General Psychiatry Flashcards
(182 cards)
1
Q
How many people will experience a mental health condition in their lifetime
A
1 in 4
2
Q
What mental health disorders are common after a MI
A
Depression - 20%
PTSD - 15%
3
Q
What mental health disorders are common after a stroke
A
Depression - 25-30%
4
Q
What mental health disorders are common in diabetes
A
Eating disorders
10% of young women with diabetes have one
5
Q
Where are most mental health problems dealt with
A
Primary care deals with 90% of cases
6
Q
What is a functional symptom
A
One without an organic cause
Has mental origin
7
Q
How many women develop post-natal depression
A
Around 10%
8
Q
What childhood experiences are major risk factors for mental illness
A
Childhood abuse and neglect
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
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
11
Q
What is meant by perception in the MSE
A
The patient’s sensory experience
Includes delusion and hallucination
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
13
Q
What is an illusion
A
Illusion is a misperception of a real stimulus
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
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)
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
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
18
Q
What is thought blocking
A
Train of thought/concentration will suddenly stop
Conversation will suddenly stop and they become quiet
19
Q
What is thought insertion
A
When someone believes that thoughts are being put into their head by other people
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
21
Q
What is a persecutory delusion or hallucination
A
One which features other people/things doing harm to the patient
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
23
Q
What are the components of the MSE
A
Appearance and behaviour Speech Mood and Affect Thoughts: control and content Perception Cognition Insight
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
25
What can be included in the behaviour section of the MSE
```
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
```
26
How do you describe speech in the MSE
```
Rate
Amount - if increased it is pressured
- if decreased are they monosyllabic or mute?
Variation in tone
Speech delay or pauses
Volume
```
27
What is a flattened affect
Seem low but still react to sad parts of the conversation
| Seen in depression
28
What is a blunted affect
Not able to show reactivity to either happy or to sad bits of the conversation
Seen in schizophrenia
29
How do you assess cognitive function in the MSE
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
30
What is a second person auditory hallucination
A second person voices which directly address the patient
| 'you'
31
What is a third person auditory hallucination
Voices which discuss the patient or provide a running commentary on their actions
32
What is a thought echo
Type of auditory hallucination
The patient experiences his own thoughts spoken or repeated out loud
Also has that long german name!
33
What are common somatic hallucination
Insects crawling on or under the skin
| Being touched
34
What is involved in thought in the MSE
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
35
What is flight of ideas
Patient will jump between topic but with some vague link such as rhymes, punning or environmental distractions
Words become inappropriately associated
36
What is a neologism
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
37
What is loosening of association
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
38
What is Knight's move thinking
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
39
What is the theme of a delusion
What it is actually about
| Common ones include: disease, guilt, sin, persecution, control, grandiosity
40
What is the purpose of the mental health act
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
41
What are the 5 criteria for detention under the mental health act
(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
42
What common presentations are not considered mental disorders and therefore are not covered by the MHA
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
43
What is SIDMA
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
44
What is the difference between incapacity and SIDMA
SIDMA is purely due to a mental illness
| Incapacity can include physical brain problems or physical disability
45
Can depression be considered SIDMA
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
46
Emergency detention under the MHA allows you to provide treatment - yes or no
NO
| This is only to determine if treatment is required and if so what type - assess patient
47
What is considered a significant risk posed by the patient to themselves
```
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
```
48
What is considered a significant risk posed by the patient to others
```
Aggression
Violence
Sexual assault
Intimidation
Arson
```
49
What is meant by using the least restrictive option
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
50
What does an emergency detention order entitle you to do
Hold them for 72 hrs to assess
Does not authorise treatment
Need to have a likely mental disorder – definite diagnosis isn’t needed
51
Who can issue an emergency detention order
A fully registered doctor - FY2 or above
| A mental health officer should also agree
52
Can an emergency detention order be appealed
No
| Patient or family doesn't have the right to get a lawyer to overturn decision
53
What does a short term detention order allow you to do
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
54
Who can issue a short term detention order
Must be an approved medical practitioner = registrar/consultant psychiatrist
Mental health officer MUST agree
55
Can a patient appeal a short term detention order
Yes
| The patient or their named person can appeal to the tribunal service
56
What does a compulsory treatment order allow you to do
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
57
Who can issue a compulsory treatment order
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
58
A tribunal is mandatory for a compulsory treatment order - true or false
True
| The Tribunal decides whether a CTO is to be granted
59
Under which circumstances can treatment be given to someone under an emergency detention
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
60
What must you do if you provide treatment to someone under emergency detention
Fill out a T4 form explaining why
| Must be done within a week
61
Which treatments are not authorised for use under the short term detention or compulsory treatment order
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
62
What is an advanced statement
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
63
Can an advanced statement be overruled
Yes
64
What is a named person
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
65
What is meant by independent advocacy
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
66
Who forms the panel of a mental health tribunal
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
67
What is the purpose of a mental health tribunal
To decide on compulsory treatment order applications and appeals
68
What powers do nurses have to hold patients
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
69
What powers do the police have to detain someone with a suspected mental health problem
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
70
What is consent
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
71
What makes consent valid
```
Given freely without duress or coercion
Legally capable of consenting
Cover the intervention/procedure
Informed
Enduring - can retain the info
```
72
What is capacity
The ability to make a decision
| Not an all or nothing - a person may have capacity for one decision but not another
73
Who should gain consent from the patient
The doctor who will actually be carrying out the procedure
74
To have capacity, what must a person be able to do?
Understand and retain relevant information
Use and weigh that information to make a decision
Communicate that decision
75
What is covered in the adults with incapacity act
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
What must a person need to know before they can give consent to an intervention
What the intervention is, its nature and purpose and why it is being proposed
Main benefits/risks/alternatives
Consequences of not receiving intervention
77
Capacity should be assumed until proven otherwise - true or false
True
| In the over 16s
78
What does the adults with incapacity act require you to do in order to carry out an intervention
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
What does a AWI section 47 certificate allow you to do
Authorises practitioner to provide reasonable interventions related to the treatment authorised - in physical disorders
Does not authorise force
80
What is a power of attorney
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
What is guardianship
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
If someone lacks capacity due to a mental disorder would you use the MHA or the AWIA to treat the mental disorder
Mental health act
| Gives more protection
83
What are the criteria for using an emergency detention order
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
What are the criteria for a short term detention
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
At what age are children presumed to have capacity
16
| Should still be included in decisions as much as possible before this
86
What would you do if a young person lacks capacity
Ask one parent for consent
| If the parents disagree with each other then seek legal advice
87
Can the MHA be used for children
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
What is the biopsychosocial model
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
What is a diagnosis
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
What is a formulation
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
What are predisposing factors
Areas of vulnerability that increase risk of the presenting issue
Includes genetics, birth circumstances, prenatal exposure to specific substances like alcohol, drug use
92
What are precipitating factors
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
What are perpetuating factors
Any conditions in the patient, family, community, or larger systems that exacerbate rather than solve the problem
Includes relationship conflicts
94
What are protective factors
Protective factors counteract the predisposing, precipitating, and perpetuating factors.
Include patients own areas of competency, skills, talents, interests and supportive elements
95
What is included in a holistic management plan
The medical treatment
Psychological treatment if needed
Occupational support
Environmental help - social skills and network, healthy life choices
96
Do mental health disorders have an impact on lifespan
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
What is mental illness onset often associated with
Periods of stress
| Lack of supportive mechanisms to cope with this
98
Which common mental health conditions can be seen across the ages
Schizophrenia
Depression
Bipolar affective disorder
Personality disorders
99
What increases risk of schizophrenia
High THC cannabis and drug induced psychosis in young people
Increasing rate of dementia and associated psychosis in the elderly
100
When does schizophrenia present
Can be at any age
Early and late onset are rare
Usually in 20s
Reluctance to diagnose in children
101
When does depression usually present
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
When does bipolar affective disorder usually present
Average age is 25
| Rare to be diagnosed by CAMHS
103
What is new onset bipolar in old age associated with
Negative outcomes
Cognitive deficits
Increased suicide risk and mortality
104
When are personality disorders officially diagnosed
Only after the age of 18
105
When do symptoms of personality disorders often present
Peak frequency of symptoms occurs at around 14
| Most people will start to access service around this stage
106
What are some of the early symptoms of a personality disorder
Emotional instability
Struggling with attachment to people
Impulsivity and risk taking
107
What is the most common mental disorder diagnosed in children and adolescents
Disruptive/behavioural disorders
Conduct disorder or oppositional defiant disorder
Usually not treated by mental health services as often not considered a mental illness
108
Conduct disorders in childhood are a predictor of what
Serious anti-social behaviour, criminality and substance misuse in later life
109
How do you manage a conduct/behavioural disorder
Early intervention by parenting/social interventions is key
| Medication is only used in most severe cases
110
when are ASD and ADHD usually diagnosed
In childhood
| Adult services are available for follow up
111
Which sex more commonly gets ASD
Males
4:1 ratio
However this may be due to misdiagnosis of girls
112
At what age is separation anxiety considered normal
Age 7 months through to preschool
113
How is separation anxiety disorder defined
Age inappropriate, excessive and disabling anxiety
| Often leads to school refusal
114
What most commonly causes trauma and attachment disorders in children
Maltreatment and abuse in early childhood
115
How do trauma and attachment disorders present in children
PTSD symptoms - anger and avoidance
Oppositional behaviour
High co-morbidity with other mental illnesses - mood, anxiety, suicide, substance misuse
116
How is medication used to treat mental disorders in children
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
What is usually used to treat mental disorders in children and adolescents
Often CBT
Therapy with parents present
Help from the school
118
What can trigger onset of mental health disorders or relapses in adulthood
```
Lots of stressors in this stage of life
Leaving school, uni
Getting a job
Marriage and children
Financial security
```
119
How does pregnancy and birth affect mental health
Pregnancy is protective for mental illness
| However the puerperium period is very high risk for developing a problem or having a relapse
120
How does puerperal psychosis present
Acute, sudden onset of psychotic symptoms
Mania
Disinhibition
Confusion
121
What are the risk factors for puerperal psychosis
```
Previous mental illness
Previous episode
Thyroid disorders
Family history
Being unmarried
First pregnancy
C-section
Perinatal death
```
122
How common is postnatal depression
1 in 10 women will develop it
| Usually presents 1-4 weeks postpartum
123
What are the risk factors for postnatal depression
```
Personal or family history of depression or anxiety
Complicated pregnancy
Traumatic birth
Relationship difficulties
History of abuse or trauma
Lack of support
```
124
Which mental health conditions are common in the over 65s
Dementia
Delirium
Pseudo-dementia
Late onset depression
125
How common are mental health disorders in the over 65s
25% of the over 65s will be affected by one
126
What is the biggest risk factor for dementia
Age
| With our ageing population, the incidence is rising
127
What characterises delirium
Acute onset and change from baseline
Lasts from hours to weeks
Fluctuates - worse at night
Decreased attention or hyperalert
DIsorientation
128
What is pseudo dementia
When a person presents with memory loss of confusion but has a lack of the actual neurodegeneration
Not progressive and insight is maintained
129
How can you manage pseudo-dementia
Responds to medication and ECT
130
What are the risk factors for late onset depression
Genetic susceptibility
Life events (i.e. loss of spouse)
Social factors (i.e. Loneliness, financial hardship)
Poor physical health (especially vascular disease)
131
What happens if there is damage to Wernicke's area
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
What happens if there is damage to Broca's area
Expressive, non-fluent dysphasia
Struggle to speak fluently but makes sense
Can understand language but have difficulty forming words themselves
133
How are memories formed
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
What is agnosia
Difficulty in recognising objects (some types include faces)
Can be seen in Alzheimer's
135
What causes Alzheimer's
Amyloid plaques form outside cells
Neurofibrillary tangles occur within the cells – protein involved in the microtubules get tangled due to hyperphosphorylation
136
Which NT is reduced in Alzheimer's
ACh
| Therefore, cholinesterase inhibitors can slow the progression but does not reverse the changes or stop them
137
List some acetylcholinesterase inhibitors
Donepezil
Galantamine
Rivastigmine
138
Is someone develops cognitive issues after a stroke, is it considered a type of dementia
Nope
| It is not progressive so not dementia
139
Visual-spacial issues are common in what type of dementia
Lewy-body
| May complain of visual hallucinations
140
What differentiates Lewy body and Parkinson's dementia
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
What are the symptoms of frontotemporal dementia
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
What causes Wernicke's encephalopathy
Due to a thiamine deficiency
Seen in alcoholics who are withdrawing
Also get with poor nutritional status (hyperemesis)
143
What are the symptoms of Wernicke's encephalopathy
Confusion
Ophthalmoplegia
Ataxia
Can also get visual/hearing impairment, reduced conscious level and hypothermia
144
How can you treat Wernicke's encephalopathy
Treat early with thiamine replacement – pabrinex
145
What are the symptoms of delirium
```
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
Describe hyperactive vs hypoactive psychomotor disturbance in delirium
Hyper = agitated, disorientated, hallucination/delusion and sometimes aggressive
Hypo = Confused, sedated, drowsy etc
147
When do symptoms of delirium get worse
At nightime
| Fluctuates throughout the day
148
What can cause delirium
```
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
List risk factors for delirium
```
Age - elderly
Dementia
Existing sensory deficits
Previous deficits
Polypharmacy
Pain
Hypotension
Dehydration
Perioperative
Immobility
Social isolation
New environment
Stress
```
150
What test is the best for delirium
4AT is best for cognitive symptoms
| Need to a range of other tests to find underlying cause
151
How do you treat delirium
Identify and treat the cause
| Manage environment and provide support
152
How do you medically manage delirium due to alcohol withdrawal
Reducing scale of benzodiazepines: commonly Chlordiazepoxide or Diazepam.
153
What medications can you use to treat delirium if conservative isn't helping
Antipsychotics are standard treatment e.g. Haloperidol 1-10mg (0.5mg in elderly).
154
What is declarative memory
Facts and events
155
What is procedural memory
Remembering how to do something
| e.g. ride a bike
156
What is episodic memory
Memories of your own life
| Past events and experiences
157
What is semantic memory
General knowledge
158
What is anterograde amnesia
A difficulty in acquiring new material and remembering events since the onset of the illness or injury.
Can't store new memories
159
What is retrograde amnesia
A difficulty in remembering information prior to the onset of the illness or injury
Forget things that have happened
160
What type of amnesia is seen in dementia
It is typically characterised initially by anterograde amnesia then later by retrograde amnesia
161
What are the differences in course of dementia and depression
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
What does the 4AT test
Alertness (normal/mild sleepiness/clearly abnormal)
AMT-4 (age, DOB, place, current year)
Attention (months backwards)
Acute or fluctuating course
163
What test is used in the diagnosis of dementia
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
What is the strongest predictor of future violent behaviour
Previous violence
165
Where in the MSE would you note that a patient was displaying verbigeration at interview
Speech
| Verbigeration is also known as word salad
166
List common subtypes of dementia
Alzheimer’s Disease, Vascular Dementia and Lewy Body Dementia
167
The prevalence of dementia increases with age - true or false
True
| Rises from 5% over age 65, to 20% of the population aged over 80
168
What must be excluded before making a diagnosis of dementia
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
What differentiates a normal and abnormal response to trauma
The severity and duration of the symptoms
170
List common reactions to trauma
```
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
What factors increase the likelihood of developing PTSD or pathological trauma reaction
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
What are the core symptoms of PTSD
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
How do you manage PTSD
Psychological therapies - CBT and eye movement desensitization and reprocessing
Medication - SSRI, short term sedative for sleep issues
174
Which classification system for psychiatric disorders is most commonly used in the UK
ICD-10 is the preferred system
| ICD-11 will take over at some point
175
What is included in perception in the MSE
Whether the person was experiencing any hallucinations
| e.g. objectively they were responding to non-apparent stimuli
176
What are the types of orders available under the mental health act
Emergency Detention
Short Term Detention
Compulsory Treatment Order.
177
Is a patient's capacity an all or nothing situation
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
How would you de-escalate a violent patient
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
How can you test cognition in clinic etc.
The Addenbrooke’s Cognitive Examination is the most commonly used
Can also use the MOCA which is much quicker
180
List the functions controlled by each area of the brain
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
What is the most common dementing illness seen
Alzheimer's disease
182
Can you test which area of the brain is involved in a cognitive decline
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.
