Flashcards in Mental Health 1 Deck (120):
What constitutes the MSE?
Appearance and Behaviour incl rapport
Speech (production and things like neologisms, echolalia)
Mood (ask - objective and subjective) and affect
Thoughts (form, content, possession phenomena)
Perceptions (hallucinations, pseudo)
What specifically is assessed in the thought section of the MSE?
What specifically is assessed in the insight section of the MSE?
Know you're unwell?
Know what the problem is?
Treatment and willingness to accept
What are the 6Ps of formulation?
Diagnostic sieve for psychiatry?
Medical or drugs and alcohol e.g. Thyroid, epilepsy
Organic e.g. Dementia
What should be screened for in HPC in psych Hx?
Mood - depression and mania (ask about sleep, energy, activity)
Anxiety - worries or fears
Psychotic - delusions and FTDs, hallucinations
What biological changes indicate Alzheimer's dementia?
Cortical atrophy and reduced Ach
B amyloid plaque formation
Describe the presentation of Alzheimer's dementia?
Insidious, often over a decade or so
Early Sx of Alzheimer's dementia?
Memory lapses - dates, names of people, missing appointments etc.
Difficulty finding words
Short term memory loss
Progressing Sx of Alzheimer's dementia?
Early frontal dysfunction - language difficulties, apraxia, planning and decision making, confusion
Late symptoms of Alzheimer's dementia?
Change in eating habits
5 screening tests potentially suitable for testing memory?
What imaging is used in assessing Alzheimer's dementia?
MRI and spect scans
Early management of Alzheimer's dementia?
Achesterase inhibitors (donepezil, Rivastigmine, galantamine)
Memantine (NMDA antagonist)
Describe progression of vascular dementia?
Stepwise progression, may be semi-sudden onset
3 types of changes resulting in vascular dementia?
Chronic small vessel change (subcortical dementia)
Inherited type of vascular dementia?
Presentations of dementia associated with vascular cause?
Focal neurological deficits
Depression/anxiety and associated signs
Early gait disturbance and incontinence
Presence of which 2 features occurring much earlier than normal are suggestive of vascular dementia?
What features characterise Lewy body dementia?
Fluctuating memory, awareness and attention
Spatial awareness problems
Recurrent well-formed visual hallucinations
Which type of dementia is associated with major REM sleep disturbance?
Which type of dementia is significantly more common in under 65s?
3 clinical syndromes of FTD?
Progressive non-fluent aphasia (Brocas)
What is the most common type of FTD?
Early signs of Huntington's disease?
Apathy, self neglect (?schizophrenia prodrome)
Clumsiness, fidgeting, facial grimaces
Mild psychosis/behavioural Sx
What is the progression of the movement disorder in Huntington's chorea?
Chorea (involuntary movements) -> rigidity and dystonia -> Parkinsonism and dementia
What is delirium?
An acute confusional state
3 major causes of delirium in elderly?
Infection - UTI, pneumonia
3 types of delirium?
Hyperactive - easily visible, restless, sleep disturbed etc.
Hypoactive - reduced oral intake, looks bit like depression
Mixed - most common (fluctuant - more hyperactive at night)
What type of dementia may appear similar to delirium?
3 features of anxiety that can start to make it pathological?
Frequency and Persistency
Impact on daily living
General psychological Sx of anxiety disorders?
Fear of losing control, dying
Under what circumstances can anxiety cause chest pain?
Hyperventilation can recruit accessory muscle use and wearing out
4 types of phobic anxiety disorder?
What 2 phobic anxiety disorders often go hand in hand?
Agoraphobia and panic disorder
What triggers panic disorder attacks?
Nothing - paroxysmal feeling of losing control, psych + physical Sx
What characterises social phobia?
Incapacitating anxiety in situations of judgement or evaluation -> Sx -> subsequent escape and avoidance
Best method of managing specific phobias?
3 types of stress reaction anxiety disorders?
Acute stress reaction
Post traumatic stress disorder
What characterises an acute stress reaction?
Symptoms over minutes or hours which typically settle within hours-days following major crisis
Symptoms include low mood, irritability, poor sleep, emotional fluctuation
What largely determines whether the diagnosis is PTSD or adjustment disorder?
The nature of the event - was it life threatening (PTSD) or not (AD)
Following a 'normal life event', over how long must symptoms have developed for adjustment disorder?
Within 1 month
Symptoms of adjustment disorder?
Often mixed anxiety and depression
Describe the symptoms of PTSD and their duration?
> 1m of recurring thoughts/flashbacks/dreams etc. of major traumatic event, subsequent distress and avoidance of potential triggers
Emotional blunting or detachment, depression symptoms
What typifies GAD?
Anxiety Sx present for most days for long period of time, triggered by anything and sometimes nothing
When does OCD typically present?
In teens or 20s
Major comorbidities associated with OCD?
Major depressive disorder
Tics, phobias, eating disorders, alcohol
What are the 2 component features of OCD?
Obsessive thoughts - intense, self-thought impulses which provoke anxiety (repetitive, unwanted, resisted) with retained insight
Compulsive thoughts - anxiety relieving, internalised consequences of the obsession
5 types of somatoform disorders?
Body dysmorphic disorder
What characterises somatisation disorder?
Repeated Sx affecting multiple different organ systems for which investigations are no help
What is hyperchondriasis?
Fear that minor (but real) Sx are due to serious underlying cause (e.g. Headache caused by brain tumour)
What is conversion disorder?
Acute presentation with serious neurological disorder e.g. Blindness, paralysis often following a stressful event
In whom are somatoform disorders most common?
What are the common types of dissociation disorder?
Depersonalisation and derealisation, possibly together
What type of disorder are depersonalisation and derealisation?
What is a dissociative fugue?
Travel to new location during temp loss of identity, severe dissociative amnesia and subsequent new role/identity - eventually recall
What is multiple personality disorder now called?
Dissociative identity disorder
What is neurasthenia?
Marked physical fatigue after minimal mental or physical effort
Conservative management of anxiety disorders?
Understanding and advice
Anxiety management courses
Medications that may be used for medical management of anxiety disorders?
Benzodiazepines - acute or severe spells
Buspirone for GAD
Symptomatic control with B blockers
Genetic background of personality disorders?
Multi focal - quantitative trait loci (QTLs)
Does Every Passage from childhood to adulthood cause problems for self and others?
Disharmonious - internal conflict between attitudes and behaviours in multiple areas of functioning
Pervasive and maladaptive to broad range of situations
Appears in childhood and persists into adulthood
Causes significant personal distress
Causes occupational, social problems
How many of the 6 icd 10 criteria for personality disorder need to be fulfilled for a diagnosis?
3 or more
What must be included in a psychiatric Hx that is not present in a normal Hx?
PPH incl admissions, sections etc. Suicide attempts
Personal and childhood Hx
Social and employment Hx
Drugs and alcohol Hx
3 clusters of personality disorder?
Cluster A - eccentric type
Cluster B - flamboyant type
Cluster C - anxiety type
Cluster A (eccentric) personality disorders?
Paranoid PD - suspicious, paranoid, may look like schizophrenia
Schizoid PD - solitary, introspective and emotionally cold, indifference to praise or criticism
Schizotypal PD - can look like extreme discomfort in emotional situations and lead to delusions or perceptual disorders
Cluster B (flamboyant) personality disorders?
Dissocial (antisocial) PD - victim of society, no guilt or regrets of actions, tendency to blame, inability to sustain relationships. Failure to learn from actions and often impulsive
EUPD (borderline) - may be borderline or impulsive type
Cluster C (anxiety type) personality disorders?
Anxious avoidant PD - limited by fear of rejection or negative evaluation
Dependant PD - automatic subordination and need to be cared for
Obsessional/compulsive PD (anankastic) - the compulsive part of OCD (perfectionist, inflexible and preoccupied with detail)
What characterises dissocial/antisocial personality disorder?
Impulsive actions and failure to learn from mistakes
Inability to maintain relationships due to lack of empathy and guilt/remorse, tendency to blame others
Characteristic features of EUPD (borderline or impulsive type)?
Tendency towards impulsive actions
Variable, unpredictable mood
Intolerance of being left alone
Self injury/damaging behaviour
Difference between histrionic and narcissistic PD?
HPD = need to be centre of attention for approval, low self esteem
NPD = thinks superior to everyone else
Which type of personality disorder is typified by inappropriate seductiveness and over-exaggerating/manipulative behaviour but sexual frigidity?
Histrionic personality disorder
Personality disorder defined by constant need for approval via the centre of attention, seductiveness and manipulation and low self esteem?
Histrionic personality disorder
Personality disorder characterised by inflated feelings of self worth and importance?
Narcissistic personality disorder
Personality disorder characterised by impulsive actions, lack of empathy/guilt and remorse and inability to learn from these, often manifesting as trouble maintaining relationships and trouble with the law?
Dissocial personality disorder
Personality disorder characterised by chronic boredom, impulsive behaviour, intolerance of being alone and labile unpredictable mood often accompanied by self-harm?
What typifies paranoid personality disorder?
Looks like paranoid schizophrenia
May lead to agoraphobia, anxiety, depression, substance abuse
Personality disorder that can look like paranoid schizophrenia?
What characterises schizoid personality disorder?
Prefers solitude, cold, emotionally withdrawn
Indifferent to praise or criticism
Personality disorder typified by cold, emotional withdrawal and indifference to praise or criticism?
What characterises Schizotypal PD?
Extreme discomfort in social situations, can precede delusional or hallucinatory behaviour
Personality disorder characterised by extreme discomfort in social situations, possibly with delusions or hallucinations?
What typifies anxious-avoidant personality disorder?
Constant fear of rejection or negative evaluation, feeling of ineptitude and apprehension
Personality disorder characterised by feelings of ineptitude and fear of negative evaluation or fear of rejection?
What characterises dependent PD?
Pervasive need to be bossed around, cared for by others so chronic subordination
Personality disorder characterised by constant subordination in order to feel cared for?
What is the difference between obsessional/compulsive (anankastic) personality disorder and OCD?
OCD can be obsessions or obsessions and compulsions
O/CPD is just compulsions, no obsessional pervasive intrusive thoughts behind it
What personality disorder may present as a perfectionist, pre-occupied with detail who has had an MI?
CHASM of Hx taking premorbid personality?
Eponymous syndrome whereby sufferers believe they are dead/walking corpses?
Eponymous syndrome whereby sufferer believes a celebrity is in love with them?
De Clerambault syndrome/delusion or erotomania
When do baby blues occur?
Start 3-5 days PP, subside by 10 days
Within what time frame does PND occur after birth?
3 months, subsides within 6 months
What is Couvade syndrome?
Blokes having pregnancy like Sx near time of wife giving birth to child
How long must Sx of GAD be present to diagnose?
5 potential SEs of atypical antipsychotics?
5 areas of first rank Sx of schizophrenia?
3rd person auditory hallucinations
Thought alienation (insertion/withdrawal/broadcast)
Made feelings/actions/impulses (control)
What needs to be present to identify the somatic syndrome?
At least 4/8 biological Sx of depression
What self report questionnaire is used for identifying PND?
What is Retts syndrome?
A neurodevelopmental disorder not unlike autism, starting around 1-2 years of age in someone following otherwise normal development
What is Fregoli's syndrome?
Delusions that a persecutor is able to impersonate others e.g. Friends and family
What do the Sx of serotonin syndrome mimic?
Like mega hyperthyroidism
What is a section 135?
Right for police to take someone from private property (community) to safe place e.g. Hospital, police station
What is a section 136?
Right for police to take someone from a public place to a safe place
What is a section 5 (4)?
Nurses holding power - keep patient in for 6 hours
What is a section 5 (2)?
Doctors holding power - keep a patient in for 72 hours (long enough for a section 2)
What is a section 4?
Emergency admission to hospital for assessment for 72 hours
Requires only 1 doctor and can have input from another to launch into a section 2
What is a section 4 used for?
Emergency assessment when only one doctor is available
What is a section 2?
Detainment for assessment for up to 28 days
Requires 2 doctors, at least one of whom is section 12 approved
What is a section 3?
Detainment for treatment for up to 6m - can be renewed for another 6m and then further years at a time
What is a section 117?
Aftercare post-section 3
What section of MHA is used to detain a patient for assessment for 28 days?
What section of MHA is used to detain patient for treatment for up to 6m?
What section of MHA details aftercare post-section 3?
What section of MHA is used to detain for emergency assessment for 72 hours?
What section is doctors holding power? How long does it last?
Section 5(2) for 72 hours
What section of MHA is nurses holding power? How long does it last?
Section 5(4) - lasts for 6 hours
What section of MHA is used to bring someone from private community setting (via break in) to a safe place by police?
What section of MHA is used by police to bring someone from a public place to a safe place?