Random Psych Conditions and things

Question 1

Somatoform Disorders

Answer 1

Physical illness symptoms occur due to poor mental health, without evidence of neurological abnormalities.

Question 2

Examples of somatoform disorders

Answer 2

Somatisation disorder/Bruquet's syndrome.
Hypochondriacal disorder
Body dysmorphia disorder
Somatofrom autonomic dysfunction
Persistent somatoform pain disorder

Question 3

Somatisation disorder/Bruquet’s syndrome symptoms

Answer 3

GI upset - nausea, vomiting, food intolerance, constipation, stomach pain.
Endocrine - low libido, irregular menses, erectile dysfunction.
Urinary - dysuria, frequency, incontinence
Neuro - paraestoesia, difficulty swallowing, loss of balance

Question 4

Diagnosing Somatisation disorder

Answer 4

2 years of unexplained symptoms
Refusal to accept reassurance form healthcare professionals of no physical cause of symptoms.
Degree of functioning impairment form symptoms or behaviour due to symptoms.
Must have numerous symptoms symptoms for each system not just an isolated one or two.

Question 5

Baby blues

Answer 5

Postnatal blues occur in 50% of new mothers. Occur in first 10 days of birth and are self-limiting. Irritable, tearful, mild depression, anxious.

Question 6

Postnatal depression

Answer 6

Occurs within 3 months of birth and can let between 2-6months.
Symptoms = anxious about baby, guilt, inadequacy, reduced affection for baby, infanticidal thoughts, obsessional, intrusive thoughts about baby, low mood, loss of enjoyment, suicidal ideation, low energy.
Management = primary care, psychological therapy, specialist advice on antidepressant drug treatment.

Question 7

Tourette’s

Answer 7

vocal or motor tic.
onset around 18yrs
Rx = risperidone

Question 8

Conversion disorder

Answer 8

Loss of motor or sensory function.

Question 9

Hypochondrial disorder

Answer 9

Persistent belief that there is an underlying serious disease

Question 10

Somatisation

Answer 10

Multiple physical symptoms which continue despite negative tests results and reassurance to patient.

Question 11

Munchausen’s syndrome

Answer 11

Intentional production of symptoms

Question 12

Malingering

Answer 12

Simulation or exaggeration of symptoms for personal gain.

Question 13

Main therapy for borderline personality disorder

Answer 13

DBT - dialectical behavioural therapy.

Question 14

Puerperal psychosis treatment

Answer 14

ECT

Question 15

Good psychotherapy for borderline personality disorder

Answer 15

Dialectical behaviour therapy

Mentalisation based therapy

Question 16

Features of borderline personality disorder

Answer 16

Fear of abandonment
Feeling empty
Self-harm and suicidal behaviour
Impulsivity
Bouts of anger and intense emotions
Inability to sustain relationships

Question 17

5 key principles to address every patient under mental health act

Answer 17

• Treated as having capacity unless proven otherwise.
• Supported in making own decisions including availability of information in different formats (written, visual, auditory etc).
• Have right to make an unwise decision.
• Anything done for someone who lacks capacity must be done in their best interest.
• Anything done for someone who lacks capacity must be the least restrictive option available.

Question 18

Section 2 of Mental Health Act

Answer 18

Detention in hospital for assessment of the patient’s mental health and potential treatment.
Lasts 28 days

Question 19

Section 3 of Mental Health Act

Answer 19

Detention in hospital for treatment necessary for health of patient or protection of others.
Lasts 6 months

Question 20

Section 5(2) of Mental Health Act

Answer 20

Doctor’s holding power of a patient for assessment under MHA. Lasts 72 hours.

Question 21

Section 5(4) of MHA

Answer 21

Nurses holding power.

Lasts 6 hours.

Question 22

Section 136 of MHA

Answer 22

Police power to remove a patient from a public place to a place of safety for mental health assessment.

Question 23

Section 135 of MHA

Answer 23

Police power to enter private home and remove patient to place of safety for mental health assessment.

Question 24

Name 5 classes of a antidepressants

Answer 24

Selective serotonin re-uptake inhibitor (sertraline)
Non-selective serotonin re-uptake inhibitor (venlafaxine)
Monoamine oxidase inhibitors (moclobemide)
Tricyclic antidepressants (amitriptyline)
Mirtazepine

Question 25

Side effects of SSRI

Answer 25

Nausea and vomiting
Sexual dysfunction
Make anxiety and suicidal ideation worse initially
Weight gain
Sleep disorder
SEROTONIN SYNDROME
DISCONTINUATION SYNDROME

Question 26

What to tell a patient starting an SSRI

Answer 26

• don’t use St John’s wart.
• suicide and anxiety may be worse initially.
• warn of other side effects e.g sleep or sexual dysfunction.
• will continue drug for a while even when you are feeling better.

Question 27

Monoamine oxidase inhibitor side effects

Answer 27

e.g Moclobemide.
Constipation
Hypotension
Sleep disorder
Nausea

HYPERTENSIVE CRISIS with tyramine rich food.
Tyramine food = mature cheese, salami, pickled herring, Marmite®.

Question 28

Side effects of tricyclic antidepressants

Answer 28

e.g. Amitriptyline.
Long QT interval - palpitations
Dizzyness, sleep disorder
Anticholinergic syndrome symptoms = dry mouth, flushed, urinary retention.

Question 29

What is anticholinergic syndrome and what drugs cause it

Answer 29

“red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, full as a flask” = flushed, dry mouth, mydriasis, altered mental state, fever and urinary retention.
TCA, anti-psychotics e.g. Haloperidol, Olanzapine, anti-convulsants e.g. Carbamazepine.

Question 30

Side effects of mirtapezine

Answer 30

Sedative!! (good for old people before bed 😴)
Weight gain
Sleep disorder

Question 31

Serotonin syndrome S+S and Mx

Answer 31

Mental state = agitation, pressure of speech.
Autonomic instability =tachycardia, diarrhoea, shivering, dry eyes.
Neruomusclar abnormalities = tremor, cloys, hyperreflexia
RX = hydrate, ensure body temp is not too hot/cooloing, benzodiazepines, cyproheptadine.

Question 32

What must be satisfied for detention under MHA

Answer 32

Presence of a mental disorder
In-patient treatment is appropriate, available and necessary.
Treatment is necessary for health and safety of the patient.

Question 33

Definition of gender dysphoria

Answer 33

Distress due to a person’s biological sex and associated gender roles (assigned at birth) and that which the person’s senses as their own identity or gender.

not all gender non-conforming people experience dysphoria.

Question 34

Cisgender

Answer 34

Identify with sex signed at birth

Question 35

Management of gender dysphora

Answer 35

• Gender identity clinic
• Endocrine investigations
• Psycho-social assessment of occupational, social and family circumstances. Advice on medical and legal consequences.
• SALT therapy.
• Psychotherapies e.g. CBT.
• Endocrine treatment.
• Trans-male = facial hair removal, genital reconstruction/testicular prosthesis, mastectomy. etc etc
• Trans-female = orchidectomy, vaginoplasty,

Question 36

Questions to assess suicide risk

Answer 36

Do you ever think about suicide?
Have you made any plans for ending your life?
Do you have the means for doing this available to you?
What has kept you from acting on these thoughts?

Question 37

Risk factors for suicide

Answer 37

Previous attempts
Male
Single / living alone
Substance or alcohol misuse
Recent initiation of SSRI therapy

Question 38

De Clerambault’s delusion

Answer 38

Famous person is in love with the patient

Question 39

Cotard’s syndrome

Answer 39

some part of the patient’s body is dead.