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psychiatry > LO > Flashcards

LO Flashcards

1
Q

History related symtpoms Q’s

A

other changes, anyone else notices change, specific symptoms, systematic enquiry).

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2
Q

History explore symptoms Q’s

A

have you seen or heard things no one else has, what do you think causes that?).

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3
Q

History past pysch history Q’s

A

suicide attempts, treatments, episodes etc).

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4
Q

History family history Q’s

A

Genogram, siblings, distant relatives important, quality of relationships

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5
Q

History past medial history Q’s

A

(developmental, head injury, endocrine, liver, vascular etc).

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6
Q

History alcohol illicit drugs Q’s

A

(pattern, regular or intermittent, impact etc)

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7
Q

History Personal history Q’s

A

friendships, developmental milestones, schooling)

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8
Q

History forensic history Q’s

A

(police, offences, recidivism, sexual or violent crimes

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9
Q

history premorbid personality Q’s

A

(consistency of behaviour, moods and interaction; how would you best friend describe you?).

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10
Q

MSE points

A

appearance, behaviour, movements, moods, speech, throughts, beliefs, precepts, suicide, homicide, cognitive function, insight

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11
Q

thoughts questions for MSE

A

phobias, obsession, flight of ideas, formal thought disorder, knights move, preoccupation, over-valued ideas, delusional beliefs, illusions, hallucinations

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12
Q

insight questions for MSE

A

spectrum, variable over time, are symptoms due to an illness, is it due to a mental illness, do they agree with the treatment plan

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13
Q

psychological symptoms with depression

A

change in mood (Anxiety, anhedonia (no longer experiencing pleasure), perplexity, depression,.), change in thought content (guilt, hopelessness, worthlessness, neurotic symptomatology, delusions, hallucinations, suicidal, loss of confidence).

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14
Q

physical symptoms with depression

A

bodily function (low energy, sleep, appetite, libido, constipation, pain) and changes in psychomotor functioning (agitation and retardation).

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15
Q

social symptoms with depression

A

loss of interests, irritability, apathy, withdrawal, loss of confidence, indecisive, loss of concentration, registration and memory.

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16
Q

mania symptoms

A

grandiose ideas, disinhibition, loss of judgement, similarities to stimulant drugs, elevated form of mood that is pathological in nature.

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17
Q

ICD-10-depression guidelines for diagnosis

A

often with depression looking for minimum of two weeks for depression, although many wait longer. Often recurring and chronic illness.
no hypomanic or manic episodes, not attributable to a psychoactive substance, if psychotic symptoms or stupor then severe depression with psychotic symptoms (exclude schizophrenia

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18
Q

ICD-10 mania guidelines for diagnosis

A

mania
one week of disruptive, elevated mood, disinhibited, overactive, decreased need for sleep, disinhibition, grandiose, alteration of senses, extravagant spending, irritable rather than elated.

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19
Q

bipolar ICD 10 guidelines

A

2 repeated episodes of depression, mania or hypomania. if no hypomania or mania then recurrent depression

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20
Q

treatment for depression drugs

A

selective serotonin reuptake inhibitor (SSRIS) is first line (citalopram etc), tricyclic antidepressants, monoamine oxidase inhibitors

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21
Q

alt. therapies for depression

A

CBT, IPT (interpersonal therapy), individual dynamic psychotherapy, ECT, psychosurgery, deep brain stimulation (DBS), Vagus nerve stimulation (VNS).

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22
Q

antipsychotics for mania Tx

A

olanzapine, risperidone, quetiapine

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23
Q

mood stabilisers for mania Tx

A

sodium valproate, lamotrigine, carbamazepine

lithium, ECT.

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24
Q

CBT description

A

examining how our thoughts relate to our feelings and behaviours. Short term focus, problem focused and goal oriented.
identify thoughts, assess whether those thoughts are unrealistic or unhelpful, identifying the potential for change, client engages then in homework tasks.

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25
Q

CBT is good for

A

depression, anxiety, phobias, OCD and PTSD.

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26
Q

behavioural activation description

A

focus on avoided activities, guide for activity scheduling for a functional analysis of cognitive processes that involve avoidance. Focus on what predicts and maintains an unhelpful response by various reinforcers. Clients are taught to analyse unintended consequences of their way of responding. Involves small changes building to long term goals, structured agenda, collaborative process.

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27
Q

interpersonal therapy description

A

time limited, focus on the present. A sick role is given (we know you have difficulties, you are allowed to have difficulties, that’s okay), constructing an interpersonal map (interpersonal connections over a given time period) with focus areas maintained in which depressive symptoms are linked to interpersonal events. It has the goals of improving interpersonal functioning and reducing depressive symptoms

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28
Q

positives of interpersonal therapy

A

Effective for depression, no formal homework, client can practice beyond sessions ending.

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29
Q

negatives of interpersonal therapy

A

Requires reflection, dependent on strong social networks

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30
Q

motivational interviewing is beneficial for

A

problem drinkers

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31
Q

motivational interviewing description

A

promotes behaviour change in a wide range of health care, more effective than advice giving. Express empathy, understand their predicament, avoid arguments and support self-efficacy with patients setting agenda.

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32
Q

define stigma

A

is a social construction that devalues people due to a distinguishing characteristic or mark

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33
Q

somatic syndrome depression ICD 10

A

marked loss of interest, lack of emotional reaction, waking 2 hours before normal time, depression worse in the morning, objective evidence of psychomotor agitation/retardation, loss of appetite/weight/libido.

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34
Q

hypomania ICD 10 symptoms

A

lesser degree, no psychosis, increased energy and activity, increased sociability, talkative, over familiar, increased sexual energy, decreased need for sleep, irritable, concentration reduced, new interests, mild overspending, not to extent of severe disruption or social rejection.

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35
Q

areas of controversy to psychiatry

A

diagnosis, social control, treatment without consent, rising rates of antidepressant prescriptions, security, detention

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36
Q

antidepressants use

A

unipolar and bipolar depressions, organic mood disorders, schizoaffective disorder, anxiety disorders

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37
Q

antidepressant efficacy

A

Efficacy is very similar amongst all drugs, delay of 3-6 weeks after a therapeutic dose is achieved before symptoms improve

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38
Q

TCA’s side effects

A

very effective profile but antihistaminic, anticholinergic, antiadrenergic, lethal in overdose, can cause QT lengthening.

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39
Q

monoamine oxidase inhibitors use

A

depression

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40
Q

monoamine oxidase inhibitors side effects

A

orthostatic hypotension, weight fain, dry mouth, sexual dysfunction,

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41
Q

MAOI risk of serotonin syndrome if taken with

A

meds that increase serotonin

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42
Q

MAO hypertensive crisis occurs If taken with

A

hypertensive crisis can develop when MAOI’s are taken with tyramine rich foods or sympathomimetics known as a cheese reaction.

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43
Q

SSRI’s treat

A

anxiety and depression

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44
Q

side effects of SSRI’s

A

discontinuation syndrome, GI upset and sexual dysfunction.

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45
Q

SSRI’s types

A

paroxetine, sertraline, Prozac, citalopram, escitalopram, fluvoxamine

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46
Q

SNRI’s used for

A

depression, anxiety and possibly neuropathic pain

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47
Q

venlafaxine side effects

A

bad discontinuation syndrome, QT prolongation, sexual side effects.

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48
Q

duloxetine use

A

efficacy for physical symptoms of depression

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49
Q

mirtazapine use

A

; hypnotic at lower doses secondary to antihistaminic effects. Very sedating but significant weight gain

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50
Q

mood stabilisers use

A

; bipolar, cyclothymia, schizoaffective

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51
Q

lithium use

A

reduces suicide rate, effective in long term prophylaxis in mania and depression

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52
Q

lithium associated with

A

Ebstein’s anomaly in pregnancy, GI distress, thyroid abnormalities, hair loss, acne, highly toxic however

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53
Q

anti convulsant examples

A

valproic acid, carbamazepine, lamotrigine,

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54
Q

valproic acid use

A

effective as lithium for mania but not in depression. Better tolerated than lithium

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55
Q

valproic acid side effects

A

Requires baseline assessments but thrombocytopenia, platelet dysfunction, nausea, vomiting, weight gain, hair loss.

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56
Q

carbamazepine use

A

first line agent for acute mania and mania prophylaxis

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57
Q

carbamazepine side effects

A

; requires monitoring, need to check levels as induced own metabolism, rash, nausea, AV conduction delays, agranulocytosis, water retention, drug-drug interactions.

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58
Q

lamotrigine side effects

A

nausea, vomiting, sedation, dizziness, ataxia, confusion and Steven Johnson’s syndrome or toxic epidermal necrolysis

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59
Q

antipsychotics symptoms

A

schizophrenia, schizoaffective disorder, bipolar disorder, psychotic depression, augmenting agents in treatment resistant anxiety

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60
Q

high doses of alcohol causes

A

intoxication; impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor and unconsciousness.

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61
Q

harmful use of alcohol is

A

pattern of use causing damage physically or mentally. >1 month or repeatedly over 12 months.

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62
Q

dependence is

A

3 or more of the following >1 month or repeatedly over 12 months.
cravings, difficulty controlling use, primacy, increased tolerance, physiological withdrawal, persistence despite harmful consequences.

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63
Q

delirium tremens is

A

profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic over activity, mortality (CV collapse, infection, hyperthermia, seizures or self injury)

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64
Q

CAGE >2

A

have you tried to Cut down?
Have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
have you felt the need for an Eye opener?

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65
Q

chronic alcohol use signs

A 
elevated GGT
macrocytosis
low platelets 
elevated ferritin
enlarged smooth edged
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66
Q

alcohol withdrawal drug is

A

benzodiazepines

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67
Q

alcohol withdrawal thiamine is used for

A

Wernicke-Korsakoff syndrome

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68
Q

alcohol withdrawal aversion medication

A

Disulfiram

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69
Q

anti-craving alcohol meds

A

acamprosate, naltrexone, nalmefene, baclofen

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70
Q

general management of alcohol addiction

A 
holistic bio-psycho-social approach
CBT/group theraoy
social work
skills training
community support
inpatient treatment
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71
Q

mental health issues around alcohol use

A

anxiety, depression, sleep disruption, morbid jealousy, alcoholic hallucinosis, deliberate self-injury, suicidal thoughts

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72
Q

physical alcohol issue

A

brain damage, loss of memory, poor control of diabetes, loss of muscle, high blood pressure, irregular pulse, enlarged heart, ulcers, gastritis, pancreatitis, impotence, trembling hands, risk of infection.

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73
Q

Wernicke’s encephalopathy symptoms

A

confusion, ataxia, opthalmoplegia, nystagmus

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74
Q

Korsakoff’s psychosis symptoms

A

impairment of recent and remote memory, preservation of immediate recall, impaired learning and disorientation, maybe nystagmus and ataxia

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75
Q

fatty liver disease pathology

A

; fat deposits around central veins and then parenchyma.

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76
Q

alcoholic hepatitis symptoms

A

hepatomegaly, jaundice, abdominal pain, fever, hepatic decompensation.

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77
Q

hepatic cirrhosis symptoms

A

; localised fibrosis around veins, collagen bridges, loss of lobules. Chance of variceal haemorrhage, encephalopathy, ascites

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78
Q

cocaine causes

A

stimulant, euphoriant, increased alertness, energy, increased confidence, impaired judgement, lessens appetite and desire for sleep.

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79
Q

cocaine side effects

A

Damages nose, airways, convulsions with respiratory failures, cardiac arrhythmias, MI, hypertension, toxic confusion, paranoid psychosis.

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80
Q

cocaine withdrawal

A

depression, irritability, agitation, craving, hyperphagia, hypersomnia.

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81
Q

heroin causes

A

drowsiness, sleepiness, mood changes, respiratory depression, nausea, vomiting, decreased sympathetic outflow (hypotension, bradycardia), lowering body temperature, pupillary constriction, constipation, risk of respiratory arrest.

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82
Q

heroin withdrawal

A

craving, insomnia, yawning, muscle pain and cramps, increased salivary, nasal, lacrimal secretions, dilated pupils, piloerection.

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83
Q

MDMA causes

A

nausea, dry mouth, increased blood pressure, increased temperature, risk of dehydration, anxiety, panic, drug induced psychosis, liver and brain damage risk.

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84
Q

cannabis side effects

A

high doses may cause anxiety, panic, persecutory ideation, hallucinatory activity. Respiratory problems, toxic confusion, exacerbation of major mental illness, cannabis psychosis

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85
Q

steroids can cause

A

skin, acne, stretch marks, baldness, hypogonadism, gynaecomastia in men. In women hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning. Increased cholesterol and hypertension, growth deficits, liver disease with cholestatic jaundice and liver tumours. Irritability and anger, hypo/mania, depression and suicidality

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86
Q

tolerance refers too

A

“reduced responsiveness to a drug caused by a previous administration” an example of homeostasis.

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87
Q

dispositional tolerance

A

– less drug reaches the active site (less absorbed, metabolised faster, more excreted)

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88
Q

pharmacodynamic tolerance

A

drug has less action at the active site (fewer drug receptors, less efficient drug receptors i.e. reduced down-stream signalling )

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89
Q

dependence refers to

A

withdrawal symptoms due drug effect -> reduced transmitter release…increased sensitivity to transmitter

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90
Q

withdrawal phenomena refers too

A

withdrawal effect of the drug is usually the reverse of the acute effect.

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91
Q

genetic basis for variation in the strength of reward centres in regards to severe alcoholism

A

association of the A1 allele of the D2 dopamine receptor gene with severe alcoholism. More likely to become alcoholics but not guaranteed.

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92
Q

psychosis refers too

A

; represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality.

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93
Q

types of hallucinations

A

5 special senses auditory, visual, tactile, olfactory or gustatory.

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94
Q

positive schizophrenia symptoms

A

hallucinations, delusions, disordered thinking

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95
Q

negative schizophrenia symptoms

A

apathy, lack of interest, lack of emotion

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96
Q

diagnosis of schizophrenia is one longer than one month in the absence of

A

longer than one month in the absence of organic or affective disorder;
alienation of though
delusions of control, influence and passivity
hallucinatory voices giving a running commentary or coming from some parts of the body
persistent delusions of other kinds that are culturally inappropriate

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97
Q

and or two of the following for diagnosis of schizophrenia

A

persistent hallucinations occurring every day for a month
neologism, break or interpolations in the train of thought
catatonic behaviour
negative symptoms; apathy, paucity of speech, blunting of incongruity.

98
Q

alienation of thought refers to

A

echoes, thought insertion, withdrawal or thought broadcasting

99
Q

psychological factors of schizophrenia

A

memory traces from ancestral past, state of fear, attempts to make sense of experiences through altering world view.

100
Q

social factors of schizophrenia

A

migration, social isolation, life events as precipitant, occupation and social class, critical emotion imposed by families

101
Q

genetic factors of schizophrenia

A

inheritable, neuregulin, dysbindin, di George syndrome

102
Q

neurochemical factors of schizophrenia

A

dopamine, glutamate, GABA, serotoninergic transmission

103
Q

other factors involved in schizophrenia

A

obstetric complications, maternal influenza, malnutrition, famine, winter birth, substance misuse

104
Q

delirium symptoms

A

prominent visuals, hallucinations, illusions, terror, persecutory and evanescent, fluctuates worse at night

105
Q

differentials for delirium

A

delirium
depressive episodes with psychotic symptoms
manic episode with psychotic symptoms

106
Q

different types of schizophrenia

A

paranoid schizophrenia, hebephrenic, catatonic, undifferentiated, post-schizophrenic depression, residual, simple

107
Q

recovery from schizophrenia is defined by

A

recover is not a simple reduction or abatement of symptoms, recovery is being able to live a meaningful and satisfying life as defined by each person in the presence or absence of symptoms

108
Q

what percentage of people recover from the first episode of psychosis

A

80%

109
Q

what percentage of people moderately recover from schizophrenia

A

50%

110
Q

treatment resistant schizophrenia tx

A

clozapine

111
Q

cognitive dysfunction of schizophrenia tx

A

acetylcholinesterase inhibitors

112
Q

persistent negative schizophrenia symptoms tx

A

augment original antipsychotics with antidepressant lamotrigine or sulpiride

113
Q

Mental Health Care Act 2003 principles

A

non-discrimination, equality, respect for diversity, reciprocity, informal care, participation, respect for carers, least restrictive alternative, benefit, child welfare

114
Q

who can be detained under the Mental Health Care Act 2003

A

anyone can be detained, <18 requires specialist

115
Q

criteria for detention under the 2003 mental health care act

A

mental disorder
significant impairment of decision making ability for medical treatment about mental disorder
significant risk to health, safety, welfare of the person or anyone else
treatment available
order necessary

116
Q

Adults with Incapacity Act 2000 incapable refers too

A

acting or, making decisions, or communicating decisions or understanding decisions or retaining memory of decisions

117
Q

principles of adults with incapacity Act 2000

A

intervention must be beneficial
intervention shall be least restrictive in relation to the freedom of the adult, consistent with the purpose of the intervention
account of past, present wishes of adult
views of relatives, carers, guardians and attorneys.

118
Q

adults with incapacity act 2000 doesn’t enable

A

authority conferred shall not authorise inconsistent decisions to the court, use of force, treatment in a hospital against someone’s will

119
Q

criminal justice and licensing act 2010

A

a person is not criminally responsible for conduct constituting an offence is to be acquitted of the offence if the person was at the time of conduct unable by reason of mental disorder to appreciate the wrongfulness
but a person doesn’t lack responsibility if the mental disorder consists only of a personality disorder characterised by aggression and irresponsibility.

120
Q

diminished responsibility refers too

A

person would otherwise be convicted of murder instead to be convicted of culpable homicide on ground of diminished responsibility for abnormality of mind. this doesn’t include influence of alcohol, drugs.

121
Q

restriction order refers to

A

having regard to the nature of the offence with which he is charged.
antecedents of the person and the risk that as a result of his mental disorder he would commit offences if set at large.

122
Q

nature of personality disorders

A

enduring pattern of inner experience and behaviour that deviates from the individual’s expectations. Manifests in cognition, affectivity, interpersonal functioning, impulse control.

123
Q

characteristics of the patterns of personality disorder

A

The pattern is inflexible and pervasive; leads to clinically significant distress or impairment in a range of important areas of functioning. The pattern is stable and traced to early adulthood cannot be better explained by another diagnosis and not attributable to a physiological change.

124
Q

Cluster A personality disorders are related to

A

problem is with the perceived safety of interpersonal relationships

125
Q

Cluster A personality disorders

A

paranoid personality disorder
schizoid personality disorder
schizotypal personality

126
Q

Cluster B personality disorders are related to

A

problems are with keeping feeling tolerable without acting

127
Q

Cluster B personality disorders

A

antisocial personality disorder
narcissistic personality disorder
borderline personality disorder
histrionic personality disorder

128
Q

Cluster C personality disorders related too

A

problem relate to anxiety and how it is managed

129
Q

Cluster C personality disorders

A

obsessive compulsive personality disorder
avoidant personality disorder
dependent personality disorder

130
Q

therapeutic options for Borderline personality disorder

A

dialectic behavioural therapy
mentalisation based treatment
symptomatic prescribing

131
Q

discuss the key symptoms for generalised anxiety disorder for a diagnosis

A

persistent for several months and occurs with psychological and autonomic arousal, muscle tension, hyperventilation and sleep disturbance but symptoms not confined to one situation or object.

132
Q

phobic anxiety disorders symptoms

A

same core features as GAD but only in specific work circumstances, may also suffer anticipatory anxiety.

133
Q

OCD symptoms

A

obsessional thoughts or compulsive acts. Arise from the distress of thoughts or attempts to resist. Stereotypical acts, not enjoyable or helpful. Often the acts are viewed as preventing harm or pointless and anxiety accompanies resistance.

134
Q

PTSD symptoms

A

delayed and or protracted reaction to a stressor of exceptional severity. Involves hyperarousal (persistent anxiety, irritability, insomnia, poor concentration), re-experiencing the phenomena (flashbacks, nightmares) and avoidance of reminders (emotional numbness, cue avoidance, recall difficulties, diminished interests).

135
Q

psychological arousal in anxiety disorders refers too

A

fearful anticipation, irritability, sensitivity to noise, poor concentration, worrying thoughts.

136
Q

autonomic arousal symptoms in anxiety disorder refers too

A

GI (dry mouth, swallowing difficulties, dyspepsia, nausea, wind, loose motions), CV (palpitations, chest pain), respiratory (tight chest, difficulty inhaling), genitourinary (frequency of urination, amenorrhoea, erectile failure, CNS (dizziness and sweating).

137
Q

muscular arousal symptoms in anxiety disorder refers too

A

tremor headache muscle pain

138
Q

hyperventilation symptoms in anxiety disorder refers too

A

hypocapnia, numbness, carpopedal spasm, breathlessness

139
Q

sleep disturbance in anxiety orders refer too

A

frequent waking, nightmares, initial insomnia

140
Q

general management for anxiety disorders

A

clear plan, explanation and education, lifestyle advice

relaxation training, medication (sedatives addictive instead SSRI’s or TCA), cognitive behavioural therapy.

141
Q

social phobia treatment

A

SSRI, CBT challenges high standards and excessive self-monitoring, negative views of self, safety barriers.

142
Q

OCD treatment

A

education, family involvement, SSRI, clomipramine, CBT, psychosurgery.

143
Q

PTSD treatment

A

: screened at one month, CBT, eye movement desensitisation and reprocessing, risk of dependence with sedatives so use of SSRI or TCA.

144
Q

genetic influences on child psychiatry

A

many genes implicated contributing small effects and many implicate Micro-RNA and epigenetic modulation. They control the influence of environmental factors on genetics expression. Inflammatory and auto-immune mechanisms are being implicated as well as genes controlling synapse formation, neurotransmission and modification.

145
Q

intra-uterine and perinatal factors for child psychiatry

A

maternal health, substance misuse, toxins, drugs, epigenetics, endocrine, immunity, premature birth and twins.

146
Q

white matter connectivity for child psychiatry

A

low connectivity associated with more cognitive instability.

147
Q

environmental factors for child psychiatry

A

relationships, parenting skills, marital harmony, family function, nutrition, class, family function, abuse, neglect, discipline, day care and schooling, peer relationships, life events and physical disability.

148
Q

stress factors for child psychiatry

A

elevated cortico-amygdala threat sensitivity, activation of norepinephrine, cortisol and epinephrine which aids in activation of macrophage that release cytokines resulting In low grade inflammation by microglia but this generates positive feedback loop with reduced cortical basal ganglia reward sensitivity; risky behaviours and more inflammation that causes further elevation of the cortico-amygdala threat sensitivity

149
Q

operant conditioning in child psychiatry refers too

A

dopamine neurons fire when you associate an action with a subsequent reward. Experience of adversity and the reward deficiency model of addiction that yields increasing tolerance and increasing behaviours to elicit rewards for satiety.

150
Q

delay aversion theory refers too in child psychiatry

A

inability to await and maintain attention is absence of immediate reward

151
Q

theory of mind refers to in child psychiatry

A

understanding false beliefs and the ability to represent other’s thoughts as different as to their own.

152
Q

expressed emotion in child psychiatry refers too

A

; illness causes worry and stress, more severe illness leads to more worry and stress. Results in negativity In relationships and increased relapse rate.

153
Q

school attendance in psychiatry refers too

A

bullying, lack of parental attention, maternal depression, learning difficulties, lack of friends.

154
Q

ODD symptoms

A

frequent loss of temper, arguing, easily angered or annoyed, showing vindictive or negative behaviours

155
Q

ADD symptoms

A

distracted, sustaining attention to low rewarding tasks difficult, problems with organisation
hyp/imp; difficulties remaining still, impulsive

156
Q

autism symptoms

A

obsession, rigid and inflexible patterns of behaviour, decreased self-other perspective and social understanding and flexible learning but increased fixed learning patterns.

157
Q

outcomes of conduct disorders

A

risk of social exclusion, poor achievement, unemployment, criminal activity, adult mental health problems, poor interpersonal relationships.

158
Q

outcomes of ADHD

A

reduced academic and employment success, criminal activity and adult mental health problems.

159
Q

autism outcomes

A

; learning disability, disturbed sleep, eating habits, hyperactive, anxiety, depression, OCD, school avoidance, aggression, temper tantrums, self injury, self harm, suicidal behaviour

160
Q

U.K. population demographic change

A

U.K. is projected by 2038 to have a heavier dominated 50-80’s age group. This is a change from 1998 which was dominated by a younger group 35-20’s.

161
Q

community rate of depression

A

12%

162
Q

community rate of dementia

A

5%

163
Q

anxiety rate of anxiety

A

3%

164
Q

hospital rate of dementia

A

31%

165
Q

hospital rate depression

A

29%

166
Q

hospital rate of delirium

A

20%

167
Q

define dementia syndrome

A

A - activities of daily living
B – behavioural and psychiatric symptoms of dementia
C - cognitive impairment
D - decline

168
Q

dementia memory symptoms

A

dysphasia expressive and receptive, dyspraxia, dysgnosia, dysexecutive.
functional decline in terms of ADLs.

169
Q

dementia symptoms

A

insidious onset, unknown date, gradually irreversible, slow progressive decline, less prominent physiological changes, consciousness clouded, normal attention span, disturbed sleep wake cycle, late stage psychomotor changes.

170
Q

neuropsychiatric disturbances for dementia

A

psychosis, depression, altered circadian rhythms, agitation, anxiety.

171
Q

lewy body dementia symptoms

A

deficits of attention, frontal executive, visuospatial must have fluctuation, visual hallucinations and parkinsonism. Suggestive signs is REM sleep disorder, severe antipsych sensitivity, abnormal DAT scan, falls syncope, loss of consciousness, autonomic dysfunction.

172
Q

frontotemporal dementia symptoms

A

behavioural disorder, early onset, early emotional blunting, speech disorder (altered output, stereotypy, echolalia, perseveration, mutism), frontal dysexecutive syndrome, late stage parkinsonism.

173
Q

MMSE components

A

orientation, short term memory, concentration, long term memory, naming objects, repeating phrases, following verbal instructions, following written answers, imagination, drawing

174
Q

MOCA components

A

visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, orientation

175
Q

drug treatments for dementia

A

acetylcholinesterase inhibitors for mild to moderate AD and memantine for moderate to severe AD/
everything else symptomatic.

176
Q

non-pharmacological treatments for dementia

A

ABC (Actions, Belief, Consequence), any form of distraction, communication, loss of DVLA

177
Q

late onset schizophrenia like psychosis may require what Tx

A

neuroleptics, often need compulsory admission

178
Q

SCOFF eating disorder screening questions

A

S – ever make yourself sick because you are uncomfortably full
C – lost control over how much you eat?
O – lost more than one stone in a three month period
F – do you believe yourself to be fat when others say you are too thin?
F – would you say that food dominates your life

179
Q

anorexia nervosa refers too

A

low weight obsession because of fear of fatness

180
Q

anorexia nervosa avoidance symptoms refer too

A

May argue they are vegan/vegetarian, dislikes, pickiness, ‘allergies’, eat slowly or only at certain times, avoid parties and social occasions, spoiling food, medication abuse/appetite suppressants.

181
Q

getting rid of calories anorexia nervosa symptoms

A

Self-induced vomiting, chewing and spitting out food, over exercise, overactivity, cooling, blood-letting, medication abuse, failing to take prescribed medication, medication abuse, failing to take prescribed medication

182
Q

bulimia nervosa refers too

A

attempted weight loss leads to vicious cycle of restriction/binge/purge at normal weight.

183
Q

binge eating disorder refers to

A

binges and periods of attempted restriction without other compensatory behaviours often overweight.

184
Q

predisposing factors eating disorders

A

high risk, obsessional, family history of OCD, anxiety, autism, compulsive exercise

185
Q

precipitating factors eating disorders

A

life events, transitions, conflicts, stresses, losses

186
Q

perpetuating factors eating disorders

A

malnourishment leading to loss of concentration, anxiety, depression, obsessional. Loss of friend and withdraw.

187
Q

first choice anti-psychotic for low weight anorexia nervosa

A

olanzapine

188
Q

EBT for anorexia (evidence based managment)

A

CBT, IPT, fluoxetine (high dose antidepressants when gained weight), family based therapy for younger patients. CBT and IPT when weight restored, ordinary supportive management effective,

189
Q

risk factors for relapses for anorexia

A

overactivity, drinking calorie free fluids, restrictive diets, purging behaviours, isolation and secrecy, having a baby, weight losing illness.

190
Q

complications of anorexia nervosa

A

poor repair and resistance, heart damage, reduced immunity, anaemia, bone loss, fertility problems, purging behaviours disrupt electrolyte balances resulting in seizures and heart arrhythmias.

191
Q

complications of over exercise in anorexia nervosa

A

risk of fatigue, amenorrhoea, infertility, osteoporosis, heat stroke, fractures, head injuries, soft tissue injuries, substance abuse, exacerbating pre-existing illness e.g. diabetes

192
Q

what psychiatric condition has the highest mortality rate?

A

anorexia nervosa

193
Q

potential risks to health for anorexia nervosa

A

hypothermia and infections In winter, hyponatremia with water filling, over exercise, purging, self-harm, suicide, refusal to attend appointments, BMI <14 risk of death rate

194
Q

management for delirium

A

correct contributing factors (pain, infection, poor nutrition, sensory impairment, sleep disturbance), anti-psychotics

195
Q

2 types of amnesic syndrome

A

Korsakoff syndrome, subarachnoid haemorrhage

196
Q

Korsakoff syndrome causes

A

3rd ventricle, bilateral thalamic infarction, post subarachnoid haemorrhage, alcoholism

197
Q

hippocampal damage causes

A

herpes simplex virus encephalitis, anoxia, surgical removal of temporal lobes, bilateral posterior cerebral artery occlusion, closed head injury, early Alzheimer’s disease.

198
Q

assessment areas in learning disability psychiatry

A

aetiology
associated biomedical conditions
psychiatric disorders, causes and consequences

199
Q

criteria for a learning disability

A

criteria: IQ<70, social or adaptive dysfunction (2+ of communication, self-care, home living, social skills, self-direction, health and safety, functional academics, leisure and work) and onset in the development period.

200
Q

mild learning disability IQ range

A

50-69

201
Q

moderate learning disability IQ range

A

35-49

202
Q

severe learning disability IQ range

A

20-34

203
Q

profound learning disability IQ range

A

<20

204
Q

alternative comms with learning disability psych

A

non-verbal ques, symbols, sign language, via a carer and use simple short language.

205
Q

LD schizophrenia presentation differences

A

associated with self-talk, change in personality, reduction in functional abilities

206
Q

LD mood disorders presentation differences

A

less likely to talk and instead noticed behaviour changes

207
Q

OCD LD presentation differences

A

obsession hard to describe but compulsions instead observed

208
Q

what fraction of autistic people present with a LD

A

2/3rd’s

209
Q

challenging behaviours LD presentation

A

head banging, mannerisms, rocking

210
Q

forensic LD presentation

A

arson and sexual crimes

211
Q

panic disorder symptoms and diagnosis

A

recurrent panic attacks and worry about further attacks.
4 of the following palpitations, sweating, trembling, choking sensations, chest pain, nausea, dizzy, depersonalisation, fear of losing control, fear of dying, numbness, chills or hot flushes

212
Q

prolonged grief disorder presentation and diagnosis

A

marked distress and disability caused by the grief reaction and persistence of this distress and disability more than 6 months after bereavement

213
Q

risk assessment for suicide

A

always ask about SI, if there are any plans or intent, prior attempts, homicidal risk, self-control, access to lethal methods, current stressors, protective factors, adequate support, arrange help or referral.

214
Q

vulnerable group for suicide

A

biggest cause of death for 15-24 year olds and men under 50y.

215
Q

1st line treatment for depression

A

1st line: assessment, support, psycho-education, lifestyle advice, active monitoring

216
Q

2nd line treatment for depression

A

sleep hygiene, active monitoring, CBT and psychosocial intervention.

217
Q

3rd line treatment for depression

A

antidepressant SSRI, interpersonal therapy, CBT, behavioural activation, couples therapy

218
Q

1st line Tx for anxiety

A

treat co-morbidities first e.g. depression.

219
Q

1st line for panic attack Tx

A

self help

220
Q

2nd line for panic attack Tx

A

psychological treatment (CBT, alt. therapies) and drug treatment (citalopram, sertraline, paroxetine, escitalopram)

221
Q

social phobia 1st line

A

CBT

222
Q

prolonged grief disorder Tx

A

counselling, antidepressants for co-morbid depression, CBT, behavioural therapy

223
Q

OCD 1st line

A

CBT, exposure and response therapy

224
Q

OCD 2nd line

A

SSRI’s sertraline, citalopram, fluoxetine, paroxetine

225
Q

OCD 3rd line

A

clomipramine

226
Q

insomnia Tx

A

screen for other causes, sleep hygiene, sleep diaries, CBT, medications not advised.

227
Q

depression when to refer to secondary care

A

MAOI initiation, combining and augmenting anti-depressants, if severe and complex, risk to life or severe self-neglect

228
Q

when to refer to secondary care for bipolar

A

refer always

229
Q

when to refer to 2ndary care for anxiety

A

: risk of self-harm or suicide, significant co-morbidity, self-neglect, treatment resistant, considering augmentation of medication

230
Q

when to refer to 2ndary for panic attacks

A

Tx resistance

231
Q

when to refer for 2ndary prolonged grief disorder

A

sig. functional impairment

232
Q

when to refer 2ry eating disorders

A

always

233
Q

depression presentation in general hospital

A

common amongst those with chronic illness, certain neurological disease and difficult due to the overlap of symptoms with physical disorders.

234
Q

why might a schizophrenic patient be in general hospital?

A

lithium toxicity or renal failure

235
Q

self harm presentation/managment

A

routinely receive psycho-social assessment. Associated with sig. mental illness, substance misuse and social problems. Often paracetamol overdose presentation.

236
Q

why might someone with dementia be in general hospital

A

UTI or pneumonia

237
Q

risk of what with eating disorder in general hospital

A

refeeding syndrome

238
Q

functional disorders tx

A

avoid subjecting to multiple investigations and inappropriate treatment. CBT, IPT, psychodynamic therapies, therapies for co-morbid disorders.

239
Q

examples of functional disorders

A

fibromyalgia, benign hypermobility syndrome, cyclical vomiting syndrome, functional dyspepsia, irritable bowel syndrome, chronic fatigue syndrome, chronic hyperventilation.

240
Q

factitious disorder refers to

A

consciously mimicking issues subconsciously for care or attention. Bit of overlap and just treat as if they have function

241
Q

malingering refers to

A

consciously mimicking symptoms for obtaining something, insurance or compensation. Insidious.

psychiatry (3 decks)

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