Psychology Flashcards
Which section allows psychiatric patients receiving treatment under section to be able leave the unit whilst supervised?
Section 17
What is a section 5(2)?
Allows hospital inpatients to be detained by the doctor who is responsible for their care, if they believe that the patient has a mental health disorder that requires further assessment.
Outline section 2 of the mental health act.
Section 2 is used to detain a patient with a presumed underlying psychiatric condition to allow a thorough assessment to be completed and a diagnosis to be reached. It lasts up to 28 days and requires two doctors, one of whom must be section 12 approved (often a psychiatrist).
Outline section 135 of the mental health act.
Allows the police to forcibly enter private property and apprehend a patient in order to take them to a place of safety. The patient can be kept there for up to 24 hours whilst further assessments and management are planned.
What is an informal admission?
When a patient requires inpatient treatment for a psychiatric condition and agrees to be admitted
What are the main features of schizoid personality disorder?
Disinterest in forming relationships and being generally emotionally detached with a flat affect.
People with schizoid personality disorder tend to maintain few relationships and have a tendency towards solitary lifestyles.
What are the main features of emotionally unstable personality disorder?
Characterised by an intense fear of abandonment and distorted self-worth. They are prone to intense but fragile relationships. They may be impulsive and have violent outbursts of emotion.
What are the main features of histrionic personality disorder?
Patients with histrionic personality disorder are classically preoccupied with their appearance and constantly in need for recognition.
They also have a tendency to be inappropriately flirtatious.
They may demonstrate dramatic expressions of emotion and react badly to rejection.
What is the first-line management option for seasonal affective disorder?
Cognitive Behavioural Therapy
What is an Argyll Robertson pupil?
Pupils that accommodate but do not react
Associated with neurosyphilis
How is syphilis treated?
Penicillin (e.g. benzathine penicillin)
What are some of the biological symptoms of depression?
Sleep disturbance
Appetite disturbance
Weight disturbance
What is the first-line management option for depression?
Cognitive Behavioural Therapy
What is the first-line medical treatment option for catatonia?
Benzodiazepines (e.g. lorazepam)
https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-018-1714-z
List some typical antipsychotics.
Haloperidol
Chlorpromazine
Loxapine
Prochloperazine
Flupentixol Decanoate
What is a somatic delusion?
Delusions related to the patient’s health or bodily function.
What are the main side-effects of tricyclic antidepressants?
Blurred vision
Dry mouth
Constipation
Tachycardia
Delirium
Urinary retention
What is the preferred SSRI in patients with a background of cardiovascular disease?
Sertraline
How is Wernicke’s encephalopathy treated and prevented?
Thiamine Replacement
What is the mainstay of managing neuroleptic malignant syndrome?
Stop the offending drug
Supportive (e.g. external cooling)
What is the first-line treatment option for Dementia with Lewy Bodies?
Acetylcholinesterase Inhibitors (e.g. rivastigmine)
What is the first-line treatment option for schizoaffective disorder?
Antipsychotic (e.g. risperidone) and Mood Stabiliser (e.g. lithium)
What is schizoaffective disorder?
Condition in which patients demonstrate features of schizophrenia (e.g. delusions, hallucinations) for at least 1 month alongside features of mood disorder (e.g. mania or depression).
The mood disturbances must be present for the majority of the period of illness, however, there should be a period of at least 2 weeks where psychosis is observed in the absence of mood symptoms.
How do baby blues manifest?
Usually within the first 2 weeks of life
Tearful
Weepy
Labile Mood
Irritable
Poor Sleep
For further information:
● NICE guidelines on Antenatal and postnatal mental health: https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#recognising-mental-health-problems-in-pregnancy-and-the-postnatal-period-and-referral-2
How are baby blues managed?
Reassurance (symptoms usually resolve within 2 weeks)
How should moderately severe postnatal depression be managed?
High Intensity Psychological Intervention
Antidepressant Pharmacotherapy (e.g. SSRI or TCA)
For further information:
● NICE guideline on Antenatal and postnatal mental health: https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#recognising-mental-health-problems-in-pregnancy-and-the-postnatal-period-and-referral-2
Which commonly used mood stabiliser is strongly associated with congenital cardiac defects?
Lithium (associated with Ebstein anomaly)
For further information:
● BNF provides invaluable advice on the safety of drugs in pregnancy and breastfeeding
● CKS Scenario: Women of childbearing age https://cks.nice.org.uk/topics/bipolar-disorder/management/women-of-childbearing-age/
● NICE guideline on Antenatal and postnatal mental health https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations
What are the main features of neonatal opiate withdrawal syndrome?
tremors, seizures, increased tone, reduced sleep)
Gastrointestinal Symptoms (vomiting and diarrhoea, feeding difficulties)
Autonomic Symptoms (sweating, fever, yawning, increased respiratory rate)
For further information:
● Paper in Pediatrics journal (2020) on Neonatal Opioid Withdrawal Syndrome: https://pediatrics.aappublications.org/content/146/5/e2020029074
What is Fregoli syndrome?
Delusional disorder in which an individual holds a false and fixed belief that different people are, in fact, a single person who is able to shapeshift and change their appearance. It is often paranoid in nature and tends to be associated with feelings of being persecuted or chased.
What is De Clérambault’s Syndrome?
A paranoid delusion that another person (often a celebrity) is in love with the patient. The object of the delusion is typically a person who is unattainable due to high social or financial status, marriage or disinterest. The object may also be imaginary, deceased or someone the patient has never met.
What is a DOLS?
Legal framework that allows a patient to be deprived of some of their rights (e.g. prevented from leaving hospital, applying mittens to preventing lines from being pulled out)
This can be implemented in a hospital or care home setting and is done in the patient’s best interests
What is adjustment disorder?
States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event.
What is agoraphobia?
Spectrum of disease which is characterised by phobias that revolve around fears of leaving home and entering public places (e.g. crowded tubes). It may manifest acutely with panic attacks.
How is serotonin syndrome treated?
Remove causative agent
Benzodiazepines (reduce agitation)
Cooling
What is somatisation?
Phenomenon in which psychological issues manifest with physical symptoms (e.g. abdominal pain).
What is a progressive supranuclear palsy?
Progressive supranuclear palsy is a Parkinson’s plus syndrome that presents similarly to Parkinson’s disease but is also classically associated with an upgaze palsy.
What are the main features of illness anxiety disorder?
Persistent belief that the patient has a specific disease despite repeatedly unremarkable examinations and investigations.
Which blood test parameter is particularly useful in making a diagnosis of neuroleptic malignant syndrome?
Creatine Kinase
What is Ekbom syndrome?
Delusional parasitosis:
A delusion in which the patient believes that their body has been infested by insects. They may experience dermal sensations that are likened to insects crawling beneath the skin.
How does vascular dementia present?
Stepwise decline in cognitive function in a patient with cardiovascular risk factors
Which questionnaire is most appropriate for diagnosing depression in the primary care setting?
Patient Health Questionnaire (PHQ-9)
What are the features of puerperal psychosis?
Severe thought disturbance
Hallucinations
Abnormal behaviour
Usually manifesting within the first 10 days postpartum
What is the first investigation that should be carried out in a child with delayed language development?
Referral to audiology for hearing tests
What are the main features of obsessive compulsive disorder?
Obsessions (uncomfortable, intrusive thoughts that the patient recognises as their own)
Compulsions (usually thought to prevent an objectively unlikely event from happening, this is recognised by the patient as being pointless and attempts to resist create tension)
Which questionnaire is used to assess obsessive compulsive disorder?
Yale-Brown Questionnaire
How does bipolar affective disorder manifest?
Periods of mania or hypomania (significantly elevated mood usually associated with high risk behaviours)
Interspersed with periods of depression
What is the second-line long-term treatment option for patients with bipolar disorder who do not respond sufficiently to lithium?
Sodium Valproate
How can an acute stress reaction be differentiated from post-traumatic stress disorder?
Acute stress reactions manifest with very similar symptoms but arise within 1 month of the traumatic event
What are the main features of post-traumatic stress disorder?
Hyperarousal
Flashbacks
Avoidance of behaviours that would precipitate flashbacks
What is the first-line treatment option for PTSD?
Trauma-Focused CBT
What are the main features of anankastic personality disorder?
A narrow focus on one’s rigid standard of perfection and of right and wrong
Focused on controlling one’s own and others’ behaviour
What are the main features of postnatal depression?
Low mood
Difficulty connecting with the baby and feelings of inadequacy
Persists beyond the first 2 weeks postpartum
What time period does the Edinburgh Postnatal Depression Scale focus on?
Last 7 Days
What are the main features of oppositional defiant disorder?
Behave badly towards figures of authority (e.g. teachers, parents)
Which blood test abnormalities are often seen in patients with anorexia nervosa?
Hypokalaemia
Hypercholesterolaemia
Hypercarotenaemia
What is the first-line management option for moderate-to-severe depression?
Antidepressant plus referral for psychological therapy
How is a staggered paracetamol overdose managed?
Start N-acetylcysteine and take bloods (including paracetamol level, LFT and coagulation screen)
What is a prolonged grief disorder?
Psychological disorder that manifests after the loss of a loved on that is characterised by an attachment disturbance featuring yearning for the deceased, loss of meaning and identity disruption
Symptoms need to be present for over 6 months to be defined as a prolonged grief disorder
What is the first-line management option for generalised anxiety disorder?
Referral for CBT and SSRI, SNRI or Atypical Antidepressant
Describe the clinical features of variant Creutzfeldt-Jakob Disease.
Initially manifests with psychiatric symptoms such as depression, anxiety and insomnia
Then, neurological symptoms become more apparent (including amnesia, ataxia and sensory neuropathy)
It is rapidly progressive and irreversible
Which neurotransmitter is deficient in Alzheimer’s disease and, hence, is a therapeutic target?
Acetylcholine
Describe the clinical features of neuroleptic malignant syndrome.
Drowsiness
Nausea
Dry mouth
Insomnia
Diarrhoea
Headache
Blurred vision
Sexual dysfunction
Worsening mood and anxiety in the first 2 weeks
How is vascular dementia treated?
Management of cardiovascular risk factors (e.g. with antiplatelet agents, antihypertensives and improving glycaemic control)
What are the main clinical features of dementia with Lewy bodies?
Psychiatric Symptoms: amnesia, visuospatial dysfunction, hallucinations, insomnia
Motor Symptoms: pill-rolling tremor, bradykinesia and rigidity
What is the most appropriate SSRI to use in children with depression?
Fluoxetine
What is Capgras syndrome?
A false, fixed belief that someone they know or recognise has been replaced by an imposter.
Which medication can be added to treat acute dystonias caused by antipsychotic medication?
Procyclidine
Outline the management of an acute paracetamol overdose.
Measure Paracetamol Level at 4 hours and plot on normogram to determine whether N-acetylcysteine is required
If it is a staggered overdose (taken over more than 1 hour), N-acetylcysteine should be commenced immediately.
Which congenital abnormality is classically associated with lithium use in pregnancy?
Ebstein Anomaly
Outline the monitoring requirements for a patient newly started on lithium therapy for bipolar affective disorder.
Weekly lithium levels until stable (then 3-monthly)
Thyroid and renal function measured every 6 months
How should a patient be switched from fluoxetine to another SSRI?
Wean fluoxetine and then leave a gap of 4-7 days before starting a low-dose of the new SSRI
Describe the symptoms of opioid withdrawal.
Fever
Generalised muscle and joint pain
Abdominal pain
Everything runs (diarrhoea, vomiting, lacrimation, rhinorrhoea)
What are some recognised complications of bulimia nervosa?
Dental erosions and caries
Oligo- or amenorrhoea
Hypokalaemia
Swollen salivary glands
Arrhythmias
Osteoporosis
Refractory constipation (due to laxative abuse)
What is the main difference between anorexia nervosa and bulimia nervosa?
Bulimia nervosa involves periods of bingeing
What is Cotard syndrome?
A nihilistic delusion in which the patient believes that they are dead or don’t exist or that a part of them is dead or decaying.
What is the first-line management option for emotionally unstable personality disorder?
Dialectical behavioural therapy
What are some features of an abnormal grief reaction?
- The grief is unusually intense and fulfils the criteria for depression
- The grief is prolonged (over 6 months)
The onset of grief is delayed, or the grieving process becomes ‘stuck’
What is Section 4 of the mental health act?
An emergency power that may be used to admit people to hospital for 72 hours for assessment but it cannot be used to treat patients against their will.
What are the main features of Wernicke’s encephalopathy?
Confusion
Ataxia
Ophthalmoplegia
What are the main features of antisocial personality disorder?
Little regard for rules
Can be aggressive and disregard the safety of themselves and others
Lack of remorse for actions
What is the most appropriate management option for an abnormal grief reaction?
Grief Counselling
What is the normal range for the QTc interval?
Men: 350-450 ms
Women: 360-460 ms
What is Couvade syndrome?
A condition in which a pregnant woman’s partner begins to experience symptoms that mimic pregnancy. The symptoms can include nausea, weight gain, disturbed sleep patterns and even, in some cases, labour pains and postpartum depression.
Which drug of abuse can increase the risk of serotonin syndrome in patients on SSRIs?
MDMA
What is the first-line treatment option for ADHD?
Provide parents with ADHD focused information, and the child with group-based support.
What are the presenting symptoms of frontotemporal dementia?
Inappropriate social behaviour
Apathy or restlessness
Presents around 50-60 years of age
Changes in personality are followed by impairment of intellect, memory and language functions
How is Parkinson’s disease diagnosed?
Clinical diagnosis (commonly described symptoms include unilateral resting tremor, bradykinesia, rigidity and gait instability)
In some cases, DaT scans may be used.
What are the main symptoms of seasonal affective disorder?
Symptoms of depression (e.g. low mood, anergia, anhedonia) that varies on a seasonal basis.
Most commonly, patients report their mood being at its worst in the winter months
What is a section 136?
Section of the mental health act that allows the police to apprehend an individual from a public place and take them to a place of safety (e.g. A&E). It is in effect for 72 hours and does not require legal authorisation.
