Deck 5 Flashcards
(95 cards)
1
Q
What are common causes of impotence?
A
- anxiety about sexual performance
- alcohol
- side effects of prescription medicines
- diabetes
- vascular disease
2
Q
What drugs can be used for sexual dysfunction in males
A
phosphodiesterase type V inhibitors (sildenafil)
3
Q
What’s another name for chronic fatigue syndrome?
A
Neurasthenia
4
Q
What is narcolepsy associated with?
A
- cataplexy (abrupt loss of muscle tone)
- hypnagognic hallucinations (on falling asleep)
- sleep paralysis (the patient wakes but is unable to move)
- 98% of patients have the HLA-DR2
5
Q
How do you treat narcolepsy?
A
Stimulants (amphetamines or modafinil)
Clomipramine is used for cataplexy
6
Q
Which parameters should be monitored during refeeding?
A
- weight
- phosphate
- ankle swelling
- potassium
- heart rate
7
Q
What are the first rank symptoms?
A
Thought insertion, echo, withdrawal or broadcasting Third person auditory hallucinations Running commentary Passivity of thought, feelings or action Delusional perception
8
Q
How long do symptoms need to be present to diagnose schizophrenia?
A
1 month
9
Q
If schizophrenic symptoms are present for less than one month then what is the temporary diagnosis?
A
Schizophreniform disorder
10
Q
What are the negative symptoms of schizophrenia?
A
Avolition Associal behaviour Anhedonia Alogia (poverty of speech) Affect blunted Attention (cognitive) deficity
11
Q
What are the poor prognostic factors for schizophrenia
A
- strong FH
- gradual onset
- low IQ
- premorbid history of social withdrawal
- no obvious precipitant
12
Q
What are the symptoms of mania?
A
Irritability Distractibility/disinhibited Insight impaired/increased libido Grandiose delusions Flight of ideas Activity/appetite increased Sleep decreased Talkative- pressure of speech Elevated mood/energy increased Reduced concentration/reckless behaviour or spending
13
Q
Risk factors for bipolar
A
Age in early 20s Anxiety disorders After depression Strong FH Substance misuse Stressful life events
14
Q
What word describes:
thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one’s self-concept.
A
Ego-dystonic
15
Q
What word describes:
instincts or ideas that are acceptable to the self; that are compatible with one’s values and ways of thinking. They are consistent with one’s fundamental personality and beliefs.
A
Ego-syntonic
16
Q
What is anxiety?
A
An unpleasant emotional state involving subjective fear and somatic symptoms
17
Q
What are the most common anxiety disorders in order of prevalence?
A
- specific phobia (3.5%)
- social phobia (1.2%)
- GAD
- agoraphobia (0.4%)
- panic disorder
- OCD
18
Q
What’s the one year prevalence of anxiety?
A
14%
19
Q
What is neurosis?
A
A collective term for psychiatric disorders characterized by distress, that are non-organic, have a discrete onset and where delusions and hallucinations are absent.
20
Q
What are the symptoms of neurosis?
A
Emotional
- anxiety is the primary emotion but depressed mood is often present
Cognitive
- worries, fears and concerns that are inappropriate or excessive but not delusional.
Behavioural
- include avoidance and other strategies intended to reduce anxiety such as repeated checking
Somatic
- physical symptoms not explained by a medical disease
21
Q
What is koro anxiety?
A
Culture specific neurosis. Severe anxiety about penis shrinkage in chinese men.
22
Q
What is dhat anxiety?
A
Culture specific neurosis. Semen loss anxiety in Asian men.
23
Q
What are the stress related disorders?
A
Acute stress reaction
Adjustment disorders
PTSD
24
Q
What are the differential diagnoses for neurosis?
A
Another psychiatric condition
- depression
- substance misuse
- psychosis
- eating disorders
- anxious (avoidant) PD
- adjustment disorder
Organic
- hyperthyroidism
- hypoglycaemia
- anaemia
- thyrotoxicosis
- cushing’s disease
- chronic conditions
25
What's the normal onset for neurosis? What are risk factors
- Early adulthood and middle age
- prevalence increases with low household income
- comorbid with depression
26
What are the subtypes of anxiety disorder?
Episodic/Paroxysmal anxiety
- situation dependent (Phobic anxiety disorder; specific phobia, agoraphobia, social phobia)
- situation independent (Panic disorder)
Continuous anxiety
Generalised anxiety disorder
27
DDx for phobic anxiety
- phobic anxiety secondary to delusions
28
Treatment for phobic anxiety
- Behavioural therapy- graded exposure to the situation
- CBT- helps patients more accurately evaluate dangerousness of stimulus
- antidepressants, anxiolytics
29
What's agoraphobia?
- 'fear of the market place'
| - anxiety provoked by open, large or crowded spaces from which immediate escape would be difficult
30
Does agoraphobia effect men or women more?
Women:men 2:1
31
What are the symptoms of agoraphobia?
Emotion
- situational anxiety in shops, crowded large spaces
Cognition
- thoughts of collapsing and being left helpless in public
Behaviour
- avoidance
Somatic symptoms
- physical sensations of panic
Associations
- strong association with panic disorder
32
What's social phobia?
A fear of other people associated with anticipation of negative evaluation by them (humiliation, criticism or embarrassment)
33
How do you treat social phobia?
CBT and antidepressant drugs, particularly SSRIs
34
What are the symptoms of social phobia?
Emotion
- situational anxiety in social gatherings
Cognition
- being judged negatively by others
Behaviour
- avoidance of social occasions
Somatic symptoms
- blushing, trembling
Associations
- alcohol misuse
35
How long must symptoms occur for panic disorder?
At least 1 month
36
Treatment for panic disorder?
CBT
| Antidepressants can exacerbate panic before reducing it.
37
DDx for OCD
- Depressive disorder (in which obsessional symptoms are common)
- Psychotic disorder
- Anankastic PD
38
Treatment for OCD
| Prognosis
- High dose SSRI, clomipramine
- CBT
- prognosis is poor if not treated
39
Aetiology for OCD
- genetic vulnerability
- anankastic personality
- social stressors
40
Is OCD more prevalent in men or women?
Equal in both
41
What is conversion disorder, primary and secondary gain?
Conversion disorder (dissociative) is a loss of function not explained by organic disease.
The term conversion was used for loss of physical function because of the unsubstantiated theory that psychological conflicts got converted into physical symptoms, thereby resolving the mental conflict (so-called primary gain) and often providing practical benefits such as attention (secondary gain).
42
How do you treat chronic fatigue syndrome?
- CBT
| - graded increases in activity
43
What's the prognosis for chronic fatigue syndrome?
- poor
| - avoidance of physical activity and belief in a physical cause are associated with a worse outcome
44
How long does adjustment disorder/adjustment reaction last?
Within a month of the stress ans does not last longer than 6 months
45
Give examples of adjustment disorders
Grief reactions
| Psychological reactions to medical conditions
46
What's the treatment for adjustment disorder?
- address continuing stressor (problem-solving therapy)
- discouraging unhelpful coping strategies
- treat depressive/anxiety symptoms
47
What is GAD?
A syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognises as excessive and inappropriate. Symptoms must be present on most days for at least 6 months.
48
Aetiology of GAD
Predisposing
- Genetic (concordance greater in monozygotic twins than dizygotic twins)
- childhood upbringing
- personality type and demands for high achievement
- being divorced
- living alone or as a single parent
- low socioeconomic status
Precipitation
- stressful life events such as domestic violence, unemployment, relationship problems ans personal illness
Perpetuating factors
- continuing stressful events
- marital status
- living alone
- ways of thinking which perpetuate anxiety
49
What's the prevalence of GAD?
2-4% in the general population
| Women to men 2:1
50
What's the ICD10 criteria for GAD?
A. A period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems.
B. At least four of the following symptoms with at least one symptom of autonomic arousal:
- symptoms of autonomic arousal: palpitations, sweating, shaking/tremor, dry mouth.
- other symptoms
• chest and abdo (difficulty breathing, feeling of choking, chest pain, nausea, abdo pain, loose stools)
• brain and mind (dizzy, fear of dying, fear of losing control, derealisation and depersonalization)
• general (hot flushes, cold chills, numbness, tingling, headache)
• tension (muscle tension/pain, restless, on edge, difficulty swallowing, lump in throat)
• non specific (startled, concentration difficulty, mind blanks, persistent irritability, sleep problems)
51
Investigations for anxiety
FBC (infection/anaemia)
TFT (hyperthyroidism)
Glucose (hypoglycaemia)
ECG (sinus tachycardia)
52
DDx for GAD
- other neurotic disorders (panic disorder, specific phobias, OCD, PTSD
- depression
- schizophrenia
- PD (anxious or dependent)
- excessive caffeine or alcohol consumption
- withdrawal from drugs
- organic (anaemia, hyperthyroidism, phaeochromocytoma, hypoglycaemia)
53
What is GAD strongly associated with?
- depression
- substance misuse
ALWAYS SCREEN FOR THEM IF YOU SUSPECT GAD
54
How do you manage GAD?
Stepped care:
Step 1
- identification and assessment
- psychoeducation about GAD and active monitoring
- exercise should be encouraged
- self help methods and support groups
Step 2
- low intensity psychological interventions (individual non-facilitated self-help, individual guided self-help, psychoeducational group-based therapy)
Step 3
- high intensity psychological interventions (CBT or applied relaxation)
- OR drug treatment (SSRI, then SNRI, then pregabalin)
Step 4
- highly specialist input (multi-agency teams)
- combination of drug and psychological therapies
- consider involvement of crisis team
55
What do the following phobias relate to?
- arachnophobia
- entomophobia
- cynophobia
- ornithophobia
Spiders
Insects
Dogs
Birds
56
What do the following phobias relate to?
- astraphobia
- lilapsophobia
- aquaphobia
Thunder
Storms
Water
57
What do the following phobias relate to?
- haemophobia
- traumatophobia
Sight of blood
| Physical injury or illness
58
What do the following phobias relate to?
- claustrophobia
- acrophobia
- nyctophobia
- nosocomephobia
Closed spaces
Heights or flying
Darkness
Hospitals
59
Are social phobias and specific phobias more common in men or women?
1:1
60
What are the risk factors for phobias?
- adverse experiences
- stress and negative life events
- other anxiety disorders
- mood disorders
- substance misuse disorders
- FH
61
How do you differentiate phobias from GAD?
1. Anxiety occurs in specific situations
2. There is anticipatory anxiety
3. There is attempted avoidance
62
How do you manage panic disorders?
Stepped approach
Step 1
- Make diagnosis and identify co-morbidities such as anxiety and derpession
Step 2
- Treatment in primary care
- Psychological therapy (CBT)
- Medication (SSRIs, then TCAs if no improvement on SSRIs)
- Self help strategies (bibliotherapy, support groups, encourage exercise)
Step 3
- Review and consider alternative treatment
Step 4
- Refer to mental health service
Step 5
- care in specialist mental health service
63
What's bibliotherapy?
Giving written info on panic disorder and how to overcome it.
64
What's the prevalence of PTSD?
3% of UK adults
| 25-30% of individuals who experienced trauma
65
What's the ratio of PTSD f:m?
2:1
66
Normal bereavement should not last beyond how many months?
6. Consider adjustment disorder
67
What's the ICD 10 criteria for PTSD?
A exposure to stressful event
B persistent remembering/reliving
C actual or preferred avoidance of similar situations
D either:
1. inability to recall some important aspects of the period of exposure to the stressor
2. persistent symptoms of increased psychological sensitivity and arousal
E criteria B, C, D all occur within 6 months of stressful event
68
What are the time scales of symptoms coming and going in acute stress reaction?
- symptoms start within 1 hour
| - symptoms diminish within 8 hours (transient stressors) or 48 hours (for continued stressors)
69
Is OCD more common in men or women?
Same in both
70
What are the most common obsessions in OCD?
- contaminated 38%
- fear of harm
- excessive concern with order or symmetry
71
What are the most common compulsions in OCD?
- checking 29%
| - washing/cleaning 27%
72
What features must be present in obsessions or compulsions?
FORD Car
Failure to resist
Originates in patient's mind
Repetitive and Distressing
Carrying out the obsessive thought/compulsive act is not in itself pleasurable
73
What is the OCD cycle?
1. obsession
2. anxiety
3. compulsion
4. relief
74
What questionnaire can be done to assess OCD?
Yale-Brown obsessive-compulsive scale (Y-BOCS)
75
DDx for OCD
- eating disorders
- anankastic PD
- body dysmorphic disorder
- anxiety disorders
- depressive disorder
- hypochondriacal disorder
- schizophrenia
- dementia
- epilepsy
- head injury
76
How do you treat OCD?
1. CBT (including ERP- exposure and response prevention)
2. pharmacological therapy
- SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram
- clomipramine (combined with citalopram in severe cases)
- addition of antipsychotic
77
What's the ratio of men to women who have somatization disorder?
10:1
78
What time frame is required for somatization disorder?
2 years
79
What's required for persistent somatoform pain disorder?
6 months of severe pain
80
What's the ICD-10 criteria for AN?
FEED
Fear of weight gain
Endocrine disturbance resulting in amenorrhoea in females and loss of sexual interest and potency in males
Emaciated (>15% below expected weight or BMI <17.5 kg/m^2
Deliberate weight loss
Distorted body image
```
At least 3 months
ABSENCE of (1) recurrent episodes of binge eating (2) preoccupation with eating/craving to eat
```
81
Features of AN
PPSS
```
Physical (fatigue, hypotheria, bradycardia, arrhythias, peripheral oedema (hypoalbuminaemia), headaches, lanugo hair)
Preoccupation with food
Socially isolated
Sexuality feared
Symptoms of depression and obsession
```
82
Aetiological factors in AN
Predisopsing
- genetics
- FH
- female
- early menarche
- sexual abuse
- preoccupation with slimness
- dieting in adolescence
- low self-esteem
- premorbid anxiety/depression
- anankastic personality
- bullying about weight
- stressful life event
- higher socioeconomic class
Precipitating
- adolescence/puberty
- criticism about eating, body shape or weight
- occupational or recreational pressure to be slim
Perpetuating
- starvation leads to neuroendocrine changes that perpetuate anorexia
- anankastic personality
- occupation
- western society
83
What's the socioeconomic class of BN?
equal in all classes
84
Aetiology of BN
Predisposing
- female sex
- FH or eating disorder, mood disorder or substance misuse
- early onset puberty
- type 1 diabetes
- childhood obesity
- physical or sexual abuse as a child
- childhood bullying
- parental obesity
- pre-morbid mental health disorder
- preoccupation with slimness
- parents with high expectations
- low self esteem
- living in a developed country
- profession (actors/athletes)
Precipitating
- early onset puberty/menarche
- perceived pressure to be thin
- criticism of body weight/shape
- family dieting
Perpetuating
- co-morbid mental health problems
- low self-esteem, perfectionism
- anankastic personality
- environmental stressor
85
What psychiatric conditions are comorbid with BN?
- depression
- anxiety
- self-harm
- substance misuse
- EUPD
86
What's the ICD-10 criteria for BN?
1. Behaviours to prevent weight gain
2. Preoccupation with eating (compulsion and shame)
3. Fear of fatness (including self-perception of being too fat)
4. Overeating at least 2 x per week over a period of 3 months
Bulimia Patients Fear Obesity
87
What is Kleine-Levin syndrome?
Sleep disorder in adolescent males characterized by recurrent episodes of binge eating and hypersomnia
88
What would the ECG changes of a BN patient be?
- prolongation of the PR interval
- flattened or inverted T waves
- prominent U waves after T waves
89
Investigations for AN patient
Blood tests
- FBC (anaemia, thrombocytopenia, leukopenia)
- U and Es (inc urea and creatinine if dehydrated, dec potassium/phosphate/magnesium/chloride)
- TFT (dec T3 and T4)
- LFTs (dec albumin)
- lipids (inc cholesterol)
- cortisol inc
- sex hormones (dec LH, FSH, oestrogens and progestogens)
- glucose dec
- amylase (pancreatitis is a complication)
VBG
- metabolic alkalosis (vomiting)
- metabolic acidosis (laxatives)
Dexa scan (osteoporosis)
ECG
- bradycardia
- prolonged QT
90
Investigations for BN
Blood tests
- FBC
- U and Es
- amylase
- lipids
- glucose
- TFTs
- magnesium/calcium/phosphate
VBG- metabolic alkalosis
ECG
- arrhythmias
- prolongation of PR interval, flattened or inverted T waves, prominent U waves
91
Management for BN
- high dose fluoxeting (60mg) stops frequency of binge eating and purging
- correct electrolyte abnormalities
- CBT-BN
- risk assess for suicide
92
What's the prognosis of BN?
Good- 50% make a complete recovery
93
What's the definition of a learning disability?
IQ below 70 with functional impairments in several areas and a childhood onset
Mild 50-69
Moderate 49-35
Severe <35
94
What proportion of the population have a learning disability and which sex is it more common in?
2% boys:girls 3:2
95
What's the most common cause of learning disability?
1. Downs syndrome (trisomy 21)
| 2. Fragile X syndrome (tri nucleotide repeat)
