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Neurosis Flashcards

(121 cards)

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1
Q

What is an acute stress disorder

A

Acute stress reaction that occurs within 4 weeks of an incident

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2
Q

Presentation of acute stress disorder

A

Intrusive thoughts- nightmares, flashbacks
Negative mood
Avoidance of trigger
Hypervigilance
Dissociation

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3
Q

Features of hyperarousal

A

Sleep disturbance
Hypervigilance- on edge looking for potential threats

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4
Q

What are features of dissociation

A

Being in a daze
Time slowing

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5
Q

First line for acute stress disorder

A

If very mild can use waitful watching
Trauma focused CBT

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6
Q

When use benzodiazepines in acute stress disorder

A

For acute symptoms like agitation and sleep disturbance
Use with caution

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7
Q

Presentation of PTSD

A

Intrusive thoughts- nightmares, flashbacks
Avoiding circumstances resembling the event
Hyperarousal
Emotional numbing
Turned to alcohol, drugs
Depressed
Anger

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8
Q

Management of PTSD

A

First line- trauma based CBT
Drug treatment not recommended first line but if its use- SNRI or SSRI
In severe cases can use risperidone or eye movement desensitisation

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9
Q

How is the severity of GAD determined

A

GAD-7 questionnaire out of 21
Mild- over 5
Moderate- over 10
Severe- over 15

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10
Q

How is GAD diagnosed

A

Excessive anxiety and worrying over at least the last 6 months over various topics
3 of following physical symptoms
- restless
- easily fatigued
- irritability
- muscle tension
- insomina
- can’t concentrate
Not explained by a substance or another mental disorder

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11
Q

How is GAD managed

A

Step 1- offer a period of active waiting unless functional impairment
Step 2- if symptoms not improved offer low intensity psychological intervention guided by preferances
- individual non-facilitated self-help
- individual guided self help
- psychoeducation groups
Step 3- for marked functional impairment as well as failed past 2 steps
- CBT or applied relaxation
- sertraline, if not tolerated offer SNRI or escitalopram/paroxetine
- if neither SSRI or SNRI not tolerated then pregabalin
Step 4- if severe functional impairment or step 3 refractory, high risk self harm
- refer for specialist

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12
Q

What should do if pregnant woman reaches step 3 of GAD

A

First line CBT
Medication wise discuss the issues associated- pregabalin best option as no documented risks

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13
Q

How long should benzos be prescribed for

A

Max 2-4 weeks

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14
Q

Diagnosis of OCD

A

Either compulsions or obsession or both
- cause marked distress
- take more than hour out of day
- interfere with normal life

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15
Q

How is OCD categorised

A

Using the Yale Brown Obsessive compulsive scale
Main categorisation is by how long spend each day occupied by thoughts or performing the acts
Mild- less than 1 hour
Moderate- 1-3 hours
Severe- more than 3 hours

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16
Q

How should mild OCD be managed

A

Either refer for CBT or via IAPT
Exposure and response prevention is used

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17
Q

How should moderate OCD be managed

A

CBT with ERP OR SSRI
1 of them
If unsuccessful after 12 weeks either change SSRI or change to clomipramine

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18
Q

What is alternative to SSRI if is not tolerated in OCD

A

Clomipramine

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19
Q

What should do if severe OCD

A

Refer to secondary care mental health team
Consider in meantime offering CBT with ERP and SSRI/clomipramine

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20
Q

What SSRIs can be used in OCD

A

Escitalopram
Paroxetine
Fluoxetine
Fluovoxamine
Sertraline

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21
Q

How long should SSRI/clomipramine be given for after remission in OCD

A

12 months and then consider

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22
Q

What are 2 types of benzodiazepam

A

Short acting
- lorazepam
- temazepam
Longer acting
- diazepam
- nitrazepam
- chlordiazepoxide

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23
Q

MOA of benzodiazepams

A

Bind to specific benzo receptors on the GABAa receptor complex which hyperpolarises neurones

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24
Q

Side effects of benzos

A

Drowsiness and tiredness
headaches
Slurred speech
Paradoxical effects including talkativeness and excitement
Dependance

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25
Withdrawal symptoms of benzos
Insomnia Anxiety Loss of appetite Tremor Weight loss Sweating Tinnitus
26
Risk factors for GAD
Aged 30-55 Living alone Divorced Being a lone parent
27
What is conversion disorder
Where psychological stress is mainfested as physical neurological symptoms- like loss of motor or sensory function
28
How do people view their conversion disorder
It is not factitious nor malingering
29
What is post concussion syndrome
When hit head can get symptoms of headache, fatigue, dizziness and anxiety depression for a few weeks following the event
30
What are the Z drugs
Zoplicone Zolpidem Zalepon
31
How long should Z drugs be given for
Up to 4 weeks
32
Side effects of Z drugs
GI Headache Memory problems Dependance High risk of falls
33
What are unexplained symptoms
Psychiatric terms for patients who have symptoms with no organic cause
34
What is somatisation disorder
Where mental problem can manifest as frequent and negative physical symptoms which must exist for at least 2 years
35
What is illness anxiety disorder (hypochondriasis)
Persistent belief in the presence of an underlying disease Refuse to accept reassurance or negative test result
36
What is factitious disorder (munchausen syndrome)
Intentional production of physical or psychological to appear sick
37
What is malingering
Fraudulent simulation or exaggeation for financial or other gain
38
What is dissociative disorder
Where separate off from certain memories Struggle with identity and can even forget certain things which happened to you
39
What is diagnosis if develop compulsions after a traumatic ordeal
Although are showing signs of OCD Diagnosis is PTSD
40
What do if someone from the military comes in with PTSD symptoms
Refer to specialist service within the military
41
How is chronic insomnia defined
Trouble falling asleep or staying asleep at least 3 nights a week for 3 months
42
Risk factors for chronic insomnia
Alcohol and substance abuse Stimulant usage Corticosteroid use Poor sleep hygiene Chronic pain and illnesses Female Age increased Unemployed Divroced
43
What drugs can use for insomnia
Benzos - tamazepam Z-drugs - zopiclone - zoplidem - zalepon
44
Side effects of sleeping pills
Dependance Daytime sedation Cogntive impairment Poor motor coordination
45
What can be presentation of sleep paralysis
When wake up are paralysed in skeletal muscles Can get hallucinations either auditory or visual
46
Management of sleep paralysis if needed/very severe
Clonazapem
47
What class of drugs can cause memory loss
Benzodiazepams
48
How to withdraw a benzo
Reduce the dose by 1/8th every forntight Can consider switching to longer term from short term
49
What is a panic disorder
When have sudden attacks of fear/panic that something bad will happen
50
What is management of a panic disorder
Step 1: recognising and diagnosis Step 2: treat in primary care Step 3: review and consider other treatments Step 4: refer to specialist mental health services Step 5: Care in mental helath services In primary care CBT and SSRI If no response then use imipramine or clomipramine
51
How are panic disorders diagnosed
Recurrent panic attacks With either persistent worry or change in behaviour Not better explained by another anxiety disorder of substance use
52
When should you use benzos in GAD
Never unless in instance of crisis
53
What is agoraphobia
A fear of and wanting to leave a situation/space such as an enclosed or public space
54
What is an adjustment disorder
An excessive reaction to a life event or psychological stressor
55
What is it when have fear of scrutiny from others or embarassing self
Social phobia
56
What is used to treat benzo overdose
Flumenazil
57
What is flumenazil
A GABA antagonist
58
How do benzo overdoses present
Drowsy Ataxia Dysarthria Nystagmus Resp depression Bradycardia
59
Once tranquilise somone what need to do
Monitor closely for signs of benzo overdose Have flumenazil at ready
60
Tinnitus, tremor, sweating and hyperarousal, what drug are being withdrawn from
Benzos
61
Management of short term insomnia
Assess if daytime dysfunction If no - sleep hygiene measures If yes or sleep hygiene fails - then assess if insomnia is due to a short term stressor so will resolve quickly If yes can consider Z-drug If no CBT-I with perhaps Z-drug or modified release melatonin if over 55
62
What is management of chronic insomnia
First line CBT-I If symptoms extremely severe or acute exacerbation use Z-drug If over 55 consider modified release melatonin
63
What hypnotic can be considered in patients aged over 55
Melatonin for 3 weeks but if works consider further 10 weeks
64
What tool is used to screen for social phobia
SPIN Social phobia inventory
65
What is it called when patient disappears for a period with no memory and end up in a different area
Dissociative fugue
66
Difference between a pain disorder and somatisation
Pain disorder- 1 symptoms Somatisation- constellation of sx
67
What is only time EMDR is not appropriate in PTSD
Combat related trauma
68
What is it called when start repeating actions of a dead person
Identification Is a defense mechanism
69
How are benzos withdrawn
Reduce by 2.5mg every 2 weeks
70
What is important thing to ask before prescribing benzos
Alcohol dependance as can synergise to cause resp depression
71
What is fear of pain
Algophobia
72
What is fear of heights
Acrophobia
73
What is fear of marriage/commitment
Gamophobia
74
What is difference between emotional and problem focused management of coping
Emotional- managing the meotions Problem- managing a stress by identifying the causes of it and dealing with those
75
Management of low libido
Rule out physical cause Refer for psychosexual counselling
76
Causes of erectile dysfunction
Anxiety Hypthyroidism Hyperprolactinaemia Post TURP Alcohol DM Cholesterol
77
What suggests psych cause of erectile dysfunction as opposed to organic
Morning erection is maintained in psych but not in organic
78
Criteria for adjustment disorder
- identifiable stressor - symptoms within 3 months of stressor - last less than 6 months - does not meet criteria for other disorders
79
What is flooding
When expose patinet directly to their phobia as soon as possible
80
What is neurosis
Inappropriate behaviour or emotional response to every day stimulus
81
What is management of phobias (social, agoraphobia, simple phobias)
CBT with exposure therapy to desensitise people Create hierarchy of exposures and work through to highest part
82
What is habituation
Where exposure to stimuli over time reduces anxiety to the stimuli
83
Difference between adjustment disorder versus acute stress reaction
Adjustment disorder- reaction to psychosocial stressor such as losing job, breakup Acute stress reaction is traumatic experience
84
Management of adjustment disorder
Group therapy Crisis counselling
85
Management of dissociative disorder
Psychotherapy DBT
86
What is the questionnaire for OCD
Yale and Brown
87
Drugs which cause low libido
Anti-histamines Blood pressure Anti-epileptics SSRI
88
Main problem of Z drugs in elderly
Falls
89
What is depersonalisation
Feeling of being outside of oneself
90
What is derealisation
Where feel world around isnt real
91
Whar are depersonalisation and derealisation seen in
Acute stress reaction and PTSD
92
What does modelling refer to
When during social learning someone may develop a phobia after watching their mother do it
93
What does conditioning refer to
Form of learning where a stimulus becomes increasingly effective in evoking a response
94
Difference in prognosis of phobia starting in childhood and one which started in adulthood after life event
Starting in childhood have poor prognosis
95
Who is agoraphobia seen in
Married young women who are unempolyed or hourse wives
96
If person has social phobia what consider as other diagnosis
If long term- anxious personality disorder
97
Can you use benzos for phobias and panic disorders
NO not recommended
98
Management options used for panic disorder
CBT/relaxation techniques Can use SSRI/venlafaxine
99
Investigating initial panic disorder
Rule out organic causes - thyroid - alcohol screen - ECG
100
What are 3 clusters of symptoms for PTSD
Hyperarousal Avoidance Reliving experience
101
What is technique used in psychotherapy for dissociative disorders
Abreaction
102
What is abreaction
Encourage person to relive experience to help repressed memories return
103
Management of somatisation
CBT/psychodynamic therapy Medication for mood disorder or pain Make sure always seen by same physician
104
How is hypochondrial disorder managed
CBT/psychodynamic therapy Medication for mood disorder or pain Make sure always seen by same physician
105
Features of a prolonged grief reaction
Persistent over 6 months Preoccupation with the deceased Clearly exceeds expected religious/cultural response Pervasive- causes impairment in other aspects of life
106
What is shoulds thinking
Thinking error where use should in critical manner
107
What is all or nothing
Where think very black or white "My alarm didnt go off, I'll cancel the meeting"
108
What is mind reading
Make conclusions about what others think "Everyone thinks im boring"
109
What is filtering
ONly paying attention to your failures not positives
110
What is disqualifying the positive
Where something positive hapens but convince self it is bad
111
What are functional symptoms
Complex issues people experience without a clear structural or physiological cause
112
Main aims for dealing with functional symptoms
Make sure patient knows you understand symptom and taken seriously Patient has a reassuing explanation Understands factors which contributed Know that symptoms can resolve
113
What is SSRI for agoraphobia
Sertraline
114
If sertraline fails for agoraphobia, what use
Venlafaxine
115
If SSRI or SNRI CI in agoraphobia what use
Pregabalin
116
What is an orgasmic disorder
Where cant climax
117
What is sexual side effect of trazodone and chlorpromazine
Priapism- anti histamines have this effect
118
What is frotteurism
Where rub genitals againsts someone
119
What is it when binge eat and then period of long sleep
Kleine-levin syndrome
120
Which SSRI for PTSD
Sertraline Paroxetine
121
Which NT most associated with anxiety
Low levels of GABA

Psych (Owen) (9 decks)

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