Intro to Psych Flashcards
1
Q
2 manuals used to diagnose and classify in psych
A
ICD10 and DSM V
2
Q
Which manual is used in Europe
A
ICD10
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
4
Q
Define mental disorder
A
Clinically recognisable set of symptoms or behaviours associated with distress and with interference with personal functions
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
6
Q
Is the multiaxial diagnosis still in use
A
No, DSM V removed it but it’s still useful (was in DSM IV)
7
Q
List features of the biopsychosocial models
A
Biological, psychological, social
Predisposing, precipitating and perpetuating features
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)
9
Q
List the 2 types of affective disorders
A
Bipolar and depression
10
Q
List OCD related disorders
A
OCD
body dysmorphia
Hoarding
Hyperchondriasis
11
Q
Define anxiety
A
Constellation of psychological and physiological response to potential or uncertain threat
12
Q
What is the purpose of anxiety
A
Exists to automatically motivate us to avoid harm
13
Q
What is state anxiety
A
The state of feeling anxious, which can be helpful in daily life
14
Q
What is trait anxiety
A
The propensity of an individual to experience state anxiety in response to any event
15
Q
Benefits of higher trait anxiety
A
Slightly higher life expectancy - lower chance of dying under 25
16
Q
Causes of higher trait anxiety
A
Environmental - constant threat, insecurity
Genetic - polymorphisms of serotonergic / noradrenergic function
17
Q
How does avoidance affect state anxiety
A
Perpetuates the conditioned fear
18
Q
Symptoms of depression
A
Low energy
Low mood
Anhedonia
19
Q
What is anhedonia
A
Incapacity to experience positive emotions in things that usually make you happy
20
Q
How do depressogenic stressors cause symptoms of depression
A
Prolonged stress causes recuperative response which overwhelms homeostasis
Also decrease self worth
21
Q
What is cognitive bias
A
Finding evidence that supports your view only
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
23
Q
What is positive reinforcement
A
When you feel okay and then something makes you feel better
24
Q
What is negative reinforcement
A
When you’re in a state of distress, then something makes you feel temporarily better
25
What does repeated negative reinforcement cause
Repetition —> habit formation —> compulsion
26
Why can’t someone choose to stop the behaviour in addiction
Habit formation erodes control to stop the behaviour
27
Causes of psychosis
Schizophrenia
Schizoaffective disorder
Depression
Other psychotic disorders
28
Two main symptoms of psychosis
Hallucinations (usually auditory) and delusions
29
Define psychosis
Group of pathologies that disrupt the process of perceiving and interpreting reality
30
How is psychosis different from delirium
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
31
Genetic predisposition of psychosis
80% heritability
High risk if you have a first degree relative with psychosis
Genes must confer significant advantage
32
Prevalence of psychosis
1/100
33
What is depression
Persistent low mood or loss of interest
34
Symptom of depression
Irritability, sadness, tearfulness, anhedonia
35
What are the 5 biological symptoms
Sleep, appetite, energy, concentration and libido
36
Other features of depression
Negative thoughts, suicidal intent
37
What is mania
Persistent elevation in mood, can be a mix of elation and irritability
38
Symptoms of mania
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
39
Symptoms of anxiety
Restlessness, tremor, dry mouth, butterflies, nausea, shortness of breath, palpitations
Excessive worries
40
4 anxiety disorders
Generalised anxiety
Phobias
Social phobia
Panic disorders
41
What is OCD
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
42
Themes of OCD
Contamination, sexual themes, religious, not closing windows/doors, impulse to do something dangerous
43
In OCD, is the patient aware that their thoughts are their own and that they are irrational?
Yes and yes
44
What are compulsions
Repetitive, stereotypical rituals
Can be physical or mental eg counting
May have to be done a certain number of times
45
What is overvalued ideas
A reasonable belief that is pursued excessively, dominates the persons life and causes distress to self / others
46
Give an example of overvalued ideas
Anorexia nervosa
47
What is psychosis
Experience of losing touch with reality through delusions, hallucinations and or formal thought disorder
48
Give an example of psychosis
Schizophrenia
49
Subtypes of schizophrenia
Paranoid, catatonic, Simple’s, hebephrenic and residual
50
Other types of psychosis
Acute / transient psychosis
Schizoaffective disorder
Delusional disorder
51
What are delusions
Fixed, false beliefs, held despite rational argument or evidence to the contrary. Out of keeping with the persons cultural / social background
52
What are the types of delusions
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
What is a perception
Awareness of stimulus through your senses
54
What is an illusion
Misperception of stimulus
55
What is a hallucination
Perception in the absence of stimulus
56
Types of hallucinations
Auditory, visual, gustatory, tactile, olfactory
57
What are schneiders first rank symptoms of schizophrenia
Delusional perception
Thought interference - thought insertion, thought withdrawal, thought broadcasting
Auditory hallucinations
Passivity phenomena
58
What is delusional perception
See something ordinary and it triggers delusional belief
59
What is Thought interference
Delusional belief that someone is interfering with your thoughts
60
What is thought insertion
An alien thought is put in your mind that is not your own
61
What’s thought withdrawal
Thoughts are being removed from your mind, suddenly gone
62
What is thought broadcasting
The public can hear or know your thoughts or they’re put on billboards / notices etc
63
Type of auditory hallucinations typical of psychosis
Third person voices talking about the patient
64
Other types of auditory hallucinations
Third person running commentary
Thought echo
Third person voices talking about the patient
65
What is passivity phenomena
Someone is controlling your movements emotions or impulses
66
Sections of psychiatric Hx
PC, HPC
Past psychiatric history and medical history
Drug and family history
Personal history
Substance misuse
Forensic history
Social history
Premorbid personality
67
When you present the patient, what do you start with
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
What is constituted in PC
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
HPC Qs
How long has it been going on for
The build up to an event
Explore different symptoms
Run through MSE
70
What is in the past psychiatric history
Any previous diagnoses
Previous Tx in primary or secondary care
Admissions, whether sectioned or not
Any psychiatric medications and doses etc
71
Medical conditions with psychiatric symptoms
Thyroid disease, MS, post MI, diabetes
Secondary to drugs eg steroids, beta blockers
Chronic pain
72
What medical conditions can be impacted by psychiatric drugs
DM - antipsychotics can cause raised glucose
73
What important Q must you ask with medication
Compliance - are they actually taking what they were prescribed
74
FHx questions
Name, age, occupation of parents, siblings
Relationship with family members
Any medical / psychiatric conditions in the family
75
What Qs are involved in a personal history
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
Substance misuse Qs
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
Qs in forensic history
Any trouble with police
Arrested / convicted / charged
History of crime without getting into trouble
Think about any temporal links to mental illness
78
What is meant by premorbid personality
What were you like before you become Ill
How would your friends and family describe you
79
Where can you get collateral information from
Ambulance, police, friends, family
80
Do you need consent to talk to their relative
Yes to share information about them with other people
But not to just listen to a family members concerns
81
What is involved in the mental state examination
Appearance and behaviour
Speech and thought form
Mood
Thought content
Perception
Cognition
Insight
82
What do you assess in appearance and behaviour
Age, gender, build
Level of self care, clothing
Scars, piercings, tattoos
Facial expression, posture
Eye contact
Engagement
Level of activity
Odd movements
83
How would you describe an emotion not suitable for the situation
Incongruent
84
What do you comment on with speech
Rate
Volume
Tone - calm, hostile, sarcastic
Flow - spontaneous, hesitant, uninterruptible
85
What is formal though disorder
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
What is flight of ideas
Too many thoughts which are linked
Can involve using the same word in multiple contexts, or rhyming
87
What does formal thought disorder suggest?
Schizophrenia
88
What is commented on in mood
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
List depression questions
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
Questions on suicide attempt / self harm
Get as much detail as possible
What happened during event - details!
What did the patient think would happen
How do they feel now
91
What is nihilistic delusion?
Belief that things are dead that aren’t
92
What 2 things do you need to comment on in mood?
Subjective and objective mood and whether it’s congruent
(Their perception and your impression)
93
What types of thought content do you comment on
Depressive, anxious, obsessional, overvalued ideas, delusions
94
What constitutes full insight
They are aware something is wrong
They know the problem is mental health
They know they require treatment
95
Do patients often have full insight?
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
What is the difference between psychology and psychiatry?
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
Under what section of MHA can someone be detained?
2 or 3
98
What is an informal admission?
Voluntary admission to psych ward as the person has capacity and is willing to go
99
Can someone on informal admission leave the pscyh ward at will?
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
Who has the final say on whether someone is detained?
AMPH - approved mental health professional
101
Who is involved in the MHA assessment?
AMPH
2 doctors - one of which knows the patients, write recommendations
The nearest relative
102
Difference between S2 and S3 of MHA
- S2 = assessment +/- Tx - 28days
- S3 = Tx - 6 months
103
Criteria for detention under MHA
- 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
What is section 5(2)?
Doctor's holding power
- used to temporarily detain patient who is trying to leave
- can only be used on inpatients NOT A&E
105
how long does section 5(2) last?
72 hours
106
Purpose of section 5(2)?
Trigger for MHA assessment (MHAA) - allowing time for this
107
What 3 criteria must be met to legally use section 5(2)?
- 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
What is not included in 5(2)?
Authorisation for treatment
109
Process of using 5(2)
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
Length of section 2
up to 28 days
111
purpose of section 2
assessment through MHAA
112
length of section 3
up to 6 months
113
purpose of section 3
treatment through MHA
114
length of section 5(4)
up to 6 hours
115
purpose of section 5(4)
urgent detention on a non ward
116
who does a section 5(4)
NURSE ONLY - no need for Dr
117
length of section 5(2)
up to 72 hours
118
purpose of section 5(2)
urgent detention on a ward
119
who does a section 5(2)
1 doctor in charge
120
what is section 136 & who does it
emergency power that POLICE have to remove suspected mentally ill person from a public place to a place of safety for further assessment
121
How long does section 136 last
24 hours
122
when can section 136 not be used
if the person is NOT in a public place
123
what is section 135
similar to section 136 but involves private property not public places
124
what is a community treatment order (CTO)
an order for supervised treatment in the community, and rapid recall if conditions not met
