Psychiatric Lectures

Question 1

List 4 advantages of classifying conditions. (4)

Answer 1

1) research
2) education of current and future practitioners
3) education of patients and their families
4) organisation of disorders for standardised treatment options

Question 2

List 4 disadvantages of classifying conditions. (4)

Answer 2

1) over-generalisation
2) confirmation bias
3) stigma
4) medicalise variations in human behaviour

Question 3

By what age are 50% of mental health conditions established?

Answer 3

14 years old.

Question 4

By what age are 75% of mental health conditions established?

Answer 4

24 years old.

Question 5

What percentage of under 18s get appropriate treatment for their mental health before becoming adults?

Answer 5

30%.

Question 6

List 2 things that childhood physical abuse is associated with. (2)

Answer 6

1) 15% increase in medical diagnoses (e.g. heart disease, COPD, cancer)
2) 16% increase in medical symptoms

Question 7

Define the most important tenet of attachment theory.

Answer 7

“An infant needs to develop a relationship with at least one primary caregiver for the child’s successful social and emotional development, and in particular for learning how to effectively regulate their feelings.”

Question 8

What is the attachment timeline for the first 24 months of a child’s life? (4)

Answer 8

1) 0-3 months —> indiscriminate attachment
2) 3-6 months —> preference for main caregiver
3) 6-12 months —> only main caregiver
4) 12-24 months —> increasingly able to separate from main caregiver

Question 9

List 3 criteria that must be met for a personality disorder diagnosis. (3)

Answer 9

1) the way the patient thinks, feels or behaves causes patient or others significant problems in daily life
2) the way the patient thinks, feels or behaves causes significant problems across different aspects of life
3) problems have continued for a long time

Question 10

What can distinguish a personality disorder from conditions such as depression, bipolar disorder or schizophrenia?

Answer 10

Fixed, long term difficulties for the patient, no relapsing-remitting pattern with periods of good function in between.

Question 11

List the main personality disorders listed in ICD-10. (8)

Answer 11

1) emotionally unstable (impulsive or borderline)
2) anakastic
3) anxious
4) dependant
5) dissocial
6) histrionic
7) paranoid
8) schizoid

Question 12

What is the origin of the term borderline in borderline personality disorder?

Answer 12

Old Freudian classification, borderline between neurotic and psychotic.

Question 13

List 3 causes of mental health conditions in the old age population. (3)

Answer 13

1) cognitive changes
2) physical changes
3) social changes

Question 14

List 5 reasons why old age psychiatric services are separated. (5)

Answer 14

1) differences in presentation
2) difference in needs (mental and physical)
3) increasing population
4) impacts on physical health
5) impacts on mental health

Question 15

List 6 considerations for pharmacological treatment of an old age patient. (6)

Answer 15

1) decreased body fat
2) decreased body water content
3) decreased albumin
4) decreased renal blood flow
5) decreased intestinal blood flow and motility
6) increased gastric pH

Question 16

List the 3 big conditions of old age psychiatry.

Answer 16

1) depression
2) delirium
3) dementia

Question 17

Define dementia.

Answer 17

an acquired global impairment of intellect, memory and personality without impairment of consciousness, it is usually progressive and irreversible

Question 18

List the 3 most common types of dementia.

Answer 18

1) Alzheimer’s disease (~66%)
2) vascular (~20%)
3) Lewy body (~15%)

Question 19

List 6 ‘other’ types of dementia.

Answer 19

1) mixed
2) frontotemporal
3) Parkinson’s disease associated
4) progressive cortical atrophy
5) primary progressive aphasia
6) alcohol related dementia

Question 20

What is the gold standard assessment of cognition in dementia?

Answer 20

ACE-III (Addenbrooke Cognitive Examination)

Question 21

What is the gold standard imaging in dementia?

Answer 21

MRI

Question 22

What imaging is used to diagnose Lewy body dementia?

Answer 22

DaT scan

Question 23

What imaging is used to diagnose frontotemporal dementia?

Answer 23

SPECT scan

Question 24

List the 5 domains of an ACE-III assessment.

Answer 24

1) attention
2) memory
3) fluency
4) language
5) visuospatial

Question 25

What is a ‘normal’ ACE-III score?

Answer 25

> 82/100

Question 26

What ACE-III domain is lower in Alzheimer’s disease? (1)

Answer 26

memory

Question 27

What ACE-III domains are lower in frontotemporal dementia? (2)

Answer 27

fluency and language

Question 28

What is the difference between Lewy body dementia and Parkinson’s disease associated dementia?

Answer 28

1) LBD - memory problems first

2) PDD - movement problems first

Question 29

Define mild cognitive impairment.

Answer 29

cognitive impairment but no functional impairment

Question 30

What is the prognosis of mild cognitive impairment? (3)

Answer 30

1) 1/3 improve
2) 1/3 remain stable
3) 1/3 progress to dementia

Question 31

Define pseudodementia.

Answer 31

cognitive impairment secondary to a mental illness (depression most common cause)

Question 32

Define delirium.

Answer 32

transient acute syndrome characterised by disturbance of consciousness, perception, sleep wake cycle, emotion and cognition

Question 33

List 5 disturbances in delirium.

Answer 33

1) consciousness
2) perception
3) sleep wake cycle
4) emotion
5) cognition

Question 34

List 3 types of delirium.

Answer 34

1) hyperactive
2) hypoactive
3) mixed

Question 35

List 7 causes of delirium.

Answer 35

PINCH ME

1) pain
2) infection
3) nutrition
4) constipation
5) hydration
6) medicines
7) environment