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Psychiatry > General Psychiatry > Flashcards

General Psychiatry Flashcards

1
Q

How many people will experience a mental health condition in their lifetime

A

1 in 4

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2
Q

What mental health disorders are common after a MI

A

Depression - 20%

PTSD - 15%

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3
Q

What mental health disorders are common after a stroke

A

Depression - 25-30%

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4
Q

What mental health disorders are common in diabetes

A

Eating disorders

10% of young women with diabetes have one

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5
Q

Where are most mental health problems dealt with

A

Primary care deals with 90% of cases

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6
Q

What is a functional symptom

A

One without an organic cause

Has mental origin

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7
Q

How many women develop post-natal depression

A

Around 10%

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8
Q

What childhood experiences are major risk factors for mental illness

A

Childhood abuse and neglect

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9
Q

What is the mental state examination

A

An observational examination carried out by the doctor - take notes of how you observe the patient
It is an objective assessment and technical description
Don’t need to explain your observation

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10
Q

If a patient is reactive what does that mean

A

The respond to normal social and conversational cues

e.g. laughs at jokes and responds to the interviewers

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11
Q

What is meant by perception in the MSE

A

The patient’s sensory experience

Includes delusion and hallucination

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12
Q

What is a hallucination

A

A perception without an external stimulus
Experienced as if it is occurring in real life
Can be in any sensory modality

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13
Q

What is an illusion

A

Illusion is a misperception of a real stimulus

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14
Q

What is meant by mood in the MSE

A

How that person is feeling at that moment in time - subjective
Record it in the patient’s own word
Doesn’t change very quickly

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15
Q

What is meant by affect in the MSE

A

How the person’s emotional state appears to you at that time
Consider the baseline and how it varies throughout (do they react, flat throughout)

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16
Q

What is a passivity experience

A

When a patient thinks something that would usually be under a person’s control such as their thoughts or speech is being controlled by someone else

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17
Q

What is thought broadcasting

A

When someone believes that everyone can see or hear what they are thinking
Other’s can access their thoughts

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18
Q

What is thought blocking

A

Train of thought/concentration will suddenly stop

Conversation will suddenly stop and they become quiet

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19
Q

What is thought insertion

A

When someone believes that thoughts are being put into their head by other people

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20
Q

What is a delusion

A

A false belief held despite evidence to the contrary
The person will believe this firmly - cant be reasoned with
There will be a functional impairment associated with the delusion

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21
Q

What is a persecutory delusion or hallucination

A

One which features other people/things doing harm to the patient

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22
Q

What is insight

A

Insight is a self-awareness in relation to the illness/symptoms and the treatments
If a person is aware that they are ill and that their experiences are symptoms then they have insight
Accepts that they need treatment
Can be present at times then disappear during times of illness - bipolar

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23
Q

What are the components of the MSE

A 
Appearance and behaviour 
Speech 
Mood and Affect
Thoughts: control and content
Perception 
Cognition
Insight
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24
Q

What can be included in appearance in the MSE

A

Age, gender, race
Grooming - are they unkempt
Attire = is it appropriate
Posture
Gait or any odd movements - tics, tremors etc
Evidence of injuries or illness - self-harm, fight injuries, pupil size or track marks (drug use)
Smell

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25
Q

What can be included in the behaviour section of the MSE

A 
Eye contact 
Rapport 
Are they open or guarded 
Are they agitated or very still (little movement or expression) 
Hyper-vigilant or calm  
Disinhibitions or overfamiliarity
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26
Q

How do you describe speech in the MSE

A 
Rate 
Amount - if increased it is pressured
- if decreased are they monosyllabic or mute?
Variation in tone 
Speech delay or pauses 
Volume
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27
Q

What is a flattened affect

A

Seem low but still react to sad parts of the conversation

Seen in depression

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28
Q

What is a blunted affect

A

Not able to show reactivity to either happy or to sad bits of the conversation
Seen in schizophrenia

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29
Q

How do you assess cognitive function in the MSE

A

Are they orientated to time, place and person - ask for date, name and where they are
Concentration - can they go through months of year backwards
Memory

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30
Q

What is a second person auditory hallucination

A

A second person voices which directly address the patient

‘you’

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31
Q

What is a third person auditory hallucination

A

Voices which discuss the patient or provide a running commentary on their actions

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32
Q

What is a thought echo

A

Type of auditory hallucination
The patient experiences his own thoughts spoken or repeated out loud
Also has that long german name!

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33
Q

What are common somatic hallucination

A

Insects crawling on or under the skin

Being touched

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34
Q

What is involved in thought in the MSE

A

Control - do they think someone else is controlling their thoughts
Content - are they having delusions, are their thoughts coherent, are they appropriate to conversation or distracted/preoccupied

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35
Q

What is flight of ideas

A

Patient will jump between topic but with some vague link such as rhymes, punning or environmental distractions
Words become inappropriately associated

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36
Q

What is a neologism

A

The patient makes up a new word or phrase
Or they use an existing word/phrase in a bizarre way
Generally have no accepted meaning

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37
Q

What is loosening of association

A

The patients speech is very muddled, illogical and hard to follow
May jump from topic to topic with no logical connection - Knight’s move thinking

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38
Q

What is Knight’s move thinking

A

When a person jumps from topic to topic suddenly with no logical connection
May be related to a word or phrase in the previous sentence

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39
Q

What is the theme of a delusion

A

What it is actually about

Common ones include: disease, guilt, sin, persecution, control, grandiosity

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40
Q

What is the purpose of the mental health act

A

Protects rights of people with a mental disorder or learning disability
Ensures those with a mental disorder receive effective care and treatment
Overrides an individuals right to self determination for their benefit in certain well defined circumstances

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41
Q

What are the 5 criteria for detention under the mental health act

A

(Likely) mental disorder or learning disability
Significantly Impaired Decision Making Ability
Need to determine treatment and likely treatment available- to actually give treatment other orders must be used
Significant risk to the health, safety or wellbeing of the patient or others
Informal/voluntary care not appropriate

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42
Q

What common presentations are not considered mental disorders and therefore are not covered by the MHA

A

Dependence on drugs and alcohol
Behaviour that causes or is likely to cause harassment or distress (if not caused by a recognised condition)
Acting as no other prudent person would (acting weird)
Sexual deviancy – paedophilia

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43
Q

What is SIDMA

A

Significantly Impaired Decision Making Ability
As a result of a mental disorder the patient is unable to make medical decisions
Affects ability to believe, understand and retain information, to make and communicate decisions

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44
Q

What is the difference between incapacity and SIDMA

A

SIDMA is purely due to a mental illness

Incapacity can include physical brain problems or physical disability

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45
Q

Can depression be considered SIDMA

A

Yes if it is severe enough
If the patient feels hopeless and does not believe treatment will help then you can say that their decision making is impaired

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46
Q

Emergency detention under the MHA allows you to provide treatment - yes or no

A

NO

This is only to determine if treatment is required and if so what type - assess patient

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47
Q

What is considered a significant risk posed by the patient to themselves

A 
Suicide
Self harm
Wandering - seen in dementia 
Vulnerability
Deterioration in mental state
Physical health – starvation, dehydration (EDs)
Poor self care
Retaliation from others due to aggressive behaviour
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48
Q

What is considered a significant risk posed by the patient to others

A 
Aggression
Violence
Sexual assault
Intimidation
Arson
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49
Q

What is meant by using the least restrictive option

A

Try and avoid detaining in hospital if possible
Only use if they refuse to stay in hospital, are incapable of making this decision, are unable to be treated in the community or if community treatment has failed

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50
Q

What does an emergency detention order entitle you to do

A

Hold them for 72 hrs to assess
Does not authorise treatment
Need to have a likely mental disorder – definite diagnosis isn’t needed

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51
Q

Who can issue an emergency detention order

A

A fully registered doctor - FY2 or above

A mental health officer should also agree

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52
Q

Can an emergency detention order be appealed

A

No

Patient or family doesn’t have the right to get a lawyer to overturn decision

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53
Q

What does a short term detention order allow you to do

A

Gives you up to 28 days for assessment and treatment
Treatment is authorised without consent
Can be extended by 3 days if extra time is needed to put together an application for a CTO or 5 days once CTO application submitted

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54
Q

Who can issue a short term detention order

A

Must be an approved medical practitioner = registrar/consultant psychiatrist
Mental health officer MUST agree

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55
Q

Can a patient appeal a short term detention order

A

Yes

The patient or their named person can appeal to the tribunal service

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56
Q

What does a compulsory treatment order allow you to do

A

Initially lasts up to 6 months
Treatment is authorised for up to 2 months of the detention
Can renew it after 6 months to extend stay

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57
Q

Who can issue a compulsory treatment order

A

Approved Medical Practitioner plus Mental Health Officer
Must also have a report from 2 independent doctors, a care plan and a mental health officer report
The mental health officer makes the application

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58
Q

A tribunal is mandatory for a compulsory treatment order - true or false

A

True

The Tribunal decides whether a CTO is to be granted

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59
Q

Under which circumstances can treatment be given to someone under an emergency detention

A

To save the patient’s life
To prevent serious deterioration in the patient’s condition
To alleviate serious suffering
To prevent the patient from being a danger to themselves or others

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60
Q

What must you do if you provide treatment to someone under emergency detention

A

Fill out a T4 form explaining why

Must be done within a week

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61
Q

Which treatments are not authorised for use under the short term detention or compulsory treatment order

A

Electroconvulsive Therapy - can be done in emergency
Nutrition by artificial means
Vagus Nerve Stimulation
Transcranial Magnetic Stimulation
Any medicine given for the purpose of reducing sex drive
Neurosurgery

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62
Q

What is an advanced statement

A

A written statement from the patient that is signed whilst they are well
Witnessed and dated
Tribunal and medical practitioner approve
It states how they would prefer (or prefer not) to be treated if they become ill in the future

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63
Q

Can an advanced statement be overruled

A

Yes

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64
Q

What is a named person

A

When a patient choose someone to protect their interests and support them
Invited to all tribunals and have right to representation, access to all documents
This person can make decisions about care
If under 16 this is a parent/guardian
If over 16 you can choose your person

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65
Q

What is meant by independent advocacy

A

It is an unbiased person who can put the patients opinions across and stands up for their interests - not connected to hospital or other services
Every person with a mental disorder has the right of access to an independent advocate - must be offered

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66
Q

Who forms the panel of a mental health tribunal

A

A psychiatrist, a convenor (solicitor) and a third person with other experience
3rd person is usually either a mental health nurse, social worker or an ex patient

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67
Q

What is the purpose of a mental health tribunal

A

To decide on compulsory treatment order applications and appeals

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68
Q

What powers do nurses have to hold patients

A

A registered mental health nurse or intellectual disability nurse can hold a patient for up to 3 hours
Only if necessary for protection of health, safety or welfare of patient or safety of others

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69
Q

What powers do the police have to detain someone with a suspected mental health problem

A

They are allowed to remove them from a public space to a place of safety - hospital or police cell
Cannot remove someone from their house – this would need a warrant
This is effective for up to 24hrs
Must appear to have a mental disorder and is in need of care and treatment

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70
Q

What is consent

A

When someone gives permission for something to happen
In medicine this must be informed - they must have all the right info to make that choice
Must consider the risks and benefits

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71
Q

What makes consent valid

A 
Given freely without duress or coercion
Legally capable of consenting
Cover the intervention/procedure
Informed
Enduring - can retain the info
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72
Q

What is capacity

A

The ability to make a decision

Not an all or nothing - a person may have capacity for one decision but not another

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73
Q

Who should gain consent from the patient

A

The doctor who will actually be carrying out the procedure

74
Q

To have capacity, what must a person be able to do?

A

Understand and retain relevant information
Use and weigh that information to make a decision
Communicate that decision

75
Q

What is covered in the adults with incapacity act

A

Adults who are unable consent or make decisions
In relation to any particular matter by reason of mental disorder or of inability to communicate because of physical disability

76
Q

What must a person need to know before they can give consent to an intervention

A

What the intervention is, its nature and purpose and why it is being proposed
Main benefits/risks/alternatives
Consequences of not receiving intervention

77
Q

Capacity should be assumed until proven otherwise - true or false

A

True

In the over 16s

78
Q

What does the adults with incapacity act require you to do in order to carry out an intervention

A

Intervention must benefit the adult
Such benefit cannot reasonably be achieved without the intervention
Take account of past and present wishes
Consult with other relevant persons
Encourage the adult to use residual capacity
Need to do anything in your power to help them communicate decisions

79
Q

What does a AWI section 47 certificate allow you to do

A

Authorises practitioner to provide reasonable interventions related to the treatment authorised - in physical disorders
Does not authorise force

80
Q

What is a power of attorney

A

A person appointed by the patient when they still have capacity - in case they lose it in future
Gives them power to act as their continuing welfare or financial attorney

81
Q

What is guardianship

A

Applied for by one or more persons or the local authority
(not the patient)
Done if a person requires someone to make specific decisions on their behalf over the long term
Granted by the sheriff

82
Q

If someone lacks capacity due to a mental disorder would you use the MHA or the AWIA to treat the mental disorder

A

Mental health act

Gives more protection

83
Q

What are the criteria for using an emergency detention order

A

Likely to have a mental disorder
Significantly impaired decision-making ability regarding treatment, due to mental disorder
Detention in hospital is necessary as a matter of urgency to determine what treatment is needed
Risk to health, safety or welfare of the person, or safety of others
Making arrangements for short term detention would involve undesirable delay

84
Q

What are the criteria for a short term detention

A

Likely to have a mental disorder
Significantly impaired decision-making ability regarding treatment, due to mental disorder
Detention in hospital is necessary for assessment or treatment
Risk to health, safety or welfare of the person, or safety of others
Cannot be treated voluntarily

85
Q

At what age are children presumed to have capacity

A

16

Should still be included in decisions as much as possible before this

86
Q

What would you do if a young person lacks capacity

A

Ask one parent for consent

If the parents disagree with each other then seek legal advice

87
Q

Can the MHA be used for children

A

Yes there is no lower age limit and there are more safeguards
It is useful in the following circumstances:
Use of force
Use of intramuscular medication
Certain treatments e.g. nasogastric feeding, ECT
Detrimental impact on relationship with carer

88
Q

What is the biopsychosocial model

A

Health is determined by interaction between biological, physiological and social factors
Allows for a better understanding of the illness and integrates specialties
Enables the development of a comprehensive and holistic care management plan

89
Q

What is a diagnosis

A

The outcome of a clinical history and examination combining the collection of signs and symptoms that then confirms the absence or presence of a health disorder
Just tells you what the patient has
Group of symptoms which classified as a condition - classification

90
Q

What is a formulation

A

Tells you how other aspects of a patient’s life contributed to their illness

  • Biological such as genetics, family history drug use
  • Psychological such as personality,
  • Social circumstances - employment, environment
91
Q

What are predisposing factors

A

Areas of vulnerability that increase risk of the presenting issue
Includes genetics, birth circumstances, prenatal exposure to specific substances like alcohol, drug use

92
Q

What are precipitating factors

A

Stressors or other events that relate to the current symptoms and may have led to their development at this time
Includes trauma, new life events, flashbacks etc

93
Q

What are perpetuating factors

A

Any conditions in the patient, family, community, or larger systems that exacerbate rather than solve the problem
Includes relationship conflicts

94
Q

What are protective factors

A

Protective factors counteract the predisposing, precipitating, and perpetuating factors.
Include patients own areas of competency, skills, talents, interests and supportive elements

95
Q

What is included in a holistic management plan

A

The medical treatment
Psychological treatment if needed
Occupational support
Environmental help - social skills and network, healthy life choices

96
Q

Do mental health disorders have an impact on lifespan

A

Yes
Many disorders have a reduction in average lifespan
Bipolar is 9-20 years less
Schizophrenia is 10-20 less
Suicide is also linked to mental disorders

97
Q

What is mental illness onset often associated with

A

Periods of stress

Lack of supportive mechanisms to cope with this

98
Q

Which common mental health conditions can be seen across the ages

A

Schizophrenia
Depression
Bipolar affective disorder
Personality disorders

99
Q

What increases risk of schizophrenia

A

High THC cannabis and drug induced psychosis in young people
Increasing rate of dementia and associated psychosis in the elderly

100
Q

When does schizophrenia present

A

Can be at any age
Early and late onset are rare
Usually in 20s
Reluctance to diagnose in children

101
Q

When does depression usually present

A

Often have first episode in teens but isn’t picked up
Can be at any age
Often missed in the elderly - loneliness and physical illness are risk factors

102
Q

When does bipolar affective disorder usually present

A

Average age is 25

Rare to be diagnosed by CAMHS

103
Q

What is new onset bipolar in old age associated with

A

Negative outcomes
Cognitive deficits
Increased suicide risk and mortality

104
Q

When are personality disorders officially diagnosed

A

Only after the age of 18

105
Q

When do symptoms of personality disorders often present

A

Peak frequency of symptoms occurs at around 14

Most people will start to access service around this stage

106
Q

What are some of the early symptoms of a personality disorder

A

Emotional instability
Struggling with attachment to people
Impulsivity and risk taking

107
Q

What is the most common mental disorder diagnosed in children and adolescents

A

Disruptive/behavioural disorders
Conduct disorder or oppositional defiant disorder
Usually not treated by mental health services as often not considered a mental illness

108
Q

Conduct disorders in childhood are a predictor of what

A

Serious anti-social behaviour, criminality and substance misuse in later life

109
Q

How do you manage a conduct/behavioural disorder

A

Early intervention by parenting/social interventions is key

Medication is only used in most severe cases

110
Q

when are ASD and ADHD usually diagnosed

A

In childhood

Adult services are available for follow up

111
Q

Which sex more commonly gets ASD

A

Males
4:1 ratio
However this may be due to misdiagnosis of girls

112
Q

At what age is separation anxiety considered normal

A

Age 7 months through to preschool

113
Q

How is separation anxiety disorder defined

A

Age inappropriate, excessive and disabling anxiety

Often leads to school refusal

114
Q

What most commonly causes trauma and attachment disorders in children

A

Maltreatment and abuse in early childhood

115
Q

How do trauma and attachment disorders present in children

A

PTSD symptoms - anger and avoidance
Oppositional behaviour
High co-morbidity with other mental illnesses - mood, anxiety, suicide, substance misuse

116
Q

How is medication used to treat mental disorders in children

A

Not first line
Most medications are unlicensed for under 16s
Children tend to have less predictable medication responses (+/- more side effects
Compliance with medication is less consistent

117
Q

What is usually used to treat mental disorders in children and adolescents

A

Often CBT
Therapy with parents present
Help from the school

118
Q

What can trigger onset of mental health disorders or relapses in adulthood

A 
Lots of stressors in this stage of life 
Leaving school, uni 
Getting a job 
Marriage and children 
Financial security
119
Q

How does pregnancy and birth affect mental health

A

Pregnancy is protective for mental illness

However the puerperium period is very high risk for developing a problem or having a relapse

120
Q

How does puerperal psychosis present

A

Acute, sudden onset of psychotic symptoms
Mania
Disinhibition
Confusion

121
Q

What are the risk factors for puerperal psychosis

A 
Previous mental illness 
Previous episode
Thyroid disorders 
Family history 
Being unmarried 
First pregnancy 
C-section 
Perinatal death
122
Q

How common is postnatal depression

A

1 in 10 women will develop it

Usually presents 1-4 weeks postpartum

123
Q

What are the risk factors for postnatal depression

A 
Personal or family history of depression or anxiety 
Complicated pregnancy 
Traumatic birth 
Relationship difficulties 
History of abuse or trauma 
Lack of support
124
Q

Which mental health conditions are common in the over 65s

A

Dementia
Delirium
Pseudo-dementia
Late onset depression

125
Q

How common are mental health disorders in the over 65s

A

25% of the over 65s will be affected by one

126
Q

What is the biggest risk factor for dementia

A

Age

With our ageing population, the incidence is rising

127
Q

What characterises delirium

A

Acute onset and change from baseline
Lasts from hours to weeks

Fluctuates - worse at night

Decreased attention or hyperalert
DIsorientation

128
Q

What is pseudo dementia

A

When a person presents with memory loss of confusion but has a lack of the actual neurodegeneration
Not progressive and insight is maintained

129
Q

How can you manage pseudo-dementia

A

Responds to medication and ECT

130
Q

What are the risk factors for late onset depression

A

Genetic susceptibility
Life events (i.e. loss of spouse)
Social factors (i.e. Loneliness, financial hardship)
Poor physical health (especially vascular disease)

131
Q

What happens if there is damage to Wernicke’s area

A

Wernicke’s dysphasia- receptive, fluent aphasia
Can speak fluently but it doesn’t make any sense – random words
Get them to do actions in response to questions (e.g. point to things) to determine if they have cognition

132
Q

What happens if there is damage to Broca’s area

A

Expressive, non-fluent dysphasia
Struggle to speak fluently but makes sense
Can understand language but have difficulty forming words themselves

133
Q

How are memories formed

A

Sensory memory is where the body notices these things (see/hear/feel etc)
If you focus on it, it goes into short term memory
If the memory is rehearsed it goes into long term from which it can be retrieved

134
Q

What is agnosia

A

Difficulty in recognising objects (some types include faces)
Can be seen in Alzheimer’s

135
Q

What causes Alzheimer’s

A

Amyloid plaques form outside cells
Neurofibrillary tangles occur within the cells – protein involved in the microtubules get tangled due to hyperphosphorylation

136
Q

Which NT is reduced in Alzheimer’s

A

ACh

Therefore, cholinesterase inhibitors can slow the progression but does not reverse the changes or stop them

137
Q

List some acetylcholinesterase inhibitors

A

Donepezil
Galantamine
Rivastigmine

138
Q

Is someone develops cognitive issues after a stroke, is it considered a type of dementia

A

Nope

It is not progressive so not dementia

139
Q

Visual-spacial issues are common in what type of dementia

A

Lewy-body

May complain of visual hallucinations

140
Q

What differentiates Lewy body and Parkinson’s dementia

A

Parkinson’s will start a year before the dementia in Parkinson’s dementia

In Lewy body the Parkinsonism begins at the same time or just after

141
Q

What are the symptoms of frontotemporal dementia

A

Loss of social awareness and impulse control
Personality and behavioural changes
Difficulty with expressive speech – Broca’s
Semantic dementia – loss of appreciation of facts and understanding words

142
Q

What causes Wernicke’s encephalopathy

A

Due to a thiamine deficiency
Seen in alcoholics who are withdrawing
Also get with poor nutritional status (hyperemesis)

143
Q

What are the symptoms of Wernicke’s encephalopathy

A

Confusion
Ophthalmoplegia
Ataxia

Can also get visual/hearing impairment, reduced conscious level and hypothermia

144
Q

How can you treat Wernicke’s encephalopathy

A

Treat early with thiamine replacement – pabrinex

145
Q

What are the symptoms of delirium

A 
Impairment of consciousness – drowsiness, coma etc 
Disturbance of cognition 
Hallucination and delusion
Disorientation  
Psychomotor disturbance 
Disturbance of sleep-wake cycle
Emotional disturbance
Huge variety of presentations
146
Q

Describe hyperactive vs hypoactive psychomotor disturbance in delirium

A

Hyper = agitated, disorientated, hallucination/delusion and sometimes aggressive

Hypo = Confused, sedated, drowsy etc

147
Q

When do symptoms of delirium get worse

A

At nightime

Fluctuates throughout the day

148
Q

What can cause delirium

A 
Infection 
GU - UTI or renal failure 
Intoxication 
Trauma - inc. post-op 
CV - MI, PE, heart failure etc 
Hypoxia 
Liver failure 
Complication of diabetes 
Neurological disorder

Basically neurological disruption due to physical insult to the brain

149
Q

List risk factors for delirium

A 
Age - elderly 
Dementia 
Existing sensory deficits 
Previous deficits 
Polypharmacy 
Pain 
Hypotension 
Dehydration 
Perioperative 
Immobility 
Social isolation 
New environment 
Stress
150
Q

What test is the best for delirium

A

4AT is best for cognitive symptoms

Need to a range of other tests to find underlying cause

151
Q

How do you treat delirium

A

Identify and treat the cause

Manage environment and provide support

152
Q

How do you medically manage delirium due to alcohol withdrawal

A

Reducing scale of benzodiazepines: commonly Chlordiazepoxide or Diazepam.

153
Q

What medications can you use to treat delirium if conservative isn’t helping

A

Antipsychotics are standard treatment e.g. Haloperidol 1-10mg (0.5mg in elderly).

154
Q

What is declarative memory

A

Facts and events

155
Q

What is procedural memory

A

Remembering how to do something

e.g. ride a bike

156
Q

What is episodic memory

A

Memories of your own life

Past events and experiences

157
Q

What is semantic memory

A

General knowledge

158
Q

What is anterograde amnesia

A

A difficulty in acquiring new material and remembering events since the onset of the illness or injury.
Can’t store new memories

159
Q

What is retrograde amnesia

A

A difficulty in remembering information prior to the onset of the illness or injury
Forget things that have happened

160
Q

What type of amnesia is seen in dementia

A

It is typically characterised initially by anterograde amnesia then later by retrograde amnesia

161
Q

What are the differences in course of dementia and depression

A

Dementia - onset is insidious over months/years and has a progressive decline

Depression has a gradual onset but takes weeks/months and has diurnal pattern
Memory is intact but concentration poor

162
Q

What does the 4AT test

A

Alertness (normal/mild sleepiness/clearly abnormal)
AMT-4 (age, DOB, place, current year)
Attention (months backwards)
Acute or fluctuating course

163
Q

What test is used in the diagnosis of dementia

A

Mini Mental State Examination (MMSE)
A screening test
Scored out of 30
Score <24 supports a diagnosis of dementia

Addenbrookes can be used as a further test

164
Q

What is the strongest predictor of future violent behaviour

A

Previous violence

165
Q

Where in the MSE would you note that a patient was displaying verbigeration at interview

A

Speech

Verbigeration is also known as word salad

166
Q

List common subtypes of dementia

A

Alzheimer’s Disease, Vascular Dementia and Lewy Body Dementia

167
Q

The prevalence of dementia increases with age - true or false

A

True

Rises from 5% over age 65, to 20% of the population aged over 80

168
Q

What must be excluded before making a diagnosis of dementia

A

Potentially treatable major physical illness causing delirium or those which in themselves may cause cognitive slowing such as hypothyroidism
May do routine bloods etc.

169
Q

What differentiates a normal and abnormal response to trauma

A

The severity and duration of the symptoms

170
Q

List common reactions to trauma

A 
Numbness, shock and denial
Fear
Depression or elation
Anger. Irritability
Guilt
Impaired sleep
Hopelessness and helplessness
Cognitive and perceptual changes
Avoidance
Intrusive experiences (flashbacks)
Hyperarousal and hypervigilance (being constantly aware of what is happening around you)
171
Q

What factors increase the likelihood of developing PTSD or pathological trauma reaction

A

Relating to the incident: man-made; prolonged exposure; high level of perceived threat, and proximity

Relating to the individual: past history of psychiatric problems; past experience of trauma; profound sense of hopelessness or powerlessness, and behavioural problems before the age of 15 years

Relating to the environment: lack of a support network; ongoing life stress; reaction of others and, lack of economic resources

172
Q

What are the core symptoms of PTSD

A

Intrusive Phenomena - flashbacks, nightmares, fight or flight reactions

Avoidant and emotional numbing symptoms - avoiding talking or thinking about event, reminders, gaps in memory, emotional numbing etc

Hyperarousal symptoms - sleep disturbance, irritability/abger, hypervigilance

Associated symptoms - survivor guilt, disassociation

173
Q

How do you manage PTSD

A

Psychological therapies - CBT and eye movement desensitization and reprocessing
Medication - SSRI, short term sedative for sleep issues

174
Q

Which classification system for psychiatric disorders is most commonly used in the UK

A

ICD-10 is the preferred system

ICD-11 will take over at some point

175
Q

What is included in perception in the MSE

A

Whether the person was experiencing any hallucinations

e.g. objectively they were responding to non-apparent stimuli

176
Q

What are the types of orders available under the mental health act

A

Emergency Detention
Short Term Detention
Compulsory Treatment Order.

177
Q

Is a patient’s capacity an all or nothing situation

A

No
A patient may have capacity to decide about
some aspects of their care, but not others.
Capacity may also change over time (may be lost, or regained) and
requires an ongoing process of review

178
Q

How would you de-escalate a violent patient

A

Nurses are fully trained in how to restrain patients in a safe way using arm and
leg holds
They then talk to the patient about what is going on and help them to calm
down and defuse their emotions.
Patients may be offered oral medication to help them become settled.
If this approach is unsuccessful they are also allowed tp give injectable medication as part of the rapid tranquilization policy (often haloperidol or lorazepam).

179
Q

How can you test cognition in clinic etc.

A

The Addenbrooke’s Cognitive Examination is the most commonly used
Can also use the MOCA which is much quicker

180
Q

List the functions controlled by each area of the brain

A

Frontal Lobe - executive function, planning, sequencing, impulse inhibition, personality, motor cortex

Temporal Lobe - memory, speech, comprehension

Parietal Lobe - visuospatial, map reading, dressing, numeracy, reading

Occipital Lobe - vision

181
Q

What is the most common dementing illness seen

A

Alzheimer’s disease

182
Q

Can you test which area of the brain is involved in a cognitive decline

A

Yes!
There are a range of additional tests usually performed by a clinical neuropsychologist
Frontal lobe testing is the most common, particularly when screening for frontotemporal dementia.

Psychiatry (14 decks)

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