🤯Psychiatry🤯 - Psychiatry Across The Lifecourse

Question 1

Which model is used for approaches to mental health?

Answer 1

Biopsychosocial model

Question 2

What are the 4 Ps of the biopsychosocial model?

Answer 2

Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

Question 3

What is meant by predisposing factors?

Answer 3

Factors that leave someone more vulnerable to developing a mental health condition

Question 4

What are precipitating factors?

Answer 4

Factors/events that trigger the development of a mental health condition

Question 5

What are perpetuating factors?

Answer 5

Factors that allow the continued presence/development of a mental health problem

Question 6

What are protective factors?

Answer 6

Factors that protect against the development or progression of a mental health disorder

Question 7

How is adolescence effectively described, in terms of brain maturation?

Answer 7

The prefrontal cortex matures later than other cortical areas
Adolescence is a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas

Question 8

What is the peak age of onset for autism spectrum disorders?

Answer 8

9

Question 9

What is the peak age of onset for ADHD?

Answer 9

12

Question 10

What is the peak age of onset for EDs?

Answer 10

17

Question 11

10 year old girl, doesn’t want to sleep in the room alone, gets raised heart rate, sweating and difficulty breathing in crowded places and does not like doing presentations in class
What condition is this?

Answer 11

Anxiety disorder

Question 14

15 year old young woman with tiredness, sleeping 12 hours/day, irritability and reduced enjoyment from her hobbies
What condition is this?

Answer 14

Depressive disorder

Question 14

10 year old boy, several attendances to GP and Emergency Department with recurrent abdominal pain, no physical cause found so far
What condition is this?

Answer 14

Somatisation

Question 15

4 year old boy, language is behind peers in class, doesn’t interact much with others, prefers watching buses/trains to playing in the playground
What condition is this?

Answer 15

Autistic spectrum disorder

Question 16

8 year old boy who has been fidgeting in lessons, speaking out of turn and struggling to stay focused on homework tasks
What condition is this?

Answer 16

ADHD

Question 17

9 year old boy, has been using increasing amounts of alcohol hand gel, wearing rubber gloves when going outdoors and lining up the toys in his room before going to sleep
What condition is this?

Answer 17

Obsessive compulsive disorder

Question 18

10 year old boy with involuntary movements in the face, neck and arms as well as making sounds which are not context-appropriate
What condition is this?

Answer 18

Tic disorder/Tourette’s syndrome

Question 19

15 year old young man with conduct disorder has been truanting from school and stealing mother’s credit cards; he was found smelling of cannabis, and more recently has been smoking it in his bedroom
What condition is this?

Answer 19

Substance misuse

Question 20

16 year old young woman who has been cutting herself with a razor when feeling distressed, and recently has bought several packets of paracetamol
What condition is this?

Answer 20

Self-harm

Question 21

14 year old girl who has been spending a lot of time thinking about her weight, has cut out carbohydrates from her diet, has been skipping breakfast and is using grandfather’s laxatives to lose weight
What condition is this?

Answer 21

Eating disorder (specifically anorexia nervosa)

Question 22

What are the core features and diagnosis for ADHD?

Answer 22

Core features and diagnosis: DSM 5
Persistent inattention and/or hyperactivity-impulsivity
Present for at least 6 months
Inappropriate behaviour for their developmental level
Interferes with functioning or development
Several symptoms before age 12
Several symptoms in two or more settings
Symptoms not better explained by another mental disorder

Question 23

What are the genetic risk factors for ADHD?

Answer 23

No isolated gene - likely multiple
Significant heritability - as high as 76%
Boys more vulnerable than girls (2:1-3:1)
3-4% prevalence
Subtypes: 20-30% inattentive, 15% hyperactive, 50-75% combined

Question 24

Environmental risk factors for ADHD?

Answer 24

Premature birth
Low birth weight
Prenatal smoking exposure

Question 25

What is the prognosis for ADHD?

Answer 25

70% of children with this disorder will still have as teenagers
40-60% still as adults

Question 26

What is dementia?

Answer 26

Degenerative disease of the brain
Irreversible and progressive changes
Umbrella term that has many underlying causes
Can be conceptualised as “chronic brain failure”

Question 27

What is the most common form of dementia?

Answer 27

Alzheimer’s disease by far
Followed by vascular dementia

Question 28

List some of the reversible causes of dementia like symptoms?

Answer 28

Normal pressure hydrocephalus
Intracranial tumours
Subdural haematoma
Depression
Delirium
(B1, B6, B12 deficiency
Folate deficiency
Hypothyroidism
Neurosyphilis)
Always think - surgical, metabolic, infect and psychiatric causes

Question 28

What is the Hakim-Adams triad?

Answer 28

Cognitive impairment/confusion
Urinary frequency/incontinence
Gait disturbance

Question 28

What can be seen in this MRI, and what would the patient be presenting with?

Answer 28

Normal pressure hydrocephalus
Presenting with the Hakim-Adams triad

Question 29

What is the epidemiology of dementia in the UK?

Answer 29

Leading cause of death in women
2nd leading cause in men (2nd to heart disease)

Question 30

What levels of functioning are exhibited by patients with mild dementia?

Answer 30

Living independently but some supervision/support often needed
Can participate in community activities and can appear unimpaired to those who do not know them
Judgement and problem solving typically impaired
Social judgement may be preserved
Difficulty making complex plans/decisions and handling finances

Question 31

What levels of functioning are exhibited by patients with moderate dementia?

Answer 31

Require supports to function outside the home, only simply household tasks maintained
Difficulties with ADLs
Significant memory loss
Judgement/problem solving often significantly impaired, social judgment often compromised
Difficulties communicating with people outside the home
Socialising difficulties - inappropriate behaviour

Question 32

What levels of functioning are exhibited by patients with severe dementia?

Answer 32

Severe memory impairment
Often disoriented to time and place
Unable to make judgement or solve problems
Lack of situational awareness
Dependent on others for ADLs and basic personal care
Urinary/faecal incontinence may emerge at this stage

Question 33

What is BPSD?

Answer 33

Behavioural and Psychological Symptoms in Dementia (BPSD)
Common in late stage dementia
Includes apathy, mood disturbances, hallucinations, delusions. irritability, agitation, aggression and sleep changes
Often precipitating symptoms which lead to being detained under the Mental Health Act (1983)

Question 34

What is used in consultations to ascertain possible cognitive impairment in patients?

Answer 34

Mini Mental State Examination (MMSE)