Psych Flashcards

Question

Seasonal affective disorder

Answer 1

depression which occurs predominately around the winter months

Answer 2

Treated the same way as depression

Answer 3

CBT is a form of talking therapy based on the concept that our thoughts, emotions, and actions are interrelted, and that negative thoughts and feelings can trap you in a negative cycle. CBT aims to help us deal with problems by approaching them from a bird's eye view and breaking them down into smaller parts to change the way we think and behave

Answer 4

* Low mood * Psuedohallucinations * false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating Last up to 6months post loss

Answer 5

* Depression * Anxiety * OCD * Eating disorders * PSTD

Answer 6

Hyperthyroidism * Abdo pain * Palpitations * Agitated and fidgety * Difficultly sleeping * Affected concentration

Answer 7

MSE GAD7 TFTs

Answer 8

Regular and uncontrolled (can be triggered by anything/ have no trigger) anxiety for \>= 6 months.

Answer 9

* Anxiety * Fear * Impaired concentration * Irritability

Answer 10

* Tremors * Palpitations * Loose stools

Answer 11

Bio * SSRI - sertraline specifically * higher dose than for depression * Try a 2nd SSRI or SNRI as 2nd line * Benzodiazepines * Acute use for mx bad bouts of GAD * Beta blockers * Reduce physical syx, e.g., tremor * CI in asthma/diabetes Psycho * CBT * Mindfullness * Psychoeducation Social * Advice on stress mx * Advice on coping mechanisms * e.g., drug & alcohol

Answer 12

Short prescription of Benzodiazepines

Answer 13

* Rapid-onset severe anxiety * Impending sense of doom * Resolves rapidly * Palpitations + tachypnoea

Answer 14

Bio * SSRIs Psycho * CBT Social * Psychoeducation * Breathing exercises * Support groups

Answer 15

Acute stress reaction that occurs in the 4 weeks after a traumatic event

Answer 16

Stress reaction that develops 4 weeks following traumatic event. Symptoms present for \>1 month.

Answer 17

* re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images * avoidance: avoiding people, situations or circumstances resembling or associated with the event * hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating * emotional numbing - lack of ability to experience feelings, feeling detached

Answer 18

Bio * Venlafaxine (SNRI) * or SSRI * Risperidone in severe cases *Medication is not 1st line* Psycho * Trauma-focussed CBT * Eye movement desensitisation and reprocessing (EMDR) * More severe cases Social *

Answer 19

Recurrent obsessional thoughts or compulsive acts are developed Obsessions: thoughts/images that are distressing, unwanted and intrusive that are recognised as own thoughts Compulsions: repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession

Answer 20

Psycho 1. CBT including exposure and response prevention Bio 2. SSRI * Quickly increased to high dose * To continue for 12 months after pt goes into remission 3. Clomipramine or alt SSRI (if first SSRI ineffective after 12 weeks)

Answer 21

* Fear of being unable to escape to a safe place * Often end up housebound

Answer 22

* Fear of being scrutinised/judged * People noticing you blush * Can tolerate large, anonymous crowds * Dislike intimate gathering

Answer 23

**Type 1** Mania + depressive episodes **Type 2** Hypomania + depressive episodes

Answer 24

Mania lasts for at least 7 days * Feelings of euphoria * Hallucinations and/or delusions * Predisposition to risky or reckless behaviour * Mutism * Severely manic pts

Answer 25

From primary care * Urgent referral to community mental health team Psych * Olanzapine * Useful in acute mania * Long term prophylaxis for bipolar affective disorder * Clonazepam &/or Lorazepam * Fast onset of action * Tranquilising effect \*Psychological therapy not usually offered to manic pts in the acute phase

Answer 26

1. Thought echo * Hears own thoughts as if spoken aloud to them 2. 3rd person voices * People talking about them from 3rd person 3. Running commentary * Voice narrating what they are saying

Answer 27

Typically lasting 3-4 days * Does not interefere majorly with day to day * Euphoric * Impulsive behaviour * Feels doesn't need sleep/far less sleep * Irritability * Flight of ideas

Answer 28

Low risk * Routine referral to CMHT High risk * Urgent referral to CMHT

Answer 29

* Mood stabilisers * Lithium * Alt Sodium Valproate * Address co-morbidities * 2-3x incr risk diabetes, CVD, COPD

Answer 30

Lithium levels should be checked 12 hours post-dose * One week after starting treatment/after dose change * Weekly until the levels are stable * Once levels are stable, measure every 3 months + every 6/12: * U&Es * TFTs

Answer 31

* Hypothyroidism * Renal impairment * Preceipitation of a relapse if suddenly discontinued

Answer 32

* Coarse tremors * GI disturbance * Ataxia * (white pills)

Answer 33

First trimester exposure associated with Ebstein's anomaly (a serious cardiac anomaly)

Answer 34

NSAIDs can increase lithium levels in the blood resulting in an increased risk for serious adverse effects like confusion, tremor, slurred speech, and vomiting

Answer 35

* N+V * Diarrhoea * Movement disorder

Answer 36

* cleft palate * spina bifida * Neural tube defects

Answer 37

Consider stopping the antidepressant and start antipsychotic therapy

Answer 38

* Acute (episode) * Transient, resolves * Organic * Drugs * Delirium * Medication * Steroids * Affective * Severe depression * Mania * Personality disorders * Schizoaffective * Schizotypal * Delusional disorder * Only have delusions

Answer 39

Ix * Take a detailed history * Drug use * FHx * Perform exam and ix * Urine drug screen * Obtain collateral hx Mx * Consider section 5(2) * Refer to psych team * Commence medication * For acute agitation: Lorazepam * Antipsychotic: Atypical but NOT Clozapine * Aripiprazole 10mgOD, or Olanzapine 10mg nocte * Education & support

Answer 40

Tearful & emotionally labile after giving birth

Answer 41

Ask 2 depression identification Qs (low mood & anhedonia), if +ve to one -\> **Edinburgh postnatal depression scale**

Answer 42

* CBT * SSRI * F/U w GP * Home visits from community midwives

Answer 43

Occurs in first 3 weeks post natal with acute onset

Answer 44

* Elevated mood * Sleeping less/not sleeping * Delusions * Often grandiose

Answer 45

Characterised by break down of thought process, contact with reality, and emotional responsiveness

Answer 46

1. Paranoid (most common) * Prominent delusions & hallucinations * Dominated by sense of anxiety that something bad will happen 2. Hebephrenic * Disorganised * Chaotic mood * 'child-like' shallow & inappropriate affect 3. Catatonic * Psychomotor disturbance 4. Simple * Only negative features, e.g., social withdrawal and blunted affect

Answer 47

* Auditory hallucinations * Abnormal thoughts * Delusions

Answer 48

* Thought insertion * Thoughts have been inserted into their brain * Thought withdrawal * Thoughts are being stolen from them * Thought broadcasting * Other people can see/hear what they are thinking

Answer 49

False, fixed belief held despite conflicting evidence.

Answer 50

Prodrome -\> Acute phase -\> Chronic phase Prodrome * Social withdrawal * Loss of interest in work and relationships Acute phase * Delusions * Hallucinations * Thought interference Chronic phase * Apathy * Blunted affect * Social withdrawal * Anhedonia * Poverty of thought

Answer 51

1) 10% 2) 50%

Answer 52

FHx * monozygotic twin has schizophrenia = 50% * parent has schizophrenia = 10-15% * sibling has schizophrenia = 10% * no relatives with schizophrenia = 1% Others * Black Caribbean ethnicity - RR 5.4 * Migration - RR 2.9 * Urban environment- RR 2.4 * Cannabis use - RR 1.4

Answer 53

Bio * Antipsychotics Psycho * CBT * Family therapy Social * Social skills training * Education * Benefits * Housing

Answer 54

Failure to respond to 2 or more antipsychotics, at least 1 of which is atypical. Each given at therapeutic dose for at least 6 weeks.

Answer 55

Clozapine * Weekly blood tests * Risk of **agranulocytosis** * Decreased leukocytes * Counsel about taking infyx syx seriously \*reduces seizure threshold

Answer 56

earliest stage of schizophrenia (not experience by everyone)

Answer 57

* Nervousness * Anxiety * Depression * Difficulty concentrating * Excessive worrying

Answer 58

Dopamine antagonist

Answer 59

Extra pyrimidal side effects *(mimics parkinsons)* * Acute dystonia * suddenly v painful contractions of parts of body * oculogyric crisis - deviation of eyes and repeated blinking * *Procyclidine* helps treat ^ * Tardive dyskinesia * Often develops with long term use * Lip smacking, sticking tongue out, difficulty swallowing, excessive blinking * Parkinsonism * Akathisia * restlessness

Answer 60

* Haloperidol * Chlorpromazine * Zuclopenthixol decanoate

Answer 61

* Olanzapine * Quetiapine * Clozapine * Risperidone * Aripiprazole

Answer 62

Affect dopamine, serotonin, histamine and adrenergic receptors

Answer 63

Metabolic * Weight gain * Dyslipidaemia * Hypercholesterolaemia * Hyperprolactinaemia

Answer 64

If missed for \>48 hours, dose will need to be retitrated again slowly ## Footnote *Starting Clozapine after a break of \>48 hours,can make side effects worse, such as blood pressure changes, drowsiness and dizziness*

Answer 65

Reduces levels * Starting smoking, or smoking more * Stopping drinking Increases levels * Alcohol binges

Answer 66

ST elevation due to myocarditis

Answer 67

considered for once monthly IM antipsychotic depot injections

Answer 68

Complication of taking antipsychotics

Answer 69

* Hyperthermia * Altered mental status - agitation, cofnusion * Muscle rigidity * Urinary incontinence

Answer 70

* **Creatine kinase** * Raised * Degree of muscle breakdown due excessive contractions * U&E * WCC * LFTs

Answer 71

* Stop antipsychotic * Psych input if MH concern * Cooling blankets * For hyperthermia * Dantrolene * Rigidity * Also ± Bromocroptine * Benzodiazepines * Agitation * Fluids * If AKI

Answer 72

ST elevation due to cardiac failure secondary to myocarditis and cardiomyopathy

Answer 73

Deeply ingrained and maladaptive pattern of behaviour persisting over many years. ## Footnote In mental health, the word ‘personality’ refers to traits that we developed as we grow up which make each of us an individual. These include the ways that we: think, feel and behave. Personality disorders manifest as experiencing significant difficulties in how you relate to yourself and others and having problems coping day to day stemming from your personality.

Answer 74

ICD-11 1. Severity: Mild --\> Moderate --\> Severe 2. Trait domain Clusters * A- 'odd cluster' * B - 'dramatic cluster' * C - 'anxious cluser'

Answer 75

* Negative affectivity: tendency to experience broad range of negative emotions with a frequency and intensity out of proportion with the situation * Dissocial: disregard for others' rights and feelings - encompassing both self-centredness and lack of empathy * Disinhibition: tendency to act rashly based on immediate external or internal stimuli without consideration of potential negative consequences * Anankastic: narrow focus on one's rigid standard of perfection/right and wrong - controlling one's own and other's behaviours and situations to ensure conformity to these standards * Detachment: tendency to maintain interpersonal distance and emotional distance

Answer 76

A- 'odd cluster' * Paranoid * Schizoid * Schizotypal B - 'dramatic cluster' * EUPD * Histrionic * Antisocial C - 'anxious cluser' * Avoidant * Anankastic * Dependent

Answer 77

* Pervasive * Persistent * Pathological

Answer 78

Bio * SSRI * Antipsychotics Psycho * CBT * DBT * EUPD * MBT * Arts therapy Social * Therapeutic communities

Answer 79

Often solitary existence due to feelings of inadequacy and fear of rejection and judgement from others.

Answer 80

* Occupied with details, rules, organization * Dedicated to work and efficiency to the elimination of spare time activities * Rigid about etiquettes of morality, ethics, or values * Unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things

Answer 81

* Disinterest in social relationships * Emotional coldness * Preference for solitary activities * Few interests * Indifference to praise/criticism

Answer 82

* Cognitive or perceptual distortions * Eccentricities of behaviours * Paranoia * Resulting in lack of relationships

Answer 83

an emotional or behavioral reaction to a stressful event or change in a person's life

Answer 84

visual hallucinations associated with eye disease - most common hallucinations are faces, children and wild animals.

Answer 85

delusion that they are infested by 'bugs'

Answer 86

Depersonalisation: persistently or repeatedly have the feeling that you're observing yourself from outside your body Derealisation: you have a sense that things around you aren't real

Answer 87

* a.k.a De Clérambault's syndrome * Delusion that a famous person is in love with them, with the absence of other psychotic symptoms

Answer 88

Feeling of insects crawling under your skin

Answer 89

sensory stimulus is present but incorrectly perceived and misinterpreted

Answer 90

Things are perceived to be smaller than they are

Answer 91

paranoid delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner, leading to preoccupation with a partner's sexual unfaithfulness based on unfounded evidence

Answer 92

* Increased tolerance * Prioritising over other things * Continuing despite negative consequence

Answer 93

Bio *Acute* * Outpt or inpt reducing dose of Chlordiazepoxide (alcohol withdrawal syx mx) * Thiamine *Longer term* * Acamprosate * Reduces cravings Psycho * Motivational interviewing Social * Alcoholics anonymous * OT help * Work, finance, housing, etc ! To stop gradually

Answer 94

* anxiety after waking * sweating and tremors * nausea or retching in the morning * vomiting * hallucinations * seizures or fits

Answer 95

Symptoms: 6-12 hours Seizures: 36 hours Delirium tremens: 72 hours

Answer 96

* agitation * confusion * autonomic dysfunction (e.g. high blood pressure, sweating and pyrexia, raised heart rate) * hallucinations * tremors

Answer 97

* Disorientated * Horizontal nystagmus * Difficulties in heel-toe walking

Answer 98

* Able to give consistent account of long term memory * Recent history inconsistent * Horizontal nystagmus

Answer 99

* Admit for medical observation * Descending regime of long-acting benzodiazepine, e.g., Chlordiazepoxide or Diazepam * +**Pabrinex** (Thiamine)

Answer 100

Methadone hydrochloride or buprenorphine

Answer 101

Acute bouts of anxiety * sedation * hypnotic * anxiolytic * anticonvulsant * muscle relaxant Use for 2-4 weeks only - development of psych and physical dependence

Answer 102

enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channel

Answer 103

* Lorazepam * Diazepam * Temazepam

Answer 104

Lorazepam ## Footnote Shortest half-life -\> levels in body decrease rapidly

Answer 105

* Confusion * Slurred speech * Unsteady gait

Answer 106

IV Flumazenil

Answer 107

Reduce dose in steps of 1/8th of daily dose every fortnight

Answer 108

IV Flumenazil

Answer 109

First trimester exposure associated with increased risk of cleft lip

Answer 110

* Central chest pain * Agitation * Hyperthermia * Hallucinations

Answer 111

* Runny nose * Dilated pupils * Goodsebumps/piloerection * Sweating/fever

Answer 112

* Morphine (Heroin is formulated from morphine) * Codeine * Fentanyl * Tramadol

Answer 113

* Drowsiness/ coma, * Respiratory depression * Pinpoint pupils

Answer 114

Urticarial rash/anaphylactoid reaction not uncommon to NAC stop and restart slow down infusion and observe for 1 hour whilst closely moniroring

Answer 115

Bedside * Full physical exam * 12 lead ECG * Body weight and height * SCOFF questionaire Bloods * FBC * may show anaemia from malnutrition or GI losses * U&Es * hypokalaemia is suggestive of vomiting or laxative abuse * LFT * may be slightly elevated from malnutrition

Answer 116

* 'Do you ever make yourself sick because you feel uncomfortably full?' * 'Do you worry that you have lost control over how much you eat?' * 'Have you recently lost more than one stone in a 3-month period?' * 'Do you believe yourself to be fat when others say you are too thin?' * 'Would you say that food dominates your life?'

Answer 117

1. Restriction of intake relative to requirements leading to a significantly low body weight 2. Intense fear of gaining weight or becoming fat 3. Disturbance in the way in which one's body weight or shape is experienced +Lanugo hair, reduced BMI, brady, hypten

Answer 118

* U&Es * Low K+ * High phosphate * **Low** FSH, LH, oestrogens and testosterone * **Raised** cortisol and GH * Impaired glucose tolerance * ECG * T wave inversion due to hypokalaemia

Answer 119

Refer to specialist ED clinic - combo of * Nutritional advice * Anorexia-focused family therapy * Individual CBT Use of MHA for admission if BMI dangerously low at \<13

Answer 120

* Hypothyroidism

Answer 121

Metabolic abnormalities which occur on feeding a person following a period of starvation

Answer 122

* U&Es! * **Low Ca** * Low K * Low Mg

Answer 123

MUST score ## Footnote *High risk: little nutritional intake \>10 days, unintentional weight loss \>15% over 3-6months, BMI\<16*

Answer 124

* Overeating/binging * Purging * Calluses on knuckles

Answer 125

* ECG * T wave inversion due to hypokalaemia

Answer 126

Refer to specialist ED clinic - combo of: * Nutritional advice * Anorexia-focused family therapy * Individual CBT

Answer 127

Scoring: 24-30 No cognitive impairment 18 - 23 Mild cognitive impairment 0-17 severe cognitive impairment

Answer 128

Bedside * MMSE * or AMTS * Urinalysis Bloods * FBC * U&E * B12/folate * TFTs * CRP Scan * CT/MRI head

Answer 129

Alzheimers has longer period of onset - often others notice syx as opposed to patient themselves Depression has biological syx e.g. weight loss, sleep disturb

Answer 130

How are they when left alone? Doing anything unsafe? Self-neglect? Aggression?

Answer 131

* Usually older person * Gradually worsening memory * Pays less attention * Problems w spatial orientation (getting loss in familiar places) * Behaviour changes as Alzheimer's progresses but not prominent at start

Answer 132

Down's syndrome

Answer 133

* Progressive memory loss (fluctuating) * Parkinsonism * Visual hallucinations

Answer 134

* Small animals and people * Things are going slower

Answer 135

First generation/typical antipsychotics ## Footnote *(cause severe confusion, severe Parkinsonism, sedation and sometimes even death)*

Answer 136

* Hx CVD * Cerebrovascular disease hx

Answer 137

3rd most common type of dementia after alz and lew body's

Answer 138

Personality change and impaired social conduct

Answer 139

1) Hippocampal atrophy - part of temporal lobe (early feature) 2) Frontotemporal atrophy

Answer 140

Bio * ACH-esterase inhibitor * e.g., donepezil, rivastigmine, galantamine * 2nd line: Memantine Psycho * Refer to memory clinic - old age psychiatrist (1) * Group cognitive simulation therapy Social * Occupational therapy assessment * Home safety, transport, care needs

Answer 141

Short term * Cardiac arrhythmias Long term * Memory impairment - retrograde amnesia

Answer 142

* raised intracranial pressure * recent cerebrovascular accident * untreated cerebral aneurysm * myocardial ischaemia or uncontrolled cardiac failure * unstable major fracture * severe osteoporosis

Answer 143

Circuitous and non-direct thinking or speech that digresses from the main point of a conversation, however the final goal of the conversation will be reached. Common in anxiety disorders and hypomania.

Answer 144

when someone uses words that rhyme with each other or sound similar

Answer 145

Delusion that their actions are being controlled

Answer 146

repetition of someone’s speech

Answer 147

patient speaks very quickly and rapidly jumps between different topics ## Footnote *Common in mania*

Answer 148

No clear links between successive thoughts Common in psychosis

Answer 149

formation of new words

Answer 150

ideas or words are repeated several times

Answer 151

Wandering from topic without returning to it

Answer 152

Belief of having the removal of a thought by an external force ## Footnote *Common in Schizophrenia*

Answer 153

loss of motor or sensory function. May be caused by stress

Answer 154

a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role.

Answer 155

persistent belief in the presence of an underlying serious disease, e.g. cancer

Answer 156

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Answer 157

transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep ±hallucinations during the paralysis *\***Clonazepam may be considered*

Answer 158

multiple physical SYMPTOMS present for at least 2 years with no organic cause found

Answer 159

Bio * Methylphenidate * 5 and above Psycho * Family therapy \<1st line\> Social * Parental training

Answer 160

* Violence * Enjoy causing harm, lying * Ignoring rights/feelings of others

Answer 161

Multisystemic (family) therapy

Answer 162

1. Verbal de-escalation 2. IM Lorazepam

Answer 163

Requires two doctors and an Approved Mental Health Professional. At least one doctor must be “approved” under s12 MHA, and ideally the other doctor would know the patient (usually a GP). The AMHP is often a social worker.

Answer 164

Assessment - 28 days

Answer 165

Assessment and treatment - 6 months

Answer 166

Dr's holding power - 72hours

Answer 167

Nurse's holding power- 6 hours

Answer 168

Police can enter your property

Answer 169

Police can bring someone from public place to a safe space

Answer 170

1) Amyloid plaques and neurofibrillary tangles (tau protein) 2) Lewy bodies (eosinophilic) deposits 3) Thromboembolic or hypertensive infarction

Answer 171

Symptoms of schizophrenia and mood disorder are equally prominent

Answer 172

Most pervasive symptom is delusion

Answer 173

Over period of one month patient must have 1 first rank syx or at least 2 other syx

Answer 174

* Re-orientate (glasses/hearing aids, clock/orientation reminders/familiar objects/adequate lighting) * Identify and treat underlying causes (infection/pain/constipation…) * Medication – halorperidol, benzodiaepines

Answer 175

Gradual, progressive

Answer 176

Insidious onset, progressive with fluctuations

Answer 177

Abrupt or stepwise

Answer 178

Insidious onset, rapid progression

Answer 179

* Previous episodes of psychosis * History of bipolar disorder * First time mothers * After instrumental delivery * FH of affective disorder

Answer 180

Admit to mother and baby unit ±antipsychotics ± ECT

Answer 181

Perceived hallucination is beyond limits of normal sensory perception, e.g., hearing an alien speaking from Mars

Answer 182

Seeing things, .e.g, faces and animals, in things

Answer 183

Flashes of lights/sound etc

Answer 184

* Cannabis * Steroids * Cocaine

Answer 185

6-12 weeks

Answer 186

* Previous puerperal psychosis * FHx PP * Underlying MH dx esp BPAD * Obstetric complx

Answer 187

Focuses on factors contributing to emotional instability which lead to a vicious cycle where you experience intense and upsetting emotions, which make you feel guilty and worthless and leads to actions that can make you feel upset again * DBT aims to introduce two important concepts: * **Validation**: accepting that your emotions are acceptable * **Dialectics**: showing you that things in life are rarely black or white, and helping you be open to ideas and opinions that contradict your own

Psych Flashcards

(231 cards)