Conditions Flashcards

Question

What is the mini mental state examination?

Answer 1

The mini mental state examination (MMSE) is a commonly used set of questions for screening cognitive function. This examination is not suitable for making a diagnosis but can be used to indicate the presence of cognitive impairment, such as in a person with suspected dementia or following a head injury. - The test takes only about 10 minutes but is limited because it will not detect subtle memory losses, particularly in well-educated patients. - In interpreting test scores, allowance may have to be made for education and ethnicity. - The mini mental state examination provides measures of orientation, registration (immediate memory), short-term memory (but not long-term memory) as well as language functioning. - The examination has been validated in a number of populations. Scores of 25-30 out of 30 are considered normal, 21-24 as mild, 10-20 as moderate and below 10 as severe impairment.

Answer 2

The abbreviated mental test score (AMTS) is a 10-point assessment to rapidly assess elderly patients for the possibility of dementia. It continues to be used as part of a screening process for both delirium and dementia, although further tests are necessary to confirm these diagnoses. The following questions are put to the patient. Each question correctly answered scores one point: 1. “What is your age?” 2. “What is the time to the nearest hour?” 3. Give the patient an address, and ask them to repeat it at the end of the test (e.g. “42 West Street”) 4. “What is the year?” 5. “What is the name of this place?” or “What is your house number?” 6. Can the patient recognise two persons (e.g. doctor, nurse)? 7. “What is your date of birth?” (day and month sufficient) 8. “In what year did World War 1 begin?” 9. “Name the present monarch/prime minister/president” 10. “Count backwards from 20 down to 1” AMTS interpretation A score of 6 or less suggests delirium or dementia, although further tests are necessary to confirm the diagnosis.

Answer 3

Psychodynamic psychotherapy gives you a regular time to think - and talk – about the feelings you have about yourself and other people, especially your family and those you are close to. You discuss: - what is happening in your life at the moment - how you do things and the part you play in things going right or wrong for you - what has happened in the past, and how the past can affect how you are feeling, thinking and behaving right now. The therapist will help you to make connections between the past and the present. He or she will often comment on what happens in the sessions as you talk together. This can help to show how some of the things that you feel, do and say may not be driven solely by conscious thoughts and feelings, but also by unconscious feelings from your past. Ways you respond and behave in the therapy sessions often mirror the way you act in your day-to-day life. When you understand these connections better, you can make decisions based on what you want or need now, not what your past experiences drive you to do. Individual psychodynamic psychotherapy usually involves regular, 50-minute meetings. These can be weekly or more often if needed. If you have a more straightforward problem, you may only need a few weeks or months of therapy. If your problems are more complicated – or long-standing – you may have to carry on longer. Although most psychodynamic therapy is carried out individually, it is also regularly carried out in groups. Analytic groups commonly last for an hour and a half, occur weekly or twice weekly, and contain up to 10 people plus a therapist.

Answer 4

- Behavioural psychotherapy helps you overcome problems by changing how you behave. For example, you may need to overcome a fear, or phobia. The therapist will help you, very gradually, to spend more and more time in the situation you fear – and will help you to feel comfortable and relaxed in that situation. - Cognitive therapy focuses more on the way that what you believe and think can keep problems going. It helps you to test any unhelpful beliefs by talking and thinking about them, and then developing ideas that are more helpful for you. You then try these out between sessions and so develop more helpful ways of thinking and acting. It can take account of what has happened in the past, but mainly looks at the present and future. - Cognitive behavioural therapy (CBT) combines these two techniques. It is structured, usually aimed at a particular problem, and is fairly brief (6-20 sessions). It's a bit like being coached – you have a number of exercises to do between sessions. In essence, you learn to become your own therapist. It focuses on current problems rather than exploring past causes of distress.

Answer 5

Like CBT, this is usually quite short, often about 16 sessions. It uses techniques and understanding derived from both cognitive and psychodynamic approaches, and commonly involves letters and diagrams in developing an understanding of your problems. The therapist helps you to: - describe how your problems have developed from the events of your life and your personal experiences; - look at the ways of coping you have developed to deal with these problems; - think of ways of changing your ways of coping so that you feel better and can cope more easily. The therapist puts this all into writing after your first few sessions. At the end of treatment, the therapist gives you a final letter which summarises your difficulties and the ways you have worked out how to cope better.

Answer 6

This is a treatment for depression, but it has also been used with other problems. It aims to help you understand how your problems may be connected to the way your relationships work. It then helps you to find out how to strengthen your relationships and find better ways of coping.

Answer 7

Used for phobic disorders Therapy uses graded exposure to real or imagined stimuli while patients perform relaxation techniques until anxiety is extinguished.

Answer 8

Used for obsessions Involves exposure to an anxiety-provoking stimulus where the patient is subsequently prevented from carrying out the usual compulsive behaviour or ritual until the urge to do so has passed

Answer 9

Used for alcohol dependence syndrome and sexual deviations. Producing unpleasant sensation in the patient in association with aversive or noxious stimulus with the aim of eliminating unwanted behaviour

Answer 10

Used for personality disorders, self-harm and suicide attempts Dialectical behaviour therapy (DBT) is a type of talking therapy. It's based on cognitive behavioural therapy (CBT), but it's specially adapted for people who feel emotions very intensely. The aim of DBT is to help you: - Understand and accept your difficult feelings - Learn skills to manage them - Become able to make positive changes in your life ‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it's possible for you to achieve both these goals together.

Answer 11

CBT focuses on helping you to change unhelpful ways of thinking and behaving. DBT does this too, but it differs from CBT in that it also focuses on accepting who you are at the same time. DBT also usually involves more group work than CBT. A DBT therapist will expect and encourage you to work hard to make positive changes.

Answer 12

Assessment (although treatment can be given without patients’ consent) Duration – 28 days (cannot be renewed) Professionals involved - 2 doctors (one S12 approved), AMHP Evidence required: a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and b) The patient ought to be detained for his or her own health or safety, or the protection of others

Answer 13

Treatment Duration – 6 months (and can be renewed) Professionals involved – 2 doctors, 1 AMHP Evidence required: (a)The patient is suffering from mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital; and b) The treatment is in the interests of his or her health and safety and the protection of others; and c) Appropriate treatment must be available for the patient

Answer 14

Emergency order Duration – 72 hrs Purposes – only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay” Professionals required – 1 doctor and 1 AMHP Evidence required – a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and b) The patient ought to be detained for his or her own health or safety, or the protection of others c) There is not enough time for 2nd doctor to attend (risk)

Answer 15

For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave Nurses’ holding power until doctor can attend 6 hours Cannot be treated coercively whilst under section - Serious mental health problem - Risk to person’s health and safety or others.

Answer 16

For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave Doctors’ holding power – 72 hours Allows time for Section 2 or Section 3 assessment Cannot be coercively treated

Answer 17

Police sections: S136 – person suspected of having mental disorder in a public place S135 – needs court order to access patient’s home and remove them to Place of Safety (local psychiatric unit or police cell) Further assessment - ??? Need Section 2 or 3

Answer 18

1. Appearance and behaviour: - Clothing, hygiene, weight - Eye contact, rapport, body language 2. Motor - Agitation, psychomotor retardation, catatonia [a state in which someone is awake but does not seem to respond to other people and their environment], waxy flexibility [body remains in any position into which they are manipulated], abnormal movements (tics, tremors, akathisia [restlessness], tardive dyskinesia [face and jaw]) 3. Mood - Mood – predominant subjective internal state; e.g. depressed (sad or numb), elated (euphoric or ecstatic), anxious, angry - Affect - immediately expressed , observable; e.g. flat, blunt, incongruous 4. Speech - Representation of thinking and observable - Tempo – poverty of thought, flight of ideas - Continuity – clang associations, puns, rhymes; perseveration 5. Thinking *Form of thought - Formal Thought Disorder: - loosening of associations- lack of connection between ideas - knight’s move - circumstantial -round the houses - tangential – off the point *Content of thought - - Delusions: Grandiose, persecutory, nihilistic, reference, jealousy, delusional perception - Overvalued idea: solitary, abnormal belief that preoccupies *Possession of thought - Thought alienation : insertion, withdrawal, broadcasting, blocking *Passivity experiences “Made” feelings thoughts and actions by external agency *Depersonalisation – out of body, Derealisation - in a play *Depressive ideas (guilt, worthlessness, hopelessness) and suicidal thoughts *Obsessions and compulsions 6. Perception *Hallucination – perception in the absence of a stimulus . In any of the 5 senses; auditory visual olfactory gustatory tactile * Illusion = misperceiving a real stimulus 7. Cognitive - Orientation, attention and concentration, memory

Answer 19

Auditory hallucinations of special types – 3rd person, running commentary, thought echo (hears thoughts spoken aloud) Thought alienation (thought no longer in control eg thought insertion, thought withdrawal, thought broadcasting, thought blocking) Passivity experiences incl somatic passivity (body sensations, thoughts and emotions controlled by external agency) Delusional perception (attributing a false meaning to a true perception)

Answer 20

- A potentially fatal disorder that occurs when nutritional intake is resumed too rapidly after a period of low caloric intake - symptoms may include oedema, confusion and tachycardia - Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces‚ these need to be replenished Preventative measures include: - The provision of 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 in 'patients who have eaten little or nothing for more than 5 days'

Answer 21

Autistic spectrum disorder refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour. The classification of autistic spectrum disorder was introduced in the diagnostic and statistical manual of mental disorders fifth edition (DSM-5), introduced in 2013. This took previous diagnoses such as Aspergers syndrome and autistic disorder and grouped them into one spectrum disorder, suggesting that the same disorder was responsible for the features of the condition and those affected fall somewhere along the spectrum. The autistic spectrum has a significant range. On one end patients have normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others. This was previously known as Asperger syndrome. On the other end, patients can be severely affected and unable to function in normal environments.

Answer 22

Features vary greatly between individuals along the autistic spectrum. They can be categorised as deficits in social interaction, communication and behaviour. Features are usually observable before the age of 3 years. 1. Social Interaction - Lack of eye contact - Delay in smiling - Avoids physical contact - Unable to read non-verbal cues - Difficulty establishing friendships - Not displaying a desire to share attention (i.e. not playing with others) 2. Communication - Delay, absence or regression in language development - Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest - Difficulty with imaginative or imitative behaviour - Repetitive use of words or phrases 3. Behaviour - Greater interest in objects, numbers or patterns than people - Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking. - Intensive and deep interests that are persistent and rigid - Repetitive behaviour and fixed routines - Anxiety and distress with experiences outside their normal routine - Extremely restricted food preferences

Answer 23

Diagnosis Diagnosis should be made by a specialist in autism. This may be a paediatric psychiatrist or paediatrician with an interest in development and behaviour. A diagnosis can be made before the age of 3 years. It involves a detailed history and assessment of the child’s behaviour and communication. Management Autism cannot be cured. Management depends on the severity of the child’s condition. Management involves a multidisciplinary team to provide the best environment and support for the child and parent: - Child psychology and child and adolescent psychiatry (CAMHS) - Speech and language specialists - Dietician - Paediatrician - Social workers - Specially trained educators and special school environments - Charities such as the national autistic society

Conditions Flashcards

(48 cards)