicious/ odd
  • B = Emotional/ impulsive
  • C = Anxious
144
Q

What personality disorders are within group A - odd/ eccentric (3)?

A
  • Paranoid - suspicious, sensitive, unforgiving
  • Schizoid - emotionally cold, lack of interest, detached
  • Schizotypal - magical thinking, unusual perceptions, inappropriate affect
145
Q

What personality disorders are within group B - emotional/ erratic (4)?

A
  • Antisocial - lack of concern, disregard for rules, aggression
  • Borderline/ EUPD - impulsive, fear of abandonment, poor self image
  • Histrionic - dramatic, crave attention, manipulative
  • Narcissistic - grandiosity, lack of empathy, need for admiration
146
Q

What personality disorders are within group C - anxious/ fearful (3)?

A
  • Avoidant - fear of criticism, self-conscious, tense
  • Dependant - doesn’t like to take control, doesn’t disagree, needs reassurance
  • Obsessive - compulsive - perfectionist, indecisive, likes orderliness + control
147
Q

What are common signs and symptoms for all personality disorders (7)?

A
  • Strong emotions
  • Low self esteem
  • Impulsive
  • Self harm
  • Substance abuse
  • Violence/ agression
  • Difficulties maintaining relationships
148
Q

What questionnaire is useful for diagnosis of personality disorders?

A

Minnesota multiphase personality inventory (MMPI)

149
Q

How are personality disorders managed?

A
  • Psychoeducation
  • Dialectical behaviour therapy (+other CBT)
150
Q

What is a particularly effective management of BPD/ EUPD?

A

Dialectical behaviour therapy

151
Q

Which personality disorder is suicide/ self harm particularly common?

A

EUPD/BPD
antisocial as well

152
Q

What are 6 psychiatric emergencies?

A
  • Neuropleptic malignant syndrome
  • Serotonin syndrome
  • Acute dystonic syndrome
  • Wernicke-korsakoff syndrome
  • Delirium tremens
  • Lithium toxicity
153
Q

What causes neuroleptic malignant syndrome?

A

Reduced dopaminergic activity due to adverse reaction to antipsychotics (dopamine receptor antagonists) or abrupt dopaminergic withdrawal (levodopa)

154
Q

What are the symptoms of neuroleptic malignant syndrome (5)?

A
  • Fever
  • Altered mental state/ confused
  • Rigidity
  • Fluctuating BP
  • Tachycardia
155
Q

How is NMS investigated (3)?

A
  • Bloods
  • CT/MRI
  • Infection screen
156
Q

What blood result is often raised in NMS?

A

Creatinine kinase

157
Q

How is NMS managed (4)?

A
  • Treat hyperthermia (e.g. with ice packs)
  • Stop drug
  • Dantrolene (muscle relaxant)
  • Bromocriptine
158
Q

What are some complications of NMS (2)?

A
  • Rhabdomyolysis
  • AKI
159
Q

What causes serotonin syndrome?

A

High synaptic concentration of serotonin

160
Q

What drugs cause serotonin syndrome (4)?

A
  • Antidepressants
  • Opioids e.g. tramadol
  • St johns worts
  • Stimulants e.g. ecstacy/ cocaine
161
Q

How do opioids sometimes cause serotonin syndrome?

A

Unknown although metabolites may be SSRIs
Tramadol acts as an SNRI

162
Q

What antidepressant is a particular risk for causes serotonin syndrome?

A

MAOIs

163
Q

What are the symptoms of serotonin syndrome (7)?

A
  • Agitation/ confusion/ hallucinations
  • Tremor
  • Rigidity
  • Hyperreflexia
  • Hypertension
  • Tachycardia
  • Hyperthermia
164
Q

How soon after starting medications does serotonin syndrome usually occur?

A

Within 2 weeks

165
Q

How is serotonin syndrome treated?

A

Chlorpromazine
Mainly supportive treatments e.g. ice packs, intubation

166
Q

What medication can be given to those with serotonin syndrome?

A

Cyproheptadine or chlorpromazine - blocks dopamine

167
Q

What is a differential diagnosis for serotonin syndrome?

A

Neuroleptic malignant syndrome

168
Q

What can help differentiate between NMS and SS in terms of signs/ symptoms?

A
  • NMS = (lead pipe) muscle rigidity
  • SS = hyperreflexia/ clonus
169
Q

How can NMS and SS be differentiated between from blood results?

A

NMS usually has raised WBC and CK more than SS

170
Q

How is self harm often carried out (5)?

A
  • Cutting
  • Headbanging
  • Burning
  • Alcohol
  • Overdoses
171
Q

What are some risk factors for self harm (6)?

A
  • LGBTQ+
  • Female
  • EUPD
  • Depression
  • Bereavement
  • Trauma/ abuse
172
Q

How is suicide often carried out (4)?

A
  • Overdose
  • Jumping from height
  • Cutting
  • Ligatures
173
Q

What are some risk factors for suicide (10)?

A
  • Sex = male
  • Age = old/ teenager
  • Depressed
  • Past history of suicide attempt
  • Employment = unemployed
  • Rational loss (psychotic)
  • Self harm
  • Organised plan
  • Non married/ divorced
  • Sick/ chronic disease
174
Q

What factors suggest a higher likelihood of a completed suicide attempt (5)?

A
  • Makes effort not to be found
  • Leaves note
  • Plans death
  • No regret
  • Violent method
175
Q

What pathway is thought to be the cause of addictive behaviours?

A

Mesolimbic reward dopaminergic pathway

176
Q

What terms are used to describe substance dependance (8)?

A
  • Withdrawal Sx
  • Tolerance
  • Narrow repertoire
  • Craving
  • Loss of control
  • Rapid reinforcement
  • Primacy
  • Continued use despite harm
177
Q

What does a narrow repertoire refer to in the context of substance dependence?

A

Exhibit same behaviour - e.g. drinking around the same times each day to maintain high BAC

178
Q

What does rapid reinforcement refer to in substance dependence?

A

Quick return to old level after stopping

179
Q

What does primacy refer to in substance dependence?

A

Takes precedence over physiological need

180
Q

What is the mechanism of action of alcohol in the brain?

A

Alcohol up-regulates GABA (inhibitory) receptors and down-regulates glutamate (excitatory) receptors

181
Q

What is the pathophysiology of long term alcohol use?

A

GABA system down-regulated and glutamate system up-regulated, therefore when alcohol is not taken this results in an imbalance in the body

182
Q

What is the recommended alcohol consumption each weak?

A

14 units

183
Q

What are some symptoms of alcohol intoxication (7)?

A
  • Ataxia
  • Slurred speech
  • Increased confidence
  • Irritable
  • Decreased GCS
  • Vomiting
  • Sexual arousal
184
Q

What are some signs/ symptoms of excess chronic alcohol use (6)?

A
  • Smelling of alcohol
  • Slurred speech
  • Bloodshot eyes
  • Telangiectasia
  • Tremor + other withdrawal Sx
  • Decreased cognitive functioning/ memory
185
Q

What are the symptoms of alcohol withdraw and what time period do they appear (3)?

A
  • 6-12 hours = anxiety + (fine) tremor
  • 24-48 hours = seizures (peak at 36 hours)
  • 48 -72 hours = delirium tremens
186
Q

What are the signs/ symptoms of delirium tremens (6)?

A
  • Corse tremor
  • Confusion
  • Delusions
  • Auditory + visual hallucinations
  • Fever
  • Tachycardia
187
Q

How is alcohol use investigated (3)?

A
  • Bloods
  • CAGE questionnaire = screening
  • AUDIT questionnaire = diagnosis
188
Q

What score on AUDIT questionnaire indicates harmful alcohol use?

A

8/10 or more

189
Q

What are the blood findings of those with alcohol use (3)?

A
  • Raised MCV
  • Raised GGT + AST>ALT
  • Raised CDT
190
Q

What questions are asked in the CAGE questionnaire?

A
  • Cut down? (think about it)
  • Annoyed (when people ask about alcohol)
  • Guilty
  • Eye opener (drink when wake up)
191
Q

What is the treatment for acute alcohol withdrawal (2)?

A
  • Chlordiazepoxide
  • IM/IV pabrinex (vitamin Bs e.g. thiamine)
192
Q

How is alcohol use managed in the long term (5)?

A
  • Naltrexone = reduces pleasure
  • Acamprosate = reduces cravings
  • Disulfiram = induces hangover Sx with alcohol
  • Oral thiamine
  • Psychological therapy
193
Q

What is the BAC limit for driving?

A

0.08%

194
Q

What are some complications of alcohol consumption (5)?

A
  • Liver cirrhosis
  • Wernicke-korsakoff
  • Pancreatitis
  • Cancer
  • Alcohol dependance + withdrawal
195
Q

What is the cause of Wernicke-Korsakoff syndrome?

A

Poor thiamine (B1) absorption –> thiamine deficiency

196
Q

What are the symptoms of wernickes encephalopathy (4)?

A
  • Confusion
  • Oculomotor disturbance/ nystagmus
  • Ataxia
  • AMS
197
Q

What are the signs/ symptoms of korakoff (3)?

A

Memory impairment/ confabulation

198
Q

What are some MRI findings in Wernicke-Korsakoff syndrome (2)?

A
  • Wernicke = reversible cytotoxic oedema
  • Korsakoff = mammillary body + thalamic atrophy
199
Q

How is Wernicke-Korsakoff treated?

A

IV pabrinex (vitamin Bs/ thiamine)

200
Q

What are the symptoms of opioid overuse/ toxicity (5)?

A
  • Pinpoint pupils
  • Resp depression
  • Reduced GCS + confusion
  • Euphoric
  • Constipated
201
Q

How is opioid overdose treated?

A

Naloxone

202
Q

How is opioid use treated in the long term?

A

Methadone

203
Q

What are some withdrawal symptoms of opioid use (6)?

A
  • Yawning
  • Anxiety
  • Dilated pupils
  • N+V
  • Lacrimation (increased tears)
  • Rinorrhoea
204
Q

What is the mechanism of MDMA, cocaine, amphetamines and LSD (4)?

A
  • MDMA (ectasy) = stimulates serotonin release + blocks reuptake
  • Cocaine = blocks dopamine reuptake
  • Meth = stimulates Da release + blocks reuptake
  • LSD = stimulates 5-HT2A receptors (serotonin receptors) in prefrontal cortex
205
Q

What are the general signs/ symptoms of MDMA, cocaine, amphetamines and LSD use (4)?

A
  • Agitation
  • Hypertension
  • Hyperthermia
  • Tachycardia
206
Q

What are two specific features of cocaine use?

A
  • Vasospasm
  • QRS prolongation + arrhythmias
207
Q

What are the two specific features of amphetamine use?

A
  • Hallucinations
  • Dilated pupils
208
Q

What are two specific features of LSD use?

A
  • Hallucinations
  • Hyperreflexia
209
Q

What are the general principles of management of drug overdoses (6)?

A
  • A-E approach
  • Intubate
  • Reduce temperature
  • Monitor BP
  • Benzodiazapines (for seizure prevention)
  • Psychological support
210
Q

What is drug misuse vs drug abuse (2)?

A
  • Abuse = use in a way that causes considerable harm
  • Misuse = use in a way different to prescription/ unsafe setting
211
Q

What are 3 common eating disorders?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
212
Q

Which eating disorder is the least common but has the highest mortality?

A

Anorexia nervosa

213
Q

What is anorexia nervosa?

A

Believing they are overweight and need to loose weight despite evidence of low/ normal BMI

214
Q

What are some risk factors for anorexia nervosa (7)?

A
  • Family history
  • Female
  • Younger age (20-40)
  • Trauma/ abuse
  • Social media
  • History of overweight
  • Depression
215
Q

What are the signs/ symptoms of anorexia nervosa (8)?

A
  • Low BMI < 17.5/ 15% below expected
  • Purging (laxatives + vomiting)
  • Weight loss
  • Amenorrhoea
  • Lanugo hair
  • Osteopenia + muscle waisting
  • Hypotension
  • Hypothermia
216
Q

What are some common cardiac complications in those with anorexia nervosa (3)?

A
  • Arrhythmias
  • Cardiac atrophy
  • Sudden cardiac death
217
Q

How is anorexia nervosa investigated (4)?

A
  • SCOFF screening questions
  • SUSS test (sit-up-squat-stand)
  • Bloods
  • ECG
218
Q

What are the SCOFF screening questions for AN (5)?

A
  • Make yourself Sick
  • Lost Control of how much you eat
  • One stone in 3 months
  • Food dominates life
  • Fat perception
219
Q

What are the blood results of someone with anorexia nervosa (4)?

A
  • Anaemia
  • Leucopenia
  • Thrombocytopenia
    reduced bone marrow activity
  • Hypokalaemia
    everything low except growth hormone + cortisol
220
Q

How is anorexia nervosa managed (5)?

A
  • Structured eating plan + supplements
  • Anorexia focused family therapy
  • CBT
  • Inpatient management
  • Fluoxetine
221
Q

What are some complications of anorexia nervosa (4)?

A
  • Refeeding syndrome
  • Osteoporosis
  • Amenorrhoea
  • Infertility
222
Q

What is the pathophysiology of refeeding syndrome?

A

Low food intake = low electrolytes, when begin eating –> insulin spike –> glucose + electrolytes move into cells –> further depletes electrolytes + glucose

223
Q

What are the important effects of referring syndrome (4)?

A
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypophosphataemia
  • Fluid overload
224
Q

What is bulimia nervosa?

A

Episodes of binge eating followed by purging (typically making oneself vomit)

225
Q

Who is typically affected by bulimia nervosa?

A

Young female (20-30) athletes/ models

226
Q

What are the signs/ symptoms of bulimia nervosa (9)?

A
  • Preoccupation with body image
  • Often normal BMI
  • Binge eating then purging
  • Erosion of teeth
  • Russels sign (callouses on knuckles)
  • Gord/ reflux
  • Parotitis
  • Halitosis (bad breath)
  • Dental carries
227
Q

What is the typical episode of a binge eating then purge like in BN?

A

Eating alone until uncomfortably full, feel guilty, then making themselves vomit

228
Q

What are some examples of ways people with BN purge (3)?

A
  • Vomit
  • Exercise
  • Laxatives/ diuretics
229
Q

How is bulimia nervosa investigated (3)?

A
  • SCOFF screening
  • SUSS -ve
  • Bloods
230
Q

How long should bulimia nervosa typically have gone on for?

A

3 months with 2 episodes per week

231
Q

What are the blood findings in those with bulimia nervosa?

A

Hypokalaemic hypochloraemia metabolic alkalosis

232
Q

How is bulimia nervosa managed (4)?

A
  • Self help + education
  • CBT (eating disorder focused)
  • Bulimia nervosa focused family therapy
  • Fluoxetine
233
Q

What are the signs/ symptoms of binge eating disorder (5)?

A
  • Higher BMI
  • Planned episodes of eating lots very quickly in private
  • Loss of control
  • Guilt/ disgust
  • Underlying psychological distress
234
Q

How long should binge eating disorder typically have been going on for for a diagnosis?

A

More than 3 months

235
Q

How is binge eating disorder treated?

A

CBT

236
Q

What are some common reasons children may be referred to CAMS (4)?

A
  • Learning disabilities
  • ADHA
  • ASD
  • Tics
237
Q

What is a learning disability vs learning difficulty?

A
  • Disability = general intelligence resulting in a lower IQ
  • Difficulty = difference in the way someone learns making it harder to learn certain things
238
Q

How are learning disabilities categorised (4)?

A
  • 50-70 = mild
  • 35-49 = moderate
  • 20-34 = severe
  • <20 = profound
    measured in IQ
239
Q

What are some causes of learning disabilities (5)?

A
  • ASD
  • ADHD
  • Genetic (e.g. downs)
  • TORCH
  • PANDAS
240
Q

What is PANDAS?

A

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - it is a controversial diagnosis where children develop tic disorders or OCD after streptococcal infection

241
Q

What is autism spectrum disorder?

A

Spectrum of severity of impaired communication and social interaction

242
Q

What age do symptoms of ASD typically appear?

A

< 3 years

243
Q

What 3 general categories can symptoms of ASD be placed in (3)?

A
  • Social interaction
  • Communication difficulties
  • Behavioural deficits
244
Q

What are some signs/ symptoms of ASD (11)?

A
  • Lack of eye contact
  • Delay in smiling
  • Avoiding physical contact
  • Difficulty reading non-verbal cues/ emotions
  • Delay in language/ minimal language
  • Difficulty with imaginative behaviour
  • Repetitive use of words/ phrases
  • Lack of interest in people
  • Repetitive movements/ behaviours
  • Fixed routine
  • Deep + intense interests
245
Q

In what situations should symptoms of ASD be present?

A

Across more than 1 setting e.g. home and school

246
Q

What questionnaire can help diagnose autism?

A

M-CHAT

247
Q

How is ASD managed?

A

Supportive - SENCO, psychologists, etc

248
Q

What are the key features of ADHD (3)?

A
  • Difficulty maintaining attention
  • Excessive energy + activity
  • Impulsivity
249
Q

What are some risk factors/ causes of ADHD (3)?

A
  • Genetics/ family history
  • Pregnancy related (e.g. low birth weight, smoking, premature)
  • Environmental factors
250
Q

In what situations should symptoms of ADHD be present?

A

Consistent across all settings

251
Q

What are some symptoms of ADHD (7)?

A
  • Short attention span
  • Easily distracted
  • Quickly moving between activities
  • Inability to complete tasks
  • Constantly moving/ fidgeting
  • Impulsive behaviour
  • Disruptive behaviour
252
Q

What assessment can help diagnose ADHD?

A

DIVA-5

253
Q

How is ADHD managed (3)?

A
  1. Watch + wait/ conservative management
  2. Methylphenidate
  3. Lisdexamfetamine
254
Q

What are some conservative management strategies for ADHD (4)?

A
  • Structured routines
  • Clear boundary
  • Healthy diet
  • Plenty of exercise
255
Q

What type of medications are used for ADHD?

A

Amphetamines (CNS stimulants)

256
Q

What should be monitored in people on methylphenidate + other ADHD drugs (2)?

A
  • Baseline ECG needed as risk of RBBB
  • Monitor height + weight on growth charts as meds can decrease appetite
257
Q

What conditions are tics associated with (3)?

A
  • ASD
  • ADHD
  • PANDAS
258
Q

What are the classification of tics (2)?

A
  • Simple (non goal orientated movements)
  • Complex
259
Q

What are some examples of complex tics (3)?

A
  • Echolalie (repeating phrases others have said
  • Involuntary swearing
  • Involuntary obscene gestures
260
Q

What is Tourettes (2)?

A
  • More than 1 year simple tics
  • Multiple complex tics
261
Q

How should tics be managed?

A

Don’t try to suppress them

262
Q

What is a Neurodevelopmental disorder?

A

Group of mental disorders affecting the development of the nervous system

263
Q

What are some examples of Neurodevelopmental disorders (4)?

A
  • ASD
  • ADHD
  • Learning disability
  • Tics
264
Q

What are some disorders affecting sleep (4)?

A
  • Insomnia
  • Narcolepsy
  • Restless leg syndrome
  • Sleep apnoea
265
Q

How can insomnia be treated (2)?

A
  • Zopiclone
  • Benzos
    should only be prescribed for a short period
266
Q

What is narcolepsy?

A

Condition impairing the ability to regulate sleep-wake cycle

267
Q

What are some signs/ symptoms of narcolepsy (5)?

A
  • Cataplexy (collapse after emotional high)
  • Hallucinations (visual)
  • Excessive daytime sleepiness
  • Sleep paralysis
  • Sleep difficulty
268
Q

How is narcolepsy treated?

A

Modafinil (CNS stimulant)

269
Q

What are some criteria for gender dysphoria (6)?

A
  • Difference between assigned gender and expressed/ experienced gender
  • Desire to be rid of ones sexual characteristics
  • Desire for characteristics of another gender
  • Desire to be a gender other than ones assigned gender
  • Belief that one has the typical reactions/ feelings of another gender
  • Desire to be treated as a different gender
270
Q

How long should these symptoms of gender dysphoria be going on for to have a diagnosis?

A

2 or more symptoms for more than 6 months

271
Q

What are some causes of cognitive impairment (7)?

A
  • Dementias + parkinsons
  • Strokes
  • Traumatic brain injuries
  • Meningitis/ encephalitis
  • Depression/ schizophrenia/ bipolar
  • Substance use
  • Genetics (e.g. downs)
272
Q

What disorders under the scope of psychiatry are common in older people (6)?

A
  • Depression
  • Dementia
  • Anxiety disorders
  • Bereavement
  • Delirium
  • Insomnia
273
Q

What factors might suggest a diagnosis of depression rather than dementia?

A
  • Rapid onset
  • Weight loss/ sleep disturbance
  • Patients worried about poor memory
  • Variable mini-mental test scores
  • Global memory loss (dementia tends to affect recent memories)

Phase 3a conditions list flashcards (31 decks)

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