Psychiatry - general, legal and Ppsychopharmacology Flashcards
What are the ‘5 Ps’ that formulate/ summarise a patients difficulties, what might be causing them and make sense of them?
- Predisposing
- Precipitating
- Presenting complain
- Perpetuating
- Protective
What model helps summarise/ categorise the risk factors and treatment for a mental health condition?
Biopsychosocial model
What makes up the biological aspects of the biopsychosocial model (4)?
- Genetics
- Birth/ pregnancy complications
- Past medical history
- Medications/ drugs
What makes up the psychological aspect of the biopsychosocial model (4)?
- Trauma/ abuse
- Self esteem
- Mood
- Personality
What makes up the social aspect of the biopsychosocial model (4)?
- Relationships
- Finances
- Stress
- Culture
What are some extra things to ask about in a psychiatric history (3)?
- Personal timeline - childhood, abuse/ trauma, etc
- Suicide + self harm
- Legal involvement
What are the important parts of a mental state examination (7)?
- Appearance + behaviour
- Speech
- Emotion (mood + affect)
- Perception (delusions…)
- Toughts
- Insight
- Cognition
What is psychosis?
Loss of touch with reality (often with impaired functioning)
What is a hallucination?
Perception in the absence of a stimulus that has the sense of reality
What is a pseudohallucination?
A hallucination that the person is able to determine is not real
What is an illusion?
Wrong interpretation of a real stimulus e.g. leaves rustling = footsteps
What is a delusion?
Fixed false unshakable belief out of keeping with social norms
What is a delusional perception?
A false meaning to a true/ correct perception e.g. the traffic light is red, therefore the martians are landing
What are delusional perceptions pathogneomic for?
Schizophrenia
What are some types of thought disorders (9)?
- Circumstantiality
- Tangentiality
- Neologisms
- Clang association
- Word salad
- Knights move thinking
- Flight of ideas
- Perseveration
- Echolalia
What is circumstantiality?
Answering a question with excessive detail and wandering, however RETURNING to the original question and answering it
What is tangentiality?
Wandering from a topic WITHOUT returning to it
What are neologisms?
New word formations e.g. combining two words to create a new one
What is clang association?
Ideas are related only because they sound similar/ rhyme
What is a word salad?
Real words strung together in a nonsense sentence
What is knights move thinking?
Unexpected and illogical leaps from one idea to another
What is flight of ideas?
Leaps from one topic to another with discernible links
What is flight of ideas a feature of?
Mania
What is perseveration?
Repetition of words despite attempt to change the topic
What is echolila?
Repeating words/ phrases that the other has said
What are two types of speech?
- Pressure = rapid (mania)
- Poverty = lack of (depression, dementia)
What is munchausens?
Fabrication of physical or psychological symptoms
What is malingering?
Fabrication of symptoms for financial/ personal gain
What is an obsession?
Mental preoccupation - pervasive + recurrent
What is a compulsion?
An urge and action (physical or mental) to obtain relief
What are some common ways peoples thoughts are affected (4)?
- Broadcasting
- Insertion
- Withdrawal
- Passivity - controlled by external source
What are the common types of delusions (4)?
- Persecutory (mistreated, trying to harm them, spying)
- Grandiose (one has special powers/ wealth)
- Guilt + worthlessness
- Nihilistic (nothing has value/ meaning)
What is capgras delusion?
Close relative replaced with imposter
What is cotard delusion?
Belief they are rotting/ dying
What is fregoli delusion?
Everyone is one person with masks
What is orthello delusion?
Believe partner is cheating on them
What is De Clerambault delusion?
Beliefe a high status person is in love with them
What is the relationship between the mental capacity and mental health act?
Mental health act can “override” capacity act - if patient has capacity they can still be detained
What circumstances can a patient be detained under the mental health act (3)?
- Evidence of mental health illness
- Risk to society or themselves
- Will benefit from admission
What are the principles of detention under the mental health act (3)?
- Least restrictive
- Patient safety protected
- Effective treatment available + given
What are the different sections of the mental health act that are important to know?
- Section 2
- Section 3
- Section 5(2)
- Section 5(4)
- Section 135
- Section 136
What does section 5(2) allow for?
Doctors holding power - detention for 72 hours
What does section 5(4) allow for?
Nurses holding power - detention for 6 hours
What does section 2 of the MHA allow for?
Admission for investigations for 28 days
Can section 2 of MHA be renewed?
No
What does section 3 of the MHA allow for?
Admission for treatment for 6 months
Can section 3 of MHA be renewed?
Yes first of all for another 6 months, then for 1 year each time
Who is required for detention under section 2 and 3 of MHA (3)?
- Approved mental health professional (usually a social worker)
- A section 12 doctor (usually a psychiatrist)
- Another doctor (ST4< - usually their GP)
What are the classes of antidepressants (5)?
- Selective serotonin reuptake inhibitors (SSRIS)
- Serotonin noradrenaline reuptake inhibitors (SNRIs)
- Monoamine oxidase inhibitors (MAOI)
- Tricyclic antidepressants (TCAs)
- Noradrenergic and specific serotonergic antidepressants (NaSSA)
How long do antidepressants typically take to start working?
4-6 weeks
When should a follow up be arranged for those starting antidepressants (2)?
- Within 2 weeks (if over 25)
- Within 1 week (if under 25)
How long should antidepressants be continued for after making a good recovery?
At least 6 months
How quickly should antidepressants (SSRIs) be discontinued?
Over period of 4 weeks
fluoxetine immediately
What are some signs/ symptoms of discontinuation syndrome (6)?
- Electric shocks
- Sweating
- Unsteady
- Diarrhoea
- Mood changes
- Restless
What is a particular risk of starting antidepressants for those under 30?
High suicide risk in first few weeks
What is the mechanism of SSRIs?
5HT (serotonin) presynaptic reuptake inhibitors