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Psych Flashcards

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1
Q

What is a delusion?

A

Fixed firmly held belief that is held despite evidence to the contrary and cannot be reasoned away. It is out of keeping with the person’s sociocultural norms.

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2
Q

What is a delusion of reference?

A

Thinking every day things (neutral events) have a special meaning or personal message behind them

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3
Q

What is a persecutory delusion?

A

Thinking that others are out to get them

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4
Q

What is a grandiose delusion?

A

Belied that they have special talents, are famous or particularly important

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5
Q

What is a depressive delusion?

A

Belief that they are guilty, worthless, end of the world is coming

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6
Q

What is delusional jealousy?

A

Preoccupation with thought that their spouse is being unfaithful without having logical proof

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7
Q

What is a delusion of control

A

Feeling under the control of a force or power

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8
Q

Describe thought withdrawal

A

Feeling that thoughts are being taken out of their head so mind left blank

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9
Q

What is thought broadcast

A

Thoughts transmitted, everyone can hear

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10
Q

What is thought echo?

A

Thoughts repeated like an echo!

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11
Q

What is thought insertion?

A

Someone else putting thoughts into the mind

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12
Q

What physical disorders can present like psychosis?

A 
Dementia 
Thyrotoxicosis
Cushing's 
Epilepsy of temporal lobe 
Drug misuse
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13
Q

What are the hallmark symptoms of psychosis?

A

Hallucinations
Delusions
Thought disorder
Lack of insight

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14
Q

What are the first rank symptoms of schizophrenia

A

Delusions of one type
Auditory hallucinations- echo, third person voices, running commentary
Thought disorder - insertion, withdrawal, broadcast
Passivity experiences

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15
Q

What are the negative symptoms of schizophrenia

A 
Under activity 
Poverty of speech 
Low motivation 
Social withdrawal
Emotional flattening 
Self neglect
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16
Q

What are the signs of schizophrenia on MSE

A

Appearance and behaviour: withdrawal, self neglect, stereotypical behaviours, responding to unseen stimuli
Speech: poverty of speech, loosening of associations
Emotion: flat affect
Thoughts: delusional beliefs, passivity, thought disorders
Perceptions: auditory hallucinations
Insight: lack!

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17
Q

According to ICD 10, which four symptoms do people need to experience one of for a diagnosis of schizophrenia?

A

Thought disorder
Delusions of control, passivity or influence
Hallucinatory voices - running commentary, third person,
Persistent delusions

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18
Q

What is the differential diagnosis for schizophrenia?

A 
Delirium
Drugs
Mood disorder with psychotic symptoms 
Delusional disorder
Schizoaffective 
Dementia
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19
Q

What is the treatment for schizophrenia

A

First line: atypical - risperidone, olanzapine

Then: typical - haloperidol

Then: clozapine

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20
Q

How quickly does schizophrenia improve following initiation of antipsychotic treatment?

A

After first few days excitement and irritability improve

After few weeks, hallucinations and delusions improve

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21
Q

What is schizoaffective disorder?

A

Schizophrenic and mood symptoms, both severe enough to reach ICD 10 criteria

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22
Q

How long do symptoms of schizophrenia need to be present for a diagnosis to be made?

A

One month

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23
Q

What is delusional disorder?

A

Delusion for at least 3 months

No presence of other symptoms

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24
Q

What are the core symptoms of depression

A

Anhedonia
Low mood
Lack of energy

For at least 2 weeks

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25
What are some depressive cognitions?
``` I am worthless Guilt Hopelessness Constant worries about health Poor concentration Suicidal ideation ```
26
State the biological symptoms or depression
``` Early morning wakening Diurnal mood variation Lack of appetite Weight loss Loss if libido Psychomotor agitation or retardation ```
27
What is the ICD 10 classification for the severity of depression?
Mild - 2 core, 2 others Moderate - 2/3 core, 3/4 others Severe - 3 core, 4 others
28
What is the difference between grief reaction and depression?
``` In grief reaction: still have ability to feel pleasure, grief comes in waves, no thoughts of worthlessness of hopelessness, able to look forward to future ```
29
Management of mild to moderate depression
CBT Then antidepressant if persists or if history of depression
30
Treatment of moderate to severe depression
Antidepressants - SSRI - different SSRI or SNRI - mirtazapine or augment with lithium/quetiapine AND CBT/ IPT ECT can be used if fast treatment needed, or situation is life threatening
31
Describe mania according to ICD 10
Mood which is predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned. Prominent and sustained for at least a week or severe enough to require admission to hospital
32
State some of the symptoms of mania
``` Increased activity Increased talkativeness Flight of ideas Loss of social inhibitions Less sleep Inflated self esteem Distract ability Reckless behaviour Sexual energy ``` Also psychotic symptoms
33
What is the difference between mania and hypo mania?
Hypo mania only four days Only some interference with personal functioning (mania there will be severe interference) No psychotic symptoms in hypomania
34
What is the difference between bipolar I and bipolar II
I - manic episodes plus major depressive episodes II - hypo mania plus depressive episodes
35
What could be differential diagnosis for bipolar?
Schizophrenia - in mania the content of delusions and hallucinations changes quickly Dementia Endocrine - hyperthyroid! Drug misuse
36
Describe treatment of bipolar disorder episode
Admission is likely to be needed Pharmacological Mania: antipsychotic (olanzapine, quetiapine, risperidone, haloperidol), if two fail then lithium, if fails then sodium valproate Depression: antipsychotic (quetiapine), then olanzapine + fluoxetine, then lithium, then SSRI
37
Why are SSRI used with caution in those with bipolar depression?
Switching to Mania
38
Describe how bipolar relapses are prevented
Continuation therapy: lithium first line, then add valproate. Lamotrogine or carbamezepine also Education of early signs of relapse
39
What are the early signs of relapse in bipolar?
``` Reduced need for sleep Over spending Increased activity Racing thoughts Elated mood Irritability Unrealistic plans ```
40
What are the psychological a symptoms of anxiety?
``` Racing thoughts Increased alertness Feeling of dread Restlessness Inability to focus ```
41
What are the physical symptoms of anxiety
Palpitations Sweating Breathlessness Shaking
42
What is GAD
Worries about worries | Maintained by belied that worries are helpful
43
What is social anxiety disorder
Fear of negative evaluation by others Avoidance of feared situations Unhelpful evaluation following social encounters
44
What is adjustment disorder?
Subjective distress and emotional disturbance, interfering with social functioning and performance, arising in period of adaption to significant life change.
45
What is a grief reaction?
Develops within three months of stressor | Does not persist for more than 6 months after stressor is no longer present
46
What is agoraphobia
Fear of leaving home, going to public places, travelling alone on public transport
47
What is an obsession in OCD?
Recurrent unpleasant thoughts or images Ego dystonic Coming from person's mind, recognised as being excessive or unreasonable
48
What is a compulsion in OCD
Action or ritual related to the obsession Person tries to resist, but feels driven to perform them It is not pleasurable to carry out
49
What is the management for anxiety disorders?
CBT SSRI Anxiolytics in short term
50
What are the core symptoms of PTSD
Re-experiencing Avoidance or rumination Hyper-arousal
51
How is PTSD treated
Trauma focused CBT EMDR Drug treatment as adjunct or if not able to do CBT Paroxtine, mirtazapine
52
What is a personality disorder?
Deeply ingrained and enduring behaviour patterns Present since adolescence Stable over time Manifests In different environments Significant deviation from average Associated with distress and problems with social performance Recognised by friends and acquaintances
53
What are the features of dissocial personality disorder?
``` Incapacity to maintain enduring relationships Disregard for consequences of actions Disregard for social norms, rules and obligations Incapacity to experience guilt Disregard for others feelings Criminal behaviour Comorbid depression and anxiety Drug and alcohol use ```
54
When can dissocial personality disorder be diagnosed? What can be diagnosed before this?
After age 18 Conduct disorders - antisocial, aggressive or defiant behaviour. Persistent and repetitive
55
How would someone with EUPD present?
``` Relationship difficulties recurrent self harm Threats of suicide Depression Impulsivity Social difficulties ```
56
What are the features of EUPD?
Unstable and intense interpersonal relationships Poorly controlled impulses Fear of abandonment and rejection Strong tendency towards suicide and self harm
57
What is the treatment for personality disorders?
Psychotherapy - long term Drug treatment for comorbidies Crisis plan
58
What is somatisation disorder
multiple physical SYMPTOMS present for at least 2 years patient refuses to accept reassurance or negative test results
59
What is hypochondrial disorder
persistent belief in the presence of an underlying serious DISEASE patient refuses to accept reassurance or negative test results
60
What is a conversion disorder
symptoms present despite lack of organic cause the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
61
What is factitious disorder
Munchausen's syndrome the intentional production of physical or psychological symptoms
62
What is malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
63
What are some predisposing factors in depression
genetic factors (higher risk if first degree relative), childhood abuse, parental loss
64
What are some precipitating factors in depression
life event substance abuse severe physical illness
65
what are some perpetuating factors in depression
``` social withdrawal stress finances work lack of confiding relationship ```
66
State some differentials for depression
grief reaction dementia substance misuse - anabolic steroids, alcohol, cannabis hypothyroidism bipolar disorder drug side effects - benzodiazepines, POCP schizophenia (if depression with psychosis)
67
What investigations should be carried out in depression
TFTs
68
What questions about secondary symptoms in depression are important to ask?
``` how is your sleep? appetite? concentration? Mood throughout the day memory? thoughts about the future/self? relationships? ```
69
For patients with mild/moderate depression, when can the use of antidepressants be considered?
a past history of moderate or severe depression initial presentation of subthreshold depressive symptoms that have been present for a long period (at least 2 years) subthreshold depressive symptoms or mild depression that persist(s) after other interventions if a patient has a chronic physical health problem and mild depression complicates the care of the physical health problem
70
Which antidepressant is most suitable in thetreament of children and young people?
fluoxetine
71
What are the side effects of SSRIs
``` GI: bleeds, nausea, dyspepsia, bloating, flatulence, diarrhoea and constipation Sweating Tremor Rashes Extrapyramidal Sexual dysfunction Sleepiness Hyponatraemia ```
72
What are the advantages of SSRI's compared to TCAs
less toxic in overdose less sedative less cardiotoxic
73
How long do SSRI's take to have their full effect
6-8wks
74
How long should someone take an SSRI for depression
at least 6 months
75
Define alcohol intoxication
chracterised by slurred speech, impaired coordination and judgement and labile affect
76
Describe the characteristics of acute alcohol withdrawal
``` • Insomnia and fatigue. • Tremor. • Mild anxiety/feeling nervous. • Mild restlessness/agitation. • Nausea and vomiting. • Headache. • Excessive sweating. • Palpitations. • Craving for alcohol. seizures hallucinations ```
77
What are the signs of alcohol dependence?
Compulsion to drink Aware of harms but persist Neglect other activities Tolerance to alcohol ``` Stopping causes withdrawal Stereotyped patterm on drinking Time preoccupied wiht alchohol Out of control of use Persistent futile wish to cut down ```
78
What are tools used to screen for alcohol dependence?
FAST AUDIT CAGE
79
State the components of the CAGE questionnaire
o Have you ever felt the need to Cut down? o Have people Annoyed you by criticising your drinking? o Do you ever feel Guilty about your drinking? o Ever had an Eye-opener to steady your nerves in the morning?
80
What signs on examination can be seen in alcohol dependency
``` palmar erythema gynecomastia ascites jaundice spider naevi ```
81
How is classical conditioning modelled in alcohol dependancy?
feeling good after having a drink (association between drinking and pleasure)(
82
How is operant conditioning modelled in in alcohol dependencu
avoiding withdrawal symptoms
83
What are some predisposing factors for alcohol dependency
``` genetics family history occupation impulsive traits culutre ```
84
What are some precipitating factors for alcohol dependency
divorce or relationship problems psychiatric illness peer pressure economic situation
85
What are some perpetuating factors of alcohol dependency
no motivation to change social reinforcement avoiding withdrawal symptoms association with pleasure activates dopaminergic reward pathway
86
What is Wernicke's encephalopathy due to?
thiamine deficiency damaging mamilliary bodies
87
What are the signs of Wernicke's encephalopthy?
ataxia nystagmus opthalmoplegia acute confusion
88
What are the neuropsychiatric complications of alcohol dependency
``` wernicke's peripheral neuropahty ED cerebellar degeneration dementia ```
89
What are the social complications of alcohol dependency
``` unemployment family breakdown prostitution debt domestic violence road accidents suicide ```
90
What are the features of foetal alcohol syndrome
``` decreased muscle tone poor cooridnation developmental delay heart defects facial abnormalities ```
91
What is delirium tremens?
most severe form of alcohol withdrawal manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse. begins 24-72 hours after alcohol consumption has been reduced or stopped
92
What are the features of delirium tremens
* Hallucinations (auditory, visual, or olfactory). * Confusion. * Delusions. * Severe agitation. * Seizures
93
What is the management of Wernicke's encephalopathy?
IV thiamine
94
How is acute alcohol detoxification managed?
admission to hospital - risk of delerium tremens/seizures sedation for symptoms of withdrawal - benzodiazepines Vitamin B complex is given as IV Pabrinex® to inpatients for a couple of days and then patients are given oral thiamine and multivitamins to prevent Wernicke's encephalopathy
95
What is the treatment for delerium tremens
ITU admission control blood glucose benzodiazepines prevent Wernicke's with thiamine
96
What are some treatment for alcohol dependence
motivational interviewing self help groups psychological therapies meds - disulfiram or acamprosate
97
What is the mechanism of action of disulfiram
inhibition of acetaldehyde dehydrogenase. so alcohol intake causes severe reaction due to Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms. therefore promotes abstinence
98
What is the mechanism of action of acamprosate
activates GABA system and reduces NMDA receptor excitation to reduce cravings for alcohol and risk of relapse.
99
What is korsakoff's psychosis?
chronic memory disorder (amnesic disorder with confabulation) caused by severe deficiency of thiamine
100
What are the features of opioid dependency
``` rhinorrhoea needle track marks pinpoint pupils drowsiness watering eyes yawning ```
101
Define delirium
acute onset of impaired consciousness and attention + perceptual or cognitive disturbance +evidence it may be related to a physical cause
102
State how dementia and delirium can be differentiated
dementia: slow deterioration slowly progressive course, alert consciousness, impoverished thought content, hallucinations not common delirium: acute onset, fluctuating course, clouded consciousness, vivid and complex thought content, , visual hallucinations very common
103
What investigations should be done in suspected delirium
Urinalysis, ECG FBC, U+E, glucose, TFTs, LFTs, calcium, folate, B12 CXR
104
What can cause delirium?
``` renal or hepatic failure thiamine, B12 or folate deficiency trauma UTI pneumonia sepsis surgery alcohol thyroid probs glucose - high or low ```
105
How should delirium be managed?
environmental - clear signage, clocks and calenders, staff explanations, appropriate lighting, sleep hygiene if distressed or a risk to self or others, short term haloperidol is given
106
What is dementia
acquired, progressive, usually irreversible global deterioration of higher cortical function in clear consciousness
107
What features need to be present for a diagnosis of dementia
multiple cognitive deficits - memory, orientation, language, reasoning, judgement impairment in activities of daily living clear consciousness
108
What are the importnant questions to ask when taking a dementia history?
``` onset short and long term memory orientation to time place and person sleep cooking/cleaning adaptions mood/personality change medical and drug history ```
109
Describe the pathophysiology of Alzheimer's
amyloid cascade hypothesis states that AD is caused by an imbalance of (too much) brain Aβ production and (too little) Aβ clearance leading to amyloid plaques and neurofibrillatory tangles
110
What are the macroscopic | cerebral features of Alzheimer's
cortical atrophy increased sulcal widening enlarged ventricles
111
Describe the pathophysiology of Vascular dementia
mulitple infarcts lead to loss of cortical parenchyma
112
Describe the pathophysiology of Dementia with Lewy bodies
Lewy bodies (abnormal deposits of protein inside nerve cells). and neurites in basal ganglia and cortex
113
What are the classic features of vascular dementia
step wise progression | focal neurologcial sx
114
What are the classic features of dementia with lewy bodies
parkinsonian features | fluctuation of cognition and alertness
115
What are the classic features of fronto-temporal dementia
early personality changes | intellectual sparing
116
What tests should eb done to exclude physical causes of memory loss in suspected dementia?
FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels. neuroimaging (e.g. Subdural haematoma, normal pressure hydrocephalus)
117
What are important differentials tp consider in dementia
``` hypothyroidism delirium normal pressure hydrocephalus subdural haematoma psychosis depression thiamine deficiency B12 deficiency hearing or visual problems ```
118
How can Alzheimer's be managed?
mild/moderate: AChE inhibitors - donepezil, galantamine or rivastigmine o Side effects include nausea, dizziness, headache, diarrhoea moderate/severe: memantine - NMDA receptor antagonist
119
What factors increased he risk of depression in the elderly
``` dementia physcial illness soical isolayion bereavement being a carer loss of independence ```
120
How can depression be distinguished from dementia in the elderly?
Depression: Poor concentration Slowness and self-neglect Depressed mood preceded memory problems Poor performance in memory testing improves when interest is aroused In depression, patients are unwilling to cooperate in interview, in dementia they are usually willing to reply to questions, but make mistakes short history, rapid onset biological symptoms e.g. weight loss, sleep disturbance mini-mental test score: variable global memory loss (dementia characteristically causes recent memory loss)
121
Name some SSRIs
sertraline citalopram fluoxetine paroxetine
122
What are the side effects of SSRIs
GI bleeds hyponatraemia sexual dysfuynction increased agitation and suicidal ideation in first 2 weejs
123
Whcih SSRI is safe in unstable angina or prev MI
sertraline
124
What are the symptoms of stopping SSRIs abruptly
``` Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep disturbances, fatigue, influenza-like symptoms, sweating ```
125
How should SSRIs be stopped
tapered over at least a few weeks
126
What is serotonin syndrome
syndrome caused due to increased serotonin -increased dose, change of SSRI
127
What are the signs and symptoms of serotonin syndrome
neuromuscular hyperactivity - clonus, tremor, hyperreflexia, rigidity autonomic dysfunction - BP changed, increased HR, hyperthermia, diarrhoea altered mental state - confusion, agitation, mania
128
Name some SNRI
venlafaxine | duloxetine
129
What are the side effects of SNRIs
hypertension prolonged QTc sweating
130
What is the mechanism of action of mirtazapine
presynaptic alpha2-adrenoceptor antagonist, increasing concentrations of NA and serotonin transmission
131
What are the side effects of mirtazapine
dry mouth weight gain drowsiness
132
Name some TCAs
amitrityline imipramine clomipramine
133
What is the mechanism of action of TCAs
inhibit breakdown of NA and serotonin
134
Which TCAs are more and less sedative
more - amitrityline, chlomipramine | less - lofepramine, imipramine
135
What are the side effects of TCAs
fatally toxic in overdose increased mortality from cardiac disease anticholinergic
136
Name some MAOI
phebelzine
137
What are the significant side effects of MAOIs
hepatotoxicity | hypertensive crisis if interaction with tyramine ricj foods - red wine, cheese
138
What is the mechanism of action of MAOIs
inhibition fo breakdwon of serotonin by monoamine oxidase
139
Name some typical antipsychotics
chlorpromazine | haloperidol
140
What are the extrapyramidal (antidopaminergic) side effects of antipsyhcotics
parkinsonism acute dystonia akathisia tardive dyskinesia
141
Describe parkinsonism
pill rolling tremor shuffling gait difficulty turning rigidity
142
Describe acute dystonia
spasm of facial muscles | grimacing
143
Describe akathisia
restlessness pacing feet in constant motion
144
Describe tardive dyskinesia
tongue protrusion abdnormal jerking of limbs lip smacking
145
What is the management if tardive dyskinesia occurs
stop the drug - prevent worsening
146
Which extrapyramidal side effects are reversible and which might not be
acute dyskinesia, akathisia and parkinsonism reversible tardive dyskinesia might not be
147
What are the signs and symptoms of hyperprolactinaemia
``` sexual dysfunction decreased bone density menstrual disturbances, breast enlargement, galactorrhoea. ```
148
Name some atypical antipsychotics
olanzapine quetiapine clozapine risperidone
149
Which antipsychotic is proven to be more efficacious than others?
clozapine
150
When can clozapine be prescribed
when treatment with 2 other antipsychotics has been tried and not been able to control symptoms
151
What are the important side effects of clozapine
agranulocytosis | seizures
152
What should be monitored in clozapine specifically
FBC every week for 18weeks every fortnight for 1 year then every month
153
What are the side effects of antipsychotics
``` high prolactin weight gain hyperglycaemia cardiovascular - raised HR, arrhythmias, prolonged QTc hypotension sexual dysfunction neuroleptic malignant syndrome ```
154
Which antipsyhchotic has the lowest incidence of sexual dysfunction
quetiapine
155
What are the signs and symptoms of neuroleptic malignant syndrome
hyperthermia, fluctuating level of consciousness, muscle rigidity, autonomic dysfunction - pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence associated with recent increased in dose of antipsychotic
156
What monitoring needs to be done in antipsychotic treatment?
pre: BP, ECG, weight. FBC, U+E, LFT, fasting glucose, blood lipids at 3m: lipids and weight at 6m: fasting glucose every year: FBC, U+E, LFT, blood lipids, fasting glucose, weight
157
When is a depot antipsychotic used?
issues with non-adherance
158
What do levels 1a, 1b, 2 and 3 mean on a psychiatric ward
``` 1a = staff within an arms length at all times 1b = staff within eye contact at all times 2 = pt checked on every 15 mins 3 = general observations ```
159
What is the Frontal Assessment Battery
bedside test used to test for frontal lobe dementia
160
Define formal thought disorder
= an impaired capacity to sustain coherent discourse, and occurs in the patient's written or spoken language. indicates a disturbance of the organisation and expression of thought.
161
In what conditions can hallucinations occur
``` schizophrenia depression with psychosis delerium drug induced psychosis Cushing's epilepsy SOL dementia with Lewy bodies ```
162
What is the therepeutic range for lithium in bipolar disorder
0.4-1mmol/L
163
How is lithium excreted?
by the kidneys
164
What are the common side effetcs of lithium
``` nausea and vomiting polydipsia, polyuria fine tremor hypothyroidism weight gain metallic taste in mouth ```
165
What should women of child bearing age be advised when taking lithium
use effective cnootraception - teratogenic in first trimester
166
What tests should be done before initiating lithium therapy?
ECG, BMI, weight | FBC, U+E, TFT, eGFR
167
What monitoring needs to take place whilst on lithium
test lithium levels every week until stable therapeutic range has been reached for at least 4 weeks then test lithium levels every 3m test TFT, U+E, eGFR and BMI every 6m
168
When should lithium levels be taken
12 hours after dose
169
What should be gievn to patients started on lithium
patient information leaflet alert card lithium record book
170
How is lithium affected by sodium levels
low sodium increases lithium levels due to competitive reabsorption of sodium and lithium in the kidneys
171
How should lithium therapy be stopoed
not suddenly - can lead to relapse | gradually - over 3m
172
What level of lithium can cause toxicity
1.5mmol/L but if symptomatic, can be caused by lowet
173
Which drugs can cause low sodium and therefore increase risk of lithium toxicity
NSAIDs ACEi diuretics
174
What are the symptoms and signs of lithium toxicity
``` anorexia ,V + D coarse tremor drowsiness and restlessness dissxiness ataxia ```
175
What are the symptoms and signs of severe lithium toxicity
``` convulsion, hyperreflexia collapse low potassium dehydration circulatory failure ```
176
What is the management fo lithium toxicity
mild-moderate toxicity: volume resuscitation with normal saline haemodialysis if severe toxicity
177
What is the mechanism of action of benzodiazepines
enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels.
178
What problems are associated with long term use of benzodiazepines
dependance | tolerance
179
How long can a benzodiazepine be prescribed for
max of 2-4weeks
180
How should the dose of benzodiazepine be withdrawn
in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight
181
what are the features of benzodiazepine withdrawal syndrome
``` insomnia irritability anxiety tremor loss of appetite tinnitus perspiration perceptual disturbances seizures ```
182
What are the drugs used to treat parkinsonism
levo-DOPA | antimuscarinics to decrease rigidity and tremor (decreases excitation of peripheral nerves)
183
How should neuroleptic malignant syndrome be managed?
stop antipsychotic benzodiazepiens for agitation cooling devices dialysis if severe AKI from muscle breakdown
184
What are the dangers of rapid tranquilisation
respiratory depression, loss of consciousness, sedation
185
Describe a section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours in order to complete a MHA assessment
186
What are the criteria for the implementation of the MHA
presence of a mental disorder that is of a nature or severity that poases a significatn risk to their safety or others safety there is no alternative to hospital admission
187
What is a mental disoder according to the MHA
any disorder or disability of the mind
188
Describe a section 5(4)
allows a nurse to detain a patient who is voluntarily in hospital for 6 hours in order to complete a MHA assessment
189
Describe a section 2
admission for assessment and treatment for up to 28 days, not renewable an Approved Mental Health Professional (AMHP) makes the application on the recommendation of 2 doctors one of the doctors should be 'approved' under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
190
Describe a section 3
admission for treatment for up to 6 months, can be renewed AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
191
What is section 17a
Some patients who are detained under Section 3 are well enough to leave hospital and carry on receiving their treatment in the community. The patient’s Responsible Clinician and an AMHP may decide that a CTO is appropriate rather than complete discharge from the section. A patient on a CTO must keep to particular conditions and can be recalled to hospital if there are concerns about their compliance with the conditions or their deteriorating mental health. A CTO lasts for up to six months and might be renewed for a further six months then yearly. in teh case of relapse, The patient’s Responsible Clinician can call the patient to hospital and has up to 72 hours to decide what to do. The CTO can be revoked and the patient readmitted
192
What is section 136
police power to remove someone to a place of safety for further assessment
193
What are the four stages to consider when making a capacity assessment
1 = does the patient have a disorder of brain functioning? if yes = doe snot have capacity understand retain weight up communicate decision
194
What are the differences between psychodynamic psychotherapy and CBT
psychotherapy - focusses or therapeutic relatioinship. results in understanding od unconscious conflicts adn brings resolution to these CBT - addresses the role of dysfunctional thoughts and beliefs and what behaviours are produced and maintained. exposes and challenged thoughts
195
What is transference in psychotherapy
the re-enactment of past relationships and emotions with the therapist
196
What is paraphrenia
late onset schizophrenia with no negative symptoms
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What is harm minimisation
strategy aiming to lessen the social and physical consequences of using drugs reduce incidence of blood borne viruses, give control help prevent overdose and help to detox
198
Which illicit drugs may produce a schizophrenia like state
amphetamines cocaine cannabis LSD

Finals (32 decks)

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