L6: Organic Psychiatry Flashcards

Question

What is a TBI?

Answer 1

“a blow or other force to the head which results in damage to the brain or alteration in brain function”

Answer 2

1. Only opens eyes in response to a voice 2. Cant talk coherently 3. Flexes in response to pain

Answer 3

1. Falls 42%: * Females \> males * High mortality in older persons 2. Transportation 29%: * Direct trauma * Shearing forces/deceleration 3. Assault 14%: * Males: females = 5:1

Answer 4

Less than 5 minutes

Answer 5

Between 5-60 minutes

Answer 6

Between 1-24 hours

Answer 7

Between 1-7 days

Answer 8

1. Disorientation 2. Memory disturbance 3. Mis-identification of family, friends, health professionals 4. Restlessness and agitation or aggression 5. Hallucinations or delusions

Answer 9

1. Capacity to concentrate 2. Use of language 3. Abstraction, calculation 4. Reasoning, processing of information * May be subtle, but have a major impact on rehabilitation

Answer 10

1. Common but not inevitable 2. A significant burden for families 3. If marked, are almost always associated with cognitive changes 4. Reduced capacity to engage in relationships 5. Inflexibility 6. Tiredness, lack of interest 7. Specific changes e.g. frontal lobe syndrome/executive dysfunction This is what distresses family the most!

Answer 11

1. Planning 2. Self-correct 3. Organise

Answer 12

1. Lack of self-monitoring 2. Insensitivity 3. Unawareness of subtle social messages

Answer 13

1. Impatience 2. Easily frustrated 3. Sexual disinhibition

Answer 14

1. Social behaviour 2. Impaired control 3. Irritability and/or aggression 4. Dependency

Answer 15

1. Anxiety 2. Loss of confidence, loss of control, status and dignity 3. Depression 4. Suspiciousness and paranoia - compounded by fear of rejection and sense of incompetence

Answer 16

Overwhelming reaction to being challenged beyond capacity

Answer 17

1. Routine and consistency 2. Reduce stresses imposed * Reduce burden on a fragile brain (eg. if patient likes coffee not tea --\> don’t ask which one --\> make coffee) 3. Clear simple instructions - repeat as necessary 4. Convey honest expectations which are realistic 5. Recognise lowered self-esteem - preserve dignity 6. Role of medication 7. Try not to take insults personally!

Answer 18

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage Pain is not solely a biological thing, it has emotional consequences --\> affects the patient's reactions and able to deal with pain

Answer 19

1. Factors related to type of trauma or disease 2. Social adversity - cumulative stressful life events depleting emotional reserves 3. Compensation

Answer 20

1. Vulnerability depends on personal and social context - what is the meaning of this pain for this individual? 2. Personality style e.g. dependent 3. Culture and family experiences 4. Physical and sexual abuse 5. Capacity to express feelings - controversial 6. Relationships 7. Fear and avoidance play a significant part in the maintenance of chronic pain

Answer 21

1. Those with chronic pain are often distressed and seeking an answer 2. Appraisal by health professionals may fail to explore the extent of suffering and functional disability 3. 30 - 40% of patients attending pain clinics have depression which can often be effectively treated

Answer 22

1. Pain is a subjective experience 2. It may represent an expression of distress 3. Chronic pain affects attitudes and beliefs 4. Attitude of health professionals (our own fantasy of rescue vs. punishment) 5. Beware co-morbidity e.g. alcohol, benzodiazepines, doctor-shopping 6. Coping not cure - setting realistic goals

Answer 23

* Had a dog in a box --\> gave electric shock * Ring a bell before shock * Move to other side of box

Answer 24

* Has a fence * Ring the bell --\> tries to move but fence in the way * Has an electric shock * Removes fence * Rings bell * Dog no longer moves to the other side despite not having a fence This can be the same with people * Meet people who haven't succeed in life --\> why bother? Given up

Answer 25

* Pain * Performance drops * Disparity * Determinant of happiness * Chronic pain * Trying to get back to normal through smaller and more achievable short term goals * Setting goals * About patient and physio * Let go of what you would do and think of what they can achieve (eg. be more empathetic)

Answer 26

1. Concern about inadequate skills to explore psychosocial issues 2. Concern about “opening a Pandora’s box” 3. Comparing patient responses to adversity (unfavourably) with one’s own, and considering them to be “not coping” vs. depressed 4. Too close to home 5. Belief that “just listening” is not a valid role that has any benefit 6. Being more interested in “urgent” or more “interesting” cases

Answer 27

1. Tendency to disregard distress as an “understandable” reaction to illness or disability 2. Reluctance to explore emotional adjustment 3. Patient grief resonates with personal grief about our own past losses 4. Major health problems in ourselves or loved ones 5. Fear of being overwhelmed 6. Unrealistic expectations of performance 7. Lack of self-awareness, knowledge or training about psychological issues 8. “Compassion fatigue”

Answer 28

1. Listening is a difficult task for health professionals who are primarily inclined to act 2. Fear of making things worse 3. Belief that nothing can be done

Answer 29

1. An emotional reaction with depressed or anxious mood (not severe) 2. In relation to a defined event 3. Does not cause major disruption to social and occupational functioning and relationships 4. Expectation of resolution with time to a new level of functioning Emergence of suicidal ideation means depression until proven otherwise

Answer 30

1. Depressed mood - note persistence and severity of depressed mood 2. Impaired capacity for pleasure 3. Cognitions - negative view of oneself, the environment and one’s future (“What’s the point, nothing will make a difference”) 4. Associated disturbances in sleep, appetite, energy, motivation, attention and concentration, libido

Answer 31

1. Depressed mood most of the day 2. Diminished interest or pleasure 3. Significant weight loss or gain 4. Insomnia or hypersomnia every day 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy every day 7. Feelings of worthlessness, guilt 8. Impaired concentration Thoughts of death

Answer 32

1. Weigh up risk factors for depression 2. Look at quality and severity of mood disturbance - pervasively impaired capacity for pleasure suggestive of depression 3. Look at persistence of symptoms 4. Emergence of guilt, worthlessness, helplessness and hopelessness typical of depression 5. Diurnal mood variation and early morning waking more typical of depression

Answer 33

1. Younger 2. Female 3. Single, separated, divorced or widowed 4. Living alone 5. Lack of social support 6. Having dependent children 7. Economic adversity 8. Poor marital or family functioning 9. History of psychiatric illness 10. Cumulative stressful life events 11. History of alcohol or other drug abuse

Answer 34

1. At the time of diagnosis or recurrence 2. During advanced stage of disease 3. Poorer prognosis 4. More treatment side-effects 5. Greater functional impairment and disease burden 6. Experiencing lymphoedema 7. Experiencing chronic pain 8. Fatigue

Answer 35

1. Biological 2. Cognitive 3. Dynamic 4. Psychosocial

Answer 36

1. Low, flat, sad mood 2. Slow movements / expressionless face 3. Tearfulness

Answer 37

1. Loss of interest and pleasure 2. Social withdrawal 3. Loss of motivation; feelings of futility about treatment 4. Feelings of hopelessness 5. Feelings of guilt or worthlessness 6. Sense of being a burden on others 7. Suicidal thoughts /wish to hasten death

Answer 38

Trying to fix/jolly the patient along: “It’s really important you keep yourself busy. You really should try to get out more. It’ll be good for you.” “Well of course you won’t beat the cancer unless you have a positive attitude.”

Answer 39

Open questions. Expression of concern. Discussion of referral: “I’m concerned about you. This depression is really hard and it might be useful if we can talk with the doctor about how we can help.” “I know you feel stuck right now, but I am confident that treatment will help you get beyond this awful feeling.”

Answer 40

1. Explore emotions/symptoms 2. Ask about thoughts of self-harm/suicide 3. Emphasise that depression is treatable 4. Suggest that the patient be referred to a specialist in psychosocial matters 5. Arrange referral 6. Continue to monitor

Answer 41

1. Normalise emotions - they’re not going crazy! * “A lot of people in your situation describe feeling like this” 2. Discuss value of support: * “It can really help to talk to a professional who understands” 3. Check their understanding of psychological support services and how they feel about the referral: * “To make sure that I have explained everything clearly, can you tell me what you have understood about the role of the psychologist?” 4. Emphasise that multi-disciplinary support is commonplace / normal practice: * “We work as a team, and your emotional well- being is an important part of your care” 5. Focus on enhancing well-being 6. Emphasise benefits to patient and family: * “You and your family don’t have to go through this on your own. We’re here to support you.”

Answer 42

1. Reduce the suffering of the patient 2. Reduce the risk of suicide - 2/3 of all suicides committed by people who are depressed 3. Suicide risk compounded by comorbid anxiety 4. Improve coping with disease burden 5. Improve outcome for children - a depressed parent one of the strongest predictors for depression

Answer 43

1. Increased mortality 2. Morbidity 3. Depression appears to be a more common pathway to alcohol abuse for women: * Note lower rates of detection of alcohol abuse in women 4. Past or current depression associated with decreased bone density in women 5. Reduced ability to cope with burden of disease

Answer 44

1. Female 2. Greater index severity 3. Greater index anxiety 4. Prior episodes of depression

Answer 45

Depression

Answer 46

 Odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations DiMatteo et al 2  Patients who are depressed are less likely to accept adjuvant chemotherapy

Answer 47

1. Male 2. Age (15-29 and \>75 years) 3. Living alone 4. Single, widowed, separated 5. Past self-harm 6. Family history of suicide 7. Alcohol or substance abuse 8. Chronic medical illness

Answer 48

1. Current depression (esp. guilt) 2. Access to means 3. Hope for the future 4. Recent experience of loss or grief 5. Shame/humilliation

Answer 49

1. Combination of supportive psychotherapy, cognitive and behavioural techniques and antidepressant medication 2. Selection of medication according to symptoms, medical status and potential for drug interactions 3. SSRIs and TCAs superior to placebo for treatment of depression in medically ill 4. No consistent evidence that SSRIs associated with increased risk of suicide

Answer 50

1. Opportunity to talk about concerns and be offered support and information 2. Being able to talk about grief, fear and anger 3. Relaxation techniques, guided imagery 4. Help with problem-solving 5. Learning not to look at things in black and white 6. Opportunity to reflect on priorities and values

Answer 51

1. St John's Wort 2. Folate 3. Relaxation 4. Fish oil 5. Acupuncture 6. Exercise

Answer 52

1. Hypericum perforatum - 300 species 2. Inhibits uptake of serotonin, noradrenaline and dopamine 3. Has high concentrations of melatonin 4. More effective than placebo for mild to moderate depression 5. Most trials lasted 4-8 weeks 6. Comparisons with antidepressants failed to use appropriate doses of antidepressants 7. Low incidence of side-effects

Answer 53

Some evidence that may be a helpful addition to antidepressant treatment

Answer 54

Better than no treatment or minimal treatment but not as effective as treatments such as CBT

Answer 55

Insufficient evidence currently to advocate benefit

Answer 56

Insufficient evidence of effectiveness

Answer 57

1. Some evidence of effectiveness in reducing depressed mood in women with breast cancer 2. Cochrane Review: * Analysis of 25 trials demonstrated benefit of exercise * More rigorous methodology reveals a moderate, non-significant effect * Insufficient detail about the amount or type of exercise required 3. Mechanism by which exercise might improve mood is unclear - emerging suggestions of reduction in inflammation and oxidation via cellular and humoral neuroimmunological changes

Answer 58

 50% for one episode  70% for two episodes  90% for three episodes

Answer 59

1. It is too important to miss 2. You don’t have to fix it - refer to someone who does this for a living! 3. You need to have a defined referral pathway, including what to do if you feel really stuck 4. You need to have a repertoire of things you can say to patients to encourage them to accept referral

Answer 60

Include attention to psychosocial issues in routine clinical practice so that patients see it as part of comprehensive care

Answer 61

1. The emotional impact of medical illness is often significant 2. Feeling stressed at times is normal 3. If this is affecting the person on a daily basis, affecting relationships or interfering with social or occupational functioning, something needs to be done * “You don’t have to suffer in silence” * “I can imagine that things might be pretty tough for you emotionally with all of this going on” * “Gosh you look worn out! Come and tell me about how you are” “I might be wrong, but I thought you looked hassled”

Answer 62

1. “During the past month have you often been bothered by feeling down, depressed or hopeless?” 2. “During the past month have you often been bothered by little interest or pleasure in doing things?”

Answer 63

1. Poor capacity to tolerate symptoms 2. Irritability 3. Increased complaints of pain 4. Alcohol or other substance abuse 5. Non-compliance with treatment recommendations 6. Difficulty making decisions 7. Negative cognitions: “Why bother?”

Answer 64

1. Recognition of the multiple factors which influence outcome 2. Awareness that the presentation, clinical course and outcome of few conditions are unaffected by emotional factors 3. Understanding of the functioning of multidisciplinary teams and the role of members working collaboratively to help patients achieve the best possible outcome

L6: Organic Psychiatry Flashcards

(100 cards)