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Learning objectives from tutorials Flashcards

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1
Q

Meanings of the term depression

A

Symptom - an emotion within the range of normal experience
Syndrome - a constellation of symptoms and signs
Illness - “recurrent depressive disorder”

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2
Q

Describe the symptoms of depressive syndrome

A

Low mood
Anhedonia - complete inability to feel pleasure
Low energy

Poor appetite 
Poor sleep 
Poor concentration
Reduced libido 
Tearfulness 
Negative thoughts 
Suicidal thoughts

May have psychotic symptoms

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3
Q

Describe the features of depressive syndrome which may be seen on a mental state examination

A

Appearance - poor self care, reduced facial movement
Behaviour - psychomotor retardation or agitation
Mood - subjective and objectively depressed, reduced range and intensity of affects
Speech - slow, quiet, monotonous
Thought form - thoughts may be slowed
Thought content - negative, guilty or suicidal; depressive delusions if psychotic
Abnormal perceptions - possible auditory hallucinations if psychotic; reduced eye contact
Insight - usually present
Cognition - not usually impaired

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4
Q

Describe the complications of depression

A

Suicide
Psychosis
Social and occupational dysfunction - unemployment or problems at work, family and relationship problems, social isolation

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5
Q

What is the minimum length of time antidepressants should be continued after eliciting a response

A

6 months

Should be continued for 6-12 months; can be continued long term if chronic depression, or as prophylaxis where depressive episodes have been frequent or severe, psychotic or involved in a single suicide attempt

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6
Q

Give an example of a biological treatment for depression

A

Antidepressants

SSRI
MOA
TCA

Electro-convulsive therapy

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7
Q

Give a psychological treatment for depression

A

Cognitive behavioural therapy

Interpersonal psychotherapy

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8
Q

Give a social treatment for depression

A

No specific treatments but modification of lifestyle factors may be helpful

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9
Q

Describe the symptoms of a manic episode

A

Abnormally elevated or irritable mood associated with increased energy and activity, increased talkativeness, inflated self esteem, decreased need for sleep, increased libido, overspending, reckless behaviour, racing thoughts IN A SYNDROMAL PATTERN

May include psychotic symptoms

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10
Q

Describe features seen in mania with psychotic symptoms

A

Speech can show flight of ideas - thoughts jumping from topic to topic
Delusions - usually grandiose
Hallucinations - usually second person auditory

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11
Q

Define the criteria for bipolar affective disorder

A

Repeated episodes of mania and depression

At least 2 episodes of mania or one episode of mania and one episode of depression

Those who only have mania are rare but are classed as having bi-polar

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12
Q

The basic treatment modality for acute mania

A

Benzodiazepines/sedation - to calm patient down and re-instate normal sleep pattern

Antipsychotics - have sedative and mood-stabilising properties, as well as reducing any psychotic symptoms

Consider stopping any Antidepressants as these can worsen or induce mania but may be appropriate if have worked in the past

Mood stabilisers - lithium, anticonvulsants

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13
Q

Basic treatment modalities used in adolescent psychiatry

A

…

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14
Q

Issues of consent in the assessment and treatment of young people

A

…

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15
Q

Clinical features OD anorexia nervosa

A

1) primary psychological disturbance - patient has dread of being overweight and imposes a new target weight - often associated with disturbance of perception
2) patient restricts food intake and uses other methods to reduce weight (self-induced vomiting, diuretics, laxatives, xs exercise)
3) BMI

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16
Q

Clinical features of bulimia nervosa

A

Episodes of binge eating - feeling of loss of control

General pre-occupation with eating

Attempts to compensate for weight gain by restricting food intake between binges (self induced vomiting, diuretics, laxatives appetite suppressants, or xs exercise

A fear of being overweight

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17
Q

Associated features and complications of eating disorders

A

Lanugo hair - fine, downy hair seen in malnourished
Russel’s sign - calluses on knuckles or back of hands due to repeated self induced vomiting
Erosion of tooth enamel
Loss of secondary sexual characteristics
Vitamin deficiency states, peripheral neuropathy
Electrolyte imbalances - due to malnutrition or vomiting
Hypotension, bradycardia
Suicide and self harm are more common
Death is due to complications - malnutrition, electrolyte distubrance, ruptured oesophagus or cardiac failure

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18
Q

Management of eating disorders

A

Dietary support and re-feeding if dangerously low weight

CBT orientated therapy with dieticians

Family therapy/intervention with the family

SSRI can help with bulimia but there isn’t an evidence basis for their use in adolescents and they are not useful in anorexia

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19
Q

Describe key aspects of assessment and management after attempted suicide

A

Assessment by a special trained staff member with ready access to psychiatric opinion

Identify any psychiatric disorder and offer referral to local mental health services for treatment

Consider the need for in-patient psychiatric care

Involvement of other relevant agencies - social services, family, school

Develop a safety plan - practical measures such as removing means to attempt suicide again (by locking medicines away) and identify person they can contact if they feel suicidal again

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20
Q

Mental state examination components

A

Appearance and behaviour

Mood - subjective, objective, affect

Speech

Thought form 
Thought content (delusions, suicidal intent)

Abnormal perceptions

Insight

Cognition

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21
Q

Differential diagnosis for presentations of disturbed or antisocial behaviour

A

Conduct disorder
Oppositional defiant disorder
ADHD
Depression

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22
Q

Basic management of common psychiatric conditions presenting with disturbed behaviour

A 
Family education
Parent management training
Family therapy 
Educational support 
Anger management for the child 
Treat comorbid problems, e.g. ADHD
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23
Q

Mental health disposals available to the court

A 
Assessment order 
Treatment order 
Committal to hospital 
Interim compulsion order 
Restriction order (can only be used with compulsion order and when there is significant risk to the public)
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24
Q

What are the possible civil provisions

A

Emergency detention certificate

Short term detention certificate

Compulsory treatment order

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25
Emergency detention certificate
Any registered medical practitioner Lasts for a maximum of 72 hours Patient must be likely to have a mental disorder Patients decision making ability is significantly impaired Significant risk to health, safety or welfare, or to safety of others No alternative to treatment in hospital and required urgently Short term detention impractical
26
Short term detention certificate
Applied by approved medical practitioner (AMP) with mental health officer (MHO) consent Patient has mental disorder Patients ability to make decisions about the provision of medical treatment is significantly impaired as a result of that mental disorder It is necessary to detain the patient in hospital for the purpose of determining what medical treatment should be given to the patient or to give them medical treatment Significant risk to health, safety and welfare of patient or others Lasts 28 days from day admitted to hospital
27
Compulsory treatment order
Granted by mental health tribunal and lasts up to 6 months Must have mental disorder Medical treatment available to prevent mental disorder worsening or to alleviate effects Significant risk to health, safety or welfare, or to safety of others Significant impairment in decision making ability Treatment cannot be provided informally
28
Describe the features of chronic alcohol misuse which may be seen on a mental state exam
``` Appearance Behaviour Mood - subjective, objective, affect Perception Insight ```
29
Screening tools regarding alcohol
FAST (how often had >X drinks on one occasion, how often forget things, how often have failed what expected of you, has anyone ever been concerned) score 3+ = hazardous level CAGE (have you ever felt you should CUT down, have people ANNOYED you by criticising your drinking, have you ever felt GUILTY about your drinking, have you ever had a drink first thing in the morning (EYE OPENER) 4 = alcoholism
30
Define delusion
A fixed belief, held despite rational argument or evidence to the contrary
31
What is a grandiose delusion
Exaggerated beliefs of being special or important (e.g. Rich and famous)
32
What are persecutory (or paranoid) delusions
Beliefs that others are trying to persecute or cause harm (e.g. People are spying on the patient)
33
What are nihilistic delusions
Beliefs regarding the absence of something vitally important (e.g. The patient is dead, homeless, or their organs are rotting)
34
What are delusions of reference
Beliefs that ordinary objects, events or other people's actions have a special meaning or significance for the patient - e.g. News reports relate to them, objects are arranged as 'signs'
35
What are delusions of control
Beliefs that outside forces control the patient in some way | - this includes delusions of passivity or thought interference
36
What are delusions of thought interference
Withdrawal: belief that someone or something is removing thoughts from the patient's head Insertion: Belief that thoughts have been put into patient's mind so they are thinking someone else's thoughts Thought insertion: the belief that thoughts are broadcast to others
37
What is a hallucination
Perception in the absence of a stimulus - hearing a voice when no-one has spoken (they feel the same as any other perception) Could be auditory, visual, touch (tactile or deep sensation), olfactory, gustatory
38
Common auditory hallucination in schizophrenia
Voices in the 3rd person - discussing or arguing with the patient
39
Medical causes for depression
Thyroid disorder - hypothyroid Chronic pain Medications such as beta blockers Alcohol or drug use
40
Describe demographic and historical factors which can increase the risk of subsequent suicide
``` Older age Male gender Mental illness Co-morbid physical illness Chronic pain Use of drugs or alcohol Social isolation - bereavement, disconnection from support systems e.g. School, family, work through unemployment or retirement Previous suicidal behaviour High lethality of method used and ongoing availability of method Physical and sexual abuse ```
41
How would you conduct a history with someone who has attempted suicide
Description of the act - violent means? Did they think it would kill them (Perceived lethality)? Planned in advance? Were they likely to be discovered? Alcohol or illicit drugs involved (increases chance of death but person less likely to have intended to die), was there a precipitant? Circumstances - prior: social difficulties, psychiatric illness. And now: how do they feel about it, do they regret it, do they still feel suicidal, have circumstances improved since the attempt Current plans
42
Describe the acute and chronic symptoms of schizophrenia
In the acute stage - hallucinations or delusions relating to disruption of ego-boundary In the chronic stage - deficits of affect, motivation and thinking
43
What are the first rank symptoms of schizophrenia
A = auditory hallucinations - hearing thoughts being repeated aloud, 3rd person auditory hallucinations B= broadcasting of thought - thought withdrawal, thought insertion, thought broadcasting C= controlled thought (delusions of control) : Passivity phenomena - delusions that their thoughts, feelings or impulses are driven by some external force or person; Somatic passivity - a delusion that some external force is causing physical sensations (which may be hallucinations) in their body D = Delusional perception - a delusion which arises because of a completely unrelated happening in external reality
44
Non-psychotic symptoms of acute schizophrenia
Mood disturbance and unusual behaviour
45
Negative symptoms of schizophrenia
``` Apathy and lack of motivation Poverty of speech (and lack or thoughts) Blunted or incongruous affect (and lack of emotions) Social withdrawal Occupational decline ```
46
Cognitive symptoms of schizophrenia
Poor executive function (reduced decision making ability) and poor abstract reasoning
47
Differential diagnosis in a psychotic patient
Psychotic mania or depression Delirium Drug induced psychosis or intoxication Medications - steroids Cerebral causes - tumour, infection, infarction, epilepsy Endocrine disease - thyroid, chronic hypoglycaemia, cushing's, addisons Systemic illness such as anaemia, carcinoma or sarcoid
48
Treatment of schizophrenia in the acute stage
Antipsychotic meds Sedatives
49
Treatment of schizophrenia in the long term
Antipsychotic medication Support in the community Rehabilitation in dedicated facilities **psychological therapies are not useful
50
What percentage of those with acute schizophrenia kill themselves
10%
51
Dependence syndrome
3 or more of the following features which occur together for at least 1 month or repeatedly over a 12 month period Compulsion - strong desire to take Difficulties controlling use Continued use despite harmful consequences Salience - higher priority given to a substance use than to other activities and obligations Increased tolerance Withdrawals when substance is used/stopped
52
Tolerance
A drugs early effects are later achievable only by higher doses
53
Withdrawal state
A group of symptoms of variable severity occurring on absolute or relative withdrawal of a psychoactive substance, after persistent use of that substance
54
Physical complications of alcohol misuse
Accidental injury, violence, sexual dysfunction GI - liver disease, gastritis, peptic ulcer, GI bleeding, pancreatitis Cardiovascular - HT, heart disease, stroke Cancer - mouth, oesophagus, liver Neurological - fits, confusional states, head injury, Wernicke's or Korsakoffs)
55
Psychiatric complications of alcohol misuse
``` Deliberate self harm Anxiety states Depression Morbid jealousy Alcoholic hallucinosis ```
56
Social complications of alcohol misuse
Employment and financial difficulties Marital and family problems Criminal convictions
57
Treatment of alcohol misuse
Alcohol counselling and psychological input Referral for help with social/occupational issues Encourage use of community support - AA Thiamine - to prevent Wernicke's/Korsakoffs Detoxification if appropriate - benzodiazepines In patient or residential treatment Medication to help with abstinence
58
Medication to help with abstinence
Acamprosate or naltrexone for alcohol craving Disulfram (antabuse) makes you feel sick if you drink alcohol
59
Treatment of opiate dependence
Counselling and psychological input Referral for help with social/occupational issues Encourage use of community supports In patient or residential treatment Methadone - gradual reduction or harm reduction by staying on same dose
60
Which antipsychotic has been shown to cause no tardive dyskinesia
Clozapine
61
Atypical antipsychotics include
Olanzipine Risperidone Clozapine
62
Typical antipsychotics include
Chlorpromazine | Haloperidol
63
When is clozapine indicated
For those who don't respond to other antipsychotic medications or are intolerant to them --> i.e. Treatment resistant schizophrenic patients
64
Potential side effects of clozapine include
``` Neutropenia Seizures Idiopathic hyperthermia Weight gain Hypersalivation ```
65
Conditions that could be caused by using antipsychotics
Obesity and weight gain Diabetes Metabolic syndrome
66
What is metabolic syndrome
Obesity Hypertension Dyslipidaemia Abnormal glucose metabolism
67
Which drugs are most problematic associated with obesity, diabetes and metabolic syndrome
Clozapine and olanzapine
68
Diagnosis of metabolic syndrome
BP>130/85 Serum HDL cholesterol >1.04 Male or >1.29 Female Serum triglyceride >1.69 Fasting glucose >6.1 Waist circumference >102cm male or >88cm female
69
Which drugs are prone to causing hyperprolactinaemia
Many antipsychotics, especially amisulpride, risperidone, and typical antipsychotics
70
Effects of hyperprolactinaemia
``` Galactorrhoea Menstrual irregularity Sexual dysfunction Osteoporosis Increased risk of breast cancer Serum prolactin levels should be checked if patients report any symptoms ```
71
Cardiac effects of antipsychotics
QT elongation | Which can lead to potentially fatal tachyarrhythmias
72
Differential diagnosis of autism
``` Deafness Asperger's Specific language disorder Learning disability Child hood schizophrenia or Rett's syndrome Neglect ```
73
What is Wernicke's
Acute thiamine deficiency Triag of confusion, ataxia and opthalmoplegia
74
What is korsakoff's
Irreversible anterograde amnesia - can register new events but can't recall within a few minutes
75
Why get extrapyramidal side effects
Widespread dopamine blockade

Psychiatry (6 decks)

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