Core Psych conditions

Question 1

What are the positive symptoms of psychosis

Answer 1

delusions
disordered thoughts/speech
hallucinations (auditory, visual, tactile, olfactory and gustatory)

Question 2

What are the negative symptoms of psychosis

Answer 2

flat/blunted affect
poverty of speech
lack of motivation
poor ability to function

Question 3

What responds better to medication in psychosis, positive or negative symptoms?

Answer 3

positive symptoms

Question 4

What is psychosis

Answer 4

loss of contact with reality

Question 5

Do positive or negative symptoms of psychosis contribute to a more negative quality of life

Answer 5

negative symptoms

Question 6

What are the different types of schizophrenia

Answer 6

paranoid
hebephrenia
catatonic
simple
residual

Question 7

What is paranoid schizophrenia

Answer 7

Auditory/visual hallucinations and delusions (persecutory and/or grandiose). No thought disorder or flattened affect

Question 8

What is hebephrenia

Answer 8

– or disorganised type. Thought disorder and flat affect present together.

Question 9

What is catatonic schizophrenia

Answer 9

either immobile or agitated/purposeless movement. waxy flexibility. echolalia/echopraxia

Question 10

What is simple schizophrenia

Answer 10

insidious and progressive negative symptoms with no history of psychotic symptoms.

Question 11

What is residual schizophrenia

Answer 11

chronic negative symptoms

Question 12

What are the schneiderian 1st rank symptoms of schizophrenia

Answer 12

Auditory hallucinations - 3rd person arguing/conversing. 3rd person commenting on patients actions

Passivity experiences - made actions/feelings - delusions of control

thought disorder - insertion/ withdrawal/broadcast

delusional perception

Question 13

What are the other types of psychosis

Answer 13

acute and transient psychosis
persistent delusional disorder
schizoaffective disorder
puerperal disorder
organic disorder

Question 14

What is acute and transient psychosis

Answer 14

Short lived psychotic presentation

Onset within 2 weeks, recovery within 3 months

Question 15

What is persistent delusional disorder

Answer 15

long standing delusion only (no hallucinations) . more common in the elderly and in those with impaired sensation e.g. blind or deaf

Question 16

What is schizoaffective disorder

Answer 16

both affective and schizophrenic symptoms are present together

Question 17

what is puerperal psychosis

Answer 17

psychosis occuring within days or weeks of birth
Often needs admission (MBU optimal) and high risk of recurrence in subsequent pregnancies
Probable hormonal aetiology in women predisposed to bipolar disorder

Question 18

What is organic psychosis

Answer 18

related to overt brain disorder or delirium

Question 19

What is the management of psychosis using the biopsychosocial model

Answer 19

Bio: antipsychotics

Psycho: family therapy or CBT

Socio: family intervention/ carer support/employment/activity/education/support with engagement/ benefits

Question 20

What are the symptoms of mania

Answer 20

Increased energy & sexual drive
Decreased need for sleep
Increased talking speed and racing thoughts
Grandiose beliefs/ inflated self esteem
Psychotic beliefs about identity / capability
Inappropriate elation or euphoria
Irritability
Involvement in activities with a high likelihood of adverse consequences e.g. extravagant shopping, sexual adventures or improbable commercial schemes
Functional impairment / risk likely

Question 21

What are the symptoms of hypomania

Answer 21

Elevation of mood for days
Talkativeness
Overfamiliarity
Increased sexual energy
Decreased sleep
Irritability

No psychotic symptoms

Question 22

How do mania and hypomania differ

Answer 22

hypomania is a lesser degree of mania that does not affect functioning, and has no psychotic symptoms

Question 23

What is bipolar disorder

Answer 23

Characterized by at least two episodes in which the patient’s mood and activity levels are significantly disturbed

This disturbance consisting on some occasions of mania/ hypomania and on others depression

Periods of recovery between episodes

Depressive episodes tend to last longer (average 6 months)

Question 24

How is bipolar disorder managed using the biopsychosocial model

Answer 24

Bio: mood stabilizers, antidepressants, antipsychotics

Psycho: talking treatments (CBT) relapse prevention, psychoeducation

Socio: family or carer support, employment/activity/education/support with engagement/ benefits

Question 25

What are the core symptoms of depression

Answer 25

low mood, anhedonia, reduced energy levels

Question 26

What other symptoms are there of depression

Answer 26

``` Reduced concentration and attention Reduced self-esteem and self-confidence Ideas of guilt and unworthiness Bleak and pessimistic views of the future Ideas/ acts of self-harm or suicide Disturbed sleep Diminished appetite Psychosis (NB nihilistic delusions) ```

Question 27

What indicates mild, moderate and severe depression

Answer 27

Mild = 2 core and 2 other symptoms Moderate = 2 core and 3-4 other symptoms Severe = 3 core and 4 other symptoms

Question 28

What are the post natal mood disorders to consider

Answer 28

baby blues post-natal depression puerperal psychosis

Question 29

What are the baby blues

Answer 29

Transient condition that affects up to 75-80% of mothers up to 2 weeks after giving birth Involves mood lability, tearfulness, mild anxiety and depressive symptoms Normal

Question 30

What is post natal depression

Answer 30

Depressive disorder in weeks / months post partum Rx as for depression Complex multifactorial aetiology

Question 31

What is the biopsychosocial management of depression

Answer 31

Bio: antidepressants (SSRIs, TCA, SSRI +TCA, +adjuvant) Psycho: talking treatment (CBT/CAT), group work/ self help, psychoeducation Socio: Family or carer support Employment / activity /education Support with engagement /benefits

Question 32

What is the management of mild depression

Answer 32

watchful waiting | improving access to psychological therapies (IAPT)

Question 33

What is the management of moderate depression

Answer 33

antidepressant (SSRI) and IAPT | consider referral to psychiatry

Question 34

What is the management of severe depression

Answer 34

``` consider referral to psychiatric ward (based on risks) Electroconvulsive therapy (ECT) ```

Question 35

What are the psychiatric emergancies

Answer 35

``` High risk, needing detention Alcohol withdrawal Delirium tremens Wernicke’s encephalopathy Lithium toxicity Acute dystonic reaction Neuroleptic malignant syndrome Seratonin syndrome Drug overdose Catatonia Acute confusional state ```

Question 36

What type of personality disorders are in cluster A (odd or eccentric disorders)

Answer 36

Paranoid: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent Schizoid: lack of interest and detachment from social relationships, apathy, and restricted emotional expression Schizotypal: a pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions

Question 37

What type of personality disorders are in cluster B (dramatic, emotional or erratic disorders)

Answer 37

Anti-social: a disregard for the rights of others, lack of empathy, increased self-image, manipulative and impulsive behaviour. Borderline: mood swings, instability in relationships, self-image/identity, behaviour and affect, often leading to self-harm and impulsivity. Histronic: attention seeking behaviour and excessive emotions. Narcissistic: grandiosity, need for admiration and a perceived lack of empathy.

Question 38

What type of personality disorders are in cluster C (anxious or fearful disorders)

Answer 38

Avoidant: social inhibition and inadequacy, extreme sensitivity to negative evaluation. Dependent: a pervasive psychological need to be cared for by other people. Obsessive-compulsive (anankastic): rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendship