PSYCH Flashcards
(156 cards)
1
Q
Psych History
A
Intro HPC Past psych history Personal history Family history Drug history Forensic history MSE Physical examination Risk assessment Conclusion
2
Q
What is included in the MSE?
A
Appearance + Behaviour Speech Mood Thought Perception Cognition Insight
3
Q
MSE: Appearance + Behaviour
A
Eye contact Rapport Clothing Agitation Co-operation Hygiene
4
Q
MSE: Speech
A
The production of speech not what is being said Speed - Slow, fast, hesitant, pressured Volume - loud, soft, muttered, shouting Language - accented, Dysphasia Neologisms, Punning
5
Q
MSE: Mood
A
Mood
Affects
6
Q
MSE: Thoughts
A
Content - Obsession, Preoccupied, Clang association, Delusions
Stream - Poverty, Racing, Withdrawal, Disinhibition
Form - Flight of idea, Looseness of association
7
Q
MSE: Types of delusions
A
Persecutory Reference - things have significance Grandiose Worthlessness Control Possession of though Over-valued ideas Obsessive Self-harm/ Suicide
8
Q
MSE: What are delusions?
A
False unshakable beliefs ideas or beliefs firmly held despite evidence to the contrary and that are not consistent with the persons education, culture or social background
9
Q
MSE: Mood?
A
Mood and Affects
Does what the patient is saying match how they are saying it
Euthymic, Elated, Depressed, Irritable, Anxious, Reactive, Flat
10
Q
MSE: Perceptions + Hallucinations
A
5 sense - Auditory, Visual, Tactile, Gustatory, Olfactory
Dissociative - Derealisation (world not real) + Depresonalisation (Detached from the world)
Illusion (misinterpretation of stimuli)
Hallucinations (perceptions without external stimuli)
11
Q
MSE: Cognition
A
Cognitively intact
or
MMSE - Orientation, Registration, Attention and Calculation, Recall, Language (3 stage command), Copy Shapes
12
Q
MSE: Insight
A
Understanding they have an illness
Willing to take treatment
Understand the consequence of not taking treatment
willing to seek help
13
Q
5Ps of formulation?
A
Presenting problem Predisposing factors (factors that already exist) Precipitating factors (factors that just made things worse) Perpetuating factors (factors maintaining the illness, impending factors that could make things worse) Protective factors (what is saving them)
14
Q
What is phenomenology?
A
No theories
Not unconscious
What is visible and Observable in terms of the patient experience
Objective description of abnormal states of mind avoiding preconceived ideas and theories. limited to the description of conscious experiences and observable behaviour
15
Q
Disorders of perception?
A
Sensory distortions
Sensory depictions
16
Q
Sensory distortions?
A
Change in intensity
Change in quality
changes in spatial form
Distortion of experience of time -Physical time + personal time (time flying or time stopping)
17
Q
Sensory depictions?
A
Illusions
Hallucinations
18
Q
What is an illusion?
A
Misinterpretation of stimuli
19
Q
What are hallucinations?
A
Perceptions without object/ external stimuli
Auditory
20
Q
Difference between 2nd + 3rd person auditory hallucinations?
A
2nd person - you will die, you are a bad person
3rd - running commentary, voices discussing or commenting
21
Q
What are visual hallucinations?
A
Commonly seen in organic conditions e.g. brain pathology
Elementary (flashes of light) or fully organised (people, animals)
22
Q
Functional hallucination
A
Auditory stimulus causes hallucination
23
Q
Reflex hallucination?
A
Stimulus in 1 sensory modality produces a sensory experience in another
24
Q
Extracampine hallucination?
A
Hallucination that is outside the limits of the sensory field e.g. voices in Paris when you are in london
25
Hypnagogic?
Hallucinations when the patient is fallling asleep
26
Hypnopompic?
Hallucination when the patient is waking up
27
4 main groups of thought disorders?
Stream
Possession
content
form
28
Disorders of stream of thought?
Tempo - Flight of ideas, Inhibition/ slowness, Circumstantiality
Continuity if thought - Perseveration, Thought block
29
Flight of ideas?
Example of stream of thought disorder
Jumping from thought to thought with a common link
30
Circumstantiality?
Example of stream of thought disorder
Talking around the point but not actually about the point. Giving all the peripheral information
31
Disorders of possession of thought?
Obsession + compulsion - Still have own thoughts but intrusive thoughts enter and are only relieved by actions. Thoughts become worse the more you try to stop
Thought Alienation - Insertion, withdrawal or broadcast
32
What is a delusion?
Example of disorder of thought content
False unshakable belief that is out of character of the individual personal, cultural or social context
33
Difference between a primary and secondary delusion?
Primary - new meaning arises in connection with some other psychological event
Secondary - Arising from some other morbid experience
34
Nihilistic delusion?
Patient believes they are already dead
Patient denies the existence of their body, their mind, their loved ones and the world around them
35
Delusions of poverty?
Convinced that they are impoverished and believe destitution is facing them and their family
36
loosening of association?
There is lack of logical association between succeeding thoughts
37
Examples of disorders of memory?
Dissociative amnesia
| Confabulations
38
Dissociative amnesia?
Sudden amnesia that occurs during the periods of extreme trauma and can last hours or days
39
Confabulations?
Falsifications of memory occurring in clear consciousness associated with organic pathology
Filling in gaps in memory with imagines or untrue experiences that have no basis in fact
40
Anhedonia?
Inability to experience pleasure of things that were usually enjoyable
41
Apathy?
Emotional indifference - lack of emotions
42
Incongruity of affect?
Emotional state and thought process are opposite
43
Blunting of affect?
Absence of emotional response
44
Conversion and Belle indifference?
Conversion - psychological conflict manifests into somatic symptoms (motor or sensory nature) that can't be identified on neuro examination
Belle indifference - conversion disorder but remains emotionally indifferent
45
Depersonalisation?
Sense of detachment of one's own body. A spectator of own activities
46
Derealisation?
Feeling the world isn't real. the world is dull and grey
47
Passivity phenomena?
Actions/ Feelings/ drives are controlled by others
48
Somatic passivity?
Delusional belief that one is a passive recipient of bodily sensations from an external agency
49
Catatonia?
State of excited or inhibited motor activity in the absence of mood disorder or neurological disease
50
Waxy flexibility?
Patient's limbs when moved feel like wax and remain in the position in which they are left
51
Echolalia (parrot)?
Automatic repetition of words heard
52
Echopraxia?
An automatic repetition by the patient of movements made by the examiner
53
Logoclonia?
Repetition of the last syllable of a word
54
Negativism?
Motiveless resistance to movement
55
Palilalia?
Repetition of a word over and over again with increasing frequency
56
Verbigeration (Brick)?
Repetition of one or several sentences or strings of fragmented word in a monotonous tone
57
Presentation order for psych?
```
History
MSE
Formulation (Presetting complaint, Predisposing, precipitating, Perpetuating (maintaining), Protective)
Risk assessment
Management plan
```
58
Positive symptoms
Hallucination
| Delusions
59
Negative symptoms?
flat
Cognitive difficulty
Poor motivation
Social withdrawal
60
Examples of disorders of form of thought?
Derailment/ Knight's moving
Tangientality
Circumstantiality
61
Difference between Knight's move thinking and Tangientality?
Knight's move thinking - Jumping from topic to topic and each sentence is unrelated
Tangientality is when the patient diverts from one topic to another but it is a gradual shift from topic rather than a sudden jump
62
Examples of disorders of stream of thought?
Pressured
Poverty
Thought block
63
Capgrass syndrome?
Irrational belief that a familiar person has been replaced with a duplicate
64
Fregoli?
Delusional misidentification - Thinking a total stranger is someone they are familiar with even if they look different
65
Delusional perception?
Real percept with delusional interpretation
66
Passivity phenomena/ Delusion of control?
Someone or something is controlling their body, mind and behaviour. They don't want to do something but they are being forced to
67
Ekbom Syndrome?
Delusional Parasitosis - believing they have skin infestations that can result in serious harm
68
De Clérambault's Syndrome?
Erotomania - Delusions that someone is in love with them
69
Examples of delusions of thought interference?
Insertion, Withdrawal, Broadcast
70
Folie à deux?
Shared delusions between 2 people
71
Grandiose?
When a patient believes they have special powers, abilities or possessions
72
Cotard's syndrome?
Delusion of immortality, the patient believes they are already dead
73
Nihilistic delusions?
Belief of being dead or decomposed or having lost ones internal organs
74
What is personality?
Collection of characteristics/ traits that develop as we grow and it influences how we think, feel and behave
75
ICD 10 personality disorder definition?
Severe disturbance in characterological condition and behavioural tendencies of the individual in several areas of personality affecting their personal and social life considerably
76
DSM cluster A?
Odd/ Eccentric
- Schizoid, Paranoid, Schizotypical
77
DSM cluster B?
Dramatic/ Erratic/ Emotional
- EUPD, Narcissistic, Dissocial
78
DSM cluster C?
Anxious/ Fearful
- OC, Dependant, Avoidant
79
Clinical features of EUPD?
```
Emotional Dysregulation
Impulsivity - sustenance, eating, exploitation, overspending
Self-harm
Interpersonal difficulty
Lack of sense of self
Abandonment issues
Stress-induced paranoia
Co-morbid mental health conditions
```
80
Ddx of EUPD?
Bipolar Affective Disorder
ADHD
Schizophrenia
Complex PTSD
81
Why would a patient with EUPD self-harm?
Not always suicidal but used to relieve psychic pain or feel something when feeling empty
82
Management of EUPD?
Acute - Crisis admission or HT
Medium - CMHT, CPN, Support worker, Care coordinator
Long term - DBT, OT
83
What is DBT?
Dialectical Behavioural Therapy - coping strategies as alternatives to self-harm
Review the situation from different perspectives and come to a conclusion
Develop coping skills to improve affective stability and impulse control
84
GPD: Dependant?
- Allowing others to make decisions for them
- Putting the needs of others before their own
- When alone, feel helpless and uncomfortable
- Fears of abandonment
- Requires excessive amount of advice
85
GPD: Dissocial?
- Callous unconcern for the feelings of others
- Disregard for social norms, rules and obligations
- Low threshold for discharge of aggression + violence
- Incapacity to experience guilt
- Prone to blame others
86
GPD: Anankastic?
- Obsessive behaviour associated with perfectionism and lack of flexibility
- Excessive adherence of social conventions
- Very conscientious
- Rigid + Stubborn
- Intrusive/ Unwelcomed thoughts
87
GPD: Histrionic?
- Dramatic + Theatrical AF, exaggerated expression of emotions
- Easily Influences
- Shallow + Labile
- Aims to be the centre of attention for excitement
- Inappropriate seductiveness in appearance and behaviour
- Only concerned with physical attractiveness
88
GPD: Anxious/ Avoidant?
- Persistent + Pervasive feelings of apprehension
- Feeling inferior to others
- Excessive preoccupation with being criticised
- Unwilling to get involved with people unless they are certain they will be liked or fear of being criticized
- Restricted lifestyle so require phsyical security
89
GPD: Schizoid?
- Few activities provide pleasure
- Emotionally cold
- Limited capacity to express warm feelings towards others
- Indifference to either praise or criticism
- Excessive preoccupation with fantasy
- Lack of close friend/ confiding relationships
90
GPD: Emotional unstable?
- Impulsive
- Difficulty controlling emotions
- Self-harm to relieve pain
- Feel empty
- Quick to make relationships but easily lose them
- Severe experience auditory hallucinations
91
GPD: Paranoid?
- Suspicious of everything
- Tendency to bear grudges
- Combative and Tenacious sense of personal rights
- Tendency to express excessive self-importance
92
3 examples of assessments for personality disorders?
- Minnesota Multiphasic Personality Inventory
- Eysenck Personality Inventory/ Personality Diagnostic Questionnaire
- Structured Psychometric Assessment
93
Alzheimers dementia cause?
Build up of amyloid plaques and neruofibrillary tangles + decreased acetylcholine production = tau build up and enlarged ventricles
94
Lewy body dementia?
Abnormal build up of alpha-synuclein
95
Signs of Lewy body dementia?
```
Parkinsonian features
Hallucinations
Shift in personality
Syncope + falls
Memory loss towards the end
```
96
Vascular dementia?
History of cerebral infarcts or arteriopathies or leukoencephalopathy
97
Signs of vascular dementia?
```
Stepwise increase in severity of symptoms
Visual field defects
Impaired gait
Attention problems
Personality changes
```
98
Frontal Temporal dementia?
Progressive degeneration of frontal/temporal lobe
Personality/ Behavioural changes
99
Progressive supraocular palsy?
Affects part of the brain just above the nerve cells that control eye movement
Problems with balance + coordination + dementia symptoms
100
Risk factors of dementia?
```
Learning difficulties
Age
Downs syndrome
Genetics
CVD
Parkinsons
Strokes
Depression
Alcohol abuse
```
101
Investigations used to diagnose dementia? HC3ABE
History, Consent, Capacity, Cognition, ADL, Examine
Examine - Gait, Balance, CVD sights, Weight loss, focal neurological signs, Visual fields, Hemiparesis, Urine
102
Management of Dementia?
MDT + Orientation + Reassurance
Acetylcholinesterase
Memantine
Lorazepam
103
MOA of Memantine?
NMDA receptor agonist - Blocks glutamine receptors to improve BPS of dementia e.g hallucinations, aggression + delirium
104
What is delirium?
Acute, transient and reversible state of confusion as the result of an organic process. It is sudden onset and fluctuates
105
Types of delirium?
Hyperactive, Hypoactive + Mixed
106
Causes of delirium?
```
Constipation
Hypoxia
Infection/ Impaction/ Intracranial
Metabolic disturbances/ Myocardial problems
Pain
Sleepiness
Prescription
Hyopthermia/ Pyrexia
Nutrition
Environmental changes
Drugs
```
107
Differences between delirium and dementia?
Delirium
- Sudden onset
- Fluctuations
- Lasts hours to weeks
- Disrupted sleep
- Impaired alertness + orientations
- Altered behaviour
- Incoherent speech rather than word-finding problems
- Disorganised/ Delusional thought
108
2 ways of assessing the mental state of a patient?
MMSE
| Addenbrooke's cognitive assessment
109
Schizoaffective disorder?
Where symptoms of schizophrenia and mood disorder and equally prominent
110
Prodromal phase of schizophrenia?
Emotional and behavioural changes affecting personal functioning and social withdrawal
Anhedonia + decreased cognition
Transient Low intensity symptoms lasting <1 week proceeded by acute psychotic episode
111
+ve symptoms of Schizophrenia?
Auditory hallucinations
Persecutory delusions
Disorganised speech/ thought alienation
112
-ve symptoms of Schizophrenia?
```
Emotional Blunting
Reduced speech
Loss of Motivation
Self-neglect
Social Withdrawal
```
113
Complications of schizophrenia?
```
Premature death
Increased risk of suicide
CVD
T2DM
Smoking related illness
Cancer
Infection
Social exclusion
```
114
Management of Schizophrenia?
Risk Assessment
Early intervention services or Home treatment team or Crisis resolution
Sectioning
Anti psychotic medication
115
What medication is used to manage treatment resistance psychosis?
Clozapine
116
Side effects of antipsychotics?
```
Weight gain
Dyslipidaemia
Sedation
Hypertension
Dry mouth
Blurred vision
Impotence
Urinary retention
Constipation
Flushing
Reduced seizure threshold
QT prolongation
Impaired glucose tolerance
Neuroleptic Malignant Syndrome
```
117
Neuroleptic Malignant Syndrome?
```
Fever
Encephalopathy
Vital dysregulation
Enzyme elevation
Rigidity + Hyperreflexia
```
118
EPSE of antipsychotics?
Acute Dystonic reactions - Jaw jerk, oculogyric crisis
Pseudoparkinsons
Akathesia (Restlessness)
Tardive Dyskinesia
119
Tardive Dyskinesia?
Late onset movement disorder due to long term antipsychotic use
Dopamine receptors become hypersensitive due to long term inhibition
Protrusion on the tongue, Tongue rolling, Chewing motion, Facial dyskinesia
Symptoms are persistent and worse with withdrawal
120
What increases the metabolism of clozapine?
Smoking + grapefruit juice
121
What decreases the metabolism of clozapine and causes it to be more potent?
Caffeine
122
Side Effects of clozapine?
```
Agranulocytosis
Neutropenia
Drooling
Constipation
QT prolongation
Hyperprolactinaemia
Myocarditis or Cardiomyoapthy
```
123
What is the difference between a manic episode and a hypomanic episode?
Manic episode - 1 week, Persistent fluctuation in extreme mood, can lead to hospitalisation and delusions/ hallucinations may be present
Hypomanic - 4 days, no impairment in functioning or evidence of psychosis
124
Bipolar I?
1 Manic episode + History of major depressive episodes
125
Bipolar II?
1+ Major depressive episodes + 1 Hypomania but no mania
126
4 types of Bipolar?
Mania
Hypomania
Depressive
Mixed
127
Management of Bipolar disorder
HTT + CRT
Compulsory admission
Antipsychotic: Haloperidol, Olanazapine, Quetiapine or Risperidone
128
What drugs can be added alongside antipsychotics to manage bipolar?
Lithium or Sodium Valporate
129
MOA of lithium?
Stimulates NMDA receptors increasing excitatory glutamate for post-synaptic neurones
Chronically causes NMDA downregulation to modulate glutamate neurotransmission
130
Which groups of people have the greatest risk of lithium toxicity?
```
Hypertension
DM
CCF
CKD
Schizophrenia
Addison's disease
```
131
GAD?
Disproportionate, uncontrollable widespread worry + a range of cognitive and behavioural symptoms e.g. muscle tensions, trembling, nervousness, sweating
132
Why are SSRI or SNRI CI in pregnancy?
Can cause persistent pulmonary hypertension in newborns
133
PTSD key symptoms?
Re-experiencing, Hyperarousal and Avoidance
134
Specific features of PTSD in children?
Re-living trauma while playing, Nightmares, Anhedonia, Expressing belief they will not live long enough to grow up, Stomach ache, Headache, Secondary enuresis, Separation anxiety
135
Screening tool used for PTSD?
Trauma Screening questionnaire or Impacts of events scale
136
Management of PTSD?
Trauma-focused CBT
Exposure therapy CBT
Trauma-Focused Cognitive Therapy
Eye movement Desensitization + Reprocessing therapy
137
Pharmacological therapy used in PTSD?
SSRI or Venlaxafine or Risperidone
138
OCD?
Recurrent obsessional thoughts or compulsive acts which can cause functional impairment + distress
139
Diagnostic tool used for OCD?
Yale-Brown Obsessive Compulsive Scale
140
Management of OCD?
Risk Assessment
CBT + Exposure response therapy
SSRI or TCA
141
SSRI used for OCD?
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
142
TCA used to manage OCD?
Clomipramine
143
Section 2 duration and purpose?
28 days
| Assessment
144
Section 3 duration and purpose?
6 months
| Treatment
145
Section 4 duration and purpose?
72 hours and if there is no time to wait for a second doctor
146
Section 5(4)?
6 hours
| Patient already admitted to hospital and wanting to leave - Nurse waiting for doctor
147
Section 5(2)?
72 hours
Patient already admitted but wanting to leave
Allow time for section 2 or 3
148
Difference between S136 and S135?
S136 - person suspected of having mental disorder in public place
S135 - Needs court order to access patients' home and remove them
149
Generalised anxiety disorder?
Disproportionate, uncontrollable widespread worry + a range of cognitive and behavioural symptoms
150
Eating disorder?
Persistent disturbance or eating related behaviour which leads to altered intake and absorption of food causing a significant impact on physical and psychological functioning
151
Anorexia Nervosa?
Body image disturbance and fear of gaining weight
| BMI <15 and denial of a sense of malnutrition
152
Bulimia Nervosa?
Recurrent episodes of uncontrolled eating of large amounts of food followed by compensatory behaviour
once a week for 3 months
153
Examples of compensatory behaviours of Bulimia Nervosa?
Vomiting, Purging, Fasting, Excessive exercise, Laxative intake, Diuretic, Diet pill use
154
Finding on examinations that could indicate Bulimia Nervosa?
Russell sign - Knuckle calluses from induced vomiting
Dental Enamel Erosions
Salivary Gland Enlargement
155
Difference between Binge Eating and Bulimia Nervosa?
Binge eating is the same as Bulimia Nervosa without the compensatory behaviour
156
SCOFF Questions?
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you lost > One stone in 3 months?
Do you believe yourself to be fat when others say you are too thin?
Would you say Food dominates your life?
