1
Q
How many people suffer from mental or behaviour disorders
A
450 milllion
2
Q
How many people commit suicide every year
A
1 million
3
Q
What do we aim to find out when taking a history and exam of a psychiatry patient
A
- Appearance
- Behaviour
- Speech
- Mood or affect
- Thoughts
- Cognition insight
4
Q
What do we want to record about a patients appearance when taking a mental state examination
A
- Features
- Level of grooming
- Gait
- posture
- Clothing
- Evidence of self harm
5
Q
What do we want to record about a patients behaviour when taking a mental state examination
A
- Eye contact
- Facial expression
- Body language
- Rapport and energy levels
6
Q
What do we want to record about a patients speech when taking a mental state examination
A
- Cadence
- Amount of verbalisation
- Tone
- Volume
- Rhythm
7
Q
What do we want to record about a patients thought when taking a mental state examination
A
- Form
- Content
- Possesion
8
Q
What is schizophrenia
A
A psychotic illness involving delusions, hallucinations and disorder of the form of thought
9
Q
What are delusions
A
Thought insertions/ withdrawals
Thought broadcasting
10
Q
What are hallucinations
A
Can be auditory or visual in the form of voices telling them to do something or intrusive thought
11
Q
What is a disorder of the form of thought
A
Thinking of themselves in the third person
12
Q
What are the different subtypes of schizophrenia
A
- Paranoid
- Hebephrenic
- Catatonic
- Delusional
13
Q
How common is schizophrenia
A
15-20 per 100,000
14
Q
At what age does schizophrenia mostly present in
A
Late 20s early 30s
15
Q
How can we treat schizophrenia
A
- Neuroleptics (medications)
- Rehabilitation
- Social care
- Psychological treatments
16
Q
What does the term affect with in psychiatry
A
Mood
17
Q
What are disorders of affect
A
Mood disorders
18
Q
Name the most common disorder of affect
A
Depression
19
Q
When does depression become pathological
A
When there is a pervasive persistence to the thoughts and feelings associated with it e.g.:
- Persistent low mood
- Anhedonia (loss of ability to experience pleasure) • Thoughts of self-harm or suicide
- Early morning wakening
- Sleep disturbances
- Slowing of speech/monotonous speech
- Failure to make eye contact
- Psychosexual dysfunction
20
Q
How common is depression
A
Affects 3-4% of the population
21
Q
Name the different theories of aetiology for depression
A
- Genetic predilection
- Biochemical imbalanced in the brain
- Psychological theories
- Sociological theories
- Life event triggers
22
Q
How can we treat depression
A
- Psychological
- Pharmacological
- Social care
- ECT
23
Q
When can anxiety be problematic
A
When there is a misplacement of feeling associated thoughts that leads to it becoming pathological
24
Q
What is anxiety a collection of
A
Disorders including; 1. Phobias 2. Panic disorders 3General anxiety disorder 4. PTSD
25
What can make anxiety worse
Drugs and alcohol
26
How can we treat anxiety
1. Psychological therapies
2. Antidepressants
3. Antipsychotics
4. Antimanics/ mood stablisers
5. Anxiolytics/sedatives
6. ECT
7. Psychosurgery
27
Give examples of psychological therapies
```
1. Cognitive behavioural therapies (CBT)
2 Interpersonal therapy
3. Behaviour therapy
4. Psychodynamic psychotherapy
5. Couples/ family therapy
6. Couples intervention
```
28
How common is dementia
5% Of the population have dementia
29
What is dementia
It is an umbrella term for brain disease causing problems with memory, thinking, problems solving and/ or languages
30
Describe what can happen to patients with untreated dementia
It is usually progressive and is frequently a terminal condition contributing directly to the cause of death
31
Name the different types of dementia
1. Vascular
2. Alzheimers
3. Lewy body dementia
4. Frontotemporal dementia
5. Others
32
Name the most common type of dementia
Alzheimers
33
How common is vascular dementia
15-25% of total dementia cases
34
What causes the symptoms seen in vascular dementia
It is due to atherosclerotic disease in the arteries supplying the brain leading to death of brain cells and concomitant loss of function
35
How common is Alzheimers
40-70% of total dementia cases
36
What causes the symptoms seen in Alzheimer's
This is due to shrinkage (atrophy) of the brain with loss of synaptic connections between brain cells due to beta-amyloid ‘plaques’ and neurofibrillary ‘tangles’ developing
37
How common is LEWY BODY dementia
2-20% of all dementia cases
38
What causes the symptoms seen in LEWY BODY dementia
Often misdiagnosed as Alzheimer’s.
Involved deposition of Lewy Bodies in the cortex which are deposition of alpha synuclein, another protein. They are also responsible for Parkinson’s disease.
39
How common is frontotemporal dementia
2-4% of all dementia cases
40
What causes the symptoms seen in frontotemporal dementia
is due to death of neurones in the frontal and/or temporal lobes of the brain with a decline in functional neurotransmitter levels - resulting in brain death and shrinkage.
Personality and behavioural changes are very prominent here due to the anatomical location of the disease process.
41
In whom is frontotemporal dementia more common in
Is much more common in younger patients than any other form of dementia i.e. in the 45-65 year old bracket.
42
What is another name for frontotemporal dementia
Picks disease
43
Give some general symptoms of dementia
1. Memory loss
2. Slowed speed of thinking
3. Blunting of mental sharpness/reaction time
4. Trouble finding or understanding info given
5. Mood disturbances
6. Movement disorders
7. Difficulty carrying out the actives of daily living
44
How can dementia affect oral hygiene
Patients may lose interest in oral health care practices as their dementia progresses and other health or social issues take precedence. Loss of dentures, poor oral hygiene and undiagnosed toothaches leading to painful abscesses are sadly not uncommon in patients with moderate to severe dementias.
45
What is illness denial
When a patient denies that they are ill and will therefore not engage with healthcare services or carry out their own self-care prac
46
What is illness affirmation
When a patient over estimates their degree of ill health and in worst case scenarios leads to malingering
47
What can contribute to abnormal illness behaviour
Sociological, psychological and psychiatric factors
48
Who do we assume has capacity
All adults are assumed to have capacity unless demonstrated otherwise
49
What requirements must a person furfil to be deemed capacitant
1. Retain information given to them
2. Weigh that information
3. Understand the consequences of that action and lack of action
4. Communicate their decision to you
50
What does IMCA stand fro
Indépendant mental capacity advocates
51
What do Independent Mental Capacity Advocates do
They are appointed people who support those who are ruled to lack capacity to make certain decisions
52
How many people in England and Wales lack mental capacity
2 million
53
What is detention defined as by the mental health act 1983
Detention means treating a patient who has not agreed voluntarily to the proposed treatment
54
What is the aim of detention
To prevent harm to the patient and to others
55
Name some common types of medications encountered by patients with mental health problems
1. Anti anxiety drugs
2. Sedatives/ hypnotics
3. Antidepressants
4. Mood stablisers
5. Antipsychotic agents
6. Anti-Parkinsonian drugs:
56
Give examples of anti anxiety drugs patients may be taking
```
antihistamine derivative hydroxyzine
benzodiazepines including:
1. clonazepam,
2. diazepam,
3. lorazepam,
4. chlordiazepoxide
```
57
Give examples of Sedatives/ hypnotics drugs patients may be taking
1. benzodiazepines such as temazepam
2. choral hydrate,
3. doxepin
4. zolpidem
58
Give examples of Antidepressants patients may be taking
1. Selective Serotonin Reuptake Inhibitors such as:
- citalopram, fluoxetine, paroxetine, sertraline
2. Serotonin and Noradrenaline Reuptake Inhibitors such as: duloxetine, venlafaxine
3. mirtazapine, trazodone
4. Tricyclic Antidepressants (TCAs) e.g. amitriptyline, doxepin, imipramine, nortriptyline
5. MAOIs - MonoAmine
6, Oxidase Inhibitors such as selegiline, phenelzine
59
Give examples of mood Stabilisers patients may be taking
1. lithium
2. carbamazepine,
3. gabapentin,
4. oxcarbazepine, lamotrigine
5. sodium valproate
60
Give examples of antipsychotic agents patients may be taking
1. Typical antipsychotics such as chlorpromazine, haloperidol
2. Atypical antipsychotics including clozapine, aripiprazole, olanzapine, quetiapine, risperidone
61
Give examples of Anti-Parkinsonian drugs patients may be taking
1. Anticholinergics such as benztropine, diphenhydramine, trihexyphenidyl
2. Other agents such as amantadine or even propranolol
62
What effect can Selective Serotonin Reuptake Inhibitors (SSRIs) have on the oral cavity
1. Xerostomia,
2. risk of bleeding increased
3. lowered analgesic effect from opioids
4. tramadol due to decreased biotransformation to their active metabolites, serotonin syndrome
63
What effect can Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs) have on the oral cavity
1. Xerostomia,
2. risk of bleeding increased
3. lowered analgesic effect from opioids
4. tramadol
5. increased risk of cardiovascular effects when using adrenaline
64
What effect can Tricyclic Antidepressants have on the oral cavity
1. Anticholinergic effects such as xerostomia,
2. orthostatic
3. hypotension,
4. drowsiness,
5. cardiac arrhythmias
65
What effect can (MAOIs) MonoAmine Oxidase Inhibitors have on the oral cavity
1. Anticholinergic effects,
2. hypotension,
3. may interact with other medications to cause hypertensive crises or serotonin syndrome
66
What effect can lithium have on the oral cavity
1. Xerostomia,
2. stomatitis,
3. metallic taste,
best to avoid NSAIDs in these patients
67
What effect can Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs) have on the oral cavity
Increased risk of bleeding (anti-platelet activity) especially if give NSAIDs
68
What effect can Valproate have on the oral cavity
1. Anticholinergic effects,
2. orthostatic hypotension,
3. erythema multiforme/Steven Johnsons syndrome,
4. aplastic anaemia, agranulocytosis,
5. multiple reactions with other drugs e.g azole antifungals etc
69
What effect can Antipsychotics have on the oral cavity
1. Anticholinergic effects,
2. orthostatic hypotension,
3. extrapyramidal side effects (jaw/neck stiffness, motor restlessness),
4. tardive dyskinesia
70
What effect can Anti-Parkinsonian drugs have on the oral cavity
Anticholinergic effects
71
Give examples of anticholinergic effects
1. Xerostomia
2. Tachycardia
3. Blurred vision
4. Dry eyes
5. Constipation
6. Urinary retention
7. Dizziness due to postural hypotension
8. Cardiac arrhythmias
9. Cognitive impairment
10. Hallucinations
72
What causes anticholinergic effects
When an agent competitively inhibit the binding of the neurotransmitter acetylcholine
4th yr- CMS- Medicine
flashcards
Decks in class (14)
# Cards
-
Cardiovascular disease57
-
Stroke and TIA21
-
Respiratory Disease89
-
Diabetes and obesity139
-
Gastroenterology105
-
Womens health144
-
Hepatic impairment186
-
Renal impairment134
-
Common mental health problems72
-
ANAEMIAS AND BLOOD TRANSFUSIONS63
-
LEUKAEMIAS AND LYMPHOMAS72
-
prolonged bleeding65
-
Non Odontogenic Facial Pain32
-
Skin disease130
