Psychiatry SAQs and SBAs Flashcards
A 27 year old woman presents to the Emergency Department following an overdose. The patient describes deeply engrained and enduring behaviour patterns, manifesting as inflexible responses to a broad range of personal and social situations.
What time frame might suggest that this patient has a PD?
problems started in adolescence and continued throughout adulthood
A 19 year old woman is admitted to a psychiatric ward. She has been hearing voices inside her head. There are 2 voices and they talk directly to her, telling her to kill herself. She has been self-harming on a regular basis for the last 5 years.
How would you best describe the voice hearing experience of this patient?
pseudohallucinations - they are in her head and are therefore not true hallucinations
A 55 year old man is taken to see his GP by his family. They report that he has had a marked change in personality. He is now extremely antisocial. He swears constantly, and does not seem to care about upsetting people. He has been in several fights both with strangers and members of his own family. He has recently taken to gambling heavily and got into significant debt. He seems to completely lack in empathy.
What is the most likely diagnosis?
Fronto-temporal dementia- often presents as change in personality
A 21 year old woman with an emotionally unstable personality disorder is advised to start psychotherapy.
The therapy includes weekly individual sessions and weekly life-skills group sessions that teach skills in 4 domains: mindfulness, distress tolerance, regulation of emotions and interpersonal effectiveness. The therapy is designed to last at least 1 year.
What therapy is being described here?
Dialectical Behaviour therapy
A 29 year old woman is in weekly therapy for an emotionally unstable personality disorder.
The patient begins to describe feelings that the therapist is too controlling. When this is explored in therapy the patient realises that this feeling is a repetition of reactions and feelings that she has towards her mother, which she has had since childhood. The patient was not consciously aware that she was doing this until it was explored in therapy.
What psychodynamic process is being described?
transference
Define counter-transference
the therapist’s unconscious (and often conscious) reactions to the patient and to the patient’s transference
Define transference
unconscious transfer of feelings and attitudes from the past onto the therapist
Define therapeutic alliance
a measure of the therapist’s and client’s mutual engagement in the work of therapy
A woman with nausea, abdominal pain, dysmenorrhoea, had several investigations.The woman does not identify a specific illness from which she fears she may be suffering. No specific cause is identified.
What is the most likely diagnosis?
Somatization disorder (also called Briquet’s syndrome)
a mental disorder characterised by multiple
recurring, frequently changing complaints about somatic symptoms, of at least 2 years duration
Define hypochondriasis
persistent belief, of at least six months’ duration, of the presence of a minimum of two serious physical
diseases (of which at least one must be specifically named by the patient)
Which is the most common compulsion in OCD?
Checking
A 17 year old was sent home from his sixth form as he smelt of alcohol. The GP refers the family to CAMHS where his dad his dad reports that his son is less interested in exploring new things. He never joins in on conversation when there are visitors at home; he gets distressed and sweats profusely when attending parties and other occasions.
What is the most likely diagnosis?
social phobia - use of alcohol is a dyfunctional coping strategy (essentially “self-medication” with an easily available anxiolytic)
Cognitive theory suggests that what is the most significant underlying factor in anxiety disorders?
Catastrophisation - higher perception of threat and of an adverse outcome
A 35 year old soldier is diagnosed with PTSD as a result of trauma he experienced in the battlefield when posted in Iraq. He has only just disclosed symptoms that have enabled a PTSD diagnosis to be confidently made. He has been suicidal and a month ago took an overdose.
What is the most appropriate treatment?
trauma focused CBT
EMDR is used more for non-combat related trauma
A 21 year old woman has a fear of injections and has presented as she wishes to become pregnant and knows she will probably then need to have some blood taken.
You think that she has a phobic disorder and try to explain principles of exposure therapy. She says exposure won’t work for her, because if she sees a needle coming towards her she faints.
What is the explanation for the alleged fainting
episodes?
This is vasovagal syncope due to a diphasic response in blood-injury phobia
Practically this means that if exposure is to be attempted then something is necessary to prevent syncope - this is done by teaching the patient a technique called “applied tension”
(which prevents venous pooling, etc.):
Spot diagnosis: 35-year old man who is concerned that his chronic worrying will make him ill
Generalised anxiety disorder (GAD)
Spot diagnosis : 75-year old woman with low mood and beliefs that her bowels have stopped working and her heart is no longer beating
Depressive episode with psychotic features
What class of medication is clomipramine?
A tricyclic antidepressant (TCA) – (but one that has a significant effect on serotonin: most tricyclics have a significant effect on norepinephrine/noradrenaline)
What are the likely side effects of clomipramine?
Similar to SSRIs but can cause some sedation – caution regarding driving and machinery use!
Would it be wise to offer clomipramine to a patient at risk of suicide?
No. TCAs are potentially much more toxic than SSRIs in overdose (marked cardiotoxicity). If the indication for use is very strong, consider offering very short repeat prescriptions and ensure safety plans are robust.
What is the Three-Component Model of Emotions used in CBT?
thoughts, feelings and behaviours
Describe the classic generic model of panic (sometimes called the Clark model)
trigger stimulus
perceived threat
apprehension
body sensations
interpretations of sensations as catastrophic
Interpersonal therapy (IPT) is a NICE recommended treatment for which condition?
depression
Family therapy is used for:
most commonly an intervention for children
used in eating disorders (particularly with younger anorexic patients)
used as an adjunctive treatment in schizophrenia e.g. prevention of relapse of schizophrenia in patients whose families show high expressed emotion (EE)
What forms of psychotherapy are available in the NHS?
psychodynamic psychotherapy
CBT
IPT
Family/systemic therapy
Outline the principles of CBT
Cognitive behavioural therapy (CBT) is a type of talking therapy where patients work with a therapist to identify and challenge negative thought patterns and behaviour.
CBT is based on the idea that how we think about situations can affect the way we feel and behave. For example, if you interpret a situation negatively, you might experience negative emotions, which may lead you to act in a certain way.
Give some defence mechanisms recognised in psychoanalysis
repression - forget about it
denial - pretend it never happened
projection - blame someone
displacement - lash out at wrong person
regression - act childlike
sublimation - find another outlet
