Mental Health 2 Flashcards Preview

Revision Qs > Mental Health 2 > Flashcards

Flashcards in Mental Health 2 Deck (99):
1

What are first rank symptoms of schizophrenia and what are their drawbacks?

Symptoms that, if present, are strongly suggestive of schizophrenia
However are also present in other disorders e.g. Dissociative identity disorder

2

4 areas of positive symptoms of schizophrenia?

Delusions
Hallucinations
Formal thought disorders
Thought passivity phenomena - withdrawal, echo, insertion, broadcasting

3

What is a delusion?

A fixed belief (conviction) held on inadequate grounds and not susceptible to rational argument or conflicting evidence to the contrary, not culturally emissable

4

5As of negative symptoms of schizophrenia?

Alogia
Anhedonia
Avolition
Affective blunting
Amotivation

5

What group of schizophrenic patients are highest risk of suicide?

Young males who have insight

6

If someone has delusions but no other disturbances, do they have schizophrenia?

No, they have a delusional disorder

7

What if psychotic symptoms last for less than a month?

Acute and transient psychotic disorder

8

What if someone develops psychotic and affective symptoms at the same time?

Probably schizoaffective disorder

9

PAD THCNeg of schizophrenia criteria?

Passivity phenomena
Auditory hallucinations (running commentary, 3rd person)
Delusions - bizarre, control or perception

Thought disorder
Hallucinations of any modality
Catatonia
Negative symptoms

10

What is delusional perception?

Normal stimulus -> irrational conclusion

11

How many of PAD must be present and for how long to make a diagnosis of schizophrenia?

At least 1 for at least a month

12

How many of THCNeg must be present and for how long to make schizophrenia diagnosis?

At least 2 for at least a month

13

What is a typical schizophrenia prodrome?

Withdrawal, lack of interest in personal appearance and hygiene, anxiety, depression, pre-occupation

14

What characterises paranoid schizophrenia?

Prominent positive symptoms often with paranoid background e.g. Persecutory delusions, running commentary, thought withdrawal/echo/insertion/control

15

Apart from the prominence of positive symptoms, what else differentiates paranoid schizophrenia from other types?

Often no affective blunting or formal thought disorder
Negative symptoms uncommon

16

What characterises hebephrenic/disorganised schizophrenia?

Earlier onset (~age 20), rapid progression of negative symptoms
Affective blunting and avolition with marked formal thought disorder
Inappropriate emotional responses and behaviour

17

What does someone with a shy and solitary premorbid personality who develops negative symptoms and a major FTD around age of 20 suggest?

Hebephrenic schizophrenia

18

What characterises catatonic schizophrenia?

Marked psychomotor disturbance with at least one dominant feature over the other positive and negative symptoms of schizophrenia

19

What are some examples of catatonic behaviour?

Stupor and mutism
Violent excitement
Bizarre posturing
Waxy flexibility
Negativism
Perseveration, echolalia

20

What is residual schizophrenia?

Have initial positive symptoms which subside and then at least a year later prominent negative symptoms present

21

What is simple schizophrenia?

Slowly progressive negative symptoms in absence of major psychotic symptoms, with massive behaviour change and vagrancy

22

What is expressed emotion EE and is it a good or bad thing?

Level of emotional expression and family and social support not helping in schizophrenia
Bad thing

23

What are the 3 components of thought form?

Associations
Determinate tendency
Goal

24

Disorders of thought form - association? What are these typical of?

Loosening of associations, which include concepts such as knights move thinking
More suggestive of schizophrenia

25

What are some disorders of determinate tendency and goal in thought form? What are they suggestive of?

Tangentiality or circumferential thinking
Flight of ideas
Word salad
Concrete thinking
More suggestive of mania, however word salad is often schizophrenic

26

What are common causes of secondary delusions?

Severe depression and mania

27

What are primary delusions?

No underlying cause of delusion - strongly suggestive of schizophrenia

28

What is Capgras delusion?

That close friends and loved ones have been replaced with identical clones

29

What is Othello's syndrome?

Delusional jealousy

30

Other disorders of thought content besides delusions?

Preoccupations
Overvalued ideas and obsessions
Confabulation

31

What is an illusion?

False processing of a normal stimulus that is not delusional (not believed to be true)

32

What is perception?

The ability to integrate and process external stimuli

33

What are hallucinations?

Integration and processing in the absence of external stimuli

34

What does a visual hallucination suggest?

Organic disease e.g. Substance use, LBD

35

What are pseudohallucinations?

A sensory experience that is as vivid as a true hallucination but recognised as not being real (a hallucination recognised as a hallucination)

36

What are pseudohallucinations commonly associated with?

Anxiety disorders - conversion disorder, somatisation disorder, dissociative disorders

37

What are common causes of olfactory hallucinations?

Organic cause - MTL epilepsy, tumours

38

What is the most common type of tactile hallucination? What are they typically associated with?

Formication (insects under skin)
Associated with cocaine, alcohol withdrawal (DT)

39

Infectious disease that can cause formication?

Lyme disease

40

Examples of general somatic hallucinations?

Bowels twisting
Flesh decomposing

41

What is Charles Bonnet syndrome?

Visual hallucinations in patients who can't see (secondary to eye disease)

42

Signs of alcohol dependence?

Withdrawal symptoms if don't drink
Compulsion to drink
Mental or physical health problems resulting from drinking
CAGE
Amount of money being spent
Impacting negatively on daily life

43

Timeline of alcohol withdrawal symptoms?

Usually peak around day 2 after significant fall in blood alcohol levels, easing by day 5
Early minor symptoms -> alcoholic hallucinosis -> withdrawal seizures -> DT

44

Early symptoms of alcohol withdrawal?

Nausea and vomiting, headache
Craving for alcohol
Insomnia and fatigue
Anxiety, restlessness, agitation
Sweating and palpitations, anaemia
Mood lability

45

Common hallucination modalities in alcoholic hallucinosis?

Visual, auditory, tactile

46

Medication of choice for acute alcohol withdrawal?

Chlordiazepoxide

47

3 reasons why alcohol use may lead to thiamine deficiency?

It is a coenzyme in alcohol metabolism
Malabsorption
Gastritis

48

When does DT normally present in relation to stopping alcohol?

1-3 days after significant drop in blood alcohol

49

Sx of DT?

Hallucinations
Delusions
Confusion
Agitation
Seizures

50

What type of state is DT and what signs does it therefore produce?

Hyperadrenergic -> mydriasis, tachycardia, sweating, hypertension, hyperthermia and sweating, tremor, ataxia

51

What is an important metabolic abnormality that can occur as a result of alcohol withdrawal acutely?

Hypoglycaemia

52

What is Wernicke-Korsakoff disease?

Spectrum of pathology due to thiamine (B1) deficiency

53

Triad of Wernickes syndrome?

Ataxia (cerebellar signs)
Mental confusion - anterograde amnesia, hallucinations
Ophthalmoplegia - double vision, movement abnormalities, droopy lids

54

3 thought/memory problems characteristic of Wernickes syndrome?

Anterograde amnesia
Confabulation
Telescoping of ideas

55

What is Korsakoff's syndrome?

Sort of chronic thiamine deficiency, causing neuronal loss and mammillary body haemorrhage

56

6 key symptoms of Korsakoff's syndrome?

Anterograde amnesia
Retrograde amnesia (long term and contextual)
Confabulation
Minimal conversational content
Lack of insight
Apathy

57

What are the ABCDS of Schneiderian first rank symptoms of schizophrenia?

Auditory hallucinations (third person running commentary)
Broadcasting of thought
Controlled thought (insertion, withdrawal, echo)
Delusional perception (normal stimulus -> bizarre conclusion)
Somatic hallucinations

58

3 endocrine causes of depression?

Addison's disease
Cushing's
Hypothyroidism

59

5 medications that can cause depression?

L dopa
B blockers
Steroids
Digoxin
OCP

60

What is Becks cognitive triad?

Negative views about self, world and future

61

3 core Sx of depression?

Low mood
Anhedonia
Low energy/tiredness

62

4 factors of low mood that makes it more likely depression than 'normal low mood'?

Duration (>2 weeks)
Intensity
Additional Sx
Diurnal variation

63

GAPES of additional depression Sx?

Guilt
Attention/concentration and Appetite
Pessimism and psychomotor
Esteem
Sleep and Suicidal ideas

64

Besides sleep and appetite, examples of somatisation of depression?

Diurnal variation of mood
Loss of libido
Psychomotor retardation
Amenorrhea, constipation

65

4 examples of psychotic depression?

Stupor
Loss of insight
Hallucinations - auditory
Delusions - mood congruent

66

When classifying >1 episode of depression, what must be included?

Recurrent depressive disorder or BAD depending on presence of mania
Classification of current episode

67

What is dysthymia?

Low mood, not meeting criteria for depression

68

What is euthymia?

Normal mood

69

What is cyclothymia?

Persistently fluctuant mood never meeting criteria for depressive or manic/hypomanic episodes

70

Conservative management of mild-moderate depression?

Watchful waiting, review within 2 weeks
Low intensity CBT, psychodynamic psychotherapy

71

Indications for antidepressant use in mild-moderate depressive episode?

Previous severe illness
Refractory to other interventions
Interfering with physical health

72

Management of moderate-severe depression?

SSRI + CBT/interpersonal therapy
Risk assessment and consider MHA referral

73

3 things to advise patients starting an antidepressant?

Monitor for akithesia
Might get better before get worse - monitor for suicidal ideas
Monitor for agitation/anxiety

74

Second line treatment options after one SSRI for depression?

Another SSRI
Mertazapine (NaSSA)
Moclobemide (MAOI)
SNRI

75

Why are venlafaxine and TCAs best avoided if possible?

High risk in overdose

76

3 indications for ECT?

Severe depression with psychosis
Treatment resistant mania
Puerperal psychosis

77

How long does the average depressive episode last?

6-8m

78

2 major endocrine causes of mania?

Hyperthyroidism
Acute phase steroids

79

Which mood disorder does FH play a bigger role in?

Mania/BAD

80

Describe the mood and insight associated with hypomania?

Mildly elated mood but full insight retained - euphoric sociability

81

SADFIR of mania symptoms?

Speech (pressure), self esteem, sex
Activity
Disinhibition, distractibility
Flight of ideas
Insomnia
Reckless behaviour

82

How long for and how many Sx must be present for mania diagnosis?

At least 3 symptoms for at least 7 days

83

For how long must mood disturbance last to diagnose depression?

2 weeks

84

For how long and how many symptoms of hypomania must be present to make diagnosis?

At least 3 Sx for at least 4 days

85

Mood and insight in mania?

May be elevated but may also be irritable
Insight may be present but often isn't

86

Psychotic Sx associated with mania?

Delusions, often persecutory or grandiose
Hallucinations (auditory)
No sleep and neglecting of self care
Incoherent speech
Suspicion and violence
Complete loss of insight

87

Psychomotor change in mania?

Psychomotor agitation

88

What 2 medications should be given in an acute manic episode?

Mood stabiliser +/- antipsychotic

89

4 examples of mood stabilisers?

Lithium
Valproate
Lamotrigine
Carbamazepine

90

Commonly used antipsychotics for mania?

Haloperidol
Resperidone
Olanzapine
Quetiapine

91

What is type I bipolar?

'Classical' type - recurrent manic episodes +/- depressive episodes

92

What is bipolar type II?

Hypomanic (less disabling) episodes and depressive episodes

93

Difference between bipolar II and cyclothymia?

Cyclothymia is BAD II but with less bad depressive episodes

94

How long do manic episodes typically last?

2 weeks - 4/5 months

95

What is rapid cycling BAD?

>4 cycles of depression and mania in a year with no intervening asymptomatic episodes

96

6 features of alcohol dependence syndrome?

Tolerance
Withdrawal of stopped
Strong desire/compulsion
Difficulty stopping or avoiding
Lack of other activities or loss of interest
Continuation despite harmful consequences

97

Features of an alcohol Hx?

CAGE to screen
Explore - how much, when, where, who, what, why?
Any social complications incl jobs, law trouble
Physical health complications - liver + GI, anaemia, Neuro, CV
Previous attempts to stop and outcomes (incl withdrawal)
Motivation to change

98

MANIC of mania symptoms?

Mood elated
Activity levels increased
Naughty behaviour - sex, spending sprees, drugs/alc
Insomnia
Confidence and chatty

99

What are Schneiders first rank Sx of schizophrenia?

Thought interference
Auditory hallucinations
Delusional perception
Delusions of control