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Phase 3a Medicine > Psych > Flashcards

Psych Flashcards

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1
Q

What are concrete concepts?

A

Real objects or situations (e.g. tremor)

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2
Q

Real objects or situations

A

What are concrete concepts?

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3
Q

What are defined concepts?

A

Classes of concepts (e.g. delusions)

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4
Q

What are concept systems?

A

Sets of related concepts (e.g. schizophrenia)

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5
Q

What is an illusion?

A

A wrong or misinterpreted perception of a real stimulus

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6
Q

What is a hallucination?

A

Disorder of perception

An experience involving the apparent perception of something not present.

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7
Q

What are hypnagogic hallucinations?

A

Vivid and frightening episodes/sensory phenomena whilst falling asleep.

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8
Q

What are hypnopompic hallucinations?

A

Unusual sensory phenomena experienced just before or during awakening.

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9
Q

What are extracampine hallucinations

A

Hallucinations outside the realms of what is feasible.

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10
Q

What are pseudo hallucinations?

A

An involuntary sensory experience vivid enough to be regarded as a hallucination but considered by the person as subjective and not real.

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11
Q

What is an overvalued idea?

A

An preoccupying idea to the extent of dominating the sufferers life
May be swayed by reason

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12
Q

Name 3 features is a delusion?

A

Firmly held belief
Not affected by rational argument or evidence
Not a conventional belief

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13
Q

Persecutory delusion

A

Believes other people are out to get them.

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14
Q

Grandiose delusion

A

Person believes they are indestructible/inflated self-importance

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15
Q

Self-referential delusion

A

Incidental information that the patient uses in reference to themselves.

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16
Q

Nihilistic (Cotard’s) delusion

A

Patient believes they are dead.

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17
Q

Capgras delusion

A

Misidentification

Believes a someone they recognise has been replaced by an imposter

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18
Q

Fregoli delusion

A

A delusional belief that different people are a single individual who changes appearance or is in disguise.

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19
Q

Subjective doubles

A

A person believes they have a Doppelganger with the same appearance, usually with different character traits.

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20
Q

Delusional perception

A

Delusion from a real stimulus - believing a percept has a special meaning for him or her.

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21
Q

Hypochondriacal delusion

A

Firm belief they have a disease

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22
Q

What are 2nd person auditory hallucinations?

A

A person talking to them

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23
Q

What are 3rd person auditory hallucinations?

A

A person talking about them

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24
Q

What are Charles Bonnet hallucinations

A

Visual hallucinations associated with eye disease

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25
What is a delusion?
Disorder of thought
26
What is a delusional perception?
Delusional belief resulting from a real stimulus. | Will be completely unrelated.
27
What is psychosis?
Severe mental disorder in which thoughts and emotions are impaired Lost connection with external reality May involve delusions and hallucinations
28
What is neurosis?
Mild mental illness caused by organic disease | No radical loss of touch with reality
29
What symptoms of stress are seen with neurosis?
Depression Anxiety Obsessive behaviour Hypochondria
30
What is passivity phenomena?
Disorder of thought and perception | Feeling that one's actions/thoughts are controlled by someone else
31
What is somatic passivity?
Passive recipient of bodily sensations by external force
32
What is catatonia?
Significantly excited/inhibited motor activity | Waxy flexibility and posturing
33
When is ECT indicated?
Treatment resistant severe depression Manic episodes An episode of moderate depression know to respond to ECT in the past Life threatening catatonia
34
What may be seen with catatonia?
Repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism
35
What is stupor?
Loss of activity with no response to stimuli | May mock progression of motor retardation
36
What is psychomotor retardation?
Slowing of thoughts and movements.
37
Name 5 types of thought alienation.
``` Thought insertion Thought withdrawal Thought broadcast Thought echo Thought block ```
38
What is a thought disorder?
Disordered thinking Thoughts and conversations appear lacking in sequence and illogical May de delusional contents
39
What is loosening of association?
Lack of logical association between thoughts giving rise in incoherent speech
40
What is circumstantiality?
Non-linear thought pattern | Rambling and convoluted speech but often reaches the point
41
What is perseveration?
Repetition of particular response in absence or cessation of stimulus
42
What is confabulation?
Gives false account to fill gaps in memory | Without conscious intent to deceive
43
What is tangeality?
Tendency to talk about things unrelated to the topic
44
What is flight of ideas?
Rapidly skipping from one thought to another, often with tentative relation
45
What is echolalia?
Meaningless repetition of another person's spoken words
46
What are clang associations?
Ideas linked by rhyme or similarity of words
47
What is neologism?
New word formation.
48
What is somatisation disorder?
Present for >2 years Psychological distress manifesting as many unexplained physical symptoms Refused to accept reassurance/test results
49
What is hypochondrial disorder?
Persistent belief of underlying physical illness | Refusal to accept reassurance/test results
50
What is conversion disorder?
Loss of motor or sensory function | May be indifferent (la belle indifference)
51
What is clouding of consciousness?
Subjective sensation of mental clouding - feeling 'foggy'
52
What is anhedonia?
Inability to experience pleasure from activities usually found enjoyable.
53
What is incongruity of affect?
Emotional responses not mirroring situation or discussion topic
54
What is depersonalisation?
Feeling detached from the body
55
What is dissociation?
Disruptions in aspects of consciousness, identity, memory,
56
What is tardive dyskinesia?
Involuntary repetitive jerky movements of the head and neck
57
What may be seen with tardive dyskinesia?
Grimacing, lip smacking, tongue protrusion.
58
What causes tardive dyskinesia?
Long term antipsychotic use.
59
What is dissociative disorder?
Progress of separative of certain memories from normal consciousness
60
What are the symptoms of dissociative disorder?
Amnesia, fugue (loss of awareness of one's identity), stupor
61
What is stupor?
State of near-unconsciousness or insensibility.
62
What is Munchausen's syndrome?
Factitious disorder | Intentional production of physical or psychological symptoms
63
What is malingering?
Fraudulent stimulation or exaggeration of symptoms with the intention of financial or other gain
64
Where does the dopamine pathway start?
Substantia nigra
65
Where does the serotonin pathway start?
Raphe nuclei
66
What are the functions of the serotonin pathway? (4)
Mood Memory Sleep Cognition
67
What is the function of the dopamine pathway? (5)
``` Reward (motivation) Pleasure, euphoria Motor function (fine tuning) Compulsion Perseveration ```
68
What causes schizophrenia?
Excess dopamine production
69
What symptoms does mesolimbic produce?
Positive
70
What symptoms does mesocortical produce?
Negative
71
Following antipsychotic treatment, what pathway can cause excess prolactin?
Tuberoinfundibular
72
What pathway is responsible for EPSE?
Nigrostriatal
73
What is a acute reaction to antipsychotic therapy?
Acute dystonic reaction
74
What symptoms may be seen hours after starting antipsychotics?
Muscle spasm Acute torticollis (wry neck) Ocular gyrate crisis
75
What may be seen 4 weeks after starting antipsychotics?
Parkinsonism Bradykinesia Rigidity Tremor
76
When does akathisia occur?
6-60 days following starting antipsychotics`
77
What is akathisia?
Movement disorder - restlessness and inability to stay still.
78
When does tardive dyskinesia occur?
Long term usage of antipsychotics (months-years)
79
What is the treatment for acute dystonia/parkinsonism?
Procyclidine
80
What can be used to treat akathisia?
Propranolol | +/- cyproheptadine
81
What is the treatment for tardive dyskinesia?
Tetrabenazine
82
Name 2 first generation antipsychotics.
Haloperidol | Chlorpromazine
83
Name 4 2nd generation antipsychotics.
Olanzapine Risperidone Quetiapine Aripiprazole
84
What receptors do newer/atypical antipsychotics act on?
D2 and 5-HT2a
85
What SE are seen with atypical antipsychotics?
EPSE Hyperprolactinemia Weight gain
86
What symptoms are seen due to hyperprolactinemia?
Galactorrhoea - lactation Amenorrhoea/infertility Sexual dysfunction - arousal, libido, ED, anorgasmia
87
What are the side effects of olanzipine?
``` Hyperprolactinemia Weight gain Diabetes CV disease EPSE ```
88
What second generation antipsychotic has the least side effects?
Aripiprazole
89
What are the side effects of clozapine?
Agranulocytosis Reduced seizure threshold Myocarditis Constipation
90
What causes neuroleptic malignant syndrome?
``` Antipsychotic medication (or withdrawal from dopaminergic medication e.g. levodopa) ```
91
When does NMS usually occur?
Insidious onset within the first 4-11 days of treatment
92
What are the symptoms of NMS?
``` Lead pipe rigidity Dysphagia/dyspnoea Hyporeflexia Normal pupils Autonomic dysfunction (hyperthermia, sweating, tachycardia, unstable BP) ```
93
What may be seen in blood results of NMS and SS?
Elevated creatinine kinase WCC Deranged LFTs Metabolic acidosis
94
What is the treatment for NMS?
Bromocriptine | Dantrolene
95
What causes serotonin syndrome?
SSRIs MAOIs Ecstacy
96
What are the symptoms of SS?
``` Increased activity Clonus/myoclonus Hyperreflexia Tremor Muscle rigidity (less severe than NMS) Dilated pupils Autonomic dysfunction (tachycardia, unstable BP) ```
97
When does SS occur?
Within 1-2 doses of SSRI | Normally combination of SSRI and MAOI
98
What is used to to treat SS?
Cyproheptadine | Benzodiazepines
99
What is cyproheptadine?
5HT-2a antagonist
100
What is dependance?
Physiological, behavioural and cognitive phenomena | Substance takes higher priority than other behaviours that once had greater value
101
How many ICD-10 features are needed to diagnose dependance?
3
102
What are the ICD-10 features of alcohol dependance. (5)
``` Compulsion Tolerance Difficulty controlling consumption Physiological withdrawal Neglect of alternatives to drinking Persistent use despite harm ```
103
What 4 classes of substances are often misused?
Stimulants Depressants Hallucinogens Opiates
104
Risk factors for substance misuse.
``` Males Low education Unemployment Younger age of usage Mental illness Peer pressure Low self esteem High stress FHx Genetic suseptibility ```
105
What CAGE score indicated problem drinking?
2
106
What is the AUDIT questionnaire?
Alcohol use disorder identification test | 10 item questionnaire
107
What does AUDIT assess?
Alcohol consumption Drinking behaviours Alcohol-related problems
108
What AUDIT score indicates hazardous drinking?
8 - 15
109
What AUDIT score indicates harmful drinking?
16 - 19
110
What AUDIT score indicates high risk or dependant drinking?
>20 High risk - dependance score <4 Dependant - dependance score >4
111
What alcohol score is used in A+E?
FAST | Score of 3 or more for first 4 questions is positive.
112
What is TWEAK?
Screening tool for alcohol abuse, max score of 7.
113
What does TWEAK stand for?
``` Tolerance - >6 drinks = 2 Worried/complained = 2 Eye-opener = 1 Amnesia = 1 Cut down = 1 ```
114
What advice should be given to patients about alcohol?
Max 14 units per week
115
What is classified as hazardous drinking?
10-35 - women | 10-50 - men
116
How many units per week is classified as harmful drinking?
35 - women | 50 - men
117
What should be asked in an alcohol history?
``` Whether the patient believes they have a problem Intake Current drinking pattern Cost Dependency and tolerance symptoms Withdrawal signs Effect on ADLs ```
118
What physical complications can alcoholism cause?
``` Liver damage Pancreatitis Cancer GI ulcers/varices/malnutrition/reflux CNS disturbance ```
119
What social complications can alcoholism cause?
Crime Violence Relationship/occupation problems
120
What psychological complications can alcoholism cause?
Anxiety, depression, personality disorder, risk of suicide
121
What chronic signs of alcohol abuse may be seen on examination?
``` Clubbing Hepatomegaly Palmar erythema Asterixis Spider naevi Gynaecomastia Dupuytren's contracture ```
122
What acute signs of alcohol abuse may be seen on examination?
``` Vomiting/nausea Ataxia Mood changes/agitation Sweating Unsteady gait ```
123
What anaemia is seen in those who abuse alcohol?
Macrocytic | Raised MCV due to vitamin B12 and folate deficiency
124
What may be seen on FBC of a person who abuses alcohol?
Thrombocytopenia
125
What liver enzymes are looked at for alcohol abuse?
ALT AST GGT (gamma-glutamyl transferase)
126
What is used to reduce alcohol cravings?
Acomprosate
127
What is used to give hangover SE of alcohol?
Disulfiram (antabuse)
128
What does disulfiram inhibit?
Acetaldehyde dehydrogenase
129
What is used to reduce the pleasure alcohol brings?
Naltrexone.
130
What is the acute management of alcohol withdrawal?
Chlordiazepoxide IV Pabrinex Thiamine 100mg BD
131
When do symptoms of alcohol withdrawal develop?
6 - 12 hours after cessation
132
What are the symptoms of alcohol withdrawal?
``` Tremor Sweating Nausea/vomiting Mood disturbance Hypertension DTs Seizures (36 hours) ```
133
When is delirium tremens seen?
72 hours after stopping alcohol
134
What are the symptoms of DTs?
``` Altered consciousness Vivid hallucinations/illusions Paranoid delusions Tremor Autonomic arousal ```
135
What hallucinations may be experienced by people with DT?
Lilliputian - visual hallucinations of children/animals | Formication - insects crawling on skin
136
What is Wernicke's encephalopathy?
Acute brain injury due to thiamine deficiency
137
What is the symptom triad of Wernicke's encephalopathy?
Delirium - acute confusion state Ocular signs - ophthalmoplegia, nystagmus Wide base gait ataxia
138
What is Korsakoff's syndrome?
Chronic state of thiamine deficiency
139
What is the triad of symptoms of Korsakoff's syndrome?
Anterograde amnesia Confabulation Psychosis
140
What are the symptoms/signs of opiate intoxication?
``` Drowsiness Mood change Bradycardia HTN Pupil constriction Respiratory depression Low body temperature ```
141
How is Wernicke's treated?
IV Pabrinex and chlordiazepoxide
142
What is Pabrinex?
High potency B1 replacement
143
What % of patients develop Korsakoff's if WE remains untreated?
70%
144
Hoe is Korsakoff's treated?
IV Pabrinex
145
What are the symptoms of opiate withdrawal?
``` Muscle cramps Low mood Insomnia Agitation Diarrhoea Shivering Flu like symptoms ```
146
What are viral complications of opioid misuse?
Needle sharing HIV Hep B and C
147
What are bacterial complications of opioid misuse?
``` Secondary to injection IE Septic arthritis Septicaemia Necrotising fasciitis ```
148
What physical problems can occur with opioid misuse?
VTE Respiratory depression and death Cravings
149
What is the acute management of opioid overdose?
Naloxone - rapid onset and short acting
150
How is opioid dependency managed?
Detoxification: 4 weeks in residential, 12 weeks in community Methadone Buprenorphine
151
What are the common causes of delirium?
``` PINCH ME Pain Infection/intoxication Nutrition (thiamine, nicotinic acid, B12/folate deficiency) Constipation Hypoxia, deHydration Medication, drugs, substance misuse Environmental Other: post-op, vascular, metabolic, endocrine pathology, head trauma, epilepsy ```
152
Describe hypoactive delirium.
Apathy Withdrawal Quiet confusion (Often misdiagnosed as depression)
153
Describe hyperactive delirium.
``` Agitation Lack of cooperation Delusions Disorientation (often confused with schizophrenia) ```
154
What is mixed delirium?
Features of both hypo and hyperactive delirium
155
What symptoms are seen with delirium?
``` Inattention Clouding of consciousness Disorientation Anterograde amnesia Visual hallucinations Paranoid delusions ```
156
How is delirium differentiated from dementia?
Delirium: Acute onset, improves, impaired attention/consciousness, fluctuating symptoms throughout the day Dementia: Gradual onset, cannot improve, remain alert, preserved consciousness, minor fluctuations throughout the day
157
What are the investigations are done for a patient with delirium?
``` Identifying cause/exclude: Bloods/cultures/gas MSU CXR ECG CT/LP ```
158
How is delirium managed?
Identify cause, treat and address exacerbating factors
159
What education and support measures are put in place for a patient with delirium?
Educate those in contact | Side room, sleep hygiene, lighting, clocks/calendars, hearing aids/glasses
160
When should you give sedatives for delirium?
Severely agitated Needed to minimise risk Give haloperidol/olanzapine
161
How would you measure cognitive impairment to monitor delirium?
MMSE
162
What is GAD?
Anxiety that is generalised and persistent - not isolated to specific environmental circumstances PResent for >6 months
163
What are the clinical features of GAD and how many are needed for diagnosis?
``` 3 of: Restlessness Irritability Easily fatigued Difficulty concentration Muscle tension Sleep disturbance ``` (+4 other features)
164
What autonomic features are seen in GAD?
Tachycardia/palpitations Sweating Shaking Dry mouth
165
What chest/abdomen features are seen with GAD?
Nausea Trouble breathing Chest pain
166
What are the RF for GAD?
35-54 years F > M Divorced/separated Living alone
167
What are protective for GAD?
16-24 years | Cohabiting
168
What must be excluded in GAD?
Hyperthyroidism Pheochromocytoma Cardiac disease
169
What medication can mimic GAD symptoms?
``` Salbutamol Theophylline Corticosteroids ADs Caffeine ```
170
What are the first step in GAD management?
Education and active monitoring Stop smoking/drinking Exercise
171
What is the second step in GAD management?
Low intensity psychological support Non-facilitated/self-guided help Psycho-educational groups
172
What is step 3 in GAD management?
CBT Relaxation techniques Medication
173
What is the first line treatment of GAD?
Sertraline
174
What is the second line treatment of GAD?
TCA - Clomipramine
175
What is panic disorder?
Recurrent panic attacks
176
What is a panic attack?
Period of intense fear Develop rapidly, reach peak at 10 minutes, < 30 mins Spontaneous or situational
177
What physical symptoms occur with PAs?
``` Palpitations Chest pain Choking Tachypnoea/SOB Dry mouth Urgency Dizziness Blurred vision Sweating ```
178
Psychological
Feeling of impending doom Fear of dying/losing control Depersonalisation Derealisation
179
What are the RF for panic disorder?
``` 15-24 years, 45-54 years Separated from partner Living in a city Limited education Early loss Physical/sexual abuse ```
180
What comorbidities are seen with PD?
Agoraphobia Other anxiety disorders Substance misuse Bipolar
181
What are the 5 management steps for PD?
1 - recognition and diagnosis 2 - CBT, sertraline 3 - review, consider alternative treatment 4 - review, referral to specialist 5 - care in specialist mental health services
182
What is agoraphobia?
Anxiety/panic symptoms associated with place or situations where escape may be difficult/embarrassing - leads to avoidance
183
Who is more likely to have agoraphobia?
M:F = 1:3 | Those with other panic/anxiety/depressive disorders, alcohol and substance misuse
184
What is the pharmacological management of agoraphobia?
SSRi | May consider short term benzos
185
What behavioural methods of management is there for agoraphobia?
Behavioural - graded exposure, relaxation training
186
What cognitive methods of management is there for agoraphobia?
Coping strategies - teach about bodily responses associated with anxiety
187
What is a phobia?
Recurring excessive and unreasonable psychological/autonomia symptoms of anxiety in presence of a specific object or situation - leads for avoidance
188
What is social phobia?
Symptoms of incapacitating anxiety restricted to certain social situations
189
What are the somatic symptoms of social phobia?
Blushing Trembling Dry mouth Perspiration
190
What are the symptoms of social phobia?
Somatic symptoms Fear of humiliation, others noticing anxiety, embarrassment Avoidance - relationship/vocational/educational problems Suicidal thoughts
191
What is the psychological treatment of social anxiety?
CBT - individual or group | Graded exposure therapy
192
What is the pharmacological treatment of social anxiety?
Beta-blockers - reduce autonomia arousal SSRIs Possible benzos if needed
193
What are compulsions?
Senseless, repeated rituals i.e. mental acts or behaviours (may be used to reduce obsessions)
194
What are obsessions?
Unwanted intrusive thoughts, images or urges that come into a person's mind
195
What qualities do obsessive thoughts usually have?
``` Unpleasant Repetitive Intrusive Irrational Recognised as patients own thoughts ```
196
Examples of compulsive acts.
``` Checking Washing Counting Symmetry Repeating certain words/phrases ```
197
What is the treatment for OCD?
CBT - exposure and response prevention (ECP) SSRI - fluoxetine/sertraline TCA - clomipramine (specific non-obsessional action)
198
What is PTSD?
Severe psychological disturbance following traumatic event.
199
What are symptoms of PTSD?
``` Involuntary re-experience in vivid dreams/flashbacks Avoidance Anxiety and panic attacks Hyperarousal Irritability Sleep disturbance Poor concentration Emotional numbing ```
200
What is the cause of PTSD?
Psychological - fear response Biological - neuro physical changes as result of chronic stress/persistent re experience Genetic
201
What may be seen on neuroimaging of PTSD patients?
Reduced hippocampal volume
202
What is the DD of PTSD?
Acute stress reaction - transient condition lasting hours-days Immediate dissociation followed by mixed emotions, anger, anxiety and confusion.
203
What is the ICD-10 classification of PTSD?
Symptoms within 6 months of precipitating event Symptoms present for at least 1 month Significant distress/impairment in social, occupational or other areas of functioning
204
How is PTSD treated?
CBT | Eye movement desensitisation and reprocessing
205
What is the 2nd line treatment for PTSD?
SSRI - sertraline
206
How is PTSD prevented?
Rehearse teamwork and techniques of stress inoculation and desensitisation
207
What is the diagnostic criteria for anorexia nervosa?
1. Weight <85% predicted or BMI <17.5 kg/m2 2. Intense fear of gaining weight/becoming fat with persistent behaviours to prevent this 3. Feeling fat when thin
208
What are the signs of AN?
``` Fatigue Decreased cognition Cold intolerance QT prolongation Bradycardia Laguno hair Constipation Failure of secondary characteristics Amenorrhoea ```
209
What would be seen on FBC of a patient with AN?
Low WCC Low Hb Low platelets
210
What endocrine/metabolic changes may be seen with AN?
``` Low glucose Low K+ Hyperthyroidism High LFT/amylase High cortisol, CCK, cholesterol ```
211
What are features of the SCOFF questionnaire?
``` Sick - make yourself Control - lost over eating One stone loss in 3 months Feel fat - when others think you're thin Food - dominates life ```
212
What are red flags for AN?
``` BMI < 13 or below 2nd centile Weight loss > 1kg per week Temperature < 34.5 BP < 80/50 SaO2 < 92% Long QT, flat T Weakness in muscles ```
213
How is AN managed in children?
1st line - anorexia focussed family therapy | 2nd line - CBT
214
How is AN managed in adults?
``` Restore nutritional balance Treat complications of starvation Involve family/carers If severe, admit for refeeding ED-CBT Maudsley anorexia nervosa treatment for adults (MANTRA) ```
215
What is refeeding syndrome?
Drop in phosphate due to rapid initiation of food following undernutrition for >10 days.
216
What are the signs of refeeding syndrome?
``` Rhabdomyolysis Resp/cardiac failure Low BP Arrhythmia Seizures ```
217
How is refeeding syndrome managed?
Slow refeeding Thiamine, vitamin B complex, multivitamin Monitor for low phosphate/K, high glucose/Mg
218
What is bulimia?
Recurrent episodes of binge eating
219
What features are seen in bulimia?
Binge eating and regular episodes to overcome this e.g. vomiting, starving, laxatives, excessive exercise
220
What signs are seen in bulimia?
``` Same as anorexia plus Oesophagitis Russell's sign Oedema (laxative, diuretics) Gastric dilation Cardiomyopathy (with laxatives) ```
221
What is Russell's sign?
Calluses on the back of the hands from self induced vomiting
222
What biochemical changes may be seen in bulimia?
Metabolic alkalosis Low Cl- and K+ Metabolic acidosis if laxatives used
223
How is mild bulimia treated?
Support, self-help books and food diary
224
How is moderate/severe bulimia treated?
Referral to EDU Fluoxetine to reduce binges/purging CBT can help
225
What are the 3 core symptoms of depression?
``` Low mood Low energy (anergia) Loss of enjoyment (anhedonia) ```
226
How long must symptoms have been present to diagnose depression?
Every/nearly everyday for 2 weeks, without change
227
Other than the 3 core symptoms, what are some other features of depression?
``` Poor sleep/early morning waking Lack of motivation Loss of concentration Lack of confidence Change in appetite Guilt/hopelessness/worthlessness Agitation Self-harm, suicide ideation Psychotic symptoms if severe ```
228
What are the criteria for mild, moderate and severe depression?
Mild - 2 core, 2 other Moderate - 2 core, 3 other Severe - 3 core, 4 other
229
What are some risk factors for depression?
Bio - genetics, reduced monoamines Psycho - childhood experience, personality traits, Social - marital status, adverse life events/disruption, low socio-economic class,
230
What % of patients with depression meet criteria for another psychiatric disorder?
66%
231
How is depression assessed in primary and secondary care?
PHQ-9 - patient health questionnaire | HADs - hospital anxiety and depression scale
232
What lifestyle changes can be used to manage depression?
``` Sleep hygiene Anxiety management Exercise/diet Socialising Psychotherapy Meditation Yoga Reduce stress ```
233
Other than lifestyle modification, what else can help manage mild depression?
``` Computerised CBT (self referral) Psychoeducation ```
234
How is moderate depression managed?
Lifestyle Antidepressants High intensity psychological therapies - CBT via IAPT
235
What can be features of severe depression?
Psychosis High risk of suicide Atypical depression
236
How is severe depression managed?
Rapid specialist mental health assessment Consider inpatient admission Electroconvulsive therapy
237
What are features of atypical depression?
Mood lift in response to positive events/good news Sleeping too much Heavy arms and legs Sensitivity to rejection/criticism
238
What is the first line treatment for depression?
SSRI - fluoxetine
239
Which SSRI prolongs the QT interval?
Citalopram
240
How should SSRI use be monitored?
Monitor FBC and U+E | SSRIs can cause hyponatraemia
241
What drugs SSRIs interact with?
NSAIDs Warfarin/heparin Aspirin Triptans
242
What should be offered instead of an SSRI for depressed patients taking warfarin/heparin?
Mirtazapine
243
What is the second line treatment for depression?
Alternative SSRI
244
What class of drug is mirtazapine?
NaSSA - noradrenergic and specific serotonergic antidepressant
245
What class of drug is duloxetine?
Serotonin-norepinephrine reuptake inhibitor | BP and ECG monitoring
246
What are the side effects of mirtazapine?
Drowsiness | Weight gain
247
What is the 4th line treatment for depression?
TCAs | MAOIs
248
What are the side effects of Amitriptyline?
``` Tachycardia Dry mouth Blurred vision Constipation Urinary retention ```
249
What are the baby blues?
Common and transient Occurs 3-5 days after birth - tearful, anxious and irritable. Commonly lasts 1-2 days but may persist for up to 2 weeks
250
What is the treatment for baby blues?
Self-limiting. Reassurance from midwife and support from family.
251
How many new mothers get postnatal depression?
10% 50% of those who have previously had PND 25% of those who have previously had bipolar/unipolar depression
252
When does postnatal depression usually present?
Starts within 1 month, peaks at 3 months
253
What is used to screen for PND?
Edinburgh postnatal depression scale (EPDS)
254
What EPDS score may indicated PND?
12/30 - 77% sensitive
255
What is the management for PND?
Reassurance and support CBT SSRIs - sertraline
256
Which SSRI shouldn't be used by breastfeeding mothers?
Fluoxetine
257
What is puerperal psychosis?
Postpartum psychosis Psychotic episode with prominent affective symptoms (depression or mania) occurring with rapid fluctuation. Rapidly fluctuating symptoms, mood lability, insomnia, disorientation.
258
What is the management of postpartum psychosis?
Hospital admission may be required Mood stabiliser, antidepressant and ECT Psychotic symptoms - SGA and long acting benzo
259
What is the risk of recurrence of postpartum psychosis?
30% | 40% risk of postpartum depression
260
When does bipolar disorder usually present?
15 - 25 years
261
What is required for bipolar diagnosis?
At least two episodes, one of which must be mania/hypomania
262
What is bipolar I?
Mania + depression | Psychotic symptoms
263
What is bipolar II?
Hypomania + depression More episodes of depression No psychosis
264
What is cyclothymia?
Cyclical mood swings with subclinical features
265
What are the signs of mania?
``` Extreme elation Over activity Pressure of speech Impaired judgement Extreme risk taking behaviour Social disinhibition Grandiosity Delusions/hallucinations ```
266
What are the signs of hypomania?
Many of the signs of mania but without psychotic symptoms. No impairment in daily function. Does not require hospital admission.
267
What is the long term treatment of bipolar disorder?
Lithium
268
How is lithium treatment monitored?
Aim for plasma level 0.6-1 mmol/L 3 monthly lithium bloods 6 monthly U+E and TSH
269
What are the side effects of lithium?
Nausea/vomiting, diarrhoea Fine tremor Nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus Thyroid enlargement, may lead to hypothyroidism ECG: T wave flattening/inversion Weight gain Idiopathic intracranial hypertension Leucocytosis Hyperparathyroidism and resultant hypercalcaemia
270
What is lithium's mode of action?
Inhibits cAMP which inhibits monoamines - increased monoamine level in body.
271
How are acute manic episodes managed?
SGA of sodium valproate alongside lithium
272
What can be given for long term management of bipolar disorder if lithium is not tolerated?
Sodium valporate
273
What does progressively increasing plasma lithium level indicate?
Nephrotoxicity
274
How long should pharmacotherapy last for bipolar disorder?
2-5 years
275
What other therapies can be used for bipolar disorder?
CBT | ECT
276
What is the strongest risk factor for schizophrenia?
Family history
277
What are the first rank symptoms of schizophrenia?
3rd person hallucinations Delusional perceptions (passivity, influence or control) Thought disorder Passivity phenomena
278
Give examples of negative symptoms.
``` Apathy Decreased motivation Withdrawal Self-neglect Blunted affect ```
279
What is the ICD10 criteria for diagnosis of schizophrenia?
At least one first rank symptom or two of: Any persistent hallucination Breaks or interpolations in train of thought - knights move speech Catatonic behaviour Negative symptoms
280
What are features of paranoid schizophrenia?
Delusions or auditory hallucinations predominate
281
What is hebephrenic/disorganised schizophrenia?
Thought disorder and flat affect present together
282
What is catatonic schizophrenia?
Stupor, posturing, waxy flexibility and negativism
283
What is undifferentiated schizophrenia?
Psychotic symptoms present but criteria for paranoid, disordered or catatonic not met
284
What is residual schizophrenia?
Positive symptoms are present at low intensity only
285
What is simple schizophrenia?
Insidious and progressive development of prominent negative symptoms with no history of psychosis episodes
286
How long do symptoms need to be present to diagnose schizophrenia?
> 6 months Present much of the time for 1 month Impairment of work/home function
287
What must be excluded as a cause of psychosis before a diagnosis of schizophrenia can be given?
Drugs - urine screen Alcohol - LFTs, FBC (macrocytosis and thrombocytopenia) Syphilis - serological test Brain lesion - CT head
288
What should be assessed in risk assessment of mental illness?
Risk to self Risk to others Risk to property
289
What is the first line management for schizophrenia?
SGA
290
What is a fatal side effect of SGAs?
Torsades de pointes - long QT | Polymorphic ventricular tachycardia
291
What is the second line management for schizophrenia?
First generation antipsychotic - haloperidol, chlorpromazine
292
What is the third line management for schizophrenia?
Resistant schizophrenia | Clozapine
293
What is schizoaffective disorder?
Symptoms of both mania/depression and hallucinations/delusions at the same time
294
How is schizoaffective disorder treated?
Antipsychotics and mood stabilisers
295
What are personality disorders?
Characterised by long lasting rigid patterns of thought, affect and behaviour
296
What is required for diagnosis of a personality disorder? (2)
1. Not attributed to brain damage or any other psychiatric disorder 2. Requires inhibition of function (work, relationships, day-to-day life)
297
How old must patients be for a diagnosis of a personality disorder?
Often present <18 year but must be >18 years to diagnose
298
What are the RF for developing a personality disorder?
``` Sexual/physical/emotional abuse Neglect Bullying Early childhood trauma Being expelled or suspended from school/truanting Deliberate self-harm Prolonged periods of misery ```
299
How should personality disorders be managed?
Dialectical behavioural therapy (DBT) - combines individual and group therapy using CBT and mindfulness
300
What are the three personality disorder clusters?
A - odd/eccentric B - dramatic/emotional C - anxious/avoidant
301
What personality disorders fall into cluster A?
Paranoid | Schizoid
302
What personality disorders fall into cluster B?
Dissocial/antisocial EUPD Histrionic Narcissistic
303
What personality disorders fall into cluster C?
Anankastic (obsessive-compulsive) Anxious Dependant
304
Describe paranoid PD.
Suspicious Preoccupied with conspiration explanations Distrusts other Holds grudges
305
Describe schizoid PD.
Emotionally cold Lacks interest in others Rich fantasy world Excessive introspection
306
Describe dissocial/antisocial PD.
``` Aggressive Easily frustrated Lack of concern for others Irresponsible Impulsive Unable to maintain relationships Criminal activity Lack of guilt Conduct disorder < 18 years ```
307
Describe EUPD.
``` Borderline: Feeling of 'emptiness' Unclear identity Intense and unstable relationships Unpredictable affect Threats or acts of self harm Impulsivity Pseudohallucinations Impulsive: Inability to control anger or plan Unpredictable affect and behaviour ```
308
Describe histrionic PD.
``` Over-dramatised Self centred Shallow Labile mood Seeks attention and excitement Seductive Manipulative behaviour ```
309
Describe narcissistic PD.
``` High self importance Lacks empathy Takes advantage Grandiose Needs admiration ```
310
Describe anankastic PD.
``` Obsessive-compulsive Worries and doubts Orderedliness and control Perfectionism Sensitive to criticism ```
311
Describe anxious PD.
``` Anxious and tense Self-conscious Insecure Fearful of negative evaluation by others Timid Desire to be liked ```
312
Describe dependant PD.
``` Passive Clingy Submissive Needs to be cared for by others Feels helpless when not in relationship Hopeless and incompetent ```
313
What is the difference between avoidant and schizoid PD?
Schizoid voluntarily withdraw from society | Avoidant desire companionship but can't due to fear of rejection
314
Describe avoidant PD.
Fear of rejection Inadequacy Sensitive to negative evaluations Desire companionship
315
What is the difference between OCPD and OCD?
OCPD - okay with the way they are, often successful professionally but not socially = EGOSYNTONIC OCD - do not like obsessions/compulsions = EGODYSTONIC

Phase 3a Medicine (6 decks)

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