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Y5 Psych > Intro to Psych > Flashcards

Intro to Psych Flashcards

1
Q

2 manuals used to diagnose and classify in psych

A

ICD10 and DSM V

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2
Q

Which manual is used in Europe

A

ICD10

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3
Q

Differences between DSM V and ICD 10

A

ICD10 focuses more on clinical use and is more descriptive not operational
DSM V has profusion on diagnoses and has operational criteria

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4
Q

Define mental disorder

A

Clinically recognisable set of symptoms or behaviours associated with distress and with interference with personal functions

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5
Q

What are the five axis in multiaxial diagnosis

A

1 = clinical disorder
2 = personality disorder or mental retardation
3 = medical or physical conditions
4 = contributing environmental or psychosocial factors
5 = global assessment of functioning

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6
Q

Is the multiaxial diagnosis still in use

A

No, DSM V removed it but it’s still useful (was in DSM IV)

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7
Q

List features of the biopsychosocial models

A

Biological, psychological, social
Predisposing, precipitating and perpetuating features

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8
Q

Describe the psych patient journey

A

Mild mental illness would go to GP - managed by GP/counselling
Moderate to severe illness who can engage and are a manageable risk would go to hospital/picked up by police - managed by GP/community mental health services/secondary care
Severe illness with significant risk would be picked up by social services - managed in ‘ward in the community’ or at home treatment / psychiatric ward (voluntary or sectioned)

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9
Q

List the 2 types of affective disorders

A

Bipolar and depression

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10
Q

List OCD related disorders

A

OCD
body dysmorphia
Hoarding
Hyperchondriasis

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11
Q

Define anxiety

A

Constellation of psychological and physiological response to potential or uncertain threat

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12
Q

What is the purpose of anxiety

A

Exists to automatically motivate us to avoid harm

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13
Q

What is state anxiety

A

The state of feeling anxious, which can be helpful in daily life

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14
Q

What is trait anxiety

A

The propensity of an individual to experience state anxiety in response to any event

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15
Q

Benefits of higher trait anxiety

A

Slightly higher life expectancy - lower chance of dying under 25

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16
Q

Causes of higher trait anxiety

A

Environmental - constant threat, insecurity
Genetic - polymorphisms of serotonergic / noradrenergic function

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17
Q

How does avoidance affect state anxiety

A

Perpetuates the conditioned fear

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18
Q

Symptoms of depression

A

Low energy
Low mood
Anhedonia

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19
Q

What is anhedonia

A

Incapacity to experience positive emotions in things that usually make you happy

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20
Q

How do depressogenic stressors cause symptoms of depression

A

Prolonged stress causes recuperative response which overwhelms homeostasis
Also decrease self worth

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21
Q

What is cognitive bias

A

Finding evidence that supports your view only

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22
Q

What features are needed to perpetuate addiction

A

State of distress
Distress reducing behaviour eg substances / self harm / disordered eating
Temporary relief from the stress due to the behaviour
Negative reinforcement causes an urge

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23
Q

What is positive reinforcement

A

When you feel okay and then something makes you feel better

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24
Q

What is negative reinforcement

A

When you’re in a state of distress, then something makes you feel temporarily better

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25
Q

What does repeated negative reinforcement cause

A

Repetition —> habit formation —> compulsion

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26
Q

Why can’t someone choose to stop the behaviour in addiction

A

Habit formation erodes control to stop the behaviour

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27
Q

Causes of psychosis

A

Schizophrenia
Schizoaffective disorder
Depression
Other psychotic disorders

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28
Q

Two main symptoms of psychosis

A

Hallucinations (usually auditory) and delusions

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29
Q

Define psychosis

A

Group of pathologies that disrupt the process of perceiving and interpreting reality

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30
Q

How is psychosis different from delirium

A

Psychosis can make sense of what you’re saying and aren’t drowsy / less responsive. They just have a shifted sense of what is real

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31
Q

Genetic predisposition of psychosis

A

80% heritability
High risk if you have a first degree relative with psychosis
Genes must confer significant advantage

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32
Q

Prevalence of psychosis

A

1/100

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33
Q

What is depression

A

Persistent low mood or loss of interest

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34
Q

Symptom of depression

A

Irritability, sadness, tearfulness, anhedonia

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35
Q

What are the 5 biological symptoms

A

Sleep, appetite, energy, concentration and libido

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36
Q

Other features of depression

A

Negative thoughts, suicidal intent

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37
Q

What is mania

A

Persistent elevation in mood, can be a mix of elation and irritability

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38
Q

Symptoms of mania

A

Increased self confidence and sense of well-being
Increased appetite, libido, energy, concentration
Over familiar and inappropriate behaviour
Psychosis
Reduced need for sleep, quickened speech and thoughts

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39
Q

Symptoms of anxiety

A

Restlessness, tremor, dry mouth, butterflies, nausea, shortness of breath, palpitations
Excessive worries

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40
Q

4 anxiety disorders

A

Generalised anxiety
Phobias
Social phobia
Panic disorders

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41
Q

What is OCD

A

Obsessional thoughts are unpleasant, unwanted, intrusive thoughts entering the mind despite attempts to resist them - images, impulses or doubts
They are the patients own thoughts

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42
Q

Themes of OCD

A

Contamination, sexual themes, religious, not closing windows/doors, impulse to do something dangerous

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43
Q

In OCD, is the patient aware that their thoughts are their own and that they are irrational?

A

Yes and yes

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44
Q

What are compulsions

A

Repetitive, stereotypical rituals
Can be physical or mental eg counting
May have to be done a certain number of times

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45
Q

What is overvalued ideas

A

A reasonable belief that is pursued excessively, dominates the persons life and causes distress to self / others

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46
Q

Give an example of overvalued ideas

A

Anorexia nervosa

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47
Q

What is psychosis

A

Experience of losing touch with reality through delusions, hallucinations and or formal thought disorder

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48
Q

Give an example of psychosis

A

Schizophrenia

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49
Q

Subtypes of schizophrenia

A

Paranoid, catatonic, Simple’s, hebephrenic and residual

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50
Q

Other types of psychosis

A

Acute / transient psychosis
Schizoaffective disorder
Delusional disorder

51
Q

What are delusions

A

Fixed, false beliefs, held despite rational argument or evidence to the contrary. Out of keeping with the persons cultural / social background

52
Q

What are the types of delusions

A

Primary = occur out the blue
Secondary = develop after another symptoms eg hearing a voice, smelling gas

Persecutory, grandiose, nihilistic, hypochondriacal, guilt, reference, erotomania, interference

53
Q

What is a perception

A

Awareness of stimulus through your senses

54
Q

What is an illusion

A

Misperception of stimulus

55
Q

What is a hallucination

A

Perception in the absence of stimulus

56
Q

Types of hallucinations

A

Auditory, visual, gustatory, tactile, olfactory

57
Q

What are schneiders first rank symptoms of schizophrenia

A

Delusional perception
Thought interference - thought insertion, thought withdrawal, thought broadcasting
Auditory hallucinations
Passivity phenomena

58
Q

What is delusional perception

A

See something ordinary and it triggers delusional belief

59
Q

What is Thought interference

A

Delusional belief that someone is interfering with your thoughts

60
Q

What is thought insertion

A

An alien thought is put in your mind that is not your own

61
Q

What’s thought withdrawal

A

Thoughts are being removed from your mind, suddenly gone

62
Q

What is thought broadcasting

A

The public can hear or know your thoughts or they’re put on billboards / notices etc

63
Q

Type of auditory hallucinations typical of psychosis

A

Third person voices talking about the patient

64
Q

Other types of auditory hallucinations

A

Third person running commentary
Thought echo
Third person voices talking about the patient

65
Q

What is passivity phenomena

A

Someone is controlling your movements emotions or impulses

66
Q

Sections of psychiatric Hx

A

PC, HPC
Past psychiatric history and medical history
Drug and family history
Personal history
Substance misuse
Forensic history
Social history
Premorbid personality

67
Q

When you present the patient, what do you start with

A

Patient - age, sex, single/married, occupation
Setting - how did they come in, who came with them, police involved
On the ward - check if they’re voluntary or sectioned

68
Q

What is constituted in PC

A

Depends on setting
Outpatient - patients issues
Ward - reason for admittance
A&E - why they have come, corroborated by whoever bought them
Always take patients view in their own words, then add anything else other people have said

69
Q

HPC Qs

A

How long has it been going on for
The build up to an event
Explore different symptoms
Run through MSE

70
Q

What is in the past psychiatric history

A

Any previous diagnoses
Previous Tx in primary or secondary care
Admissions, whether sectioned or not
Any psychiatric medications and doses etc

71
Q

Medical conditions with psychiatric symptoms

A

Thyroid disease, MS, post MI, diabetes
Secondary to drugs eg steroids, beta blockers
Chronic pain

72
Q

What medical conditions can be impacted by psychiatric drugs

A

DM - antipsychotics can cause raised glucose

73
Q

What important Q must you ask with medication

A

Compliance - are they actually taking what they were prescribed

74
Q

FHx questions

A

Name, age, occupation of parents, siblings
Relationship with family members
Any medical / psychiatric conditions in the family

75
Q

What Qs are involved in a personal history

A

Ask the patient to take you through their life story
Pregnancy / birth
Developmental milestones
Home life during childhood - trauma
Academic ability / friends / bullying / behaviour problems
Jobs - types, reasons for leaving, relationships with colleagues
Relationships, children - details about any children

76
Q

Substance misuse Qs

A

Smoking, alcoholic, recreational drugs
Don’t make assumptions
Age of starting, pattern of use, harmful use ie problems caused
Look for dependence / medical complications

77
Q

Qs in forensic history

A

Any trouble with police
Arrested / convicted / charged
History of crime without getting into trouble
Think about any temporal links to mental illness

78
Q

What is meant by premorbid personality

A

What were you like before you become Ill
How would your friends and family describe you

79
Q

Where can you get collateral information from

A

Ambulance, police, friends, family

80
Q

Do you need consent to talk to their relative

A

Yes to share information about them with other people
But not to just listen to a family members concerns

81
Q

What is involved in the mental state examination

A

Appearance and behaviour
Speech and thought form
Mood
Thought content
Perception
Cognition
Insight

82
Q

What do you assess in appearance and behaviour

A

Age, gender, build
Level of self care, clothing
Scars, piercings, tattoos
Facial expression, posture
Eye contact
Engagement
Level of activity
Odd movements

83
Q

How would you describe an emotion not suitable for the situation

A

Incongruent

84
Q

What do you comment on with speech

A

Rate
Volume
Tone - calm, hostile, sarcastic
Flow - spontaneous, hesitant, uninterruptible

85
Q

What is formal though disorder

A

Where speech is disturbed as a reflection of disordered thought
Thoughts can become muddled, vague, disorganised, disjointed
Poverty of thought or racing thoughts
Sudden break in speech
Too much information but still makes sense
Can have derailment and word salad - random words

86
Q

What is flight of ideas

A

Too many thoughts which are linked
Can involve using the same word in multiple contexts, or rhyming

87
Q

What does formal thought disorder suggest?

A

Schizophrenia

88
Q

What is commented on in mood

A

Depressed with negative cognitions and biological sx of depression
Elated mood with increased sense of well-being and biological sx of mania
If they’ve not come with depression specifically, then look for it

89
Q

List depression questions

A

How have you been feeling
Are you enjoying things are normal
Has your sleep been okay
How is your appetite
How are your energy levels
Can you concentrate as normal
How do you feel about yourself
What are your plans for your future

90
Q

Questions on suicide attempt / self harm

A

Get as much detail as possible
What happened during event - details!
What did the patient think would happen
How do they feel now

91
Q

What is nihilistic delusion?

A

Belief that things are dead that aren’t

92
Q

What 2 things do you need to comment on in mood?

A

Subjective and objective mood and whether it’s congruent
(Their perception and your impression)

93
Q

What types of thought content do you comment on

A

Depressive, anxious, obsessional, overvalued ideas, delusions

94
Q

What constitutes full insight

A

They are aware something is wrong
They know the problem is mental health
They know they require treatment

95
Q

Do patients often have full insight?

A

No, usually partial insight, eg knowing something is wrong but they think it’s their neighbours fault or that they think theres nothing wrong but will take medication anyway

96
Q

What is the difference between psychology and psychiatry?

A

Psychologist do not have a general medical background, they are purely specialised in psychology
Psychiatrists prescribe, psychologists do not
Psychologists are based around talking therapy

97
Q

Under what section of MHA can someone be detained?

A

2 or 3

98
Q

What is an informal admission?

A

Voluntary admission to psych ward as the person has capacity and is willing to go

99
Q

Can someone on informal admission leave the pscyh ward at will?

A

YES (in theory) - they have capacity to consent to admission so can leave. But sometimes in ward they have deprivation of liberty so can’t

100
Q

Who has the final say on whether someone is detained?

A

AMPH - approved mental health professional

101
Q

Who is involved in the MHA assessment?

A

AMPH
2 doctors - one of which knows the patients, write recommendations
The nearest relative

102
Q

Difference between S2 and S3 of MHA

A
  • S2 = assessment +/- Tx - 28days
  • S3 = Tx - 6 months
103
Q

Criteria for detention under MHA

A
  • suffering from mental disorder (not substance use)
  • of a nature / degree to warrant admission to hospital
  • admission is needed to protect health / safety of patient and others
  • S2 = assessment +/- Tx - 28days
  • S3 = Tx - 6 months
  • Must have considered alternatives
104
Q

What is section 5(2)?

A

Doctor’s holding power
- used to temporarily detain patient who is trying to leave
- can only be used on inpatients NOT A&E

105
Q

how long does section 5(2) last?

A

72 hours

106
Q

Purpose of section 5(2)?

A

Trigger for MHA assessment (MHAA) - allowing time for this

107
Q

What 3 criteria must be met to legally use section 5(2)?

A
  • Approved clinician (consultant) or their deputy (99% of the time, its their deputy)
  • Must have a full licence (ie not F1, only F2 or above)
  • Has to be the team looking after the patient, not the psych team
108
Q

What is not included in 5(2)?

A

Authorisation for treatment

109
Q

Process of using 5(2)

A

Personally examined the patient
State why informal admission is no longer appropriate, what you think is causing Sx and the acute risks
Sign & date it
Given to nurse in charge / hospital managers
Triggers a MHAA

110
Q

Length of section 2

A

up to 28 days

111
Q

purpose of section 2

A

assessment through MHAA

112
Q

length of section 3

A

up to 6 months

113
Q

purpose of section 3

A

treatment through MHA

114
Q

length of section 5(4)

A

up to 6 hours

115
Q

purpose of section 5(4)

A

urgent detention on a non ward

116
Q

who does a section 5(4)

A

NURSE ONLY - no need for Dr

117
Q

length of section 5(2)

A

up to 72 hours

118
Q

purpose of section 5(2)

A

urgent detention on a ward

119
Q

who does a section 5(2)

A

1 doctor in charge

120
Q

what is section 136 & who does it

A

emergency power that POLICE have to remove suspected mentally ill person from a public place to a place of safety for further assessment

121
Q

How long does section 136 last

A

24 hours

122
Q

when can section 136 not be used

A

if the person is NOT in a public place

123
Q

what is section 135

A

similar to section 136 but involves private property not public places

124
Q

what is a community treatment order (CTO)

A

an order for supervised treatment in the community, and rapid recall if conditions not met

Y5 Psych (10 decks)

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