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Flashcards in Mental Health 1 Deck (120):
1

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)
Cognition
Insight

2

What specifically is assessed in the thought section of the MSE?

Form
Content
Possession etc.

3

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

4

What are the 6Ps of formulation?

Problem
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
Plan

5

Diagnostic sieve for psychiatry?

Medical or drugs and alcohol e.g. Thyroid, epilepsy
Organic e.g. Dementia
Psychotic
Affective
Anxiety
Personality disorder

6

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

7

What biological changes indicate Alzheimer's dementia?

Cortical atrophy and reduced Ach
B amyloid plaque formation
Neurofibrillary tangles

8

Describe the presentation of Alzheimer's dementia?

Insidious, often over a decade or so

9

Early Sx of Alzheimer's dementia?

Memory lapses - dates, names of people, missing appointments etc.
Difficulty finding words
Short term memory loss

10

Progressing Sx of Alzheimer's dementia?

Early frontal dysfunction - language difficulties, apraxia, planning and decision making, confusion

11

Late symptoms of Alzheimer's dementia?

Personality change
Apathy
Wandering, disorientation
Incontinence
Change in eating habits

12

5 screening tests potentially suitable for testing memory?

MMSE
Addenbrookes/ACE
AMTS
MOCA
6-CIT

13

What imaging is used in assessing Alzheimer's dementia?

MRI and spect scans

14

Early management of Alzheimer's dementia?

Achesterase inhibitors (donepezil, Rivastigmine, galantamine)
Memantine (NMDA antagonist)

15

Describe progression of vascular dementia?

Stepwise progression, may be semi-sudden onset

16

3 types of changes resulting in vascular dementia?

Stroke
Multi-infarct
Chronic small vessel change (subcortical dementia)

17

Inherited type of vascular dementia?

CADASIL

18

Presentations of dementia associated with vascular cause?

Focal neurological deficits
Depression/anxiety and associated signs
Early gait disturbance and incontinence

19

Presence of which 2 features occurring much earlier than normal are suggestive of vascular dementia?

Gait disturbance
Incontinence

20

What features characterise Lewy body dementia?

Fluctuating memory, awareness and attention
Spatial awareness problems
Mild Parkinsonism
Recurrent well-formed visual hallucinations

21

Which type of dementia is associated with major REM sleep disturbance?

LBD

22

Which type of dementia is significantly more common in under 65s?

Frontotemporal

23

3 clinical syndromes of FTD?

Behavioural variant
Progressive non-fluent aphasia (Brocas)
Semantic dementia

24

What is the most common type of FTD?

Behaviour variant

25

Early signs of Huntington's disease?

Personality changes
Apathy, self neglect (?schizophrenia prodrome)
Clumsiness, fidgeting, facial grimaces
Mild psychosis/behavioural Sx

26

What is the progression of the movement disorder in Huntington's chorea?

Chorea (involuntary movements) -> rigidity and dystonia -> Parkinsonism and dementia

27

What is delirium?

An acute confusional state

28

3 major causes of delirium in elderly?

Infection - UTI, pneumonia
Constipation
Medications

29

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)

30

What type of dementia may appear similar to delirium?

LBD

31

3 features of anxiety that can start to make it pathological?

Intensity
Frequency and Persistency
Impact on daily living

32

General psychological Sx of anxiety disorders?

Internal tension
Fear of losing control, dying
Agitation

33

Under what circumstances can anxiety cause chest pain?

Hyperventilation can recruit accessory muscle use and wearing out

34

4 types of phobic anxiety disorder?

Agoraphobia
Panic disorder
Social phobia
Specific phobia

35

What 2 phobic anxiety disorders often go hand in hand?

Agoraphobia and panic disorder

36

What triggers panic disorder attacks?

Nothing - paroxysmal feeling of losing control, psych + physical Sx

37

What characterises social phobia?

Incapacitating anxiety in situations of judgement or evaluation -> Sx -> subsequent escape and avoidance

38

Best method of managing specific phobias?

Systematic desensitisation

39

3 types of stress reaction anxiety disorders?

Acute stress reaction
Post traumatic stress disorder
Adjustment disorder

40

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

41

What largely determines whether the diagnosis is PTSD or adjustment disorder?

The nature of the event - was it life threatening (PTSD) or not (AD)

42

Following a 'normal life event', over how long must symptoms have developed for adjustment disorder?

Within 1 month

43

Symptoms of adjustment disorder?

Often mixed anxiety and depression

44

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
Hypervigilance

45

What typifies GAD?

Anxiety Sx present for most days for long period of time, triggered by anything and sometimes nothing

46

When does OCD typically present?

In teens or 20s

47

Major comorbidities associated with OCD?

Major depressive disorder
Tics, phobias, eating disorders, alcohol
Schizoid PD

48

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

49

5 types of somatoform disorders?

Somatisation disorder
Hyperchondriasis
Conversion disorder
Body dysmorphic disorder
Pain disorder

50

What characterises somatisation disorder?

Repeated Sx affecting multiple different organ systems for which investigations are no help

51

What is hyperchondriasis?

Fear that minor (but real) Sx are due to serious underlying cause (e.g. Headache caused by brain tumour)

52

What is conversion disorder?

Acute presentation with serious neurological disorder e.g. Blindness, paralysis often following a stressful event

53

In whom are somatoform disorders most common?

Young women

54

What are the common types of dissociation disorder?

Depersonalisation and derealisation, possibly together

55

What type of disorder are depersonalisation and derealisation?

Anxiety (dissociative)

56

What is a dissociative fugue?

Travel to new location during temp loss of identity, severe dissociative amnesia and subsequent new role/identity - eventually recall

57

What is multiple personality disorder now called?

Dissociative identity disorder

58

What is neurasthenia?

Marked physical fatigue after minimal mental or physical effort

59

Conservative management of anxiety disorders?

Understanding and advice
Psychotherapy, counselling
Anxiety management courses
CBT

60

Medications that may be used for medical management of anxiety disorders?

Benzodiazepines - acute or severe spells
Antidepressants (SSRIs)
Buspirone for GAD
Symptomatic control with B blockers

61

Genetic background of personality disorders?

Multi focal - quantitative trait loci (QTLs)

62

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
Enduring
Pervasive and maladaptive to broad range of situations
Appears in childhood and persists into adulthood
Causes significant personal distress
Causes occupational, social problems

63

How many of the 6 icd 10 criteria for personality disorder need to be fulfilled for a diagnosis?

3 or more

64

What must be included in a psychiatric Hx that is not present in a normal Hx?

PPH incl admissions, sections etc. Suicide attempts
Risk assessment
Personal and childhood Hx
Social and employment Hx
Drugs and alcohol Hx
Forensic Hx

65

3 clusters of personality disorder?

Cluster A - eccentric type
Cluster B - flamboyant type
Cluster C - anxiety type

66

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

67

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
Histrionic/narcissistic PD

68

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)

69

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
The murderers/psychopaths

70

Characteristic features of EUPD (borderline or impulsive type)?

Tendency towards impulsive actions
Variable, unpredictable mood
Intolerance of being left alone
Chronic boredom
Self injury/damaging behaviour

71

Difference between histrionic and narcissistic PD?

HPD = need to be centre of attention for approval, low self esteem
NPD = thinks superior to everyone else

72

Which type of personality disorder is typified by inappropriate seductiveness and over-exaggerating/manipulative behaviour but sexual frigidity?

Histrionic personality disorder

73

Personality disorder defined by constant need for approval via the centre of attention, seductiveness and manipulation and low self esteem?

Histrionic personality disorder

74

Personality disorder characterised by inflated feelings of self worth and importance?

Narcissistic personality disorder

75

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

76

Personality disorder characterised by chronic boredom, impulsive behaviour, intolerance of being alone and labile unpredictable mood often accompanied by self-harm?

EUPD

77

What typifies paranoid personality disorder?

Looks like paranoid schizophrenia
May lead to agoraphobia, anxiety, depression, substance abuse

78

Personality disorder that can look like paranoid schizophrenia?

Paranoid PD

79

What characterises schizoid personality disorder?

Prefers solitude, cold, emotionally withdrawn
Indifferent to praise or criticism

80

Personality disorder typified by cold, emotional withdrawal and indifference to praise or criticism?

Schizoid PD

81

What characterises Schizotypal PD?

Extreme discomfort in social situations, can precede delusional or hallucinatory behaviour

82

Personality disorder characterised by extreme discomfort in social situations, possibly with delusions or hallucinations?

Schizotypal PD

83

What typifies anxious-avoidant personality disorder?

Constant fear of rejection or negative evaluation, feeling of ineptitude and apprehension

84

Personality disorder characterised by feelings of ineptitude and fear of negative evaluation or fear of rejection?

Anxious-avoidant PD

85

What characterises dependent PD?

Pervasive need to be bossed around, cared for by others so chronic subordination

86

Personality disorder characterised by constant subordination in order to feel cared for?

Dependent PD

87

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

88

What personality disorder may present as a perfectionist, pre-occupied with detail who has had an MI?

Obsessional/compulsive PD

89

CHASM of Hx taking premorbid personality?

Character
Hobbies
Attitude
Sociability
Mood

90

Eponymous syndrome whereby sufferers believe they are dead/walking corpses?

Cotard delusion

91

Eponymous syndrome whereby sufferer believes a celebrity is in love with them?

De Clerambault syndrome/delusion or erotomania

92

When do baby blues occur?

Start 3-5 days PP, subside by 10 days

93

Within what time frame does PND occur after birth?

3 months, subsides within 6 months

94

What is Couvade syndrome?

Blokes having pregnancy like Sx near time of wife giving birth to child

95

How long must Sx of GAD be present to diagnose?

Over 6m

96

5 potential SEs of atypical antipsychotics?

Weight gain
EPSEs
Agranulocytosis
Postural hypotension
Hepatitis

97

5 areas of first rank Sx of schizophrenia?

3rd person auditory hallucinations
Thought alienation (insertion/withdrawal/broadcast)
Made feelings/actions/impulses (control)
Somatic passivity
Delusional perception

98

What needs to be present to identify the somatic syndrome?

At least 4/8 biological Sx of depression

99

What self report questionnaire is used for identifying PND?

Edinburgh

100

What is Retts syndrome?

A neurodevelopmental disorder not unlike autism, starting around 1-2 years of age in someone following otherwise normal development

101

What is Fregoli's syndrome?

Delusions that a persecutor is able to impersonate others e.g. Friends and family

102

What do the Sx of serotonin syndrome mimic?

Like mega hyperthyroidism

103

What is a section 135?

Right for police to take someone from private property (community) to safe place e.g. Hospital, police station

104

What is a section 136?

Right for police to take someone from a public place to a safe place

105

What is a section 5 (4)?

Nurses holding power - keep patient in for 6 hours

106

What is a section 5 (2)?

Doctors holding power - keep a patient in for 72 hours (long enough for a section 2)

107

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

108

What is a section 4 used for?

Emergency assessment when only one doctor is available

109

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

110

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

111

What is a section 117?

Aftercare post-section 3

112

What section of MHA is used to detain a patient for assessment for 28 days?

Section2

113

What section of MHA is used to detain patient for treatment for up to 6m?

Section 3

114

What section of MHA details aftercare post-section 3?

Section 117

115

What section of MHA is used to detain for emergency assessment for 72 hours?

Section 4

116

What section is doctors holding power? How long does it last?

Section 5(2) for 72 hours

117

What section of MHA is nurses holding power? How long does it last?

Section 5(4) - lasts for 6 hours

118

What section of MHA is used to bring someone from private community setting (via break in) to a safe place by police?

Section 135

119

What section of MHA is used by police to bring someone from a public place to a safe place?

Section 136

120

Section of MHA used to allow supervised leave from inpatient facility?

Section 17