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Psychiatry > Psychiatry Phase 1a > Flashcards

Psychiatry Phase 1a Flashcards

1
Q

What fraction of people have mental illness in their lifetime?

A

1/3

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2
Q

What are the two main differences between physical and mental illness?

A
  1. Lack of diagnostic certainty

2. Poor engagement with patients

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3
Q

Name three treatment options for mental illness generally

A
  1. Psychotherapies
  2. Social therapies
  3. Medication
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5
Q

What is psychic anxiety?

A

Feeling of fear or dread

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6
Q

What are obsessions?

A 
Ego-dystonic thoughts
Repetitive, circular ruminations
May be bizarre and sound delusional
Insight maintained
Unbidden and resisted
Resistance leads to anxiety
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7
Q

What are the physical symptoms of anxiety?

A 
Palpitations
Sweating
Dry mouth
Splanchnic vasoconstriction (butterflies)
Tremor
Paraesthesia (pins and needles)
Depersonalisation
Syncope
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8
Q

What are compulsions?

A

Motor response to obsessional thoughts
Often ritualistic, stereotyped, precise
Start again if interrupted or doubt
E.g. hand washing, counting, arranging and symmetry, checking door locks

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9
Q

What are the classifications of anxiety?

A 
Generalised anxiety disorder
Panic disorder
Agoraphobia
Simple phobia
Social phobia
Obsessive compulsive disorder (OCD)
Post traumatic stress disorder (PTSD)
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10
Q

In who are anxiety disorders most commonly diagnosed?

A

Women (2:1)
LGBT community
Ethnic minorities
Social care users

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11
Q

Is anxiety normal?

A

Yes, it’s only a disorder if its excessive, impacts on life or out of context

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12
Q

What is the median onset age of anxiety

A

11 years old

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13
Q

Describe anxiety disorder (4 features)

A
  • Anxiety that is excessive or out of context
  • Psychic fear and physical symptoms
  • Most common cause of mental illness
  • Treatable with medication and physiological therapies
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14
Q

What are the core features of depression? (3 symptoms)

A

Pervasive low mood/sadness
Loss of energy (anergia)
Loss of enjoyment (anhedonia)

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15
Q

What are the physical symptoms of depression?

A 
Loss of appetite 
Weight loss
Diurnal variation of mood
Poor sleep
Loss of libido
Constipation
Psychomotor slowing or agitation
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16
Q

What are the psychological symptoms of depression?

A 
Poor concentration
Feelings of guilt
Feelings of hopelessness
Low self esteem
Indecisiveness
Suicidal ideation
Delusions
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17
Q

In who is depression most common?

A

Women (2:1 diagnosed)
LGBT
North of England
Unemployed

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18
Q

What is the most common cause of death in young men?

A

Suicide. Rates are rising in young and middle aged men

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19
Q

In who is suicide most common?

A

Men (3:1)
Drug/alcohol use disorders
Depression

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20
Q

How many suicides occur annually?

A

Over 6000

21
Q

What are the treatment options for depression? (3)

A
  1. Medication- antidepressants (response after 2-3 weeks)
  2. Psychological therapies- 12 session CBT
  3. Social prescribing- exercise, company
    90% of patients make a full recovery
22
Q

What are the symptoms of mania?

A 
Elated mood
Irritability 
Over-energised
Grandiose
Little need for sleep
Poor concentration
Poor judgement
Over-spending 
Rapid speech
23
Q

What are the symptoms of schizophrenia?

A 
Hallucination
Delusion
Abnormal behaviour
Disorganised speech
Disturbances of emotions
24
Q

What are hallucinations?

A

Hearing, seeing or feeling things that are not there

25
Q

What are delusions?

A

Fixed false beliefs not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary

  • Passivity
  • Thought alienation
26
Q

What is abnormal behaviour (in schizophrenia)?

A

Disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt

27
Q

What is disorganised speech (in schizophrenia)?

A

Incoherent or irrelevant speech

28
Q

What are disturbances of emotions?

A

Marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language

29
Q

What is formal thought disorder?

A

Failing to follow the semantic and syntactic rules of language. Seen in schizophrenia

30
Q

What are the two major psychotic disorders? What age is onset common?

A

Schizophrenia and bipolar affective disorder (BPAD)

  • Together described as severe mental illness (SMI)
  • Typically episodic and can usually be well-managed
  • Schizophrenia tends to have a teenage onset and disrupts education, family life and relationships
  • BPAD tends to occur later in life once education and early career goals have been achieved. Impact is less pronounced and highly varied
31
Q

What is SMI associated with?

A

Long term conditions and poorer health outcomes
Smoking, alcohol and substance misuse (psychosis associated with cannabis consumption)
Life expectancy reduced by 15-20 years

32
Q

What are the treatment options for schizophrenia?

A

Antipsychotics
Psychological therapies
Family therapy
Arts therapy

33
Q

What are the four primary functions of the brain?

A
  1. Organise sensory input
  2. Make sense of sensory and social information (predictive models)
  3. Motivate survival (avoid harm- physical, social)
  4. Maximise efficiency
34
Q

What disorders are related to compulsions?

A 
Anxiety
Depression
Self-harm
Addiction
OCD
Eating disorders
35
Q

Describe the feedback that perpetuates anxiety disorder and depression

A

Anxiety disorder can be conceptualised as a self-perpetuating network of positive feedback loops, arising from normally adaptive responses

36
Q

In what context does self harm usually occur?

A

Self harm typically occurs in the context of low self worth and persistent distress. It serves various functions, mainly related to reducing this distress

37
Q

In what context does addiction usually occur?

A

Repeated negative reinforcement, in the context of persistent states of suffering/distress/tension, is a central part of the development of addictions

38
Q

What is the powerful unconscious component of addictions mediated by?

A

The substances’ direct action on neural circuits for motivation and reward-seeking. The social context of addictions is absolutely central to their development

39
Q

What is OCD characterised by?

A

Intrusive thoughts/images

  • distressing
  • involuntary (can’t control despite considerable effort)

Compulsive behaviours
- serve to relieve state of anxiety/tension

Negative reinforcement, driven by the distress caused by the intrusive thoughts, and cemented by habit-formation, are central to compulsion in OCD

40
Q

How can eating disorders be conceptualised?

A

As means of reducing intense distress, particularly that associated with feeling everything is out of control

41
Q

What is madness?

A

People who hear voices/disorganised behaviour/thought disorder considered differently to other mental illnesses, and are seen as less relatable and put in a separate box

42
Q

What is psychosis defined as?

A

Hallucinations and delusions. It represents a large group of different disease processes and can be conceptualised as reality failure

43
Q

What mental illness has a significant genetic component?

A

Schizophrenia
Prevalence 1% and heritability 80%
Genes for D2, neurodevelopment and inflammation

44
Q

What hormone is seen in excess in schizophrenia

A

Striatal dopamine

  • seen in PET scans
  • especially in response to stress
45
Q

What is the role of dopamine?

A

Anticipated reward —> directed attention
Reward prediction error signalling
Salience (sense of importance attached to perceptions)

46
Q

What is the function of working memory?

A

Preconscious working memory stores large amount of data
Allows you to contextualise the present moment
Deficits in working memory —> thought and perception loses context, flow, order

47
Q

What are the five causes of psychosis?

A
  1. Genetic component
  2. Developmental adversity/abuse
  3. Neurodevelopmental
  4. Life stressors
  5. Relationship with recreational drugs
48
Q

What are the treatment options for psychosis?

A 
Antipsychotics
- antidopaminergic
Psychological therapies
- CBT
Social support
- supportive environments, structures and routines

Psychiatry (1 decks)

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