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UKMLA Prep > Mental health > Flashcards

Mental health Flashcards

Condition and Presentation

1
Q

Anorexia nervosa

A

serious mental health disorder characterized by self-imposed starvation and a relentless pursuit of extreme thinness.

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2
Q

Subtypes of anorexia

A

*. Restrictive Subtype: Characterized by minimal food intake and excessive exercise.

  • Bulimic Subtype: Involves episodic binge eating followed by behaviors like laxative use or induced vomiting.
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3
Q

ICD-11 Criteria:

A
  • Significantly Low Body Weight
  • Fear of Gaining Weight
  • Distorted Body Image
  • Restrictive Eating
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4
Q

DMS-5 criteria anorexia

A
  • Restriction of Energy Intake
  • Intense Fear of Gaining Weight
  • Body Image Disturbance
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5
Q

Anorexia nervosa

A
  • more common in females
  • more common in dev countries
  • co-occurs with other psychiatric disorders, such as depression and anxiety
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6
Q

Signs and symptoms of anorexia

A

Hypotension
Bradycardia
Enlarged salivary glands
Lanugo hair (fine hair covering the skin)
Amenorrhoea

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7
Q

BMI- AN vs Bulemia

A
  • bulemia may have normal BMI
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8
Q

AN blood investigations q

A
  • Deranged electrolytes - typically low calcium, magnesium, phosphate and potassium
  • Low sex hormone levels (FSH, LH, oestrogen and testosterone)
  • Leukopenia
  • Raised growth hormone and cortisol levels (stress hormones)
  • Hypercholesterolaemia
  • Metabolic alkalosis, either due to vomiting or use of diuretics
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9
Q

Managment of AN

A
  • CBT
  • MANTRA
  • SSRI
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10
Q

When to admit patients for ano

A

USS test (sit-up, squat, and stand). Admission is also indicated if proximal muscle weakness suggests weak respiratory muscles.

If patients are very unwell the MARSIPAN checklist should be used to guide management.

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11
Q

Refeeding syndrome

A

A potentially fatal disorder that occurs when nutritional intake is resumed too rapidly after a period of low caloric intake

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12
Q

Symptoms of refeed syndrome

A

oedema, confusion and tachycardia

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13
Q

Electrolytes in refeed syndrome

A

Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces‚ these need to be replenished

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14
Q

Managment of refeed syndrome

A
  • high-dose vitamins (eg. Pabrinex) before feeding commences
  • Monitoring with daily bloods and replenishing electrolytes early
  • Building caloric intake gradually with the help of a dietitian‚ NICE recommends that refeeding is started at no more than 50% of calorie requirement
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15
Q

cardiac symptoms assoicated with cardiac arrhythmias

A

Bradycardia and prolonged QTc are often seen

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16
Q

Negative prognostic factors for ano

A
  • Presentation after the age of 20 years‚ difficult to reverse fixed beliefs
  • BMI <16 kg/m2
  • Marked anxiety when eating in front of others, which indicates issues with socialisation
  • Binging/vomiting responds less well to CBT than starvation
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17
Q

Cautions of SSRI

A
  • Avoid in mania
  • Should be used with caution in children and adolescents
  • Sertraline is best for patients with ischaemic heart disease
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18
Q

SSRI side effects

A
  • GI upset
  • Anxiety and agitation
  • QT interval prolongation (especially associated with citalopram)
  • Sexual dysfunction
  • Hyponatraemia
  • Gastric Ulcer
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19
Q

Seretonin syndrome triad

A
  • mental status changes
  • autonomic hyperactivity
  • neuromuscular abnormalities
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20
Q

Managment of Seretonin syndrome

A

discontinuation of the offending drug and supportive care.

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21
Q

SNRIs side effects

A
  • Nausea
  • Insomnia
  • Increased heart rate
  • Agitation
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22
Q

NaSSAs side effects

A

Sedation
Increased appetite
Weight gain
Constipation/diarrhoea

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23
Q

TCA cautions

A
  • Contraindicated in those with previous heart disease
  • Can exacerbate schizophrenia
  • May exacerbate long QT syndrome
  • Use with caution in pregnancy and breastfeeding
  • May alter blood sugar in T1 and T2 diabetes mellitus
  • May precipitate urinary retention, so avoid in men with enlarged prostates
  • Uses the Cytochrome P450 metabolic pathway, so avoid in those on other CP450 medications or those with liver damage
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24
Q

TCA side effects

A

Urinary retention
Drowsiness
Blurred vision
Constipation
Dry mouth

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25
Q

TCA toxicity signs

A

drowsiness, confusion, arrhythmias, seizures, vomiting, headache, flushing, and dilated pupils

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26
Q

Investigations of TCA overdose

A

blood tests (FBC, UE, CRP, LFTs), Venous Blood Gas, and an ECG to check for QT interval prolongation.

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27
Q

Managment of TCA overdose

A
  • Supportive care based on patient symptoms
  • NAC or charcoal in 2-4 hours
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28
Q

Cautions of MAO inhibitors

A

Cerebrovascular disease
Manic phase of bipolar disorder
Phaeochromocytoma
Severe cardiovascular disease

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29
Q

Side effects of MOA inhib

A

Hypertensive reactions (‘cheese reaction’) with tyramine-containing foods (so patients need to avoid pickled herring, Bovril, Oxo, Marmite, cheese, salami).
Should also avoid broad bean pods as these contain dopa.

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30
Q

class A personality disorders

A
  • PARANOID PERSONALITY DISORDER
  • SCHIZOID PERSONALITY DISORDER
  • SCHIZOTYPAL PERSONALITY DISORDER
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31
Q

PARANOID PERSONALITY DISORDER

A

Characterised by a pervasive and enduring pattern of irrational suspicion and mistrust of others
Demonstrates hypersensitivity to criticism and potential slights
Exhibits reluctance to confide in others due to fear of information being used maliciously against them
Often preoccupied with unfounded beliefs about perceived conspiracies against themselve

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32
Q

Schizoid personality disorder

A

Characterised by an enduring pattern of detachment from social relationships and a restricted range of emotional expression
Displays a pervasive lack of interest in or desire for interpersonal relationships, often preferring solitary activities
Shows an emotional coldness, detachment, or flattened affectivity
Often has few, if any, close relationships outside of immediate family

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33
Q

Schizotypal personality disorder

A

Characterised by a chronic pattern of impaired social interactions, distorted cognitions and perceptions, and eccentric behaviours
Demonstrates inappropriate or constricted affect, and peculiar, eccentric or bizarre behaviour
Displays odd thinking and speech, such as magical thinking, peculiar ideas, paranoid ideation, and belief in the influence of external forces
Shares certain cognitive or perceptual distortions with schizophrenia, but maintains a more intact grasp on reality

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34
Q

Class B personality disorders

A

ANTISOCIAL PERSONALITY DISORDER
BORDERLINE PERSONALITY DISORDER
HISTRIONIC PERSONALITY DISORDER
NARCISSISTIC PERSONALITY DISORDER

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35
Q

ANTISOCIAL PERSONALITY DISORDER

A

Defined by a pervasive pattern of disregard for and violation of the rights of others.
Individuals with this disorder exhibit a lack of empathy and frequently engage in manipulative, impulsive actions.
Manifestations include aggressive, unremorseful behaviour, and consistent irresponsibility, which often results in a failure to obey laws and social norms.
Children diagnosed with conduct disorder are at increased risk of developing this as they grow older. Prevention can be through parenting programmes, as well as trialling group-based CBT.

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36
Q

BPD

A

Characterised by a recurring pattern of abrupt mood swings, unstable personal relationships, and self-image instability.
The propensity towards self-harm is commonly observed in these patients.
Relationships often fluctuate between extremes of idealisation and devaluation, a process known as “splitting”.
There is often an inability to control temper and manage affective responses appropriately.
Also known as emotionally unstable personality disorder (EUPD) there may be a history of previous trauma, including sexual abuse.
Management is with dialectical behavioural therapy (DBT).

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37
Q

Histronic personality disorder

A

Predominantly characterised by attention-seeking behaviours and excessive displays of emotion.
Individuals may display inappropriate sexual behaviours.
Their emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated.
They often perceive relationships as being more intimate than they truly are, reflecting a distorted perception of interpersonal boundaries.

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38
Q

Narcissistic personality disorder

A

Characterised by a persistent pattern of grandiosity, a strong need for the admiration of others, and a marked lack of empathy.
Individuals with this disorder often display a sense of entitlement and will exploit others to fulfil their own desires.
Tendency to be arrogant and preoccupied with personal fantasies and desires, often at the cost of disregarding others’ feelings and needs.

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39
Q

Class C personality disorder

A

AVOIDANT PERSONALITY DISORDER
DEPENDENT PERSONALITY DISORDER
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

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40
Q

OCD

A

Characterised by an excessive preoccupation with orderliness, perfectionism, and control, often at the expense of flexibility, openness, and efficiency
Contrary to obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD) is not associated with recurrent, intrusive thoughts or rituals
Indications may include strict adherence to routines, perfectionism to the point of dysfunction, and a persistent reluctance to delegate tasks to others
Symptoms are generally ego-syntonic, meaning the patient perceives them as rational and desirable, thereby differentiating OCPD from OCD, where symptoms are typically ego-dystonic and distressing to the individual.

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41
Q

Dependant personality disorder

A

Characterised by a pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour
Individuals often lack self-confidence and initiative, relying excessively on others for decision-making
Patients may urgently seek new relationships as a source of care and support when existing ones end

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42
Q

Avoidant personality disorder

A

Characterised by intense feelings of social inadequacy, fear of rejection, and hypersensitivity to criticism
* Patients often self-impose isolation to avoid potential criticism, despite a strong desire for social acceptance and interaction

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43
Q

Bullimia nervosa

A

binge-eating episodes followed by compensatory behaviors, such as self-induced vomiting, laxative abuse, diuretics, fasting, or excessive exercise

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44
Q

epidemiology of Bulimia nervosa

A

Affects adolescents and young adults, with onset in late adolescence or early adulthood.
Prevalence: Lifetime 1-2% in women, less than 0.5% in men.
Female to male ratio: Approximately 10:1.
Relatively stable prevalence over the last few decades.

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45
Q

Psychological symptoms of bulimia

A
  • Binge Eating: Loss of control, consuming large amounts of high-caloric food urgently.
  • Purging: Induced vomiting, laxative or diuretic misuse, and excessive exercise.
  • Body Image Distortion: Distorted perception despite maintaining normal or slightly above average weight.
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46
Q

Physical symptoms of bulimia

A

Dental Erosion: Resulting from recurrent self-induced vomiting.
Parotid Gland Swelling: Resulting from recurrent self-induced vomiting.
Russell’s Sign: Scarring on the back of the hand or knuckles from repeated self-induced vomiting.
Amenorrhea: Present in 50% despite normal weight.
Excessive Vomiting Complications: Boerhaave syndrome or Mallory-Weiss tear.

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47
Q

Wernicke’s encephalopath

A

Acute neurological syndrome resulting from a deficiency in thiamine (vitamin B1).

Related to chronic alcohol abuse

48
Q

Wernicke’s encephalopath triad

A
  • mental status changes (confusion)
  • ataxia,
  • ophthalmoplegia/nystagmus.
49
Q

Korsakoff’s syndrome symptoms

A
  • Profound anterograde amnesia
  • Limited retrograde amnesia
  • Confabulation (patients fabricate memories to mask their memory deficit)
50
Q

Investigations of Wernicke’s encephalopathy

A
  • Thiamine level testing: Low levels are indicative of deficiency.
  • FBC
  • Urea and Electrolytes
  • Liver Profile
  • Clotting
  • Bone Profile
  • Magnesium
  • MRI can show typical changes in specific regions of the brain, as well as mamillary body atrophy in Korsakoff’s syndrome.
51
Q

Management of Wernicke’s encephalopath

A
  • find underlying issue
  • Thiamine supplementation
52
Q

Management of Korsakoff’s syndrome

A
  • thiamine suplements
  • rehab (+alcohol support)
  • managment of patient’s environment
53
Q

Transient global amnesia (TGA)

A

sudden, transient neurological condition primarily characterized by acute disruption of both short-term and long-term memory.

54
Q

epidemiology of TGA

A

middle-aged and elderly individuals

55
Q

Features of TGA

A
  • Sudden onset of memory loss
  • retrograde amnesia
  • anterograde amnesia
  • confusion/ dejavu
    *preserved personality
    *motor skills normal
  • Spontaneous resolution of symptoms, typically within 24 hours
56
Q

TGA investigations

A
  • Brain CT or MRI
  • EEG
  • Neuropsychological tests
  • Blood tests: To exclude metabolic causes such as hypoglycemia or electrolyte imbalance
57
Q

Managment of TGA

A
  • Reassurance:
  • Supervision
  • Follow-up: A neurological review is advised, especially if episodes are recurrent.
  • There are no specific pharmacological treatments for TGA.
58
Q

TGA and DVLA

A

No need to inform

59
Q

criteria to be detained mental health act

A
  • They must have a mental disorder
  • There must be a risk to their health/safety or the safety of others
  • There must be a treatment (however this can include nursing care, not just drugs)
60
Q

MHA Section 2

A
  • Admission for mental health assessment and treatment for up to 28 days,
  • non-renewable.
  • The application for admission is initiated by an Approved Mental Health Professional (AMHP) or the patient’s nearest relative.
  • This section necessitates the recommendation of two doctors, one of whom must be ‘approved’ under Section 12(2) of the MHA
61
Q

MHA section 3

A
  • Permits admission for treatment lasting up to 6 months, with the provision for renewal.
  • Mandates the involvement of an AMHP and two doctors, both of whom should have examined the patient within the last 24 hours.
62
Q

MHA section 4

A
  • Designed for emergencies when applying Section 2 would cause an unnecessary delay.
  • Requires the recommendation of a single doctor and the involvement of either an AMHP or the nearest relative.
  • The patient can be detained for a maximum of 72 hours, typically followed by a transition to Section 2.
63
Q

MHA Section 5(2)

A

Holding power which enables a doctor to legally detain a voluntary patient in the hospital for a period of 72 hours.

64
Q

MHA section 5(4)

A

Section 5(4) is comparable to a Section 5(2) but is enacted by registered nurses and has a duration of 6 hours.

65
Q

Section 17a

A

Allows for a Supervised Community Treatment (also known as a Community Treatment Order).

66
Q

Section 135

A

Court order enabling the police to enter a property to escort a person to a Place of Safety (either the police station or, more commonly, an Accident and Emergency Department (A&E)).

67
Q

Section 136

A

Provides police officers the authority to take an individual, who seems to be suffering from a mental disorder and is in a public place, to a Place of Safety.

68
Q

Investigations for paracetamol overdose

A

Full Blood Count (FBC)
Urea and Electrolytes
Clotting Screen
Liver Function Tests
Venous Blood Gas - Severe metabolic acidosis
Paracetamol level

69
Q

Managment of paracetamol overdose

A

Charcoal
NAC

70
Q

Classificiations of paracetamol overdose

A

Acute overdose - excessive amounts in less than 1 hour, usually in context of self-harm)
Staggered overdose - excessive amounts of paracetamol ingested over longer than 1 hour, usually in context of self harm)
Therapeutic excess - excessive paracetamol taken with intent to treat pain or fever and without self-harm intent, ingested at dose greater than licensed daily dose (more than 75mg/kg/24 hours).

71
Q

OCD managment

A
72
Q

Postpartum psychosis

A

serious psychiatric disorder that typically develops within the first two weeks following childbirth

73
Q

Postpartum psychosis syptoms

A

Paranoia
Delusions
Capgras delusions - misidentification syndrome characterised by the belief by the patient that the close person is replaced by an imposter who looks physically the same
Hallucinations
Manic episodes
Depressive episodes
Confusion

74
Q
A
75
Q

Managment of postpartum psychosis

A
  • Antipsychotic medications - olanzapine and quetiapine are safe to take while breastfeeding
  • Mood stabilisers in some instances
76
Q

Schizophrenia

A

hronic or relapsing and remitting form of psychosis characterized by positive symptoms (such as hallucinations, delusions, thought disorders) and negative symptoms (including alogia, anhedonia, and avolition)

77
Q

Criteria for Schizophrenia

A

ICD-11 Criteria: Symptoms present for at least 1 month, causing significant impairment.

DSM-5 Criteria: Symptoms persist for at least 6 months, encompassing at least one month of active-phase symptoms (must include one prominent ‘ABCD’ symptom).

78
Q

Subtypes of schizophrenia

A

Paranoid Schizophrenia: Characterized by delusions and hallucinations, often with a persecutory theme.

Catatonic Schizophrenia: Features motor disturbances and waxy flexibility.

Hebephrenic Schizophrenia: Marked by disorganized thinking, emotions, and behavior.

Residual Schizophrenia: Residual symptoms persist after a major episode.

Simple Schizophrenia: Characterized by a gradual decline in functioning without prominent positive symptoms.

79
Q
A
80
Q

Typical antipsychotic

A
  • first-generation’ antipsychotics
  • antagonists to D2 receptors but also on cholinergic, adrenergic and histaminergic receptors
81
Q

Extrapyramidal symptoms of typical antipsychotic 4

A
  • Acute Dystonia: Involuntary muscle contractions causing spasms.
  • Akathisia: Restlessness and an inability to sit still.
  • Parkinsonism: Tremors, rigidity, and bradykinesia (slowed movements).
  • Tardive Dyskinesia: Involuntary, repetitive movements, especially of the face.

Hyperprolactinemia

82
Q

Histamine H1 Receptor Blockade

A

Drowsiness and sleepiness

83
Q

Alpha-1 Adrenergic Receptor Blockade

A

Orthostatic hypotension

84
Q

Anticholinergic Effects of typical antipsychotic

A

Dry mouth.
Constipation.
Blurred vision.
Urinary retention.

85
Q

Atypical anti psychotic

A

D2, D3 and 5-HT2A antagonists, with less overspill into other receptors.

86
Q

Examples of atypical antipsychotics

A

risperidone, quetiapine, olanzapine, aripiprazole and clozapine

87
Q

EPS (Extrapyramidal Symptoms) atypical

A
  • lower risk of causing EPS compared to typicals.
    Lower risk of tardive dyskinesia.
88
Q

5-HT2A Receptor Blockade atypical

A

Atypicals have a reduced risk of causing EPS due to serotonin receptor blockade.

89
Q

Monitoring atypical antipsychotic

A
  • weight (weeks, then at 12 weeks, at 1 year, and then yearly.)
  • fasting blood glucose, HbA1c, blood lipids
  • Prolactin baseline
  • ECG
  • blood pressure (12 weeks and one year)
90
Q

Clozapine

A
  • atypical antipsychotic that is indicated if there is failure of treatment of 2 other antipsychotic medication
  • treatment- resistant schizophrenia
91
Q

Side effects of clozapine

A

agranulocytosis, neutropenia, reduced seizure threshold, myocarditis, slurred speech (due to hypersalivation), constipation

92
Q

Monitoring clozapine

A

FBC

Blood lipids and weight

Blood lipids and weight

93
Q

Neuroleptic malignant syndrome

A

potentially life-threatening, idiosyncratic reaction to antipsychotic medications, particularly those that block dopamine receptors.

94
Q

Clinical features of NMS

A
  • hyperthermia
  • altered mental state
  • autonomic dysregulation
  • rigidity
95
Q

NMS investigation

A

FBC - Monitoring for potential leukocytosis or signs of infection.
Creatine Kinase (CK) Levels: Markedly elevated CK levels are often observed due to muscle breakdown.
Renal and Liver Function Tests: monitoring organ function due to the potential systemic effects.

96
Q

Management of NMS

A
  • discontinue causative agent
  • supportive care ( aggressive cooling)
  • benzodiazepines
  • dantrolene
  • intensively monitoring
97
Q

ICD-11 criteria GAD

A

Excessive worry and apprehension.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue.
Duration: At least 6 months.

98
Q

DSM-V Criteria: GAD

A

Excessive anxiety and worry about various domains.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue, irritability.
Duration: At least 6 months.

99
Q

GAD epidemiology

A
  • common in females
  • associates with depression, substance abuse and personality disorder
  • onset 35-40 years is more likely indicative of depressive disorder or organic disease.
100
Q

Risk factors of GAD

A

lower socioeconomic status, unemployment, divorce, renting rather than owning a home, lack of educational qualifications, and urban living.

101
Q

Psychological symptoms GAD

A

Fears, worries, poor concentration, irritability, depersonalization, derealization, insomnia, night terrors

102
Q

Motor symptoms GAD

A

Restlessness, fidgeting, a feeling of being on edge

103
Q

GAD Neuromuscular

A

Tremor, tension headache, muscle ache, dizziness, tinnitus

104
Q

GI GAD symptoms

A

Dry mouth, dysphagia, nausea, indigestion, “butterflies” in the stomach, flatulence, frequent or loose bowel movements

105
Q

Cardiolovascular symptoms GAD

A

Chest discomfort, palpitations

106
Q

Genitourinary GAD symptoms

A

Urinary frequency, erectile dysfunction, amenorrhea

107
Q

Respiratory symptoms GAD

A

Dyspnea, tight/constricted chest

108
Q

Management

A

Psycho- education
Self help
CBT
SSRI
Propranolol

Patients under 30 should therefore have a follow-up appointment within 1 week to monitor progress.

109
Q

ICD-11 criteria panic disorder

A

Recurrent, unexpected panic attacks.
At least one attack followed by a month of persistent concern.
Avoidance behaviors related to attacks.

110
Q

DSM-V criteria panic tracks

A

Recurrent, unexpected panic attacks.
Persistent concern about future attacks.
Behavioral changes: Avoidance of situations associated with attacks.

111
Q

Epidemiology of panic disorder

A

Prevalence of 1-2% in the general population.
2-3 times more prevalent in females.
Bimodal incidence, peaking at ages 20 and 50.
Agoraphobia is concurrent in 30-50% of cases.
Increased risk of attempted suicide with comorbid depression, alcohol misuse, or substance misuse.

112
Q

Clinical feature of panic disorder

A

Difficulties in breathing.
Chest discomfort.
Palpitations.
Hyperventilation
Numbness
Shaking, sweating, dizziness.
Depersonalization/derealization.
May result in fear of situations where panic attacks occur or lead to agoraphobia.
Development of a conditioned fear-of-fear pattern.

113
Q

Management of panic disorder

A
  • CBT
  • fear of fear cycles
    *SSRI
  • Clomipramine
114
Q

increased risk of going on to complete suicide:

A
  • hx self harm or prev suicide attempt
  • mental health disorder (e.g depression, bipolar disorder)
  • male
  • drugs and alcohol use
  • planned attempt
  • poor social support
115
Q

Risk management suicide

A
  • mild risk - primary care as long as patient as established support network with GP follow ups
  • moderate severe risk A&E/admitted and reviewed by Psychiatry liaison team
116
Q

Delirium symptoms

A

Disorientation
Hallucinations - visual or auditory
Inattention
Memory problems
Change in mood or personality. Sundowning is agitation and confusion worsening in the late afternoon or evening.
Disturbed sleep

117
Q

Management of delirium

A
  • sleep hygiene
  • haloperidol or lorazepam. Olanzapine

UKMLA Prep (32 decks)

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