Clinical Handbook - Main Conditions 2 Flashcards

Question

Give some of the key features of panic disorder

Answer 1

PANICS Disorder Palpitations Abdominal distress Numbness/Nausea Intense fear of death Choking feeling/Chest pain Sweating/Shaking/Shortness of breath Depersonalization/Derealization

Answer 2

Psychiatric: GAD , phobic anxiety disorder, dissociative disorder, bipolar affective disorder, depression, schizophrenia, adjustment disorder Organic: Phaeochromocytoma, hyperthyroidism, hypoglycaemia, carcinoid syndrome, arrhythmias, alcohol/substance withdrawal

Answer 3

SSRIs are first-line but if they are not suitable, or there is no improvement after 12 weeks, then a TCA, e.g. imipramine or clomipramine may be considered Benzodiazepines should not be prescribed CBT is the psychological intervention of choice

Answer 4

when they occur: GAD= peristent, panic = episodic, phobic = situational associated behaviour GAD= agitation, panic= trying to escape, phobic= avoidance cognition GAD = constant worry, panic = fear of sxs, phobic = fear of situation

Answer 5

an intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

Answer 6

Abnormal bereavement has a delayed onset, is more intense and prolonged (>6 months). The impact of their loss overwhelms the individual’s coping capacity.

Answer 7

Normal adjustment refers to psychological reactions involved in adapting to new circumstances Adjustment disorder is when there is significant distress (greater than expected), accompanied by an impairment in social functioning

Answer 8

Exposure to traumatic events - at risk groups e.g. armed forces, medics, refugees Pre-trauma: history of mental illness, females, low socio- economic background, childhood abuse Peri-trauma: Severity of trauma, perceived threat to life, adverse emotional reaction during or immediately after event. Post trauma:Concurrent life stressors, absence of social support.

Answer 9

reliving - flashbacks, nightmares avoidance hyperarousal - difficulty with concentration, sleep, exaggerated startle response emotional numbing

Answer 10

Questionnaires: Trauma Screening Questionnaire (TSQ), Post-traumatic diagnostic scale CT head: if head injury suspected

Answer 11

Psychiatric: Adjustment disorder, acute stress reaction, bereavement, dissociative disorder, mood or anxiety disorders, personality disorder Organic: Head injury (result of traumatic event), alcohol/substance misuse.

Answer 12

adjustment disorder requires a non-catastrophic event, whereas PTSD involves an exceptionally traumatic event The symptoms in adjustment disorder must occur within 1 month of the event whereas PTSD must occur within 6 months

Answer 13

SSRI (most commonly paroxetine), mirtazipine, SNRI CBT, EMDR

Answer 14

Unwanted intrusive thoughts, images or urges that repeatedly enter the individual’s mind. They are distressing for the individual who attempts to resist them and recognizes them as egodystonic and a product of their own mind.

Answer 15

Repetitive, stereotyped behaviours or mental acts that a person feels driven into performing. They are overt (observable by others) or covert (mental acts not observable).

Answer 16

FORD Car Failure to resist: At least one obsession or compulsion is present which is unsuccessfully resisted. Originate from patient’s mind Repetitive and Distressing Carrying out the obsessive thought (or compulsive act) is not in itself pleasurable, but reduces anxiety levels.

Answer 17

A. Either obsessions or compulsions (or both) present on most days for a period of at least 2 weeks. B. Obsessions (thoughts, ideas or images) or compulsions have all of the clinical features (FORD Car) C. The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.

Answer 18

Questionnaires: Yale–Brown obsessive–compulsive scale (Y-BOCS) → 10-item questionnaire with each item graded from 0–4; e.g. Time occupied by obsessive thoughts (0 = none, 4 = extreme, >8 hours/day).

Answer 19

Anankastic personality disorder Eating disorders - AN and BN Body dysmorphic disorder (time consuming behaviours e.g. mirror gazing) Anxiety disorders Depressive disorder Hypochondriacal disorder Organic: dementia, epilepsy, head injury

Answer 20

CBT : ERP - patients are repeatedly exposed to the situation which causes them anxiety (e.g. exposure to dirt) and are prevented from performing the repetitive actions which lessen that anxiety (e.g. washing their hands) SSRIs : fluoxetine, paroxetine, sertraline, citalopram

Answer 21

a group of disorders whose symptoms are suggestive of, or take the form of, a physical disorder but in the absence of a physiological illness e.g. Somatization disorder, hypochondriacal disorder, undifferentiated somatoform disorder, persistent somatoform pain disorder

Answer 22

characterized by symptoms which cannot be explained by a medical disorder and where there are convincing associations in time between symptoms and stressful events, problems or needs.

Answer 23

distressing event emotional distress dissociation (separating distressing event from normal consciousness) conversion (conversion of emotional distress into physical sxs) gain (primary gain = stress relief, secondary gain = financial benefits)

Answer 24

CRAMPS Childhood abuse Reinforcement of illness behaviours Anxiety disorders Mood disorders Personality disorders Social stressors

Answer 25

(1) Multiple symptoms, often occurring in different organ systems (2) Vague symptoms that exceed objective findings (3) Chronic course (4) Presence of a mental health disorder (5) History of extensive diagnostic testing (6) Rejection of previous physicians.

Answer 26

Blood tests: FBC (anaemia, infection), U&Es (electrolyte disturbance), LFTs (liver or biliary pathology), CRP (infection, inflammation), TFTs (thyroid dysfunction) Further investigations: A. Gastrointestinal symptoms: AXR, stool culture, OGD, colonoscopy, diagnostic laparoscopy B. Cardiovascular symptoms: ECG, 24 hr tape, ECHO, angiogram C. Genitourinary symptoms: urine dipstick, MSU, cystoscopy

Answer 27

Dissociative (conversion) disorder. Factitious disorder Malingering Other psychiatric disorders: Mood disorder, psychotic disorder, anxiety disorder, PD Multi-systemic disease

Answer 28

Patient seeks advantageous consequences of being diagnosed with a medical condition. For instance, evading criminal prosecution or receiving government benefits (i.e. secondary gain).

Answer 29

(Munchausen’s syndrome): The individual wishes to adopt the ‘sick role’ in order to receive the care of a patient, for internal emotional gain (i.e. primary gain).

Answer 30

SSRIs CBT interventions reducing specific causes of stress (e.g. marriage counselling)

Answer 31

Many people like yourself have physical symptoms that we cannot find a reason for. We usually call these ‘medically unexplained symptoms’ or ‘functional illness' I would like to reassure you however, that there are still ways we can help you. Relate to a disorder they are more familiar with → ‘We know that most physical illnesses get worse if the patient feels tense or down, for example stress makes asthma worse, and therefore I feel that if we manage other problems in your life you will automatically feel better within yourself. How do you feel about this?’

Answer 32

fam hx female, early menarche low self esteem premorbid anxiety/depression obsessional / anankastic personality bullying at school stressful life events

Answer 33

adolescence criticism regarding eating / body shape occupational pressure to be slim e.g. models, ballet dancers

Answer 34

Starvation leads to neuroendocrine changes that perpetuate AN perfectionism, obsessional personality

Answer 35

FEEDD Fear of weight gain Endocrine disturbance resulting in amenorrhoea in females and loss of sexual interest and potency in males Emaciated (abnormally low body weight): >15% below expected weight or BMI <17.5 kg/m2 Deliberate weight loss with ↓ food intake or ↑ exercise. Distorted body image Must be for at least 3 months with no binge eating episodes

Answer 36

Blood tests: FBC (anaemia, thrombocytopenia, leukopenia), U&Es (↑ urea and creatinine if dehydrated, ↓ potassium, phosphate, magnesium and chloride), TFTs (↓ T3 and T4), LFTs (↓albumin), lipids (↑ cholesterol), cortisol (↑), sex hormones (↓ LH, FSH, oestrogens and progestogens), glucose (↓), amylase (pancreatitis is a complication) VBG: Metabolic alkalosis (vomiting), metabolic acidosis (laxatives) DEXA scan: To rule out osteoporosis ECG: Arrhythmias such as sinus bradycardia and prolonged QT are associated with AN patients Questionnaires: e.g. eating attitudes test (EAT)

Answer 37

Gastro - enlarged salivary glands, pancreatitis, constipation, peptic ulcers, hepatitis Cardio - cardiac failure, arrythmias, low bp, bradycardia Renal - renal stones, renal failure MSK - proximal myopathy, osteoporosis

Answer 38

biological: tx of medical complications e..g electrolyte disturbance SSRIs for co-morbid depression / OCD psychological: CBT cognitive analytic therapy family therapy Social: self help groups voluntary organisations

Answer 39

A potentially life-threatening syndrome that results from food intake after prolonged starvation or malnourishment, due to changes in phosphate, magnesium and potassium. It occurs as a result of an insulin surge The phosphate depletion causes reduction in cardiac muscle activity which can lead to cardiac failure.

Answer 40

Measure serum electrolytes prior to feeding and monitor refeeding bloods daily, start at 1200 kcal/day and gradually increase every 5 days, monitor for signs such as tachycardia and oedema.

Answer 41

an eating disorder characterized by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ‘ideal body shape/weight’.

Answer 42

‘Bulimia Patients Fear Obesity’ binging (2 episodes per week over 3 months of overeating) purging fear of fatness (pre)occupied with eating

Answer 43

Normal weight: Usually the potential for weight gain from bingeing is counteracted by the weight loss/purging behaviours. Depression and low self-esteem. Irregular periods. Signs of dehydration: ↓ blood pressure, dry mucous membranes, ↑ capillary refill time, ↓ skin turgor, sunken eyes. Consequences of repeated vomiting and hypokalaemia

Answer 44

muscle weakness, cardiac arrhythmias and renal damage.

Answer 45

Blood tests: FBC, U&Es, amylase, lipids, glucose, TFTs, magnesium, calcium, phosphate Venous blood gas: May show metabolic alkalosis ECG: Arrhythmias as a consequence of hypokalaemia (ventricular arrhythmias are life threatening), classic ECG changes (prolongation of the PR interval, flattened or inverted T waves, prominent U waves after T wave)

Answer 46

Anorexia nervosa – with bulimic symptoms. EDNOS (Eating Disorder Not Otherwise Specified) Depression Obsessive–compulsive disorder Organic causes of vomiting, e.g. gastric outlet obstruction.

Answer 47

erosion of dental enamel Russel's sign (calluses on hands) Mallory-Weiss tears arrhythmias renal stones / renal failure amenorrhoea

Answer 48

Biological: A trial of antidepressant should be offered and can ↓ frequency of binge eating/purging. Fluoxetine (usually at high dose, 60 mg) is the SSRI of choice. Treat medical complications of repeated vomiting, e.g. potassium replacement. Psychological: Psychoeducation about nutrition, CBT-BN Social: Food diary to monitor eating/purging patterns, techniques to avoid bingeing (eating in company, distractions), small, regular meals, self-help programmes.

Answer 49

A deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

Answer 50

low socioeconomic status family hx poor parenting abuse during childhood

Answer 51

WWW: Cluster A = ‘Weird’; Cluster B = ‘Wild’; Cluster C = ‘Worriers’

Answer 52

SUSPECTS Suspicious of others Unforgiving (bears grudges) Spouse fidelity questioned Perceives attack Envious (jealous) Criticism not liked/Cold affect Trust in others reduced Self-reference

Answer 53

DISTANT Detached (flattened) affect Indifferent to praise or criticism Sexual drive reduced Tasks done alone Absence of close friends No emotion (cold) Takes pleasure in few activities

Answer 54

AM SUICIDE Abandonment feared Mood instability Suicidal behaviour Unstable relationships Intense relationships Control of anger poor Impulsivity Disturbed sense of self (identity) Emptiness (chronic)

Answer 55

CORRUPT Callous Others blamed Reckless disregard for safety Remorseless (lack of guilt) Underhanded (deceitful) Poor planning (impulsive) Temper/Tendency to violence

Answer 56

LAW FIRMS Loses point of activity (due to preoccupation with detail) Ability to complete tasks compromised Workaholic at the expense of leisure Fussy (excessively concerned with minor details) Inflexible Rigidity Meticulous attention to detail Stubborn

Answer 57

Bulimia nervosa Depression Obsessive–compulsive disorder Schizophrenia: Delusions about food Organic causes of low weight: Diabetes, hyperthyroidism, malignancy Alcohol or substance misuse.

Clinical Handbook - Main Conditions 2 Flashcards

(81 cards)