Psych Flashcards
(431 cards)
1
Q
What are the 9 components of a psych Hx?
A
-P/C + Hx of P/C
-Past medical Hx
-Past psych Hx
-Family Hx
-Personal Hx
-Social circumstances
-Forensic Hx
-Premorbid personalities
-Strengths + assets
2
Q
What topics should you cover in P/C + Hx of P/C?
A
-How patient feels today
-How long patient has been on ward
-Reason for admission
-Informally vs detained
-Symptoms, onset, duration, stressors, course
-Triggers
3
Q
What topics should you cover in PMHx?
A
-Any medical conditions
-Past hospitalisations
-Allergies/sensitivities (to meds)
-Meds
4
Q
What topics should you cover in past psych Hx?
A
-Previous contact w/ MH services as child/adult
-Private Tx?
-OTC remedies?
-Existing psych diagnoses?
-Under CMHT?
-Previous inpatient stays?
-Under section?
-Previous self-harm/attempts on life
5
Q
What topics should you cover in FHx?
A
-Parents alive?
-FHx of MH?
-FHx of suicide?
-Siblings? + relationship with them
6
Q
What topics should you cover in personal Hx?
A
-Early development e.g. prem, walk/talking development
-Child health-physical or pyschological
-Memories of growing up-school, relationships w/ peers, bullying
-Experience of puberty
-Exams/academics
-Emotional + intimate relationships e.g. partners, children-relationship with
-Ever been victim of physical/emotional/sexual abuse?
7
Q
What topics should you cover in social circumstances?
A
-Where do they live? Alone/with friends/family
-Working/training/unemployment, relationship w/ supervisors/colleagues
-Money worries/debts/loans/gambling problems
-Alcohol/drug abuse-reasons for use, quantity etc
8
Q
What topics should you cover in forensic Hx?
A
-Ever been in trouble w/ the law?
-Charged? With what?
-Ever been to prison?
-Ever been victim of a crime?
9
Q
What topics should you cover in premorbid personality?
A
-Personality prior to illness
-Normal routine before?
-Normal response to stress?
-You said you have a couple of very supportive friends. If they were here now how would they describe you? Would you agree with them?
10
Q
What is a premorbid personality?
A
Patient’s personality traits, behavioural patterns + emotional characteristics before the onset of a mental disorder/other significant life-altering event
11
Q
What topics should you cover around strengths + assets?
A
-Interests, hobbies, faith, spiritual belief
-Proud of what?
-What gives pleasure/enjoyment?
-What would you like to do in the future?
12
Q
What is an MSE?
A
Clear, objective snapshot of someone’s mental functioning at a given time
13
Q
What are the 8 domains of the MSE? + what is the acronym?
A
ASEPTIC Risk
Appearance + behaviour
Speech
Emotion (mood + affect)
Perception
Thoughts (content + process)
Insight + judgement
Cognition
Risk
14
Q
What is phenomenology?
A
Philosophical + research method that explores the nature of consciousness and subjective experiences, focusing on how individuals perceive and understand their world
15
Q
What should you notice about appearance + behaviour?
A
-Attitude
-Attire
-Hygiene/grooming
-Eye contact
-Facial expression
-Body language
-Pyschomotor activity e.g. retardation, restlessness, fidgety, catatonia
-Involuntary movements e.g. tics, grimaces, tremors
16
Q
What should you notice about speech?
A
-Rate, tone, volume, pitch
-Poverty of thought/flight of ideas
-Continuity-clang associations, puns, rhymes, perseverations
17
Q
What are perseverations?
A
Repetition of a particular response despite the absence/removal of the stimulus
(e.g. a patient is asked what their name is, and they then continue to repeat their name as the answer to all further questions
18
Q
What should you notice about mood + affect?
A
-Elated vs low
-Euthymic vs reactive ( changes in response to actual or potential events)
-Labile effect
-Flat
-Blunted
Congruency of affect
19
Q
What is mood?
A
Patient’s emotional state over a longer period of time
20
Q
What is affect?
A
Emotional state of a patient at a given moment in time
21
Q
What is a euthymic mood?
A
Normal, stable + tranquil mood
22
Q
What is a labile affect?
A
Exaggerated changes in emotion
23
Q
What is a flat mood?
A
Severe reduction in emotional expressiveness
24
Q
What is a blunted mood?
A
Reduction in intensity of emotional response
25
What is congruency of affect?
Whether expressed emotion matches felt mood-if outward display matches how they're feeling inwardly
26
Name 5 abnormalities of thought
-Loose associations
-Thought blocking
-Neologisms
-Word salad
-Circumstantial thoughts
27
What are loose associations?
Moving rapidly from one topic to another with no apparent connection between the topics.
28
What is thought blocking?
Sudden cessation of thought, typically mid-sentence, with the patient unable to recover what was previously said.
29
What are neoligisms?
Words a patient has made up which are unintelligible to another person.
30
What is word salad?
Random string of words without relation to one another
31
What are circumstantial thoughts?
Thoughts which include lots of irrelevant and unnecessary details but do eventually come back to the point
32
What are delusions?
Firm, fixed beliefs based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms.
33
What are overvalues ideas?
Solitary, abnormal beliefs that are neither delusional nor obsessional but preoccupying to the extent of dominating the person’s life (e.g. the perception of being overweight in a patient with anorexia nervosa).
34
Name 5 types of delusion?
Grandiose, persecutory, nihilistic, reference, jealousy
35
What is thought insertion?
A belief that thoughts can be inserted into the patient’s mind.
36
What is thought withdrawal?
A belief that thoughts can be removed from the patient’s mind.
37
What is thought broadcasting?
A belief that others can hear the patient’s thoughts.
38
What are obsessions?
Thoughts, images or impulses that occur repeatedly and feel out of the person’s control.
39
What are compulsions?
Repetitive behaviours that the patient feels compelled to perform despite recognising the irrationality of the behaviour.
40
What is a hallucination?
Perception in the absence of a stimulus. Can happen in any of the 5 senses.
41
What is an illusion?
Misperceiving a real stimulus
42
What is a functional hallucination?
Stimulus results in hallucination in same modality (voices heard when person hears tap running )
43
What is a reflex hallucination?
Stimulus in one modality results in hallucination in another (voices heard whenever a cat seen)
44
What is an extracampine hallucination?
Hallucination outside limit of sensory field ( voices heard in Paris when person in Australia)
45
What should you notice about cognition?
-Attention, concentration, memory, orientation
-Can you focus on things like the tv?
-Do you know where you are, date, time etc?
46
What are first rank symptoms?
Specific symptoms are characteristic of schizophrenia
47
What are the first rank symptoms?
-Auditory hallucinations of specific types – 3rd person, running commentary, thought echo
-Thought alienation
-Passivity experiences incl somatic passivity
-Delusional perception
48
What should you notice/ask about insight + capacity?
-Evidence of impairment of mind/brain?
-Can they understand, retain + weigh up info + communicate decisions?
Do you think you are ill and require help or treatment?
How do feel about being in hospital?
What do you think we can help you with when you come here?
You say you are no longer ill can you tell me a little more about this?
49
What is formulation?
Concise summary of the origins and nature of a person's problems, together with opinion on what may go wrong in the future and what steps should be taken to improve matters
50
What are the 5 P's of psychiatric formulation?
Presenting problem
Predisposing factors
Precipitating "
Perpetuating "
Protective "
51
Give 4 examples of predisposing factors
Drugs/alcohol
Genetic vulnerabilities
Trauma
Social isolation
52
Give 4 examples of precipitating factors
Relationship breakdown
Bereavement
Bullying
Loss of job
53
Give 4 examples of perpetuating factors
Unhealthy lifestyle
Financial difficulties
Poor coping strategies
Poor engagement
54
Give 3 examples of protective factors
Social support
Secure job
Financial security
55
What are the core symptoms of depression?
Low mood, anhedonia and fatigue/low energy.
56
According to NICE, how long should core symptoms be present to diagnose depression?
At least 2 weeks.
57
What are the psychological/emotional symptoms of depression?
Low self-esteem, guilt, hopelessness, suicidal thoughts, anxiety, irritability.
58
What are the physical symptoms of depression?
Early morning waking, reduced appetite, weight loss, slow movement, loss of libido.
59
What is the difference between mild, moderate, and severe depression?
Mild: few symptoms, minor functional impairment; Moderate: significant symptoms, difficulty functioning; Severe: marked symptoms with or without psychotic features, serious functional impairment.
60
Name some risk factors for depression.
Family history, previous episodes, chronic illness, social isolation, substance misuse, adverse childhood experiences.
61
What is the first-line treatment for mild depression according to NICE?
CBT
Exercise
62
When are antidepressants recommended in depression?
Moderate to severe depression, or if symptoms persist after psychological therapies.
63
What is the first-line pharmacological treatment for moderate to severe depression?
SSRIs (e.g. sertraline or citalopram).
64
Name two side effects of SSRIs.
Gastrointestinal upset, sexual dysfunction, insomnia, increased anxiety (initially).
65
What should be monitored after starting an SSRI?
Suicidal ideation, side effects, and effectiveness (especially during first 2 weeks).
66
How long should antidepressant treatment continue after remission?
At least 6 months, or 2 years if recurrent depression.
67
What are the red flag symptoms requiring urgent referral in depression?
Suicidal ideation with intent, psychotic symptoms, severe self-neglect.
68
What is the role of the PHQ-9?
Tool to assess severity of depression and monitor response to treatment.
69
What are the criteria for diagnosing depression using ICD-10?
At least 2 core symptoms + 2 or more additional symptoms for ≥2 weeks; severity based on total number and impact on function.
70
What is persistent depressive disorder (dysthymia)?
Chronic low mood for ≥2 years with intermittent symptom severity; not meeting full criteria for major depression.
71
What is the role of CBT in depression?
Targets negative thought patterns and behaviors; effective for mild to moderate depression.
72
Name an example of a second-line antidepressant.
Mirtazapine, venlafaxine, tricyclics like amitriptyline (less commonly used due to side effects).
73
When is ECT used in depression?
Severe depression with life-threatening features or treatment-resistant depression.
74
What is treatment-resistant depression?
Depression not responding to at least two adequate trials of antidepressants.
75
What are the aims of ECT?
Induce generalised seizure to relieve severe symptoms. Given under anaesthetic.
76
Name some SE's of ECT
Short-term memory loss
Headaches
Muscle aches
77
How would you treat psychotic depression?
Combo of antipsychotics e.g. olanzapine, quetiapine + antidepressants. Also ECT is an option
78
Name 3 types of postnatal depression
Baby blues
Postnatal depression
Puerperal psychosis
79
What is the 'baby blues' and how common is it?
Temporary mood changes affecting more than 50% of women in the first week after birth; characterized by mood swings, anxiety, tearfulness, irritability.
80
What are the typical symptoms of 'baby blues'?
Mood swings, low mood, anxiety, irritability, tearfulness. Symptoms are mild and resolve within 2 weeks of delivery.
81
How long do 'baby blues' last and what is the treatment?
Symptoms last a few days to 2 weeks and no treatment is required.
82
What is the difference between 'baby blues' and postnatal depression?
'Baby blues' is transient, mild, and resolves quickly, whereas postnatal depression is more severe, lasting at least 2 weeks and requires treatment.
83
What is the prevalence of postnatal depression?
Affects about 1 in 10 women, typically peaking around 3 months after birth.
84
What are the core symptoms of postnatal depression?
Low mood, anhedonia (lack of pleasure), and low energy. Similar to depression outside pregnancy.
85
How long must symptoms last for a diagnosis of postnatal depression?
Symptoms should last at least 2 weeks.
86
What is the treatment for postnatal depression?
Depends on severity; it may include psychotherapy, medication (antidepressants), or both.
87
What is puerperal psychosis and how common is it?
A rare, severe mental illness that affects about 1 in 1,000 women, usually starting 2-3 weeks after childbirth.
88
What are the symptoms of puerperal psychosis?
Delusions, hallucinations, mania, depression, confusion, and thought disorder.
89
What is the treatment for puerperal psychosis?
Urgent assessment and specialist mental health services, including possible admission to a mother and baby unit, medication, and potentially ECT.
90
What is the Edinburgh Postnatal Depression Scale (EPDS) and how is it used?
A screening tool to assess postnatal depression. It includes 10 questions with a score out of 30. A score of 10 or more suggests postnatal depression.
91
What is the scoring system for the Edinburgh Postnatal Depression Scale (EPDS)?
Score out of 30; a score of 10 or more suggests the presence of postnatal depression.
92
What characterizes Bipolar I Disorder?
Characterized by at least one manic episode, which may be preceded or followed by hypomanic or depressive episodes.
93
What characterizes Bipolar II Disorder?
Characterized by at least one hypomanic episode and at least one depressive episode, but never a full manic episode.
94
What is a manic episode?
An elevated, expansive, or irritable mood lasting at least 1 week, with symptoms such as increased energy, decreased need for sleep, grandiosity, and risky behaviors.
95
What is a hypomanic episode?
A less severe form of mania, lasting at least 4 days, with similar symptoms but not causing significant functional impairment or requiring hospitalization.
96
What are the key symptoms of depression in bipolar disorder?
Low mood, loss of interest or pleasure, fatigue, feelings of worthlessness or guilt, and thoughts of death or suicide.
97
How long must symptoms last to diagnose a manic episode?
At least 1 week
98
How long must symptoms last to diagnose a hypomanic episode?
At least 4 days, without significant functional impairment.
99
What is rapid cycling in bipolar disorder?
It refers to the occurrence of 4 or more mood episodes (mania, hypomania, or depression) within 12 months.
100
What is the prevalence of bipolar disorder?
About 1-2% of the population; onset typically occurs in late adolescence or early adulthood.
101
What is the treatment for acute mania in bipolar disorder?
First-line treatment includes antipsychotics (e.g., olanzapine, quetiapine, haloperidol) or mood stabilizers (e.g., lithium).
Taper + stop antidepressants
Benzos to help sleep
102
What is the treatment for acute bipolar depression?
Olanzapine + fluoxetine
Antidepressants may be used with caution, but mood stabilizers (e.g., lithium or lamotrigine) are typically preferred.
103
What is the treatment for maintenance therapy in bipolar disorder?
Lithium = GS for maintenance therapy; anticonvulsants (e.g., valproate, lamotrigine) and antipsychotics may also be used.
104
What is lithium toxicity and what are the signs?
Signs include nausea, vomiting, tremor, confusion, ataxia, and in severe cases, renal failure and seizures.
105
What should be monitored regularly in patients on lithium?
Thyroid function, renal function, and lithium levels.
106
What are some psychosocial interventions for bipolar disorder?
Cognitive-behavioral therapy (CBT), psychoeducation, and family therapy.
107
What are the key diagnostic criteria for bipolar disorder according to the DSM-5?
A distinct period of elevated or irritable mood lasting at least 1 week (for mania) or 4 days (for hypomania), plus other symptoms of mania or depression.
108
Which criteria is used for bipolar disorder?
DSM-5
109
When should lithium lvls be monitored + what should they be?
12hrs after most recent dose, between 0.6-0.8mmol/L
110
Name risk factors for bipolar
Genetics-first degree relative w/ bipolar=increased risk
Prem birth
Childhood mistreatment
Cannabis use
111
What are the main types of antidepressants?
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
112
What do neurotransmitters do?
Neurotransmitters carry chemical signals across the synapse
113
How do SSRIs work?
Block the reuptake of serotonin by the presynaptic membrane on the axon terminal. This results in more serotonin in the synapses throughout the cns, boosting the communication between neurones.
114
How do SNRIs work?
Block the reuptake of serotonin + noradrenline
115
How do TCAs work?
Block the reuptake of serotonin and noradrenaline
Block acetylcholine + histamine receptors = anticholinergic and sedative side effects.
116
Give some examples of SSRIs
Sertraline, citalopram, escitalopram, fluoxetine and paroxetine
117
What is a key SE of citalopram?
Prolongation of QT interval -> torsades de pointes
118
What is torsades de pointes? Key features?
Polymorphic ventricular tachycardia
Looks like QRS is twisting around baseline
Will either terminate spontaneously or ->ventricular tachycardia->cardiac arrest
119
Name some key SEs of SSRIs
GI-nausea, diarrhoea
Headaches
Sexual dysfunction-loss of libido, erectile dysfunction
Anxiety/agitation
Increased suicidal thoughts, suicide risk
120
Name 2 examples of SNRIs
Duloxetine, venlafaxine
121
Name 2 examples of TCAs
Amitriptyline, nortriptyline
122
What are TCAs used to treat?
Neuropathic pain
Depression
123
What is a key SE of TCAs?
Arrhythmias-tachycardia, prolonged QT, bundle branch block
Anticholinergic SEs
Sedation
124
What kind of drug is mirtazapine? + what are it's key SEs?
Atypical antidepressant
SE=sedation, increased appetite, weight gain
125
How long should you wait after starting antidepressants to review?
2 wks (1wk for 18-25s) due to increased risk of suicide
126
What are the core symptoms of Generalised Anxiety Disorder (GAD)?
Persistent and excessive worry about various domains, accompanied by physical symptoms like restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
127
How long must symptoms persist to diagnose Generalised Anxiety Disorder (GAD)?
Symptoms must be present for at least 6 months.
128
What is the prevalence of Generalised Anxiety Disorder (GAD) in the UK?
Approximately 5% of the population.
129
What is the first-line treatment for Generalised Anxiety Disorder (GAD)?
CBT
SSRI
130
What is the role of benzodiazepines in the treatment of Generalised Anxiety Disorder (GAD)?
Benzodiazepines are not recommended for long-term management due to risks of dependence and tolerance; they may be considered for short-term use in severe cases.
131
What is Panic Disorder?
A type of anxiety disorder characterised by recurrent and unexpected panic attacks, along with persistent concern about having more attacks or significant maladaptive changes in behaviour related to the attacks.
132
What is Social Anxiety Disorder (Social Phobia)?
A marked fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny by others, leading to avoidance or distress.
133
What is Specific Phobia?
A marked fear or anxiety about a specific object or situation, leading to avoidance or distress.
134
What is the first-line treatment for Specific Phobia?
Exposure therapy - form of CBT
135
What is the role of medication in Specific Phobia?
Medication is not typically used; however, short-term use of benzodiazepines may be considered for specific situations, such as flying.
136
What is Post-Traumatic Stress Disorder (PTSD)?
A mental health condition triggered by experiencing or witnessing a traumatic event, characterised by symptoms such as flashbacks, nightmares, hypervigilance, and avoidance of reminders of the trauma.
137
What are the treatments for Post-Traumatic Stress Disorder (PTSD)?
Trauma-focused CBT
SSRI
EMDR (eye movement desensitisation and reprocessing)
138
What is the role of Cognitive Behavioural Therapy (CBT) in the treatment of anxiety disorders?
Cognitive Behavioural Therapy (CBT) is a first-line treatment for many anxiety disorders, focusing on identifying and challenging unhelpful thoughts and behaviours, and gradually facing feared situations.
139
Name 5 secondary (physical) causes of anxiety
Substance abuse + withdrawal e.g. caffeine, stimulants, bronchodilators, cocaine
Hyperthyroidism
Pheochromocytoma
Cushing's
140
Name 4 indications for ECT
Tx-resistant severe depression
Severe depression causing harm to patient e.g. with self-neglect
Catatonia
Ongoing mania/psychosis e.g. in schizophrenia/bipolar
141
How many session do ECT patients normally have?
Twice weekly for 6-12wks but reassessed after every Tx. Some may have long-term 'maintenance' ECT
142
What drugs are given to patients having ECT?
Short-acting anaesthetic e.g. propofol
Muscle relaxant e.g. suxamethonium (succinylcholine)
143
How are ECT patients monitored?
Continuous EEG
144
What are panic attacks?
Sudden onset of intense physical + emotional symptoms of anxiety, should come on quickly (within minutes) and last a short time before symptoms gradually fade
145
What are some physical symptoms of panic attacks?
Tension, palpitations, tremors, sweating, dry mouth, chest pain, shortness of breath, dizziness and nausea.
146
What are some emotional symptoms of panic attacks?
Feelings of panic, fear, danger, depersonalisation (feeling separated or detached) and loss of control.
147
What is a phobia?
Extreme fear of certain situations or things, causing symptoms of anxiety and panic
148
What questionnaire can be used to assess anxiety?
GAD-7
149
How would you manage mild anxiety?
Self-help strategies e.g. meditation, sleep, diet, exercise, avoid alcohol, caffeine + drugs
150
How would you manage moderate-severe anxiety?
CBT
*SSRIs-1st line = sertraline, paroxetine, escitalopram
SNRI e.g. venlafaxine
Pregabalin
Propranolol
151
What type of drug is pregabalin + how does it work?
Binds to calcium channels + decreases neuronal excitability = inhibited release of some neurotransmitters
152
How can propranolol help in anxiety disorders?
Reduces activity of sympathetic nervous system-helps with physical symptoms like tremors, sweating, palpitations
153
How do benzos work?
Stimulate GABA receptors (similar action to alcohol) to relax brain=relief from anxiety. Easy to build up tolerance though
154
Name 5 key symptoms of PTSD
-Intrusive thoughts related to event
-Flashbacks, images, sensations etc
Hyperarousal-feeling on edge, irritable
-Emotional numbing/ derealisation/ depersonalisation
-Avoidance of triggers
-Negative emotions + beliefs
155
How does EMDR work?
Processing traumatic memories while performing specific eye movements. The theory is that the improperly stored traumatic memories are reprocessed and stored again in a more normal way so that they no longer cause as much negative emotion and distress.
156
What is the difference between CBT + DBT?
CBT focuses on helping change unhelpful ways of thinking + behaving
DBT focuses on that but also accepting who you are as a person-developed for personality disorders
157
What is DBT?
Dialectical behavioural therapy-talking therapy to help regulate intense emotions, reduce self-harm + improve relationships
158
What is CBT?
Cognitive Behavioural Therapy = a structured, goal-oriented type of talk therapy that teaches individuals to identify and change negative or unhelpful thinking patterns and behaviours
159
Name 3 neurophysiological changes in anxiety
-Reduced connectivity between prefrontal cortex + limbic system
-Polymorphic variations in 5-HT (serotonin) transporters = diminished signalling
-Dysregulation of the HPA (hypothalamic-pituitary-adrenal axis)
160
What is the core pathophysiology of ADHD?
Dysfunction in the dopamine + norepinephrine systems in the brain, particularly the prefrontal cortex which affects attention, impulse control + executive function
161
What are the core symptoms of ADHD?
Inattention
Hyperactivity
Impulsivity
162
How is ADHD diagnosed according to NICE guidelines?
Symptoms must be present for at least 6 months.
Symptoms must be inappropriate for the child’s developmental level.
Symptoms must cause significant functional impairment in two or more settings (e.g. school, home
Made on clinical assessment with input from parents, teachers etc
163
What age group is typically diagnosed with ADHD?
Symptoms must be present before the age of 12 and ADHD is typically diagnosed in childhood
164
What are the different subtypes of ADHD according to DSM-5?
Inattentive type
Hyperactive-Impulsive type
ADHD, Combined type
165
What is the first-line treatment for ADHD?
Stimulant medications (e.g. methylphenidate, Lisdexamfetamine
Dexamfetamine
Atomoxetine)
Parent training
Behavioural interventions
166
What is the role of psychoeducation in managing ADHD?
Psychoeducation involves educating the patient and their family about ADHD its impact on life
167
What is the significance of comorbidities in ADHD?
ADHD often co-occurs with other conditions such as anxiet,y depression, learning difficulties, and oppositional defiant disorder (ODD).
168
What is the role of stimulant medications in ADHD management according to NICE guidelines?
Stimulants are highly effective in managing core symptoms of ADHD but their use requires careful monitoring for side effects such as insomnia, appetite suppression, and potential CV effects.
169
What lifestyle modifications can help manage ADHD symptoms?
Regular exercise + healthy diet
Sleep hygiene
Routine and structure in daily activities can help manage inattention and impulsivity
170
What are the potential long-term effects of untreated ADHD?
Academic underachievement and school failure.
Increased risk of substance misuse and other risky behaviours.
Difficulties in interpersonal relationships and employment.
171
What are the side effects of stimulant medications in the treatment of ADHD? (common + less common)
Common side effects: Insomnia, appetite suppression, headache, and stomach upset.
Less common: Hypertension, anxiety, and tics.
172
What is the role of atomoxetine in ADHD treatment?
Atomoxetine is a non-stimulant medication that works by inhibiting the reuptake of norepinephrine. It is often used when stimulant medications are contraindicated or poorly tolerated. It may take several weeks to show effectiveness.
173
What is the diagnostic criteria for ADHD in adults according to NICE guidelines?
Symptoms of inattention and/or hyperactivity/impulsivity present since childhood.
Functional impairment in at least two areas of life (e.g. work, relationships
Symptoms not better explained by another MH condition
174
What behavioural interventions can be used for ADHD?
Parent training: Techniques to improve children’s behaviour and support parents. Behavioural therapy: Teaching children to control impulsive behaviour and improve organisation.
Cognitive behavioural therapy (CBT): Used in adults to address time management + self-regulation
175
What factors contribute to the development of ADHD?
Genetic-sig heritability
Pregnancy-related e.g. maternal smoking, prem, low birth weight
Environmental
176
What screening tool can be used for ADHD referrals?
Adult ADHD Self-Report Scale (ASRS)
177
How common is ADHD?
Affects 5% global pop
178
Name 4 differentials for ADHD
Anxiety/depression
Autism
Childhood trauma/PTSD
Personality disorders
179
What regular checks should you do for people on ADHD meds?
Height, weight, HR, BP every 6mths
180
What is FND + what is it also known as?
Sensory + motor symptoms that are not explained by any neurological disease and may be caused by underlying psychosocial factors
AKA conversion disorder
181
What is somatisation disorder and how do you treat it?
Individuals experience physical symptoms, often accompanied by excessive thoughts, feelings, and behaviours related to those symptoms. Treated with CBT, anxiety meds, mindfulness
182
183
What is catatonia?
Abnormal movement, communication and behaviour, patients awake but not behaving normally e.g. unusual postures, odd actions, repeat sounds, blank + unresponsive
184
What are the 2 most common causes of catatonia?
Severe depression
Bipolar disorder
185
What is depersonalisation-derealisation disorder?
Feeling of being separated or outside their body
Feeling that the world is not real.
186
What is dissociative amnesia?
Forgetting autobiographical info typically after trauma=memory gaps
187
What is dissociative identity disorder?
Previously multiple personality disorder, patient lacks clear sense of individual identity-associated with severe stress + trauma in childhood
188
What is reactive attachment dorder?
Emotional withdrawal and inhibition, sadness, fearfulness, irritability and impaired cognition caused by severe neglect + trauma in early childhood
189
What does attachment theory describe?
Importance of creating healthy, consistent and secure attachments to at least one nurturing individual during early childhood, particularly for the first two years of life. This creates a stable and secure base for the child to grow and develop.
190
What is factitious disorder aka Munchausen syndrome?
Conscious effort to fake illness and seek medical attention for personal gain.
The symptoms are invented, exaggerated or induced (through self-injury). Faking symptoms provides attention, affection, relationships and care from others. They may get satisfaction from puzzling medical professionals. It can lead to significant and unnecessary investigations and interventions.
191
What is Cotadr delusion?
Patient's false belief they are dead/dying aka walking corpse syndrome. Often caused by depression/schizophrenia/brain tumours/migraines
192
What is Capgras syndrome?
Delusion that an identical duplicate has replaced someone close to them
193
What is Alice in Wonderland/Todd syndrome?
Incorrectly perceiving the sizes of body parts or objects, also associated change to time perception + migraine symptoms.
Causes=migraine, epilepsy, brain tumours
194
What year was the MHA written + updated?
Written 1983
Updated 2007
195
What is the MHA?
Legal framework for informal and compulsory care/treatment of people with a mental disorder in England and Wales.
196
What is a mental disorder?
Any disorder or disability of the mind, can include:
Mental illness
Personality disorder
Learning disability (if aggressive behaviour/irresponsible conduct)
Disorders of sexual preference
197
Name 4 people involved in the MHA application
Section 12 approved doctor
AMHP (approved mental health practitioner)
Responsible clinician=overall responsibility for patient's care e.g. consultant
Nearest relative
198
Which section covers voluntary admission?
Section 131 = informal admission, free to leave at any time but must have capacity
199
What is involved in a section 2-time scale, purpose, end result?
Compulsory admission for assessment
Up to 28 days
Cannot be renewed, can convert to section 3
AMHP + 2 doctors
200
What is involved in a section 3-time scale, purpose, end result, who involved?
Compulsory admission for treatment
Up to 6mths
Can be renewed for another 6mths, then yearly
AMHP + 2 doctors
201
What is section 4 for?
Admission for assessment in emergency cases, rarely used
202
What is involved in a section 5(2)-time scale, purpose, end result?
Emergency holding power for doctor
Up to 72hrs until MH assessment can be done
203
What is involved in a section 5(4)-time scale, purpose, end result?
Nurse's holding power
Up to 6hrs until further assessment
204
What are the two police holding powers?
Section 135 (enter private property to remove to place of safety)
Section 136 (someone suspected of suffering from MH disorder to be removed from public place to place of safety) lasts up to 24hrs
205
Name some SSRIs
Sertraline
Fluoxetine
Paroxetine
Citalopram
206
Name some SNRIs
Duloxetine
Venlafaxine
207
Name some TCAs
Amitriptyline
Nortriptyline
208
What is the mechanism of action of SSRIs?
They inhibit the reuptake of serotonin (5-HT), increasing its levels in the synaptic cleft.
209
What are common side effects of SSRIs?
Nausea, headache, sexual dysfunction, insomnia, and increased anxiety early in treatment
210
What is the mechanism of action of SNRIs?
They block the reuptake of both serotonin and norepinephrine.
211
What additional side effect can occur with SNRIs that is not typically seen with SSRIs?
Increased BP
212
How do tricyclic antidepressants (e.g., amitriptyline) work?
They inhibit the reuptake of serotonin and norepinephrine and block muscarinic, histamine, and alpha-adrenergic receptors.
213
What are common side effects of tricyclic antidepressants?
Sedation, weight gain, anticholinergic effects (dry mouth, blurred vision, constipation), and cardiotoxicity (arrhythmias).
214
What is the mechanism of action of MAOIs (e.g., phenelzine)?
They inhibit monoamine oxidase, an enzyme that breaks down serotonin, norepinephrine, and dopamine.
215
What dietary restriction is required with MAOIs, and why?
Avoid aged or fermented foods and alcohol due to the risk of hypertensive crisis.
216
What symptoms can occur after abrupt cessation of short half-life antidepressants like paroxetine or venlafaxine?
Flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances ("brain zaps"), and mood swings.
217
What are key symptoms of serotonin syndrome?
Agitation, confusion, myoclonus, hyperreflexia, fever, and diarrhoea.
218
What should be done if serotonin syndrome is suspected?
Immediately discontinue all serotonergic medications
219
Name 4 neurotransmitters
Dopamine
Serotonin
Noradrenaline
Gamma-aminobutyric acid (GABA)
220
Name a key cardio concern with citalopram
QT prolongation -> torsades de pointes ->HF
221
What comorbidity are SNRIs contraindicated with?
Uncontrolled hypertension
222
What are TCAs commonly used for?
Neuropathic pain
223
What cardio conditions can be caused by TCAs?
Arrhythmias
Prolonged QT
Bundle branch block
224
Name 2 key SEs of mirtazapine + therefore which group of patients it is often used for
Sedation
Increased appetite->weight gain
Often used in elderly with poor sleep + low weight
225
What is serotonin syndrome?
Symptoms caused by excessive serotonin activity
226
What are the 3 categories of symptoms in serotonin syndrome?
Altered mental state e.g. anxiety, agitation
Autonomic nervous system hyperactivity e.g. tachycardia, HTN, hyperthermia
Neuromuscular hyperactivity e.g. hyperreflexia, tremor, rigidity
227
Name 3 typical (1st gen) anti-psychotics
Haloperidol
Chlorpromazine
Loxapine
228
How do typical anti-psychotics work?
Dopamine receptor antagonists that work by inhibiting dopaminergic neurotransmission
229
What 2 types of SE are often experienced with typical anti-psychotics?
Extra-pyramidal SEs
Anticholinergic SEs
230
Name 4 anticholinergic SEs of antipsychotics
Blurred vision
Constipation
Dry mouth/skin
Tachycardia
231
What property of typical antipsychotics makes them sedatives?
Antihistamine
232
What cardio SEs are at an increased risk with haloperidol?
Arrhythmias, torsades, ventricular arrhythmias
233
What is the acronym for EPSEs of anti-psychotics?
A-cute
D-ystonia,
A-kathisia,
P-arkinsonism
T-ardive dyskinesia
234
What is acute dystonia?
Involuntary muscle contractions leading to abnormal postures or repetitive movements
235
What is akithesia?
Feeling of internal restlessness and a compelling urge to move
236
What are the EP parkinsonism SEs?
Resting tremor
Cogwheel rigidity
General slowing of motor function
237
What is tardive dyskinesia?
Involuntary, choreoathetoid movements that primarily affect the orofacial and tongue muscle, with extension to the trunk and extremities
238
Name 6 atypical anti-psychotics
Aripiprazole
Clozapine
Olanzapine
Paliperidone
Quetiapine
Risperidone
239
How do atypical (2nd gen) anti-psychotics work?
Dopamine and serotonin antagonists.10 They work by blocking the D2 dopamine receptors and the 5-HT2A subtype of the serotonin receptor.
240
What SEs are more + less common with atypical anti-psychotics?
Less common-EPSEs
More common-weight gain + metabolic syndrome
241
Describe the metabolic SEs of anti-psychotics
Obesity
Hypertension
Impaired fasting glucose
Hypertriglyceridaemia
Low HDL cholesterol
242
Name 4 key SEs of clozapine
Hypersalivation
Tachycardia
Anticholinergic SEs
*Agranulocytosis + leukopenia
243
What is agranulocytosis + leukopenia, what do they cause + how are they monitored?
Low WCC - specifically low granulocytes = reduced immuno-resilience
Monitor WCC + absolute neutrophil count
244
Which anti-psychotic is used for Tx resistance?
Clozapine
245
What is NMS + what are its characteristics?
Neuroleptic malignant syndrome:
- life-threatening reaction to medications characterised by:
- altered mental status, fever, muscle rigidity and autonomic dysfunction
246
What drugs can cause NMS?
Meds w/ dopamine receptor-antagonist properties
247
Describe the course of NMS?
Starts within hrs/days of exposure:
Muscle rigidity->fever->mental state change + autonomic instability e.g. agitation/drowsiness + flushing/sweating/pallor/incontinence
248
How do you treat NMS?
Discontinue the causative medication
Aggressive hydration, cooling blankets to manage hyperthermia, and correcting any metabolic abnormality
Bromocriptine (dopamine agonist) and dantrolene (muscle relaxant) in severe cases
249
Name the 6 clinical features of anticholinergic toxicity (X as a Y)
“Red as a beet” – Flushing
“Dry as a bone” – Dry mucous membranes
“Blind as a bat” – Mydriasis (dilated pupils)
“Mad as a hatter” – Altered mental status, e.g. delirium, hallucinations, agitation, restlessness, confusion, seizures and jerking movements
“Hot as a hare” – Fever
“Full as a flask” -Urinary retention
250
How do you treat anticholinergic toxicity?
Activated charcoal if within 1hr
IV fluids
IV sodium bicarbonate if dysrhythmias
*Physostigmine = acetylcholinesterase inhibitor
251
Name 3 mood stabilisers used in bipolar disorder + 1 antipsychotic
Lithium
Sodium valproate
Carbamazepine
Quetiapine (anti-psychotic with mood stabilising properties)
252
How does lithium work?
It alters cellular signalling to prevent mania + depression
253
What monitoring is required when starting lithium?
Bloods every week at start - lithium lvl must be measured 12hrs after dose
Frequency decreases to once a month, then every 3mths
Need 6mthly TFTs, U+Es, calcium
254
Name 5 common SEs of lithium
Polydipsia
Polyuria
Weight gain
Fatigue
Fine tremor
255
What are some signs of lithium toxicity?
Confusion
Drowsiness
Problems with vision
Loss of appetite
Difficulty speaking
Seizures
Excessive thirst and urination
256
What mnemonic can be used for lithium SEs + complications?
L-ethargy
I-nsipidus (diabetes)
T-remor
H-ypothyroidism
I-nsides (gastrointestinal)
U-rine (increased)
M-etallic taste
257
What common drug should be avoided with lithium + why?
NSAIDs as they increase the serum lithium levels
258
Is lithium dangerous in pregnancy + breastfeeding?
Can cause 1st trimester birth defects
Increased risk of foetal heart defects
Can pass through breastmilk-avoid whilst breastfeeding
Patients on lithium should be on reliable contraception
259
What is ASD?
Autism spectrum disorder = neuro-developmental disorder with abnormal social interaction, communication, and repetitive behaviours
260
What is Asperger syndrome/autism spectrum disorder?
Part of ASD but no intellectual/functional language impairment
261
What are the 3 areas of deficit which are features of ASD + when do they first appear?
Usually observable before 3yrs:
Deficits in social interaction, communication + behaviour
262
Describe 4 deficits in social interaction in ASD
-Lack of eye contact
-Delay in smiling
-Avoiding physical contact
-Difficulty establishing friendships
263
Describe 4 deficits in communication in ASD
-Delay in language development
-Repetitive use of words/phrases
-Difficulty with imaginative/imitative behaviour
-Lack of appropriate non-verbal communication e.g. smiling, eye contact
264
Describe 4 deficits in behaviour in ASD
-Intense interests in objects/numbers/patterns rather than people
-Repetitive behaviours/movements e.g. hand-flapping/rocking and fixed routines
-Anxiety + distress with experiences outside their regular routine
-Extremely restricted food preferences
265
How is ASD diagnosed?
Assessment by psychiatrists + clinical psychologists
266
How common is ASD is boys:girls?
4:1
267
What causes ASD?
No identifiable cause but predisposing factors:
Infantile spasms
Congenital rubella
Fragile X syndrome
268
Name 2 conditions which have increased prevalence on people with ASD?
Epilepsy
ADHD
269
Name 2 diagnostic tools for ASD
DISCO - Diagnostic Interview for Social and Communication Disorders
ADOS - Autism Diagnostic Observation Schedule
270
What services can help patients with ASD?
Specialist education
OT/speech therapy
Clinical psychology
Sleep hygiene
271
How can patients with ASD be helped in a hospital setting?
Don't overcrowd rooms
Use clear, direct, literal language
Enable company of ppl they trust
Ask about communication preferences
272
What are obsessions?
Unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore
273
What are compulsions?
Repetitive actions the person feels they must do, generating anxiety if they are not done
274
What are the 4 steps of the OCD cycle?
-Obsessions
-Anxiety
-Compulsion
-Temporary relief
275
How can OCD be managed?
Mild-education + self-help
More severe-CBT with exposure + response prevention, SSRIs, Clomipramine (antidepressant)
276
What is PTSD?
Post-traumatic stress disorder-mental health condition resulting from traumatic experiences, with ongoing distressing symptoms and impaired function
277
What can PTSD increase risk of?
Depression
Anxiety
Substance misuse
Suicide
278
Name 5 examples of traumatic events that might cause PTSD
Violence-sexual, DV, physical
Car accident
Major health event/death
Natural disaster
War + conflict
279
Name 5 key symptoms of PTSD
Intrusive thoughts
Re-experiencing-flashbacks/images/sensations
Hyperarousal-on edge
Depersonalisation/derealisation
Negative emotions + beliefs
280
What is the diagnostic tool for PTSD?
TSQ-trauma screening questionnaire
281
How can PTSD be managed?
Trauma-focused CBT
EMDR - eye movement desensitisation + reprocessing
SSRIs
282
How does EMDR work?
Eye movement desensitisation and reprocessing (EMDR) involves processing traumatic memories while performing specific eye movements. The theory is that the improperly stored traumatic memories are reprocessed and stored again in a more normal way so that they no longer cause as much negative emotion and distress.
283
What is schizophrenia?
Severe, long-term mental health disorder characterised by psychosis. It affects thinking, perception, and affect.
284
What is affect?
An individual's underlying feeling state, encompassing emotions and moods
285
When does schizophrenia commonly present + how common is it?
15-30, affects 1% of pop
286
Name 2 hypotheses for the development of schizophrenia
Neurodevelopmental hypothesis-brain changes/injury/poor development cause disease
Neurotransmitter hypothesis-XS dopamine in mesocorticolimbic tracts (+ve symptoms) + less dopamine in mesocortical tracts (-ve symptoms)
287
Name 3 neurotransmitters implicated in schizophrenia
Dopamine
Serotonin
Glutamate
288
Name 4 RF for schizophrenia
FHx + genetics
Malnutrition, infections in utero
Drug abuse-cannabis
Lower socioeconomic class/stressful life experiences
289
What is schizoaffective disorder?
Combines the symptoms of schizophrenia with bipolar disorder. Patients have psychosis and symptoms of depression and mania.
290
What is schizophreniform disorder?
Same features as schizophrenia but for less than 6mths
291
Name 5 differentials for psychosis
Mania
Psychotic depression
Drugs
Stroke/brain tumour
Cushings
292
What are the 4 first rank symptoms of schizophrenia?
Auditory hallucinations
Thought interference
Delusions
Passivity-actions felt to be influenced by external agent
293
What is a delusional perception?
When the patient experiences an ordinary and unremarkable perception that triggers a sudden, often self-related delusion
294
What are the 4 A's for -ve symptoms of schizophrenia?
Affective flattening (minimal emotional reaction)
Alogia (“poverty of speech”)
Anhedonia (lack of interest in activities)
Avolition (lack of motivation)
295
According to ICD-11, what does a diagnosis of schizophrenia require?
2+ symptoms to be present for at least 1 month, at least one symptom needs to be a first rank symptom
296
What kinds of medications are used to treat schizophrenia?
Anti-psychotics = D2 receptor antagonists
297
Name 4 complications of schizophrenia
CVD
Suicide
Cancer-delayed presentations
Substance abuse
298
What is the average life expectancy of someone with schizophrenia?
Reduced by 15-25yrs
299
What is the purpose of a suicide risk assessment?
Establish patient's intent
Assess seriousness of attempt
Assess how they feel about their attempt
300
What is self-harm + what is the most common form?
Self-injury without suicidal intent, most commonly cutting
301
In which demographics is self-harm more common?
Females + ppl under 25
302
Why do ppl self-harm?
As a response to emotional distress and acts as a way for the person to cope with their emotions
303
What is suicide?
A person causing their own death
304
In which demographics is suicide most common?
Men (X3 more common) + ppl over 50
305
What are the 6 steps of the cycle of self-harm?
Emotional suffering
Emotional overload
Panic
Self-harming
Temporary relief
Shame and guilt
306
Name 6 presenting features that increase the risk of suicide?
Previous attempts
Escalating self-harm
Feelings of hopelessness/being a burden
Impulsiveness
Making plans
Writing a suicide note
307
How do you manage self-harm?
Empathy, support + communication
Identify triggers
Remove means
Discuss strategies for avoiding future eps
Treat underlying MH conditions e.g CBT
308
What can you give within 1hr of an overdose to reduce absorption?
Activated charcoal
309
What do you give for an overdose of paracetamol?
Acetycysteine
310
What do you give for an overdose of opioids?
Naloxone
311
What do you give for an overdose of cocaine?
Diazepam
312
What do you give for an overdose of cyanide?
Dicobalt edetate
313
What do you give for an overdose of carbon monoxide?
100% O2
314
What should you ask about a current episode of self-harm/suicide attempt?
Precipitant?
Planned/impulsive?
Precautions to avoid discovery taken?
Alcohol used?
Method
Thoughts then + now
How were they found?
315
What should you ask about an overdose?
Which meds?
Meds sourced where?
How much did they take?
What did they think the amount of meds would do?
316
What questions should you ask about cutting self-harm?
Where are cuts?
How many cuts?
How deep?
How did the patient feel whilst they were cutting?
What was the patient hoping the cutting would do?
317
What histories should you cover in a self-harm/suicide risk assessment?
Previous self-harm
Past psychiatric Hx
Past medical Hx
Drug Hx
FHx
Social Hx
318
What is a personality disorder?
A disturbance in personality functioning regarding how an individual behaves, interprets situations and perceives themselves
319
What are the 3 categories of PD according to the DSM-5?
Cluster A-Suspicious
Cluster B-Emotional/impulsive
Cluster C-Anxious
320
What is a paranoid PD?
Difficulty in trusting or revealing personal information to others.
321
What is a schizoid PD?
Lack of interest or desire to form relationships with others and feelings that this is of no benefit to them
322
What is a schizotypal PD?
Unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.
323
What is an antisocial PD?
Reckless and harmful behaviour, with a lack of concern for the consequences or the impact of their behaviour on other people. It often involves criminal misconduct.
324
What is borderline PD?
Fluctuating strong emotions and difficulties with identity and maintaining healthy relationships.
325
What is a histrionic PD?
Involves the need to be the centre of attention and performing for others to maintain that attention
326
What is a narcissistic PD?
Feelings that they are special and need others to recognise this, or else they get upset. They put themselves first.
327
What is an avoidant PD?
Severe anxiety about rejection or disapproval and avoidance of social situations or relationships.
328
What is a dependent PD?
Heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach.
329
What is an obsessive-compulsive disorder PD?
Unrealistic expectations of how things should be done by themselves and others and catastrophising about what will happen if these expectations are not met.
330
How are PDs managed?
DBT
CBT
Talking/group therapies
Short-term meds e.g. antidepressants/anti-psychotics
331
What deficiency is caused by alcohol XS + why?
B12 (thiamine), alcohol causes it to be poorly absorbed
332
What can B12 deficiency cause?
Wernicke's encephalopathy (medical emergency with a high mortality rate) + Korsakoff syndrome (often irreversible)
333
Name 3 features of Wernicke's
Confusion
Oculomotor disturbances (disturbances of eye movements)
Ataxia (difficulties with coordinated movements)
334
Name 2 features of Korsakoff's
Memory impairment (retrograde and anterograde)
Behavioural changes
335
What is substance misuse disorder?
Consumption of substances that leads to the involvement of social, psychological, physical, or legal problems
336
What are the most common substances abused?
-Cannabis, cocaine + ecstasy (16-59yrs)
-Alcohol for all ages
337
Name 3 features of substance dependence
-Impaired control over substance use
-Increasing priority over other aspects of life or responsibility
-Psychological features suggestive of tolerance and withdrawal
338
What is alcohol dependence?
Daily alcohol consumption, strong urges and cravings for alcohol, difficulty controlling consumption, tolerance to the effects of alcohol and withdrawal symptoms when stopping
339
How does alcohol work?
Depressant-stimulates GABA to relax brain
Inhibits glutamate receptors (AKA NMDA) = further relaxation
340
How do you calculate units of alcohol?
Volume (ml) x Alcohol content (%) / 1000
341
What are the UK recommendations for alcohol consumption?
Not more than 14 units per week
Spread evenly over 3 or more days
Not more than 5 units in a single day
342
Name 5 complications of alcohol XS
Alcoholic liver disease
Wernicke-Korsakoff syndrome
Pancreatitis
Cancer risk
CVD risk
343
Name 2 screening questionnaires for alcohol use
AUDIT (Alcohol Use Disorders Identification Test)
CAGE
344
What are the CAGE q's?
C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
345
Name 5 potential examination findings of an alcoholic
Smelling of alcohol
Slurred speech
Bloodshot eyes
Dilated capillaries on the face (telangiectasia)
Tremor
346
What alcohol withdrawal symptoms would you expect between 6-12hrs?
Tremors, sweating, headache, craving, anxiety
347
What alcohol withdrawal symptoms could you expect between 12-24hrs?
Hallucinations
348
What alcohol withdrawal symptoms could you expect between 24-48hrs?
Seizures
349
What alcohol withdrawal symptoms could you expect between 24-72hrs?
Delirium tremens
350
What is delirium tremens?
Severe form of alcohol withdrawal caused by XS adrenergic activity
351
Name 5 symptoms of delirium tremens
Acute confusion
Delusions/hallucinations
Tremor, ataxia
Tachycardia, HTN, hyperthermia
Arrhythmias
352
What can be used to treat alcohol withdrawal?
Chlordiazepoxide (Librium) = benzodiazepine
High dose vit B IM/IV to combat W-K syndrome
353
What are the long-term Tx's for alcohol dependence?
Specialist alcohol services e.g. detox programme, CBT
Oral thiamine (prevents W-K)
Acamprosate, naltrexone or disulfiram = meds to maintain abstinence
354
What is tolerance?
Loss of effect when taking same dose
355
What is dependence?
Physiological/psychological need to keep using a drug
356
What is the reward pathway in the brain + what is it's primary neurotransmitter?
Mesolimbic pathway, dopamine
357
Name 3 key structures in the mesolimbic pathway that are affected by substance misuse
Basal ganglia, amygdala + prefrontal cortex
358
Describe how substances/behaviours cause addiction?
-Cause release of dopamine
-Triggers pleasurable feelings in reward system
-Repetition=positive reinforcement=operant conditioning
-Repeated exposure decreases number + sensitivity of dopamine receptors
-Requiring increasingly strong stimulus for same reward
359
Give 3 examples of opioids, what is their MOA?
Heroin
Codeine
Morphine
MOA=stimulates opioid receptors
360
Give 3 examples of CNS stimulants, what is their MOA?
Cocaine-blocks reuptake of dopamine
MDMA (ecstasy)-stimulates serotonin release + blocks reuptake
Methamphetamine-stimulates dopamine release + blocks reuptake
361
Give 2 examples of CNS depressants, what is their MOA?
Alcohol
Benzodiazepines
MOA=stimulates GABA receptors
362
Give an example of a hallucinogen, what is its MOA?
LSD
MOA=stimulates serotonin receptors, particularly 5-HT2A receptors
363
What is the MOA of cannabis?
Stimulates cannabinoid receptors (CB1 and CB2)
364
Name 2 anticonvulsants and their MOA
Pregabalin
Gabapentin
MOA-blocks calcium channels, decreasing release of excretory neurotransmitters
365
What is the MOA of nicotine?
Stimulates nicotinic acetylcholine receptors
366
What is dementia?
Progressive and irreversible impairment in memory, cognition, personality and communication
367
What is delirium?
Acute, transient and reversible state of confusion, usually the result of other organic processes
368
Under what age would it be early-onset dementia?
Under 65
369
What is mild cognitive impairment?
A deficit in cognition and memory that is greater than expected with age but not significant enough for a diagnosis of dementia. Can still live independently.
370
What are the most common forms of dementia?
1)Alzheimer's dementia
2)Vascular dementia
371
What are the characteristic histological features of Alzheimer's?
Amyloid plaques-clumps of beta-amyloid
Neurofibrillary tangles-made from tau proteins
372
What are the most common symptoms of Alzheimer's?
Memory loss
Changes in planning, reasoning, speech + orientation
373
What causes vascular dementia + what are RFs?
Vascular damage + impaired blood supply to brain
RF-same as CVD e.g. smoking, HTN
374
How does vascular dementia progress?
Stepwise fashion-period of stability then acute decline, then stability
375
Describe some clinical features of vascular dementia
Mood disturbances/disorders
Psychosis/delusions/paranoia in later stages
Emotional lability
376
What features are associated with Lewy body dementia?
Features of parkinsonism
Also:
visual hallucinations, delusions, REM sleep disorders, fluctuating consciousness
377
Describe the progress of Lewy body dementia
Rapid progression-death common within 7yrs post-diagnosis
378
What are Lewy bodies?
Spherical alpha-synuclein that deposit in the brain, they are present in Lewy body dementia + Parkinson's disease
379
What group of people does frontotemporal dementia most commonly affect? Life expectancy?
Responsible for lots of dementia diagnoses in under 65s
Life expectancy = 8yrs after Dx
380
What causes frontotemporal dementia?
Atrophy, neuron damage + death in frontal + temporal lobes due to deposition of abnormal proteins. Some genetic component.
381
What are the 3 presentation types for frontotemporal dementia?
-Behavioural (altered emotions, decline in interpersonal skills, obsessions/rituals)
-Semantic (decline in word understanding, facial recognition)
-Non-fluent (speech fluency + comprehension affected)
382
Name 3 medications that can mimic dementia (cause cognitive impairment, memory impairment/personality changes)
Anticholinergic urological drugs e.g. solifenacin
Antihistamines e.g. promethazine
TCAs e.g. amitriptyline
383
Name 3 psychiatric conditions that could mimic dementia
Depression
Psychosis
Delirium
384
Name 2 neuro conditions that could mimic dementia
Brain tumours
Huntington's
385
Name 4 endocrine disorders that could mimic dementia
Hypothyroidism
Cushing's
Hyperparathyroidism
Adrenal insufficiency
386
What vitamin deficiencies could mimic dementia?
Vitamin B12 deficiency
Thiamine (B1) deficiency
387
Name 3 modifiable RF for dementia
Exercise
Mental stimulation
BP control
388
Name 5 types of memory screening test
Six Item Cognitive Impairment Test (6CIT)
10-point Cognitive Screener (10-CS)
Mini-Cog
General Practitioner Assessment of Cognition (GPCOG)
Montreal Cognition Assessment (MoCA)
389
What is the ACE-III?
Addenbrooke’s Cognitive Examination-III (ACE-III) is a detailed and comprehensive assessment tool for memory impairment, typically used by specialist memory services
390
What 5 domains does the ACE-III test?
Attention
Memory
Language
Visuospatial function
Verbal fluency
Scored out of 100, <88 may suggest dementia
391
How can you manage dementia (non-pharmacological)?
-Forward care planning, wills, PofA
-Therapy for behavioural + psychological symptoms
392
What meds can be used in dementia Mx?
Alzheimer's:
Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine + Memantine (blocks NMDA receptors)
For psych/behavioural symptoms:
SSRIs
Antipsychotics
Benzos for crisis Mx
393
How do you differentiate between delirium, dementia + depression in terms of onset?
Del-acute, sudden hrs->days
Dem-gradual, over mths->yrs
Dep-gradual, over wks->mths
394
How do you differentiate between delirium, dementia + depression in terms of course?
Del-fluctuating, often reversible
Dem-slowly progressive, irreversible
Sep-variable, often episodic
395
How do you differentiate between delirium, dementia + depression in terms of affect on attention?
Del-severely impaired, difficulty paying attention
Dem-often preserved at early stages
Dep-often preserved at early stages but may seem distracted
396
How do you differentiate between delirium, dementia + depression in terms of affect on consciousness?
Del-altered consciousness, from drowsy->hyperalert
Dem-usually clear till late stages
Dep-clear consciousness
397
How do you differentiate between delirium, dementia + depression in terms of affect on cognition?
Del-global cognitive impairment, changes in memory, orientation + language
Dem-gradual memory impairment
Dep-difficulty w/ concentration, slower processing but memory intact on questioning
398
What is an eating disorder?
Psychiatric conditions involving an unhealthy and distorted obsession with body image and food
399
What is anorexia nervosa?
When a person feels they are overweight despite evidence of normal or low body weight. It involves obsessively restricting calorie intake to lose weight. Often, the person exercises excessively and may use diet pills or laxatives to limit the absorption of food.
400
Name 4 physical features of anorexia nervosa
Weight loss (15% below expected or BMI<17.5)
Amenorrhea
Lanugo hair (fine, soft hair across most of body)
Hypotension
401
How do patients with bulimia nervosa present?
Often have normal body weight but it fluctuates
402
What does bulimia involve?
Binge eating followed by purging
403
Name 4 physical features of bulimia
Dental erosion
Swollen salivary glands
GO reflux
Calluses on knuckles = Russell's sign
404
What may be seen on blood gas with bulimia + why?
Alkalosis from repeated vomiting of HCl from stomach
405
What is a binge eating disorder?
Characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. The person typically feels a loss of control. Patients likely to be overweight.
406
Name 4 potential blood test findings in restrictive eating disorders
Anaemia (low haemoglobin)
Leucopenia (low white cell count)
Thrombocytopenia (low platelets)
Hypokalaemia (low potassium – due to vomiting or excessive laxatives)
407
What is refeeding syndrome?
After extended period of nutritional deficit, when someone resumes eating, risk of arrhythmia, HF + death
408
What causes refeeding syndrome?
Carbohydrate intake increases insulin which shifts magnesium, potassium and phosphate out of the blood (into cells) and sodium into the blood-extra re-absorption in kidneys
409
What are the overall effects of refeeding syndrome?
Hypomagnesaemia (low serum magnesium)
Hypokalaemia (low serum potassium)
Hypophosphataemia (low serum phosphate)
Fluid overload (due to water following the extra sodium into the extracellular space)
410
What are the risks with refeeding syndrome?
Arrhythmia, HF + death
411
How is refeeding controlled to prevent refeeding syndrome?
Slow reintroduction of foods, limit calories
Magnesium, potassium, phosphate and glucose monitoring
Fluid balance monitoring
ECG monitoring in severe cases
Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine
412
How are eating disorders managed?
CBT/ psychological counselling
Address other psychosocial factors e.g. depression, anxiety, relationships
If mild then self-help resources
If severe, may require compulsory admission for refeeding + monitoring
413
What is a learning disability?
Lifelong condition affecting intellectual ability (IQ<70) + overall cognitive + adaptive behaviour. It typically presents before adulthood and can impact understanding, communication, and daily living skills
414
Give 3 examples of a learning disability
Down syndrome, global developmental delay, fragile X syndrome
415
What is a learning difficulty?
Specific challenges in learning without affecting overall intelligence
416
Give 3 examples of a learning difficulty
ADHD, dyslexia, dyspraxia
417
How are learning disabilities classified?
Based on IQ (intelligence quotient):
55 – 70: Mild
40 – 55: Moderate
25 – 40: Severe
Under 25: Profound
418
Name 5 conditions that are strongly associated with learning disabilities
Down syndrome
Antenatal problems e.g. fetal alcohol syndrome, maternal chickenpox
Autism
Epilepsy
Problems at birth e.g. prem, hypoxic ischaemic encephalopathy
419
What 4 things must people do to show they have capacity?
Understand info
Retain long enough to make decision
Weigh up options
Communicate decision
420
What is dyspraxia?
AKA developmental co-ordination disorder, difficulty in physical co-ordination, delayed gross + fine motor skills
421
What is global developmental delay?
A child displaying slow development in all developmental domains
422
Name 4 examples of underlying diagnoses presenting as global developmental delay
Down's syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
423
Name 5 underlying conditions that a gross motor delay may indicate
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
424
Name 4 underlying conditions that a fine motor delay may indicate
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
425
Name 4 conditions that a delay to speech and language may indicate
Hearing impairment
Learning disability
Autism
Cerebral palsy
426
What may a personal and social delay indicate?
Autism
Parenting issues
Emotional + social neglect
427
What are the 4 categories for development?
Gross motor
Fine motor
Speech + language
Social, emotional + behavioural
428
How is GDD defined?
Child under 5 delayed more than 2 s.d. below age appropriate mean in 2+ domains
429
How common is GDD?
Affects 1-3% children under 5
430
What are the 5 red flags for development which should prompt urgent assessment?
No social smile by 8 weeks
Not sitting by 9 months
Not walking by 18 months (need to exclude muscular dystrophy)
No words by 2 years
Developmental regression (loss of previously acquired skills) at any time
431
What is the aim with investigating GDD?
Identify underlying medical conditions
Tx underlying
Genetic implications for family + future children
Multidisciplinary support + education
