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Sheff 3a > Pych From Flash Cards > Flashcards

Pych From Flash Cards

1
Q

What is a hallucination

A

Perception experienced
In the absence of an external stimulus
Origination in the outside world

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2
Q

What is circumstantiality ? Seen in ?

A

Anxiety disorders

Lots of trivial detail when answering but will eventually get to the point

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3
Q

What is loosening of association

A

Breakdown in association between topics
-chain of thoughts random

“Knights move thinking”

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4
Q

5 points for OCD diagnosis

A

> 2 weeks of O and C

OWN thoughts / impulses

Intrusive / repetitive and unpleasant

Attempt to resist

Not pleasurable - Temporary relief of tension

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5
Q

3 parts of catatonia

A

Stupor - Fully conscious but unresponsive

Posturing - Strange postures held for substantial periods of time

Waxy flexibility - Limbs can be moulded into position (Could be increased muscle tone)

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6
Q

Define mood disorder

A

Persistent disturbance of mood that is severe enough to cause
-> impairment in ADLs

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7
Q

Negative sx of schitz?

A 
Poverty of speech 
Blunting of affect 
Social withdrawal / isolaition 
Lack of motivation 
Poor self care
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8
Q

Personality types associated with hebernephric schitz

A

Schitzoid / typal

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9
Q

Prominent features of hebernephric

A

Though disorder
Odd behaviour
Fleeting hallucinations / delusions
Mood changes - inappropriate affect

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10
Q

Sx in simple schiz

A

Mainly negative
Few positive sx
Poor functioning

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11
Q

What is schitzoaffective

A

Meets the criteria for schitz and bipolar in the same episode

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12
Q

Talk through the neruodevelopmental model for schitz

A

Genes

Early environmental
-Obstetric complications

Childhood
-impairments in Eg Intellect, motor, social

Adolescence

  • Stressors
  • psychoactive drugs

-> prodrome

Early adulthood
->schitz

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13
Q

2 Key features of phobic disorders

A

Situational - Anxiety caused by specific stimuli or objects

Avoidance - provides temporary relief but reinforces the fear

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14
Q

What is an adjustment disorder?

A

Reactions to stress that are more long than acute stress reactions

  • Usually begin within 1 month
  • Don’t last longer than 6 months
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15
Q

Features of adjustment disorders

A

Emotion - Depression, anxiety, poor concentration, irritable

Cognition - preoccupation with event

Behaviour - angry outbursts

Somatic - Moderate autonomic

Associations - Chronic stressor

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16
Q

Main DDx of OCD

A

Depressive disorder - obsessional Sx are common

Psychotic disorder - obsessions generally regarded as untrue

Obsessional personality disorder

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17
Q

Aetiology of OCD

A

Genetic vulnerability
Anakastic personality
Social stressors

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18
Q

What is PTSD ? Features? Associations

A

Delayed response to a severe traumatic event
-may be months -years after event

Emotion - anxiety, irritability, numbness
Cognition - Repeated reliving of events + nightmares
Behaviour - Avoidance of situations. With triggers
Somatic - Exaggerated startle response

Associations
Substance misuse
Depression

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19
Q

What are cluster A personality disorders? Egs and basic features?

A

Eccentric - suspicious or solitary

Paranoid

  • suspicious and distrusting
  • Bears grudges
  • Sensitive to criticism
  • Self-importance

Schitzoid

  • Emotionally cold
  • Social isolation
  • lack of joy of living

Schtizotypal
-Magical / odd beliefs

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20
Q

What are cluster B personality disorders? Egs and basic features?

A

Dramatic - emotionally liable and intense

Antisocial

  • unstable relationships
  • low frustration threshold
  • irritable and impulsive
  • Failure to learn from experience
  • Failure to accept responsibility
  • lack of guilt
  • Young men

Borderline (emotionally unstable)

  • Multiple turbulent relationships
  • impulsivity
  • recurrent emotional crisis
  • variable intense mood
  • stress related psychotic like sx
  • Young women

Histrionic

  • Exaggerated theatrical replays of emotion
  • Attention seeking
  • vain
  • Suggestable
  • Shallow liable mood

Narcissistic

  • Grandiose self importance
  • exaggerates achievements / abilities
  • exploits others
  • arrogant
  • expects special praise and respect
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21
Q

What are cluster C personality disorders? Egs and basic features?

A

Anxious

Anakastic - obsessional

  • Excessive orderness
  • Preoccupation with detail
  • Inflexible
  • Lack of humour

Anxious - Avoidant

  • Perstinet tense and apprehensive
  • Avoid personal contact
  • Fear of criticism / rejection
  • Feel inadequate

Dependant

  • Encourage others to make decisions
  • Excessive need to be taken care of
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22
Q

When you suspect delirium how could you duct impaired consciousness during history taking?

A

Problems establishing passage of time
-“How long has this interview been going on?”

Concentration tasks
-Count back from 20

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23
Q 
Cortical vs subcortical dementia’s 
Memory loss 
Personality 
Mood 
Co-ordination 
Motor speed
A 
Cortical - Eg alzheimers 
Memory loss - Severe 
Personality - Indifferent 
Mood - Normal
Co-ordination -Normal
Motor speed -Normal 
Subcortical Eg hungtintons 
Memory loss - Moderate 
Personality -apathy
Mood - Flat, depressed 
Co-ordination - Impaired
Motor speed - Slowed
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24
Q

RFs for Alzheimer’s

A

E4 variant of apoE gene
Low education
First degree relative with AD
Vascular RFs

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25
Presentation of AD (4 areas of cognitive impairment and lobes ) ? What other features? Late sx?
Enduring, progressive global cognitive impairment 1- Visual spacial (parietal): Familliar routes become difficult, Can’t dress properly 2- Memory (Temporal) 3- Verbal: Receptive (temporal), expressive (frontal) 4- Executive functions Lack of insight that problems are caused by disease Agnosia - inability to interpret sensation Later -Irritability, behavioural Change, mood change, psychoses
26
3 key features of Lewy body ? Seen on histology? | Mx? What drugs to avoid ?
Fluctuating cognitive impairment Visual hallucinations Later -> Parkinsonism Lewy body’s in the brainstem and neocortex - Eosiniphilic intracytoplasmic neuronal inclusion bodies - Make of a-Synuclein Cholinesterase inhibitors - Eg donepazil AVOID ANTIPSYCHOTICS
27
What is frontotemporal temporal dementia also called ? Features?
Picks disease ``` Early onset and loss of insight Personality change Expressive dysphasia Memory relatively preserved Family hx common ```
28
What are pick bodies
Build up of tau proteins | -> spherical, silver staining aggregations
29
Onset of Huntington’s
Early ~20-40
30
What is prion disease also called? What happens? Cause? Prognosis? Features? Diagnosis?
Creutzfeldt-Jakob disease Prions (abnormal proteins) can convert normal proteins into ones which fold into bizarre shapes (SPONGIFORM) Most cases are sporadic but sometimes transmitted from meat products containing CNS tissue affected by -bovine spongiform encephalopathy Rapid onset and progression - death within 1year Myoclonic jerks Seizures Cerebellar ataxia Diagnosis Brian biopsy EEG - triphasic waves
31
Pressure in normal pressure hydrocephalus ? Features? Usual age?
CSF pressure is raised Features - Wet, wobbly and wacky - Urinary incontinence - Problems walking - ataxia - mental slowing - apathy / inattention 50-70
32
Seen on CT/MRI of normal pressure hydrocephalus ?
Disproportionate ventricular enlargement
33
Most prominent feature of alcoholic dementia ? Brain feature?
Visuospacial defects - Dressing, getting lost on familiar routes Atrophy of white matter and frontal lobes [True alcohol-induced dementia is rare - usually vascular / alzheimers]
34
Main organs affected in Wilson’s ? Others? What are the neuopychiatric sx?
Brain and liver Eyes Kidneys Heart Parathyroid Irritability, mild deterioration and clumsiness Behaviour changes Specific changes follow -> Parkinsonism, ataxia + migrane
35
What opportunistic infection common in AIDS dementia
Crytococcus
36
Levels of substance misuse
At risk consumption - Increased risk of harm but none yet Harmful - associated with health consequences but not yet dependance Dependance - physical and psychological - get withdrawal sx
37
Aetiology of substance misuse
Genetic - Heritable component of vulnerability and personality - metabolism of substances Neurological -Abnormalities in Dopamine, GABA Psychological - Personality - learnt behaviour Socioeconomic - Cultural norms - price and availiblity
38
Adverse health effects of cannabis?
Panic / anxiety Gateway drug Paranoid ideation Heavy use -> risk of schitz
39
Effects of opioids
``` Euphoria Analgesia Constipation Drowsiness Respiratory depression N+V Pupil constriction ```
40
Adverse health and social effects of opioids
Risk of blood borne viruses High rates of morbidity / mortality Psych - increased risk of suicide Major negative social effects
41
Withdrawal from opioids begins? Features?
8-12hrs after last dose Peaks at 24-48 hours ``` Craving Restlessness Sweating Abdo pain, Vomiting Dilated pupils Goose bumps ```
42
Signs of opioid OD
``` Unconscious pinpoint pupils Bradycardia Hypotension Shallow breathing -> may resp arrest ``` IM Naloxone
43
Which benzo commonly used for alcohol / substance withdrawal?
Chlodiazepoxide
44
Harmful effects of alcohol
Medical - liver damage: hepatitis, cirrhosis, fatty - CV: cardiomyopathy, hypertension - GI: pancreatitis, peptic ulcer, oesophageal varsities - Neoplasms: Liver, oesophagus - Blood: Anaemia ``` Neurological Epilepsy Blackout Neuropathy Korsakoffs / wernikies Cerebellar degeneration Head injury Delirium Tremens ``` ``` Psychiatric Hallucinations Morbid jealousy Sexual dysfunction Dementia Depression ``` ``` Social Accidents Relationship problems Violence Employment Crime ```
45
Mx of alcohol withdrawal
Obs ever 4 hours Chlordiazepoxide Oral thiamine Pabrinex - Vit B/C
46
Methadone half life? What does it do? | Subutex?
Long - 5/7 Blocks opiate receptors completely -> heroin will have no effect Partial blocker -> Herron will have effect - used for more low risk
47
What premorbid experiences / characteristics contribute to eating disorders?
Adverse parenting - Low contact, arguments, high expectations Sexual abuse Family dieting / pressure to be slim ``` Premorbid characteristics Low self esteem Perfectionism Anxiety Early menarche ```
48
Ix in anorexia
``` FBC - normocytic, normochromic anaemia, thrombocytopenia, mild leukopenia U+E TFT - low T3, normal TSH/ T4 Increased cortisol / growth hormone Low FSH, LH and oestroadol ECG - prolonged QT ```
49
2 Types of bulimia
Purging - compensatory behaviour Eg vomiting, laxatives, diuretics Non-purging - Fasting and exercise
50
What characterises bulimia ?
Binge eating Recurrent compensatory behaviour At least twice/week for 3 months
51
Management of insomnia
Treat underlying disorder - Anx / depression ... Stimulus control - bed when sleepy / routines Sleep hygiene - avoid caffeine / noises / light Relaxation therapy Hypnotics Eg benzos
52
Typical antipsychotics work on D2 receptors, what additional receptor do atypical work on?
5 HT2a
53
What side effect is more common with atypical ?
Metabolic syndrome
54
Mx of akathisia ?
Benzos and b blockers
55
Mx of acute dystonia / Parkinsonism ?
Procyclidine Procyclidine / change antipsychotic
56
Side effects of antipsychotics
ESPEs Anticholinergic Dry mouth, urinary retention, postural hypotension, constipation, blurred vision Metabolic syndrome - Olanzapine is worst for weight gain Hyperprolactinaemia Women -> abnormal menses / galactorrhea Men -> decreased libido, sexual dysfunction, gynacomastia -haloperidol, risperdone and chlorpromazine Prolonged QT - haloperidol
57
What is the sign of muscle damage in neuroleptic malignant syndrome ?
Raised creatine kinase
58
What are MAOIs good for
Less effective than SSRIS / TCA but good for atypical depression
59
Main indication for SNRIs
Lack of response to SSRIs
60
What is transference ? Counter transference?
Set of expectations, beliefs and emotional responses that a patient brings to a doctor-patient relationship The therapists own reaction to the patient

Sheff 3a (30 decks)

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