Neurotic disorders Flashcards
(127 cards)
1
Q
Percentage of adults in the UK with any kind of neurosis at any one time
A
15%
2
Q
Percentage of GP consultations which are for anxiety related disorders
A
25%
3
Q
Mean age of onset for generalised anxiety
A
30
4
Q
Mean age of onset for panic disorder
A
22-25
5
Q
Mean age of onset for OCD
A
20
6
Q
Mean age of onset for social phobia
A
15
7
Q
Median age of onset for blood-injection-injury phobias
A
5-6
8
Q
Life time prevalence for blood-injection-injury phobias
A
3.5%
9
Q
Sex distribution of OCD
A
Boys > girls
Men = women in clinical samples
Women > men in community samples
10
Q
Point prevalence of OCD among adults
A
1-3%
11
Q
Point prevalence of OCD among children and teenagers
A
1-2%
12
Q
Lifetime prevalence of OCD
A
2-3%
13
Q
Sex with earlier age of onset of OCD symptoms
A
Men
14
Q
Four broad categories of symptoms in OCD
A
Aggressive, sexual, and religious obsessions with checking compulsions
Symmetry and ordering obsessions and compulsions
Contamination obsessions with cleaning compulsions
Hoarding obsessions and compulsions
15
Q
Findings in brain imaging of patients with OCD
A
Hypermetabolism of caudate/orbitocingulate region
16
Q
Infection which can lead to PANDAS
A
Streptococcal infection
17
Q
Criteria for PANDAS
A
Presence of OCD or a tic disorder
Age of onset between 3 and the start of puberty
Abrupt onset or a disease course with dramatic exacerbations
Onset occurring after Streptococcal infection
Abnormal neurological exam during an exacerbation
18
Q
First line treatment for mild OCD
A
Self help
Low intensity CBT with exposure response prevention
19
Q
Second line treatment for mild OCD
A
Higher intensity CBT with exposure response prevention OR
SSRI
20
Q
First line treatment for moderate OCD
A
SSRIs or CBT with exposure response prevention
21
Q
First line treatment for severe OCD
A
SSRIs and CBT with exposure response prevention
22
Q
Second line treatment for severe OCD
A
Alternative SSRI or clomipramine
23
Q
Percentage of patients who show improvement in OCD symptoms after SSRI treatment
A
60-70%
24
Q
Four symptom categories seen in PTSD
A
Intrusion
Avoidance
Negative alterations to cognition and mood
Alterations to arousal and reactivity
25
Point prevalence of PTSD
1%
26
Lifetime prevalence of PTSD among American adults
6.8%
27
Lifetime prevalence of PSTD among American women
9.7%
28
Lifetime prevalence of PSTD among American men
3.6%
29
Percentage of males exposed to traumatic events
60%
30
Percentage of females exposed to traumatic events
50%
31
Type of trauma where men are more likely than women to develop PTSD
Rape
32
Pre-traumatic factors which increase the likelihood of developing PTSD
Psychiatric disorder
Female sex
Personality type with an external locus of control
Lower socioeconomic status
Lower educational status
Ethnic minority status
Cluster B personality disorders
33
Peri-traumatic factors which increase the likelihood of developing PTSD
Higher severity of trauma
Perceived threat to life
Peritraumatic dissociation
34
Post-traumatic factors which increase the likelihood of developing PTSD
Perceived lack of support
Subsequent life stress
Physical illness
35
Protective factors which decrease the likelihood of developing PTSD
High IQ
High socioeconomic status
Having an opportunity to grieve for the loss
36
Length of time of symptoms where watchful waiting should be considered for PTSD
Up to four weeks
37
Interventions for PTSD with symptoms present within three months of the trauma
Trauma focussed CBT
Non benzodiazepine hypnotic medication for short term use after four consecutive nights of sleep disturbance
Antidepressant medication
38
Number of sessions of trauma focussed CBT usually used for PTSD
8-12
39
Number of sessions of trauma focussed CBT usually used if treatment starts within one month of the trauma
Five
40
Interventions used for PTSD where symptoms are present for more than three months after a trauma
Trauma focussed CBT
EMDR
Paroxetine, mirtazapine, amitriptyline or phenelzine
41
Antidepressants which are second line in NICE guidelines for PTSD after psychological therapies
Mirtazapine
Paroxetine
42
Antidepressant which is licensed for females but not males with PTSD in the UK
Sertraline
43
Effectiveness of trauma focussed CBT compared to EMDR for PTSD
Likely equal
44
Psychological intervention which may increase the risk of PTSD after trauma
Psychological debriefing
45
Psychologist who discovered EMDR
Shapiro
46
Percentage of people with PTSD who experience remission after two years
50%
47
Percentage of people with PTSD who have ongoing symptoms after six years
33%
48
Time after stressor when symptoms of an acute stress reaction start
Usually within minutes
49
Time after stressor when symptoms of an acute stress reaction should resolve
Within 2-3 days - often within hours
50
Lifetime prevalence of generalised anxiety disorder
5%
51
Point prevalence of generalised anxiety disorder
2-3%
52
MZ concordance of generalised anxiety disorder
41%
53
DZ concordance of generalised anxiety disorder
4%
54
Number of items in the Hamilton anxiety scale
14
55
Score on the Hamilton anxiety scale suggestive of clinical recovery
<7
56
SSRIs used for acute treatment of generalised anxiety disorder
Escitalopram
Paroxetine
Sertraline
57
TCA used for acute treatment of generalised anxiety disorder
Imipramine
58
Medications used for acute treatment of generalised anxiety disorder apart from SSRIs and TCAs
Venlafaxine
Duloxetine
Buspirone
59
Medications used for long term treatment of generalised anxiety disorder
Paroxetine
Escitalopram
Venlafaxine
Pregabalin
60
Antipsychotics used as adjuncts for generalised anxiety disorder
Olanzapine
Risperidone
61
First line medication class for generalised anxiety disorder
SSRIs
62
First line psychological treatment for generalised anxiety disorder
CBT
63
Herbal treatment which shows most evidence for treatment of generalised anxiety disorder
Kava shrub (Piper methysticum)
64
Reason for withdrawal of the kava shrub from the UK market for anxiety treatment
Hepatotoxicity
65
Interaction between evening primrose oil and phenothiazides
Can cause seizures
66
Point prevalence of social phobia
2.8%
67
First line treatments for social phobia
SSRIs
CBT
68
Second line medication for social phobia
Phenelzine
69
Third line medications for social phobia
SSRI + clonazepam combination
Gabapentin
Pregabalin
70
Point prevalence of panic disorder
0.9%
71
Lifetime prevalence of panic attacks without panic disorder
28%
72
Lifetime prevalence of panic disorder
4.7%
73
Mean age of onset of panic attacks
22
74
Heritability of panic disorder
30-40%
75
First line treatments for panic disorder
CBT
SSRIs
Self help
76
Length of time to continue treatment with SSRI for panic disorder to assess efficacy
12 weeks
77
SSRI with most evidence for body dysmorphic disorder
Fluoxetine
78
Prevalence of somatisation disorder
1-2%
79
Percentage of adults with dissociative disorder
10%
80
Antidepressants which are licensed for treatment of PTSD
Sertraline
Paroxetine
81
Blood tests in patients with PANDAS which indicate prior streptococcal infection
ASO
Anti-DNAse B
82
Percentage reduction in YBOCS score which suggests treatment response in OCD
35% reduction
83
Length of time before its effects are needed when propranolol should be taken
1 hour
84
Male:female ratio for generalised anxiety disorder
1:2
85
Male:female ratio for agoraphobia
1:3
86
Options for treatment resistant OCD
Clomipramine and SSRI combination
Antipsychotic and SSRI combination
Refer to specialist team
87
Subtypes of OCD which have a poor response to both SSRIs and CBT
Hoarding rituals
Sexual and religious obsessional thoughts
88
Subtype of OCD which has a higher risk for first degree relatives to be affected
Symmetry and ordering rituals
89
Benzodiazepine of choice in severe hepatic impairment
Oxazepam
90
Features of adjustment disorder
A maladaptive reaction to a psychological stressor
Excessive preoccupation with the stressor
Once the stressor has ended symptoms resolve within 6 months
91
Length of time symptoms of adjustment disorder last once the stressor is removed
Up to 6 months
92
Examples of stressors which may cause adjustment disorder
Divorce
Buying a house
Loosing a job
A new illness or disability
93
Additional features required for a diagnosis of complex PTSD compared with PTSD
Problems with affect regulation
Persistent negative self-beliefs
Persistent difficulties in sustaining relationships
94
First line treatments for PTSD in adults
Trauma focused CBT
EMDR
Trauma focused computerised CBT
95
Length of time SSRIs should be continued for in OCD if effective
At least 12 months
96
Length of time antidepressants should be continued in panic disorder before a switch is considered
12 weeks
97
Most common anxiety disorder in the epidemiological catchment area study
Phobia
98
Brain structure implicated in the development of PTSD
Amygdala
99
Description of the nature of the traumatic event in PTSD as per ICD 11
Extremely threatening or horrific nature
100
Core symptoms which must be present for a diagnosis of PTSD
Re-experiencing the event
Deliberate avoidance of reminders of the event
Persistent perception of heightened current threat
101
Medication recommended by NICE for PTSD but which is not licensed
Mirtazapine
102
Two main somatoform disorders in ICD 11
Bodily distress disorder
Body integrity dysphoria
103
Features of bodily distress disorder
Presence of physical symptoms that are distressing
Usually involving multiple body systems
Excessive attention towards the symptoms
No organic pathology found to explain symptoms
Often repeated contact with medical professionals about the symptoms despite reassurances given
104
Features of body integrity dysphoria
An intense and persistent desire to become physically disabled
Results in harmful consequences either through physical harm or functional impairment due to the preoccupation
Desire starts by early adolescence
105
Difference between bodily distress disorder and hypochondriasis
For bodily distress disorder the main concern is the symptoms, not a diagnosis
For hypochondriasis the main concern is that there is a serious medical diagnosis which is not being found
106
Dissociative disorders seen in ICD 11
Dissociative neurological symptom disorder
Dissociative amnesia
Trance disorder
Possession trance disorder
Dissociative identity disorder
Partial dissociative identity disorder
Depersonalisation derealisation disorder
Other specified dissociative disorders
107
Features of dissociative neurological symptom disorder
Involuntary disturbance to one or more motor, cognitive, or sensory functions, lasting at least several hours
Not consistent with a recognised medical condition, substance misuse or another psychiatric diagnosis
Results in significant impairment
108
Features of depersonalisation
Someone experiences themselves as feeling strange or unreal
They may feel detached from their own body
Can have a sense of emotional numbing
Distressing
Usually acute onset
109
Features of derealisation
Someone experiences the world around them as strange or unreal
They may feel detached from their surroundings
Distressing
Usually acute onset
110
Medications used for pathological gambling disorder
SSRIs
Naltrexone
Mood stabilisers
111
Medication preferred for pathological gambling where there is comorbid impulse control
Naltrexone
112
Syndrome characterised by symptoms of heart disease with no organic cause found
Da Costa's syndrome
113
Length of time medication should be continued in body dysmorphic disorder to prevent relapse
12 months
114
Body area most commonly perceived to be abnormal in patients with body dysmorphic disorder
Skin
115
Maximum length of time benzodiazepines should be prescribed for anxiety according to the Maudsley guidelines
4 weeks
116
Sedatives recommended in hepatic impairment
Lorazepam
Oxazepam
Temazapem
Zopiclone
117
First line treatment for long term insomnia
CBT-I
118
Longest treatment with z-drugs should be given for insomnia
2 weeks
119
First line treatment for simple phobia
Graded exposure
120
Examples of non-REM sleep disorders
Sleep walking
Sleep terrors
Confusion arousals
121
Examples of REM sleep disorders
REM behavioural disorder
Sleep paralysis
Nightmares
122
Most common comorbid condition with hyperchondriasis
Generalised anxiety disorder
123
Medication which can be used to augment SSRIs in body dysmorphic disorder
Buspirone
124
Common medical comorbidities of panic disorder
HTN
Migraine
COPD
IBD
125
Alternative name for PTSD relating to veterans
Combat neurosis
126
Common precipitants for transient global amnesia
Exertion
Cold
Pain
Emotional stress
Sex
127
Benzodiazepine with the shortest half life
Oxazepam
