workbook Questions Flashcards
What are: Level 1a Level 1b Level 2 General Observations on the ward?
1a: nurse in arms reach
1b: nurse can see
2: checked & documents every 15mins
General obs: checked & documented every 60mins
WhatarethechaptersincludedintheICD10?
1-17: Diseases & other morbid conditions
18: symptoms/signs/abnormal clinical & lab findings not elsewhere classified
19: injuries, poisioning & certain other consequences of external causes
20: external causes of morbidity & mortality
21: factors influencing health status & contact with health services
(F01-99: Mental, Behavioural & Neurodevelopmental disorders)
Describetheinteractionsbetweenmentalandphysicalhealth
Psychological response to physical illness:
Uncertainty about future, search for meaning, anger, sense of failure, stigma, isolation
Psychiatric illness as a consequence of psychological response to physical illness:
Adjustment disorder, anxiety states, affective disorders, body image probs, sexual probs, eating disorders, substance misuse, PTSD
Patients presenting with mediacally unexplained symptoms may be due to:
Undiagnosed physical illness, somatisation (bodily complaints, assumed to arise from psyk disturbance, but contributed to organic illness), psychiatric illness, malingering (deliberate exacerbation of symptoms for obvious gain), fictitious disorder (fabrication of symptoms without obvious motive), dissociation/conversion disorder
Whatisdysthymia
Persistent, mild depression
Whymightdepressionbemorecommoninwomen?
Bio: women experience specific forms of depression-related illness, including premenstrual dysphoric disorder, postpartum depression and postmenopausal depression and anxiety, that are associated with changes in ovarian hormones
Psycho: women more often present with internalizing symptoms and men present with externalizing symptoms
Social: differences in socioeconomic factors: including abuse, education and income
Whatsocialfactorsmakepeoplevulnerabletodepression?
Poor childhood experiences Traumatic life events Poor relationships Substance misuse Financial issues
Whataretheindicationsforelectroconvulsivetherapy(ECT)?
Severe depressive illness (concerns over health/safety)
Uncontrolled mania
Catatonia
WhataretheadvantagesanddisadvantagesofSSRIsas
comparedtotricyclicantidepressants?
Relatively safe in overdose (TCA: cardiotoxicity, anticholinergic SEs)
More selective & inhibits re-uptake of serotonin (TCAs: mainly NA)
Whatis“thoughtbroadcast”?
Delusion that thoughts are being transmitted to everyone around
WhatarethecoresymptomsofschizophreniaaccordingtotheICD classification?
Fundamental & characteristic distortions of thinking & perception, and affects that are inappropriate or blunted
Clear consciousness & intellectual capacity usually maintained
Most important psychopathological phenomena:
Thought echo, insertion, withdrawal, broadcasting
Delusional perception, delusions of control
Influence or passivity
Hallucinatory voices commenting or discussing patient in 3rd person
Thought disorders
Negative symptoms
Whatisadelusionandhowcanitbedistinguishedfromnormalexperience?
Fixed, firmly held belief which is usually false & is held despite evidence & cannot be reasoned away
Out of keeping with patient’s cultural background
Whatisthedifferencebetweensecondpersonandthirdpersonauditory hallucination
2nd: voice appears to address them
3rd: voice(s) talking about them
Whichformsofhallucinationsarecharacteristicof
Schizophrenia
Organic disorders
Schizophrenia: Auditory, tactile
Organic: visual, olfactory (in frontal lobe pathology)
Whyisanassessmentofinsightimportant?
Risk assessment
Presence of illness, need for treatment, usefulness of treatment
What is a ‘word salad’
confused or unintelligible mixture of seemingly random words and phrases
a form of speech indicative of advanced schizophrenia.
Inwhatconditionscanhallucinationsoccur?
Schizophrenia (auditory, tactile)
Organic disorders e.g. Dementia, head injury, tumour (visual, olfactory frontal lobe)
Psychotic depression (auditory)
Bipolar disorder (auditory)
Whatisthedefinitionofaneuroticdisorder?
what disorders are included under this umbrella term?
mental disorder in which the predominant disturbance is a distressing symptom/group of Sx
which one considers unacceptable and alien to one’s personality
without a marked loss of reality testing
behavior does not actively violate gross social norms although it may be quite disabling
the disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress
there is no demonstrable organic etiology
Phobias, anxiety disorders, OCD, adjustment disorders, conversion disorders, somatoform disorders
Whyarepatientswithdependentpersonalitiesatriskof
develpingdepression?
Vulnerable when dependence on others breaks down
Insecure Allows others to take responsibility Usually compliant Feel unable to self care Need help to make decisions
Whyisthediagnosisofpersonalitydisorderpotentiallya
dangerousoneto make?
Subjectivity in diagnosis
May not be maladaptive (e.g. Narcassistic PD being a successful businessman)
Often present/becomes problematic when failing
Debate whether it exists entirely separately from co-occuring psychiatric disorder(s)
Repercussions for individual
Whatare“simplephobias”?
centre around a particular object, animal, situation or activity.
They often develop during childhood or adolescence and may become less severe as you get older.
E.g. Arachnophobia
What are complex phobias
tend to be more disabling than simple phobias
tend to develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.
E.g. Social phobia, agoraphobia
Whatproblemsareassociatedwiththelongtermuseof
benzodiazepines?
Dependence
withdrawal
WhyareanticholinergicdrugsusedtotreatParkinsonism?
Treat extra-pyramidal side effects associated with low Dopamine
Thought to act by blocking central cholinergic receptors, thus balancing cholinergic & dopaminergic activity of basal ganglia
Whatisneurolepticmalignantsyndrome?
Rare idiosyncratic response to antipsychotics
Caused by sudden reduction in dopamine activity
Risk renal failure (a med emerg)
Autonomic dysfunction: hyperpyrexia, tachycardia, unstable BP, excessive sweating, salivation, urinary incontinence
Increase in CK
musc rigidity
(Supportive treatment: stop antipsychotic, fluids, monitoring)
Whatarethesideeffectsoftricyclicantidepressants?
Cardiotoxic in overdose
Anticholinergic side effects (e.g. Dry mouth, blurred vision, constipation, drowsiness, cognitive impairment, hallucinations)
Whyshouldchlorpromazinebeavoidedintheelderly?
May cause hypotension
Increases risk of DVT/PE
Affects temperature regulation (increased risk hyper/hypothermia)
Whataretheextrapyramidaleffectsofantipsychotics?
Parkinsonism: bradykinesia, mask face, resting tremor, cogwheel rigidity
Whatarethedangersofrapidtranquillisation?
when medicines are given to a person who is very agitated or displaying aggressive behaviour to help quickly calm them.
This is to reduce any risk to themselves or others, and allow them to receive the medical care that they need.
Usually using benzodiazepines or antipsychotics
Risk loss of consciousness, hypotension, bradycardia, tardative dyskinesia/NMS etc in benzodiazepines
Whatarethesymptomsoflithiumtoxicity?
tremor, ataxia, dysarthria, nystagmus, renal impairment, and convulsions
WhocanapplyaSection5(2)?
(Inpatients only)
RMO or nominated deputy (doctor on call)
Detention for up to 72hrs to allow completion of MHA
Who can apply a section 5(4)?
(Inpatients only)
RMO
Detention of an inpatient for up to 6hrs for medical assessment where mental illness suspected
Whatarethe4stagestoconsiderinmakingaCapacity
Assessment.
Understand
Retain
Weigh up
Communicate
Whyisregularsupervisionimportantforapsychotherapist?
Personal well being
Well being of patients; protect clients & improve ability to value clients
Required by all counsellors & psychotherapists
What are the potential advantages of therapeutic community treatment overindividualpsychotherapy?
Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self-identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change
Evolving emotion-regulation systems
What are the symptoms of obsessivecompulsive disorder and how are they treatedwithCBT?
OCD:
Obsession = unwanted intrusive thoughts which are unpleasant & raise anxiety. Derived from own mind
Compulsion: associated behaviour (senseless, repeated rituals but have insight - often a way to reduce distress of obsession)
A need for perfectionism, to control, inability to delegate, feelings of doubt & caution, preoccupation with detail
CBT:
Accept thoughts & divorce of meaning
Response prevention (delay response & see what happens)
Whataretheprincipaldifferencesbetweenpsychodynamic
psychotherapyand cognitivebehaviouralpsychotherapy
Psychodynamic psychotherapy (psychoanalytical): the systematic use of a relationship between a patient and a therapist (as opposed to physical and social methods) to produce changes in feelings, cognition and behaviour Attempts to re-structure personality (based on Freud's approach to psychoanalysis)
CBT:
Focuses on thoughts & assumptions
Helps change unhelpful thoughts (cognitions) & actions (behaviours)
Theory:
◦we respond to our interpretation of events, not to raw
events alone
◦& if this is the case, cognitive change required to produce
emotional/behavioural change
Whatis“transference”?
redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood
Past experiences/expectations projected onto real life
Whyismotivationimportantinassessingapatient’ssuitabilityforpsychodynamic psychotherapy?
Require motivation to enquire about inner self
Whydopatientsinpsychodynamic psychotherapyoftengetworsebefore
Theygetbetter?
Have to address unresolved issues
Conflict
Whatisthedifferencebetweendeliriumanddementia?
Delerium: organic reaction, fluctuating impaired consciousness, acute onset
Dementia: syndrome of progressive & global intellectual deterioration without impairment of consciousness
Whatisthemostcommonformofdementia?
Alzheimers (60%)
Whatisparaphrenia?
mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality (its negative symptom).
WhataretheneuropathologicalfeaturesofAlzheimer’sDisease?
Beta amyloid plaque deposition
Neurofibrillary tau tangle formation
Neuronal loss: hippocampal, parietal lobe
Whyisamultidisciplinaryapproachimportantinoldagepsychiatry?
Multiple symptoms
No cure; manage/minimise symptoms
Whatisanencapsulateddelusion?
a delusion that usually relates to one specific topic or belief but does not pervade a person’s life or level of functioning.
Inwhatwaysmayexcessiveuseofalcoholpresenttothepsychiatrist?
Thymine defociency:
Wernicke’s encephalopathy (acute)
Confusion, ataxia, ophthalmoplegia
Korsakoff's syndrome Hypothalmic damage & cerebral atrophy Inability to acquire new memories Confabulation Lack insight Apathy
Whatarethehealthrisks(physicalandpsychosocial)ofillicitopioiduse?
Overdose: resp depression
Numbness, stupor
Addictive: loss of finances, social support, job
Whatismeantby“harmminimisation?”
acknowledges that some people in societies will use alcohol and other drugs
therefore incorporates policies/public health strategies which aim to prevent or reduce drug related harms.
Whatistherecommendedsafeweeklyintakeofalcohol(a)formen(b)for women?
14 units/week, spread over at least 3 days
Units = strength (ABV) x volume (ml) ÷ 1,000 = units
Whatarethesymptomsofacutealcoholwithdrawal(deliriumtremens)?
Sweats, nausea, tremor
Whichillicitdrugsmayproduceaschizophrenialikestate?
Alcohol Cannabis Benzodiazepines Barbituates Amphetaines Cocaine Hallucinogens Ffluoroquinolone (permanent)
Whatarethediagnosticfeaturesofbulimianervosa?
Recurrent binge episodes
Preoccupation with body weight
Inapprop compensatory behaviour to overcome effect of binge
Whatisthecauseofamenorrhoeainanorexianervosa?
Primary Hypothalmic disturbance = reduced secretion LH & FSH
Whatdrugsareusedinthetreatmentofbulimianervosa?
Antidepressants
Whattypesofpsychotherapyareusedinthetreatmentofanorexianervosa?
CBT, family therapy, psychodynamically informed behavioural tx
Whyaretricyclicantidepressantspotentiallydangerousinanorexianervosa?
Both increase QT interval
Whatarethemostseriousphysicalcomplicationsofanorexianervosa
Deficiency: Thiamine, K, Na, Ca, phosphate
Endocrine disturbance
Osteoporosis
Sinus bradycardia
What are the common causes of acute confusional state?
(Delerium) Malnutrition Meds e.g. Benzodiazepines Alcohol (withdrawal) Infection Metabolic abnormalities e.g. Hypoglycaemia Hypoperfusion Hypoxia
Why are psychiatric disorders difficult to diagnose in people with learning disability?
Communication barriers
Psychiatric conditions may present in less usual way
Whatisa“behaviouralphenotype”?
patterns of behaviour that present in syndromes caused by chromosomal or genetic abnormalities.
WhatarethefeaturesofDownsyndrome?
Physical abnormalities
Intellectual abnormalities
WhatisFragileXsyndrome?
genetic disorder. Symptoms often include mild to moderate intellectual disability. Physical features may include a long and narrow face, large ears, flexible fingers, and large testicles. About a third of people have features of autism such as problems with social interactions and delayed speech. Hyperactivity is common and seizures occur in about 10%. Males are usually more affected than females.
Typically due to expansion of CGG triplet repeat
Whatarethediagnosticfeaturesofautism?
Core symptoms: Social difficulties Restrictuve/repetitive patterns of interest/behaviour/activity Present early in dev period Clinically sig impairment Not due to another condition
