Psych Flashcards

Question

A patient is hyperaroused but is able to go to work - is this mania or hypomania

Answer 1

Hypomania --> mania requires disruption to day to day life

Answer 2

``` Initial suicidal ideation Sexual dysfunction Drowsiness (esp with ETOH) Decreased seizure threshold Hyponatraemia N&V Blurred vision Anxiety Sweating tremor Persistent pulmonary hypertension in the newborn ```

Answer 3

MAOI- cheese reaction

Answer 4

Psychotic or v severe irretractible depression (affecting things like eating and drinking

Answer 5

Anergia Anhendonia Low mood

Answer 6

Mainly depression w/ hypomania

Answer 7

Mania w/ depression

Answer 8

4 or more episodes a year

Answer 9

Sodium Valproate

Answer 10

GI disturbances, ataxia, tremor, fit, renal failure, slurred speech, arythmia

Answer 11

NO - give folate and contraception advice

Answer 12

Ebstein's anomaly - Atrialisaiton of the right heart, tricuspid valve moves down, right to left shunt thru ASD/PFO

Answer 13

Only with a mood stabiliser as can trigger mania

Answer 14

Around 50%

Answer 15

Thiamine deficiency | Causes Ataxia, confusion and eye problems (ophthalmoplegia & nystagmus)

Answer 16

Irreversible anterograde amnesia - can't remember new events | Will confabulate to fill in the gaps

Answer 17

CAGE - Have you ever felt you needed to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Answer 18

``` ~48 hours into abstinence Confusion Hallucinations esp visual Gross tremor Autonomic disturbance Affective changes - fear, hilarity Delusions ``` Treat with reducing chlordiazepoxide regimene + thiamine (pabrinex)

Answer 19

``` Tolerance Compulsion Withdrawal problems controlling use Salience - become so imptortant to use other needs are neglected Reinstatement after absitnance Continued use despite harm Narrowing of repitoire ```

Answer 20

Risk assess - risk to self, to others, vulnerability, suicide etc

Answer 21

``` Trauma Hypoxia Infectioon Metabolic - liver/renal failure, electrolyte imbalance Endocrine - hypoglycaemia CNS pathology Drug withdrawal ```

Answer 22

``` Sudden onset (days-weeks) Fluctuating consciousness Short duration <6m Impaired consiousness Poor atention Disorganised thinking Delusions - transient, muddled Hallucinations - visual Treat underlying cause ``` LOOK OUT FOR HYPOACTIVE DELIRIUM - stupour, drowsiness, withdrawal

Answer 23

Fear of being unable to escape to safe place

Answer 24

Obsessions - recurrent intrusive thoughts --> recognised as unpleasant, irrational, and the patients own Compulsions - to try and reduce the anxiety

Answer 25

``` Occurs after a traumatic event Happens within minutes and should resolve within hours Depresonalisation and derislisartion Disorientation Agitated, panicky ```

Answer 26

``` Rare, disabling, chronic Multiple medically unexplained symptoms Frequently changing symptoms Symptoms persist for more than 2y Multiple investiagations Refusal to accept advice ``` Rx - don't conduct further investagations, involve family, try to give them copping strategies

Answer 27

Both mood disorder (usually BPAD-like) and schizophrenia in the same episode

Answer 28

Preoccupation with eating and body weight Binginging food Then purging - laxative, vomiting Signs of vomiting - parotid swelling, dental erosion, Russell's sign (calluses on dorsal of hand) & calluses on finger Weight often normal Have insight - often want help can cause cardiac arrhythmia and renal failure Rx - CBT, interpersonal psychotherapy, SSRIs e.g fluoxetine (help impulse control as well as depression)

Answer 29

Dissociative Amneisa Dissociative fugue - purposeful trip away from home, new identity Dissociative stupor - motionless and mute but aware of surroundings Rx - usually spontaneously resolves, can give supportive therapy to increase insight and help with stress management

Answer 30

Weight loss by diet restriction and one of: 1) self induced vomiting 2) excessive exercise 3) appetite suppressants or diuretics 4) laxatives ``` BMI <17.5 Morbid fear of fatness Body image distortion Loss of libido Fatigue Amenorrhoea ```

Answer 31

``` Guant Dehydrated Proximal myopathy cold extremities bradycardia and hypotenison Exhibit peripheral oedema Parotid gland enlaegmenet and erosion of tooth enamel if vomting ``` ``` Can cause - osteoporosis, cardiac arrhythmia (2º to hypokalaemia), pancreatitis, hepatitis (nuturiton - low serum protein, raised bilirubin, LDH, ALP) seizures, peripheral neuropathy, pancytopenia, suicide ```

Answer 32

``` Low: Hb U+E Phsophate Glucose T3 FH/LH/E2 Ca Mg Cl ``` ``` Raised: ALp Bilirubin CK Amylase Cortisol Growth Hormone Cholesterol ```

Answer 33

Psycho-deucation Treat comorbid psych issues Nutritional management and weight restoration Motivation interviewing - try to engage ambivalent patients Family therapy Interpersonal therapt CBT Medical treatment - esp if physical complications, rapid weight loss of BMI<13.5 Inpatient - BMI <13, extreme rapid wt loss, serious physical complications high suicide risk

Answer 34

BMI <13 Weight loss >1kg a week purpuric rash cold peripheries Core body temp less than 34.5 hypotensions (Systolic <80, diastolic <50) bradycardia <40 Prolonged QT Inability to stand from squatting wo/ using arms (squat test) Electrolyte imbalance (K<2.5, Na <130, PO4 <0.5)

Answer 35

U+E TFTs Lithium levels

Answer 36

IQ <70 Mild - 50-69 Moderate - 35-49 Severe - 20-34 Profound <20

Answer 37

10% of mothers Insidious onset over weeks, ~3m (or progress from baby blues) Obsessive recurrent intrusive thoughts about harming baby Depressive cognitions --> guilty, failure of a mother Rx - support, admission to mother and baby unit, consider antidepressants 90% respond to treatment within 1m

Answer 38

Begin within 10d Tearful, weepy, muddled, liability of mood NORMAL - occurs in up to 3/4 Reassure, family support, antenatal education

Answer 39

``` 1 in 500-1000 ~2w after birth Marked restlessness and fear perplexity - can't deal with it Then psychotic symptoms: affective disorder, delusions e.g baby is possed/evil Command hallucination to hurt baby ``` Symptoms can fluctuate quickly Antipsychotics, mood stabilisers, antidepressants (Avoid lithium if breast feeding if possible) most settle in 6w and fully recovered by 6m

Answer 40

Tourrettes

Answer 41

A smooth philtrum: The divot or groove between the nose and upper lip flattens Thin vermilion: The upper lip thins Small palpebral fissures (opening of eyelid): Eye width decreases Skin folds at corner of eye short nose small head Foetal growth retardation/short stature Behaviuoural difficulties learning disabilities neurological problems - epilepsy, hearing loss

Answer 42

1. Lack of reciprocal social interaction --> not interested in people, poor attachment, weird eye contact, can't read emotions 2. Restricted behaviours and routine - repetitive, stereotype behaviour 3. Communication abnormalities - concrete thinking, absent gestures, absent expressive speech, delayed comprehension, speech disorders (monologues, formal pedantic language, pronoun reversal) hypo or hyperactivity to sensory input ¡present in early childhood! Impair everyday functioning

Answer 43

1º - toilet training never mastered - usually delayed bladder innervation or developmental delay (but stress and relaxed or strict toilet training can cause) 2º - dry for a year but lost --> usually stress related Rx - refer to paediatrics, reassure child and family, restrict fluids, start charts, Bell and Pad (underpants alarm), TCA or desmopressin

Answer 44

Inappropriate defecation after age 4 Boys more commonly affected Mostly relate to constipation - due to dehydration, painful defecation (e.g fissure), fear of punishment, toilet fears, Hirschsprung disease Also due to diarrhoea, learning difficulties , occasionally hostile, stress Rx - Laxitives for constipation, reassure, review toilet training, star charts

Answer 45

HEARING TEST

Answer 46

Poor social skills and restricted interest w/ normal language and IQ

Answer 47

Support, behaviour therapy, speech and language therapy, special education 75% have learning disabilites 25% have epilepsy

Answer 48

delusion that the individual is loved by someone famous

Answer 49

Odd tangential association between ideas lead to disruption of speech Can't follow connection between topics unlike flight of ideas

Answer 50

Stream of accelerated thought with abrupt changes, but can usually follow associations (e.g alliteration, homonoyms) is a form of pressure of speech

Answer 51

Invent a new word

Answer 52

Connections between patients thoughts are difficult to follow

Answer 53

Chronic low mood not meeting depression standards

Answer 54

Fear of having a specific severe illness, in the absence of real organic pathology

Answer 55

Feel insects under skin

Answer 56

Inchoherent mess of words and phrases

Answer 57

Lasts 28 days For assessment Needs AMHP, and 2 doctors (1 S12)

Answer 58

Lasts. 6 m for treatment Need 2 doctor (1 s12) and AMHP

Answer 59

Holding power for patient on ward Need 1 docto Last 72 hours

Answer 60

Police remove from public to safe place | Last 72 hours

Answer 61

Police remove from house to save place

Answer 62

Nurses holding power for someone on ward | last 6 hours

Answer 63

Have to take treatment while living in community, and can be recalled to hospital for someone who was under a section 3

Answer 64

Emergency section for 72 hours, require one doctor and AMHP

Answer 65

Lasts more than 2 years or delayed onset | self neglect

Answer 66

Planned and premeditated Final acts in anticipation - closing accounts, writing notes Violent/dangerous methods Trying not to be found People who think the act would be irreversible Didn't seek help/angry someone helped them Regrets surviving Numerous previous attempts Still hopeless for future

Answer 67

Acamprostate - anti-craving drugs Disulfram - causes build up of acetaldhyde, which is unpleasant Naltrexone - opioid antagonist, reduces pleasure of alcohol

Answer 68

Partial agonist of µopioid receptor Blocks euphoric effects wo/ withdrawal Sublingal tablet

Answer 69

Liquid Long half life Full agonist at opiate receptors

Answer 70

``` Babies born to heroin addicted mothers Suffer with withdrawal symptoms --< start within hours, can last weeks High pitched cry restlessness tremor hypertonia convulsions diarrhoea vomiting sweats fever tachypnoea ``` Rx - neonatal opiate preparations, anti-convulsants, supportive measures (opiates can also cause IUGR, low birth wt, prematurity, and risk of SIDS increased)

Answer 71

10% of 10 year olds 4x more common in boys RF - urban, parental criminality, harsh/inconsistent parenting, maternal depression, deprivation Persistantly bullying, sterling, fighting Socialised - have friends who they are antisocial with Unsocilaised - rejected by other children

Answer 72

Milder form of CD In children under 10 provocative, disobidient behaviour towards adult No extreme antisocial behaviour

Answer 73

Inattention - chaotically flit between tasks, distractible Hyperactive - excess energy, loud Impulsivity and disinhibition - can't share, social disinhibited (butt in) disorganised ``` These are worse in unfamiliar envorinments Short tempered Poor social relationships Do poorly at school Low self esteem ```

Answer 74

Conners rating scale

Answer 75

Questionaires, Classroom observation Child psych + paeds assessment Educations psychologist assessment

Answer 76

Educate parents and teachers Active promotion of behaviour and education process with kid - advice on behaviour modification, building concentration, self esteem Behaviour intervention - clear rules and expectations, clear rewards and consequences Advice that dietary restriction doesn't help Try behaviour and education therapy first + family therapy, before giving drugs But if really severe can give at same time Methylphenidate or dexamphetamine reduce motor activity (can cause growth retardation so drug holidays) Non-stimulant - atomoxetine (increase attention and decreases unwanted motor activity)

Answer 77

up to 75% have learning difficulties | 25% have seizures/epilepsy

Answer 78

``` Group A - paranoid bois SUSPECT Sensitive Unforgiving --> grudges Suspicious Possessive and jealous Excessive self-importance Conspiracy theories Tenacious sense of rights ```

Answer 79

``` Group A - socially withdrawn and flat ALL ALONE Anhedonic Limited emotional range Little sexual interest ``` ``` Apparent indifference to praised/citicism Lacks close relationships One player activity Normal social convention ignored Excerssive fantasy world ```

Answer 80

Group B ACTORS ``` Attention seeking Concerned with own appearance Theatrical Open to suggestion Racy and seductive Shallow affect ```

Answer 81

``` Group B AEIOU Affective Instability Explosive Behaviour Impulsive Outbursts of anger Unable to plan or consider consequences ```

Answer 82

``` Group B SCARS Self image unclear Chronic empty feelings Abandoment fears Relationships are intense and unstable Suicide attempts and self harm ```

Answer 83

``` Group B LOSE IT Lacks impulse control Outbursts or threats of violent Sesntivity to being thwarted or criticised Emotional instability Inability to plan ahead Thoughtless of consequences ```

Answer 84

``` Type B - angry bois FIGHTS Forms but can't maintain relationship Irresponsive Guiltless Heartless Temper easily lost Someone else thought ```

Answer 85

Type C - perfectionists DEFLATED ``` Doubtful Excessive detail Tasks not completed Adheres to rules Inflexible Likes own way Excludes pleasure and relationships Dominated by intrusive thoughts ```

Answer 86

Group C - anxious bois AFRAID ``` Avoids social contact Fears rejection/criticism Restricted lifestyle Apprehensive Inferiority Doesn't get involved unless sure of acceptance ```

Answer 87

Type C SUFFERS ``` Subordinate Undemanding Feels helpless when alone Fears abandomnet Encourages others to make decisions Reassurance needed ```

Answer 88

3Ps Pervasive - occurs in all/most areas of life Persistent - evident in adolescence and continues throughout adulthood Pathological - causes distress to self and others and impairs function ``` ICD 10 require following (REPORTD): Relationship affected Enduring Pervasive Onset in childhood adolescence Results in distress Trouble in occupational/social performance Don't have brain damage or another psych disorder ```

Answer 89

Derailment is a type of formal thought disorder in which there are disjointed thoughts with no meaningful connections. It is commonly seen in schizophrenia, but also presents sometimes in other disorders.

Answer 90

Circumstantial thinking is somewhat difficult to describe but occurs when the person talks around a subject exhaustively with only loosely relevant associations. They will usually return to the point but only after many detours of almost irrelevant (or certainly over-inclusive) information

Answer 91

Cyclothymia | is diagnosed where there is persistent instability of mood with a cycle of low grade elevated and depressed mood

Answer 92

Logoclonia describes the symptom of repeating the last syllable of a word repeatedly and is often seen in Parkinson’s disease

Answer 93

Echolalia is the phenomenon whereby words or sentences that the patient hears are repeated back, sometimes continuously and incessantly. It often has an organic cause such as dementia or brain injury but may also be seen in functional disorders such as schizophrenia

Answer 94

Alogia is the phenomenon of ‘not having any words’ and refers to extreme poverty of speech. It is commonly seen in severe negative schizophrenia or dementia

Answer 95

Negativism is the symptom whereby catatonic patients will appear to automatically do the opposite of what they are asked to do. This is not just resisting instructions or movement but actually attempting to perform the opposite instruction or movement.

Answer 96

Clanging is a form of thought disorder whereby words are used based on their similar sounds or rhyming and the meaning becomes unimportant. For example, ‘A cat pat on my hat sack, ate the bait and skated’. It is seen in schizophrenia

Answer 97

``` hypokalaemia low FSH, LH, oestrogens and testosterone raised cortisol and growth hormone impaired glucose tolerance hypercholesterolaemia hypercarotinaemia low T3 ```

Answer 98

low phosphate Low K Low magnesium Swtich from fat to carb metabolism causes increased secretion of insulin, moving these electrolytes intracellularly

Psych Flashcards

(137 cards)