conditions Flashcards
1
Q
what are affective disorders
A
Disorders of mental status and function where altered mood is the core feature
2
Q
what may be secondary causes of an affective mood disorder
A
cancer, dementia, drug misuse or medical treatment (steroids).
3
Q
what 2 classification systems are used to diagnose affective disorders
A
ICD- 10 – International classification of disease 10th Edition – World Health Organisation
DSM-5 – Diagnostic and Statistical Manual of Mental Disorder 5th Edition – American Psychiatric Association
4
Q
what is depression
A
An emotion/ state of feeling, or mood, that can range from normal experience to severe, life-threatening illness
5
Q
what percentage of people with depression have recurrent episodes
A
80%
6
Q
is depression more common in males or females
A
females
7
Q
what age range is highest risk for depression
A
18-44
median 25, mean 27
8
Q
does depression run in the family
A
increased risk in 1st degree relatives
9
Q
what things is the onset of depression often associated with
A
excess of adverse life events such as separations, bereavements (exit events)
10
Q
when does depression become abnormal
A
- Persistence of symptoms (length)
- Pervasiveness of symptoms (how they affect you)
- Degree of impairment to daily activities
- Presence of specific symptoms or signs
11
Q
what is the diurnal variation of depression
A
worse in morning
12
Q
what is anhedonia
A
loss of ability to derive pleasure from experience
can’t experience pleasure in the things you normally would
13
Q
what are some physical changes in depression
A
lack of energy can't sleep/ early wakening loss of appetite loss of libido constipation pain
14
Q
how can depression change psychomotor functioning
A
o Agitation – restless anxiety
o Retardation – abnormal slowness of thought and action
15
Q
what are some signs of severe depression (SUICIDE)
A
S – suicide plan/ ideas U – unexplained guilt/ worthlessness I – inability to function (pshycomotor retardation/ agitation) C- concentration impairment I – impaired appetite D – decreased sleep/ early wakening E- energy low/ unaccountable fatigue
16
Q
what are some social changes that can occur in depression
A
Loss of interests
Irritability
Apathy
withdrawal, loss of confidence, indecisive
Loss of concentration, registration & memory
17
Q
what is agitation
A
a state of restless overactivity, aimless or ineffective
18
Q
what is apathy
A
loss of interest in own surroundings
19
Q
what is stupor
A
a state of extreme psychomotor retardation in which consciousness is intact.
The patient stops moving, speaking, eating and drinking. On recovery can describe clearly events which occurred whilst stuporose. Very severe form of depression
20
Q
how long do symptoms of depression last for diagnosis
A
2 weeks
21
Q
what must you always ask about mood before you diagnose depression
A
ever had episodes of elevated mood - bipolar
22
Q
what can depression as a diagnosis not be attributed to
A
psychoactive substance use,
organic mental disorder
recent bereavement
23
Q
what is the required for a mild depression diagnose
A
At least 2 of the typical symptoms and 2 other core symptoms (4+ in total)
24
Q
what is the required for a moderate depression diagnose
A
At least 2 of the typical symptoms and 4 other core symptoms (6+ in total)
25
what is the required for a severe depression diagnose
All 3 of the typical symptoms and additional 5 core symptoms (8+ in total)
26
what are the 3 'typical' symptoms of depression used in ICD-10 classification
Depressed mood that is abnormal for most of the day almost every day for the past two weeks, largely uninfluenced by circumstances. May be slight diurnal variation (worse in morning)
Loss of interest or pleasure in daily life, especially things previously enjoyed. (anhedonia)
Decreased energy or increased fatigability that pervades life
27
what are additional core symptoms that add to the ICD-10 cdiagnosis of depression
¥ Change in appetite +/- weight loss without dieting.
¥ Disturbed sleep – initial insomnia or early wakening (3+ hours earlier than usual)
¥ Psychomotor retardation (limited spontaneous movement, sluggish thought process), or agitation (subjective feeling of restlessness)
¥ Decreased libido (sex drive)
¥ Reduced ability to concentration
¥ Unreasonable feelings of guilt or worthlessness or self-reproach. Loss of confidence or self esteem.
¥ Decreased concentration
¥ Recurrent thoughts of death by suicide or any suicidal behaviour
28
what time period is there increased risk of psychiatric admission after childbirth
30 days
29
what is baby blues
low mood within 2 weeks of burst - short lived, related to tiredness and hormonal changes
30
how many woman experience puerperal psychosis
1 in 500 deliveries with a risk of recurrence of 1-3 with subsequent deliveries
31
what is somatic syndrome
Mood disorder characterised by cluster of physical symptoms
32
give features of somatic syndrome
¥ Marked loss of interest or pleasure in activities that are normally pleasurable
¥ lack of emotional reactions to events or activities that normally produce an emotional response
¥ waking 2 hrs before the normal time
¥ Depression worse in the morning
¥ Objective evidence of psychomotor agitation or retardation
¥ Marked loss of appetite
¥ Weight loss (5%+ of body weight in a month)
¥ Marked loss of libido
33
what is the differential diagnosis of depression
- Normal reaction to life event - SAD – seasonal effectiveness disorder
- Dysthymia - Cyclothymia
- Bipolar - Stroke, tumour, dementia
- Hypothyroidism, Addison’s, Hyperparathyroidism
- Drugs e.g. B-blockers
- Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
34
give some measurement tools of depression
SCID (Structured Clinical Interview for DSM 5 disorders)
SCAN (Schedules for Clinical Assessment in Neuropsychiatry) – ICD10 classifications
HDRS (Hamilton Depression Rating Scale)
BDI-II (Beck Depression Inventory II)
HADS (Hospital Anxiety and Depression Scale)
PHQ-9 (Patient Health Questionnaire 9)
35
give classes of antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic antidepressants (TCAs)
Monamine Oxidase Inhibitors
36
what are psychological treatments of depression
CBT, IPT, Individual dynamic psychotherapy, family therapy
37
what are physical treatments of depression
ECT (strong evidence), Psychosurgery, Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS)
38
how long are anti-depressants continued for after recovery to prevent relapse
6 months
39
what regimen is used to switch antidepressant drugs
maudsley regimen
40
what is the 1st line treatment for depression
SSRI
| fluoxetine, citalopram, sertraline
41
how long may SSRI's take to work
6 weeks
42
what do you need to do if you prescribe someone citalopram
ECG - long QT intervals
43
why are SSRI's first line treatment for depression
favourable benefit: risk ratio
44
what is 3rd line treatment for depression
Mirtazapine (noradrenergic and specific serotenergic antidepressant)
venlaflaxine (serotonin and noradrenaline reuptake inhibitor (SNRI))
45
what is 4th line treatment for depression
Lithium is effective as an adjunctive therapy but has significant toxicity problems.
Consider other antidepressants such as TCA (noritriptyline, clomipramine) or monoamine oxidase inhibitors (MAOIs) (moclobemide, phenezine).
46
what is the normal clinical course of depression
```
typical episode lasts 4-6 months
54% recovered at 26 weeks
12% fail to recover
80+% have further episodes – 40% in mild
15% die by suicide
```
47
what is mania
A term to describe a state of elevated feeling/mood, that can range from near-normal experience to severe, life-threatening illness (can be a danger to yourself).
Rarely a symptom, often associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs
48
what kind of behaviours are seen in mania
rapid speech, hyperactivity, low sleep, hyper sexuality. extravagance
49
what is meant by hypo main
• Hypomania
o Lesser degree of mania, no psychosis, (hallucinations/ delusions)
o Mild elevation of mood for several days on end
o Increased energy and activity, marked feeling of wellbeing
o Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep
o May be irritable
o Concentration reduced, new interests, mild overspending
o Not to the extent of severe disruption of work or social rejection
50
what re the main differences between mania and hypomanis
hypomania has no psychosis and no disruption of work or social rejection
51
how long must the symptoms of mania last for diagnosis
1 week
52
what are symptoms of mania (without psychotic symptoms)
o Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
o Disinhibition
o Grandiosity – sense of self importance
o Alteration of senses
o Extravagant spending
o Can be irritable rather than elated.
53
what is the psychiatric differential diagnosis of mania
```
Mixed Affective state Schizoaffective disorder Schizophrenia Cyclothymia
ADHD
Alcohol
Antidepressants
cocaine/ amphetamine
```
54
what is the medical differential diagnosis of mania
```
Stroke
MS
Tumour
Epilepsy
AIDS Neurosyphilis
Endocrine – Cushing’s, hyperthyroidism
SLE
```
55
what methods can be used to measure symptoms of mania
* SCID
* SCAN
* Young Mania Rating Scale (YMRS) – measure how symptoms change
56
what is the treatment of acute mania
Antipsychotics – Olanzapine, Risperidone, Quetiapine
| Mood Stabilisers - Sodium Valproate, Lamotrigene, Carbamazepine
57
what can be used to treat severe mania
ECT
58
what is bipolar disorder
repeated (2+) episodes of depression and mania or hypomania.
| If no mania or hypomania then diagnosis is recurrent depression.
59
what is the mean onset for bipolar disorder
21
| >30 unusual
60
does bipolar disorder run in families
associated with 1st degree relatives
| early onset 15-19
61
what is the treatment for bipolar disorder
successful treatment of depressive/ manic episodes
| prophylaxis - lithium (mood stabiliser)
62
what mood stabiliser is used to treat bipolar disorder
lithium
63
what are signs of lithium toxicity
decreased vision, D&V, low potassium, ataxia, tremor, dysarthria, coma
64
what should you monitor when you prescribe lithium
Check Li levels weekly for 4 weeks, then monthly for 6 months, then 3 monthly if stable.
65
what is the typical clinical course of bipolar disorder
```
typical manic episode lasts 1-3 months
60% recovered at 10 weeks
5% fail to recover
90% have further episodes
1/3 have poor outcome, 1/3-1/4 have good outcome
10% die by suicide
```
66
what is psychosis
Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
severe form of mental illness
67
what do people with psychosis lack
insight - into having illness, how it affects them, need for treatment/ hospitalization
68
what illnesses may have psychotic symptoms
Schizophrenia
organic mental disorder – delirium, brain tumour
If occur with Severe affective disorder - Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms
69
what are the main 2 features of psychosis
hallucinations - no external stimulus
delusional beliefs
disordered thinking
70
what is the most common cause of psychosis (not intoxication)
schizophrenia
71
what are the positive and negative symptoms of schizophrenia
positive - hallucinations, delusions, disordered thinking
| negative - apathy, anhedonia, lack of emotion
72
how long must schizophrenic symptoms occur for to be diagnosed
over a month
73
what are single symptoms that diagnose schizophrenia
alienation of thought - thought broadcasting, insertion, withdrawal
delusions
auditory hallucinations
persisting delusions of other kinds that are impossible
74
give symptoms that if 2 are present then schizophrenia is diagnosed
persistent hallucinations that occur every day
breaks in train of thought - irrelevant speech
catatonic behaviour
negative symptoms - apathy, blunting, incongruity of emotional response
75
what is the most common form of schizophrenia
paranoid
76
what is meant by a predisposing, precipitating and perpetuating factor for a psychiatric illness
predisposing - at risk
precipitating - made it happen
perpetuating - keep it going
77
what are schneider's first rank symptoms of schizophrenia
alienation of thought - thought broadcasting, insertion, withdrawal
delusions
auditory hallucinations
persisting delusions of other kinds that are impossible
78
give examples of catatonic behaviour
excitement, posturing or waxy flexibility (don’t correct odd position), negativism, mutism and stupor (unresponsive).
79
what neurochemistry is linked to schizophrenia
increased dopamine activity
| Also Glutamate, GABA, Serotoninergic transmission linked to negative symptoms
80
what are some biological factors that may lead to schizophrenia
```
genetics - neurkgulin, dysbindin
neurochemistry - dopamine
Obstetric complications/ Maternal influenza
Malnutrition and famine
Winter birth – more chance
Substance misuse
```
81
what population has a high excess of schizophrenic patients
migrants - change in time, moral and cultural symbols
82
what kind of psychotic symptoms are seen in a Depressive episode with psychotic symptoms
¥ Delusions of guilt, worthlessness and persecution (dead/ rotting)
¥ Derogatory auditory hallucinations – arguing etc.
83
what kind of psychotic symptoms are seen in a manic episode with psychotic symptoms
Delusions of grandeur; special powers or messianic roles
| Gross overactivity, irritability and behavioral disturbance: Manic excitement
84
what class of drugs is used to treat schizophrenia
ant- psychotics
85
what side effects are seen with 1st generation anti-psychotics - chlorprozamine, haloperidol
extra-pyramidal - tremor, slurred speech akathisia (motor restlessness), dystonia (continuous spasms and muscle contractions
86
what side effects are seen with 2nd generation anti-psychotics
weight gain, hyperglycaemia, dyslipidamiea
87
what type of drug are 1st generation anti-psychotics
dopanima antagonists
| e.g. chlorprozamine, haloperidol
88
what type of drug are 2nd generation anti-psychotics
serotonin and dopamine antagonists
| e.g. amisulpride, olanzapine, quetiapine, risperidone, zotepine
89
what is the only licensed 3rd generation anti-psychotic
aripiprazole
| dopamine partial agonist
90
what drug is used for treatment resistant schizophrenia
clozapine
91
what is a major Side effect of clozapine
blood dyscrasia - need weekly FBC for 18 weeks, then fortnight for 18 weeks then monthly
92
what is meant by early intervention in the treatment of schizophrenia
CBTp and increased family/social support
| grade A evidence
93
what percentage of people recover after an episode of psychosis
80%
94
what are good prognostic factors for recovery of schrizophrenia
Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant ,
Acute onset
Mood disturbance
Prompt treatment, Maintenance of initiative, motivation
95
what are poor prognostic factors for recovery of schrizophrenia
slow, insidious onset
prominent negative symptoms
substance misuse
early age of onset
96
what is the DSM-5 definition of a personality disorder
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
(no history, no other diagnosis, no physiological change)
97
what are the prominent problems with cluster A personalities
perceived safety of interpersonal relationships
| Thought as being a sequelae of severe problems in early relationships.
98
what are the prominent problems with cluster B personalities
keeping feelings tolerable without acting
99
what are the prominent problems with cluster C personalities
relate to anxiety and how it is managed (in relationships
100
what 3 personality disorders are seen in cluster A personalities
paranoid
schizoid
scizotypical
101
what is meant by a paranoid personality disorder
no one can be expected to have anything but malign intent and have a pervasive distrust and suspiciousness of others.
Patients with a Paranoid PD do not usually come for treatment
102
what is meant by a schizoid personality disorder
patients look as if they have no interest whatsoever in social relationships (restricted range of expressions and emotions) and may always choose soliatary experiences. Characteristically, they seem aloof and odd.
103
what is meant by a schizotypical personality disorder
very odd ways of thinking and relating that are not quite as engrained as in a psychotic disorder. Seen is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships and distortions of behaviour
not likely to be seen
104
what is meant by obsessive compulsive personality disorder
There is a preoccupation with obstinacy, perfectionism, and orderliness at the expense of efficiency and flexibility that probably protects the patient from anxiety
105
what 2 types of personality disorders are seen in cluster C personalities
obsessive compulsive personality disorder
| avoidant/dependent personality disorder
106
what is meant by avoidant / dependent personality disorder
People often try to cope with anxiety about interpersonal situations either by avoiding them completely with hypersensitivity to negative evaluation or by getting other people to take over their lives with clinging behaviour and fears of separation. Seen in substance use disorders.
107
what 4 types of personality disorders are seen in cluster B personalities
antisocial personality disorder
borderline personality disorder
narcissistic personality disorder
histrionic personality disorder
108
what is meant by histrionic personality disorder
patients have had badly damaged development in their ability to relate to people. Have a pattern of excessive emotionality and attention seeking beginning in early adulthood. Instead of any straightforward relating, they tend to relate in a heavily sexualised way, inappropriate to the context and like to draw attention to themselves.
109
what is meant by narcissistic personality disorder
present with a grandiose sense of their own importance and a
sense of exceptional entitlement, but suspect instead that the patient is really quite damaged in their self-esteem, and relies on this rigid presentation of their importance in order to cover this
lack empathy
110
what is meant by antisocial personality disorder
=Characterised by a repeated tendency to
disregard and to violate the rights of others. Psychopathic people tend to engage in more extreme violence, with prominent callousness and lack of emotion, and with little remorse for their victims
111
where are there high rates of people with antisocial personality disorder
prison
112
what are the age restrictions for antisocial personality disorder
must be 18
| evidence of conduct disorder <15
113
what is the ICD classification of antisocial personality disorder (read only)
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
114
what is the most clinically relevant personality disorder
borderline
115
what is meant by borderline personality disorder
Emotionally Unstable Personality Disorder. Pervasive pattern of instability of interpersonal relationships and self-image.
116
what is the common history of people with borderline personality disorder
serious problems in their early attachments, or significant childhood trauma.
developed
an uncertain sense of the safety of relationships, and are prone to feeling like they are going to be abandoned
117
what is the ICD classification of borderline personality disorder (read only)
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
118
what is the main management of personality disorders
psychotherapy - relationship therapy
best doen in a group
at least 18 months
119
what is meant by dialect behavioural therapy
derived from behavioural psychology and from mindfulness. In DBT, therapists help the patient to find ways to manage intense feelings, and to find behavioural strategies for how they relate to others that may prevent them from getting such strong feelings.
120
what is meant by mentalization based treatment
derived mainly from developmental psychology and from psychodynamic practice. Therapists help the patient to recognise times when they feel overwhelmed and cannot do anything but act. They work with them to think about what they are actually feeling, and to try to understand what the other party is feeling, and to use these alternative perspectives to make a more reality-oriented way of relating to others
121
when do most cases of anorexia nervosa start
before 22
122
what percentage of eating disorder cases are male
10%
123
what is diabulimia
omit insulin after meals
124
what personalities are attributed to eating disorders
intelligence
driven/ focused
perfectionist
125
what is a screening tool used for eating disorders
SCOFF
126
describe the SCOFF screening tool for eating disorders
1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you have lost Control over how much you eat?
3. Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?
127
what is the main fear in anorexia
fatness
128
what is the diagnostic criteria for anorexia
reduced intake of calories to reduce weight
compensatory behaviours when food can't be avoided
BMI <17.5 / 15% below ideal
fear of weight gain
129
what are some compensatory behaviours seen in eating disorders for eating food
```
Self-induced vomiting
, laxative abuse,
excessive exercise,
abuse of appetite suppressants / diuretics to dehydrate
over activity
cooling - inadequate dress
```
130
what is a sign of anorexia in postmenarchal woman
secondary amenorrhoea
131
what are signs of anorexia
```
low tem, BP, pulse
constipation
cold intolerance
dry skin
languo hair
fainting
scalp hair loss
fatigue
```
132
why does anorexia lead to bloating
gut muscle slows down leading to consitpation
133
what is bulimia nervosa
episodes of binge eating with a sense of loss of control followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets).
134
how many times must binging/ purging occur for a bulimia diagnosis
2x a week for 3 months
135
what is the BMI of people with bulimia
normal
136
why are people with eating disorders at risk of cardiac arrhythmia
electrolyte imbalance - low K
137
what is russels sign a sign of
callus on back of hand - during in bulimia
138
why may people with bulimia get more upper GI symptoms (mouth sores, heartburn, chest pain)
increased stomach acid
139
what commonly becomes swollen in pateitns with bulimia
parotid glands
140
what drug can be used to help treat bulimia
fluoxetine
141
what is the prognosis of bulimia
in 2-10 years, 50% improve, 20 % show no change
142
what features are seen in binge eating disorder
unusually fast eating, usually alone.
unusually large amounts consumed.
uncomfortably full; often “buzzed” after eating.
embarrassment, shame, guilt, depression
143
what are some common ways people avoid calories
going vege/ vegan
developing allergies
odd eating habits - slow, finish last
avoid parties/ social
144
what are some behaviours seen in eating disorders
body checking - repeated weighing/ mirror
| pro-ana websites
145
what are psychological consequences of eating disorders
narrowed focus of interest
unable to interpret emotions
increased depression, anxiety and obsession with food
146
what are social consequences of eating disorders
isolated form friendships
| loss of interest in sexual reltionships
147
what are some physical consequences of eating disorders
```
reduced immunity
fertility problems
hear arrhythmias
dry skin, cold intolerance
delayed puberty
languo hair/ scalp hair loss
short stature
```
148
what are some predisposing factors to eating disorders
personality trait run in families - OCD, anxiety, perfectionism
149
what are some precipitating factors to eating disorders
puberty/ hormonal changes
increased exercise
stressful life events - moving, bullying, break up, exams
150
what are some perpetuating factors to eating disorders
delayed gastric emptying - feel bloated
obsession - phobia increases as avoidance increases
unsupportive families
151
what psychiatric disorder has the highest mortality
anorexia
| 10x risk of premature death
152
what is the average length of recovery for anorexia nervosa
6-7 years
153
what is the first line treatment for severe anorexia
re-feeding
154
how does re-feeding syndrome occur
rapid initiation of food after >10 days fasting, due to low phosphate
155
do anti-depressants help anorexia
not on starved brain
| high dose
156
what anti-psychotic is occasionally used to treat anorexia
olanzapine
157
what act give the right to treat people even in the absence of consent to save life or prevent serious deterioration
Scottish mental health act
158
what is the biomechanical engineering model of stress
Stress and strain on a person can be tolerated until a breaking point then physiological and psychological stress occur ‘straw that broke the camels back’
159
what is the medicophsyiological model of stress
general and non-specific event occurs and produces a fight or flight response. If stressor persists, person experiences an alarm reaction followed by a physiological adaptation that can be coped with until exhaustion is reached
160
what is the psychological (transactional) model of stress
stress is a dynamic transaction between individual and environment. Assumes an environmental stressor doesn’t’t always cause an individual to cause stress and that response is personal . An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope
161
what are the 2 different ways of coping
Problem focussed -Where efforts are directed toward modifying stressor.
Emotion focussed - Modify emotional reaction.
162
what are the psychological symptoms of anxiety
```
Fearful Anticipation – worrying before you know what’s going to happen
Irritability
Sensitivity to noise
Poor concentration
Worrying Thoughts
```
163
what are the autonomic symptoms of anxiety
GI – dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loose motion
Respiratory – tight chest, difficulty inhaling
Cardiovascular – palpitations, missed beats, chest pain
Genitourinary – frequency/ urgency of micturition
CNS – dizziness and sweating
164
what is generalised anxiety disorder
Persistent (several months) symptoms not confined to a situation or object and can occur in any environment
165
what are the classes of symptoms of anxiety
```
Psychological arousal,
Autonomic Arousal,
Muscle Tension, - tremor , headache, muscle pain
Hyperventilation
Sleep Disturbance
```
166
what are the most common symptoms seen in generalised anxiety disorder
nervousness, sweating, trembling, light headed, palpitations, epigastric discomfort
167
what disorder replaces anxiety with age
somatisation
168
what is the non pharmacological treatment for GAD
counselling - education and explanation
advice re caffeine, alcohol, exercise
CBT
169
what is the medical therapy of anxiety
SSRIs first line - TCA/ MOAI
preglabalin
B blockers can imporobce somatic symptoms
170
what is proven to be the best method of treating anxiety and why
CBT - learn skills that can be applied
171
what is the differential diagnosis of anxiety disorders
Psychiatric - Depression, Schizophrenia, Dementia , Substance, Misuse
Physical -Thyrotoxicosis, Phaeochromoctoma, Hypoglycaemia, Asthma or Arrhythmias
172
what is different with GAD and phobic anxiety disorder
phobic only experience in specific circumstances that are not dangerous
173
what is agoraphobia
fear of situations difficult to escape - tend to avoid
174
what is social phobia
fear of scrutiny by other people
175
what things does CBT challenge
¥ Negative views of self (question if reasonable)
¥ “Safety barriers” to avoid situations that make anxious
¥ Unrealistically high standards
¥ Excessive self monitoring
¥ Education and advice
176
what is the treatment of social phobias
SSRI antidepressants effective - CBT remain remission
177
what are the core features of OCD
experience of recurrent obsessional thoughts and compulsive acts.
178
what are obsessional thoughts
stereotyped, purposeless words, ideas or phrases that come in to mind.
Occurring repeatedly not willed
Unpleasant and distressing (often the antithesis of personality type)
179
what do people with OCD get when they try to resist their obsessive thoughts/ compulsive acts
key anxiety symptoms
180
what are compulsive acts
Senseless, repeated rituals. (predictable)
Not enjoyable or helpful i.e. do not result in useful activity
Often viewed by sufferer as preventing some harm to self or others; “magical undoing” or preventing the distress of the obsession
181
what is the management of OCD
educations/ explanation
CBT
fluoxetine (SSRI), clomipramine (TCA)
182
what is post traumatic stress disorder
Delayed and or protracted reaction to a stressor of exceptional severity
183
what things may precipitate PTSD
```
Combat – military
Natural or human-caused disaster
Rape
Assault/ sexual assault
Torture
Witnessing any of these events
```
184
why is PTSD twice as common in women than men
rape/ sexual assault
185
what are risk factors for PTSD
nature of stressor
vulnerability - mood disorder, lack of social support
partly genetics
previous neurotic disease
186
what are protective factors against PTSD
higher education and social group, good paternal relationship
187
what are the 3 key element of reaction
1. hyperarousal (autonomic)
2. Re-experiencing phenomena
3. avoidance of reminders
188
when do the PTSD usually occur
3 moths after event
189
what are the symptoms of PTSD caused by autonomic hyperarousal
persistent anxiety, irritability, insomnia, poor concentration, sweating
190
what percentage of people recover form PTSD in 1 year
50%
191
what is given if people have severe PTSD
CBT - short term 16 sessions – includes relaxation, psychoeducation, cognitive coping strategies
192
what special type of therapy is given to people with PTSD
Eye Movement Desensitisation and Reprocessing therapy – uses bilateral sensory stimulation to assist clients in processing traumatic experiences
193
what are organic mental disorders
characterised by demonstrable organic brain damage or mental disorder arising in the context of demonstrable physical disease.
194
what is different about the onset of organic mental disorders and learning disability
organic mental disorders are acquired whereas learning disabilities are present form birth/ childhood
195
what are common features of cognitive impairment seen in organic mental disorders
```
disorientation
impaired concentration
memory loss
language - expressive and receptive dysphagia
insight
poor judgement
```
196
what is affected first in disorientation when someone has cognitive impairment due to an organic mental disorder
position in time and place
197
what does the test of 7s assess
attention/ concentration
198
what type of memory loss is usually seen in cognitive impairment due to an organic mental disorder
anterograde - difficulty to register information
199
what behaviour abnormalities are seen in organic mental disorders
agitation, aggression – change in personality
Slowing, psychomotor retardation
Abnormal social conduct – disinhibited, hallucinations
200
what mood changes are seen in organic mental disorders
low mood, anxiety, mania
201
what psychotic features may be seen in organic mental disorders
Hallucinations (mostly visual), delusions (persecutory/ harm)
202
what is the difference in hallucinations between schizophrenia and organic mental disorders
schizo - auditory
| organic - visual
203
what is difference about the onset of dementia and delirium
delirium - acute - mins/ hours/ days
| dementia - insidious - weeks/ months/ years
204
what is delirium
Transient organic mental syndrome of acute or subacute onset which is characterised by global cognitive impairment.
205
give some presenting features of delirium
¥ Impaired attention/concentration
¥ Anterograde memory impairment
¥ Disorientation in time, place or person
¥ Fluctuating levels of arousal
¥ Disordered sleep/wake cycle
¥ Increased/decreased psychomotor activity
¥ Disorganised thinking as indicated by rambling, irrelevant or incoherent speech
¥ Perceptual distortions, leading to misidentification, illusions, and hallucinations
¥ Changes in mood such as anxiety, depression and lability
206
when are symptoms of delirium often worse
nighttime
207
what is the difference between hypoactive delirium and hyperactive delirium
hypo- drowsy and withdrawn
| hyper - agitated and upset
208
give some causes of delirium
```
drugs
Infections - UTI
alcohol/ drug withdrawal
metabolic
endocrinopathies
toxins
dehydration/ constipation
```
209
what is the management of delirium
find precipitating cause and treat
| optimise support, get family in
210
when are sedatives given in delirium
extreme agitation/ risk
| investigations are needed
211
what is dementia
A syndrome which characterised by global cognitive impairment which is chronic in nature
212
give types of dementia
Alzheimer’s, vascular, lewy body, fronto-temporal
213
what is meant by anterograde amnesia
lose orientation in place/ time, can’t hold new information, can’t learn new things
214
what is meant by retrograde amnesia
have little memory from 2/3 years ago but full memory of past
215
are global intellectual abilities spared in amnesic syndromes
yes , still present
216
what things can cause damage to the hippocampus that may lead to amnesia
```
Herpes simplex virus encephalitis
Anoxia
Surgical removal of temporal lobes
Head injury
Bilateral posterior cerebral artery occlusion
Early Alzheimer’s
```
217
what things can cause diencephalic damage that may lead to amnesia
```
Korsakoff’s syndrome – thiamine vit B1
deficiency
3rd ventricle tumours and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage – especially anterior communicating artery aneurysms
```
218
What is developmental psychopathology
science underpinning psychiatry
219
how is it proven that disorder such as ADHD and Autism are highly genetic.
twin studies - MZ vs DZ
220
what studies are increasingly used to identify genetic risk factors for psychiatric disorder
Genome wide association studies (GWAS)
221
what type of genetic factors are likely to be important in psychiatric disorders
Genetic factors serving modulation of gene expression - control influence of environmental factors on genetic expression
222
if the pregnant mother smokes marijuana what is the child more susceptible to in childhood
depression
223
what toxins affect formation of brain important for subsequent mental health (Intrauterine and perinatal factors )
lead, mercury and PCB’s
224
why are twins more prone to mental health disorders
competing in intrauterine environment > reduced brain formation
225
what conditions are higher in kids with foetal alcohol syndrome
ADHD, LD and DHD (developmental coordination disorder/ dyspraxia)
226
why is white matter connectivity important in the brain
functions that require interplay between brain areas e.g. working memory between hippocampus and anterior cingulate
227
what features are seen in conduct disorders
frequent loss of temper, arguing, becoming easily angered or annoyed, showing vindictive or other negativistic behaviours.
228
what features are seen in ADD
distractibility, sustaining attention to tasks that don’t provide high level of stimulation or frequent rewards, distractibility and problems with organization
229
what is impulsivity
tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences
230
what are some environmental factors that can impact child mental health
```
carer-child relationship
parental mental disorders
family dysfunction
abuse/ neglect
bullying
peer relationships
```
231
how do early life stresses impact the brain
influences function of limbic circuit including amygdala. Mood and patterns of response to threat including withdrawal and/or aggressive response.
232
what is the scientific basis of reward based learning
Dopamine neurons fire when you associate an action with a reward (Addiction)
233
what is meant by the executive and cortical control behaviour pathway
Taking control over ‘automatic’ and learned behaviours through own development
Intentional decision-making and forward planning.
Requires self-awareness and capacity to self-monitor
234
what behaviour pathway explains ADHD
delayed aversion/ gratification
| inability to wait and maintain attention in the absence of immediate reward
235
what is the theory of mind (absent in autism)
be able to understand a false belief and recognise a different mental state
compared to reality.
236
what are some mental health problems associated with being out of school
```
¥ Anxiety
¥ Conduct disorder – refusing / deciding not to do what is expected of them
¥ Autism
¥ Depression
¥ Obsessional compulsive disorder
```
237
what effects may mental health disorders have on school performance
```
learning difficulties
poor attention
difficulty controlling emotions
anxiety/ depression/ lack of energy
difficulty joining in/ making friends
```
238
what are the 3As of anxiety disorders
Anxious thoughts and feelings (e.g. impending doom)
Autonomic symptoms – tingling, churning, urination, blurred vision, heart palpating
Avoidant behaviour
239
where in the brain is reduced connectivity seen in generalised anxiety disorders
Reduced connectivity between right ventrolateral cortex and amygdal
240
what disorder is the child suffering from if they have problems at the doorstep or at the school gate
door - separation anxiety from paretns
| social - fear of joining group
241
is fluoxetine safe to use in children with anxiety
yes
242
how may anxiety be treated in kids
behavioural therapy
| SSRIs
243
describe a successful cognitive behaviour cycle
Challenge behaviour > succeed > improve self-confidence> increases resilience to take on more challenges
244
describe an unsuccessful cognitive behaviour cycle
Challenge behaviour > avoidance gives sense of failure > lower self confidence > vulnerability and greater pattern of avoidance for new challenged
245
why is cognitive behavioural therapy different in children
don't have cognitive awareness
| parents involved
246
what are the goals of CBT in children
¥ Externalisation: take blame, guilt and anger away from disorder
¥ Psychoeducation: explaining the problem in terms that make sense to everyone
¥ Goal-setting: choosing reasonable objectives that can be achieved, agree on goals
¥ Motivatin.
247
when is the onset of autism/ aspergers
<3 years
248
what brain neuropathology's are assocoiated with autism
mainly glutaminergic synaptic function and GABA regulation
249
what physical conditions are associated with autism
Rubella, Callosal agenesis, Down’s syndrome, Fragile X, Tuberous sclerosis.
250
what ratio of males to females are affected by autism
males 3:1
251
what are social features seen in autism
lack of reciprocal conversation, expressing emotional concern, abnormal response to being hurt
252
how do autistic children have a lack of non verbal communication
no declarative pointing, modulated eye-contact, facial expression
253
what repetitive behaviours are seen in autism
mannerisms, obsessions, bizarre preoccupations and interests
| Rigid and inflexible patterns of behaviour – routines, rituals and repetitive play
254
how can autism manifest as clinical problems
```
learning disabilities
disturbed sleep/ eating
high naxiety/ depression
OCD
school avoidance
agression/ temper
self injury/ harm
```
255
what is the management of autism
¥ Recognition, description and acknowledgement of disability
¥ Decrease the demands -> reduce stress ->improve coping
¥ Parent training
¥ Psychopharmacology– risperidone (aggression), melatonin (sleep), SSRI (repetitive behaviour)
256
what drug can be given to children to control aggression
risperidone
257
what drug can be given to children to control repetitive behaviours
SSRIa
258
what is the Most common neurobehavioral disorder of childhood
Attention deficit hyperactivity disorder (ADHD
259
is ADHD genetic
80%
260
what are the core diagnostic criteria for ADHD
1 ) Inattention: unable to listen/ attend closely to detail, sustain attention in play activities, follow
instructions, finish homework, organise tasks needing sustained application, lose/ forget things
2) Hyperactivity: squirming/ fidgeting, always on the go, talks incessantly, climbs over everything, restless,
no quiet hobbies
3) mpulsivity: blurts out answers, interrupts others, can’t take turns, intrudes on others,
261
how is ADHD diagnosed
clinically
| history form parents/ school
262
what is the rule of 1/3 for ADHD
At 18, 1/3 have no symptoms, 1/3 have symptoms that don’t need medications and 1/3 still need medication.
263
what drugs can be used to manage ADHD
methylphenidate / atomoxetine (lasts 4 hours – purely symptomatic)
SE - appetite, weight, sleep
264
what is the permanent management fo ADHD
parental training
265
what are features seen on oppositional defiant disorder
- Refusal to obey adult request - Often argues with adults
- Often loses temper - Deliberately annoys people
- Touchy or easily annoyed by others
- Spiteful or vindictive
266
what is ODD most likely to result form
impaired parenting
| associated with adversity
267
describe parent training programmes
¥ Structured training in groups, individuals or self-taught (e.g. DVD packages)
¥ 1-2hrs/wk for 8-12 weeks
¥ Informed by social-learning theory e.g modelling behaviour.
¥ Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships.
268
what are lifetime outcomes of hard to manage children
antisocial behaviour, substance misuse, long-term mental health problems
269
what is the best way to control hard to manage children
parent training programmes
270
what do children use self injury as
is a coping mechanism
| harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation
271
what combination is particularly high risk for suicide
mood disorder, substance misuse and conduct disorder
272
give factors that increase the risk of suicide
- Persistent suicidal ideas
- Previous suicidal behaviour
- High lethality of method used
- High suicidal intent and motivation
- Ongoing precipitating stresses
- Mental disorder
- Poor physical health
- Impulsivity, neuroticism, low self esteem, hopelessness
- Parental psychopathology and suicidal behaviour
- Physical and sexual abuse
- Disconnection from support systems
273
how is a suicide attempt i a young person handled
admit to age appropriate medical ward for treatments and psychosocial assessment
274
what is the hospital prevalence of depression
21%
275
what is the hospital prevalence of dementia
31%
276
what is the hospital prevalence of delirium
20%
277
is dementia reversible
no
278
when do dementia symptoms vary
day to day
279
what is different about the attention span in dementia and delirium
normal in dementia
| short in delirium
280
what is different about consciousness span in dementia and delirium
dementia - clouded in late stage
| delirium - fluctuating
281
what is similar about depression and dementia
depressed mood coincides with memory loss
282
what is the dementia syndrome of depression
depressive pseudo dementia
283
what percentage of people with dementia will have co-existing symptoms of depression at some stage
50%
284
what is the ABCD of dementia
A for Activities of Daily Living (ADLs)
B for Behavioural and Psychiatric Symptoms of Dementia (BPSD)
C for Cognitive Impairment
D for Decline
285
what are the cognitive features of dementia
¥ Memory loss (dysmnesia)
¥ Plus one or more of
o dysphasia (communication)- expressive, receptive
o dyspraxia (inability to carry out motor skills)
o dysgnosia (not recognising objects)
o dysexecutive functioning
Functional decline
286
what are the 3 stages of AD progression
early
mild-moderate
severe
287
describe the early stage of alzheimers disease
symptoms free
288
describe the severe stage of alzheimers disease
functional ability is lost completely and institutionalization is inevitable.
289
what are the 4A's of alzheimers
amnesia
aphasia
agnosia
apraxia
290
how is the diagnosis of alzheimers made
```
clinical assessment
clinical + collateral history
mental state examination
physical and bloods
cognitive assessment
```
291
what deficits are seen in dementia with lewy body
Deficits of attention, frontal executive, visuospatial
292
what are important features of lewy body dementia that may lead you to the diagnosis
Fluctuation - marked, important feature
Visual hallucinations
Parkinsonism
293
whta scan may be abnormal in LEWY body dementia
DAT scan sensitivity and specificity around 85%
| full stop sign
294
what is different about the DAT scan in a patient with dementia with Lewy bodies and AD
AD patient will show normal re-uptake of the dopamine transporter in the head of the caudate nucleus and putamen in the shape of a ‘comma’
DLB, re-uptake in the putamen is reduced, leading to the ‘full-stop’ sign
295
what sign is seen on a DAT scan of a patient with dementia with lewy bodies
full stop
296
what are key features of frontotemporal dementia
behaviour/ personality change
early onset
speech disorder
297
what speech disorders may be seen in FTD
altered output, stereotypy, echolalia, perseveration, mutism
298
what is seen on neuroimaging of FTD
abnormalities in frontotemporal lobes
299
what things are not severely impaired in neuropsychology
Memory, praxis and visuospatial function not severely impaired
300
what is the usual clinical presentation of vascular dementia
gradual deterioration in executive function, as well as mood changes such as apathy or irritability
301
who should you notify when you make a diagnosis of dementia
DVLA
302
why is memory relatively spared in vascular dementia
preservation of cortical grey matter
303
what are the 2 most common tests done to assess cognition
mini- mental state examination
| MOCA
304
is capacity task specific
yes
305
what 5 things must be present for a person to have capacity
Act, communicate, understand, make decisions, retain memory
306
what are the 2 types of guardianship
finance
| wellfare
307
what drugs are used to treat mild to moderate dementia
Acetylcholinesterase Inhibitors (AChI) - donepezil, rivastigmine, galantamine
308
what drug is licensed for severe dementia
Memantine
309
what other classes of drugs may be used to treat dementia
¥ Antipsychotics - risperidone, quetiapine, amisulpride)
¥ Antidepressants - mirtazapine, sertraline)
¥ Anxiolytics - lorazepam
¥ Hypnotics - zolpidem, zopiclone, clonazepam
¥ Anticonvulsants - valproate, carbamazepine
310
how do Acetylcholinesterase Inhibitors treat dementia
Improve cognitive function
| Slow decline but do not stop disease progression
311
what are side effects of Acetylcholinesterase Inhibitors
Nausea, vomiting, diarrhoea, fatigue, insomnia, muscle cramps, headaches, dizziness, syncope, breathing problems
312
what fraction of care home residents have dementia
three quarters
313
what is the prevalence of depression in the elderly community
15%
314
what is different about the way depression presents in the elderly
Less – depressed mood, expressed suicidal wishes
| More – insomnia, hypochondriasis, suicide, agitation
315
what are normal reactions to grief
```
Ð Alarm
Ð Numbness
Ð Pining – illusions or hallucinations may occur
Ð Depression
Ð Recovery and reorganisation
```
316
when does fried become abnormal
over 2 months
317
what are abnormal features of grief
```
Ð Persisted beyond 2 months
Ð Guilt
Ð Thoughts of death
Ð Worthlessness
Ð Psychomotor retardation
Ð Prolonged and marked functional impairment
Psychosis
```
318
what are triggers for suicide in the elderly
loneliness, widowed, ill health, chronic pain, recent life events
319
what is the management of late onset schizophrenia
Often needs compulsory admission
Neuroleptics
Increase in social contact
320
what imaging would you do to confirm the diagnosis of alzheimers
T1 weighted MRI
321
what is a learning disability
A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’
322
what are the 3 diagnostic criteria for learning disability
1. Intellectual impairment (IQ < 70)
2. Social or adaptive dysfunction
3. Onset in the developmental period (
323
what are classed as social/ adaptive dysfunctions in learning disabilities
communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure & work
324
what scale is used to assess social or adaptive dysfunction in learning disabilities
vineland scale
325
what percentage of learning difficulties are mild
80%
326
what is the IQ of mild, moderate, severe and profound learning disability
mild - 50-69
moderate - 35-49
severe- 20-34
profound - <20
327
what level are people with a mild learning disability
High school level, can read/ write, support
| independently but still need help with money, work and safety
328
what level are people with a moderate learning disability
Primary school level, problems with executive function
| e.g. planning say and getting to activities so need support at home
329
what level are people with a severe learning disability
Pre-school – need help with most things, limited verbal
| speech, can’t concentrate or manage on their own
330
what level are people with a profound learning disability
often no verbal communication, need 24/7 support,often
| co-exists with other co-morbidities
331
what should health professionals think about when dealing with severe learning deficiencies
alternative communication strategies
observable signs are relied on more in making the diagnosis e.g. weight loss, withdrawal, agitation, tearfulness in depression and behavioural disturbance in psychotic disorder
332
what is diagnostic overshadowing (learning disability)
putting presenting symptoms down to learning disability rather than another potentially treatable cause.
333
why is the prevalence of IQ <70 2.5% but he prevalence of LD is 1-2%
- higher mortality in LD
| - if can function <70 not a LD
334
what single gene mutations are associated with LDs
Fragile X, PKU, Retts Syndrome
335
what micro deletion/ duplication mutations are associated with LDs
DiGeorge Syndrome, Prader-Willi, Angelman syndrome
336
what chromosomal abnormalities are associated with LDs
Down Syndrome chr21
| Turners
337
what ante natal and post natal infections may cause LD
ante-natal e.g. rubella (less common due to MMR), zika globally
post-natal e.g. meningitis, encephalitis
338
what toxin may cause LD in the womb
alchohol - foetal alcohol syndrome
339
what % of people with epilepsy have a LD
10-50%
340
name some Physical conditions associated with learning disabilities:
```
epilepsy
sensory impairments - haring 40%, vision 20%
obesity
constipation
cerebral palsy
```
341
what infection is very common in learning difficulties
Helicobacter pylorii
342
what is different about auditory hallucinations in scrizophrenia and in LD
schrizo - angry and distressing
| LD - make them fell better
343
why are mood disorder sin people with LD more likely to be picked up by carers
Less likely to complain of mood changes
| biological symptoms such as lack of appetite, loss of interest in sex
344
why are OCD and LD closely linked
Ritualistic behaviour and obsessional themes
345
what fraction of people with autism have a LD
1/2
346
what is similar about ADHD and LD
in severe LD children are overactive, distractible and impulsive but NOT to extent that would indicate diagnosis of ADHD
347
why don't people with less than moderate IQ go to prison
cant have trial as won’t understand trial or crime
