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Phase 3a > Psych > Flashcards

Psych Flashcards

1
Q

What are the domains of a mental state assessment?

A
  1. Appearance and behaviour- physical health, hygiene, clothes, posture, motor abnormalities
  2. Speech- tone, volume, speed, rhythm
  3. Thoughts
  4. Mood- underlying emotion (e.g. mild climate, dysthymic)
  5. Affect- how you present (e.g. presents as warm but cloudy, tearful or angry)
  6. Perception- any hallucinations, illusions
  7. Cognition- consciousness, memory, orientation, attention
  8. Insight- ability to understand one’s condition
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2
Q

What is a delusion of reference?

A

When you believe actions of other people/media/events are directly related and communication to you

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3
Q

What is a delusion of grandeur?

A

Believing you are incredibly famous, rich, intelligent etc.

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4
Q

What is a persecutory delusion?

A

Believing that someone/something has malicious intent against you

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5
Q

What is thought insertion?

A

Believing thoughts have been inserted into your mind

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6
Q

What is thought broadcast?

A

Believing your thoughts are being broadcasted to others

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7
Q

What is thought withdrawal?

A

Believing your thoughts are being taken out of your mind

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8
Q

What are the most common types of delusion in schizophrenia?

A

Persecutory or delusions of reference

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9
Q

What are examples of positive symptoms in schizophrenia?

A

Delusions
Hallucinations
Illusions
Formal thought disorders: disorganised speech, neologisms (making up words)
Abnormal physical behaviours- uncomfortable and strange postures/ positions, inability to move, random movements etc.

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10
Q

What are examples of negative symptoms in schizophrenia?

A

Reduced social function :
Physical signs- weight change, poor hygiene, not taking care of oneself, withdrawn from interactions
Speech- poverty of speech (not speaking much, unable to explain answers)
Blunting of affect
Difficult to distinguish from depression
Avolition- lack of interest in life
Bradykinesia

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11
Q

What are the types of hallucinations?

A

Auditory
Visual
Olfactory
Tactile

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12
Q

What are lilliputian hallucinations?

A

Common in Charles Bonnet Syndrome

- hallucinations of little people

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13
Q

What are the first rank symptoms in schizophrenia?

A

Symptoms that are very indicative of schizophrenia;

  • All thought alienation- insertion, withdrawal, broadcast
  • 3rd person auditory hallucination (voices outside the head talking about you)
  • Somatic/ tactile hallucinations (something touching you, insects crawling out of your skin)
  • Delusional perception
  • Passivity- being controlled
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14
Q

What is delusional perception?

A

When seemingly normal things are perceived to have an other meaning to you (e.g. traffic lights showing amber means the world is going to end)

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15
Q

What are the second rank symptoms in schizophrenia?

A

Symptoms that are common in schizophrenia and other psychiatric conditions

  • Delusions of reference
  • Paranoid delusions
  • Persecutory delusions
  • 2nd person auditory hallucinations (more often in mania)
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16
Q

What is the diagnostic criteria for schizophrenia?

A

ICD-10: 1 first rank symptom for at least 1 month

DSM-5: 2 of the following symptoms for 6 months (inc 1 postive)

  • delusions
  • hallucinations
  • disorganised speech
  • disorganised or catatonic behaviour
  • negative symptoms

IN THE ABSENCE OF DRUG INTOXICATION, BRAIN DISEASE OR PRIMARY AFFECTIVE DISORDERS

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17
Q

What are common differential diagnoses for schizophrenia?

A
  • Delusional disorder (one primary delusion)
  • Brief psychotic disorder (symptoms for less than a month)
  • Manic depression (distinguished with periods of elation)
  • Organic psychosis (caused by neurological disease or drugs)
  • Drug intoxication (illegal and steroids)
  • Epilepsy
  • Dementia
  • B12 deficiency
  • Hypoglycaemia
  • Trauma/ head injury
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18
Q

What is the pathology of schizophrenia?

A
  • excess dopaminergic activity

- abnormal glutamate activity

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19
Q

What investigations would you do in ?schizophrenia?

A
  • drug screening
  • EEG
  • blood glucose
  • neuro exams
  • CT/MRI (SOL, enlarged ventricles)
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20
Q

What is the aetiology/ risk factors of schizophrenia?

A 
Genetics (family history)
Poor neurodevelopment (abuse, school problems)
Low socioeconomic status 
Over-involved families 
Adverse life events 
Drug abuse (cannabis)
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21
Q

What is a personality disorder?

A

An abnormal behavioural pattern formed in childhood/adolescence that causes issues in forming relationships or functioning in society.

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22
Q

What is the aetiology of personality disorders?

A

Genes + environment

  • abnormal perinatal/postnatal development
  • abuse
  • poor attachments
  • poorly formed behaviour patterns in childhood
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23
Q

What are the 3 clusters of personality disorders?

A

A: Odd/ eccentric
- Schizoid PD (Social withdrawal, restricted emotion or
pleasure, aloof)
- Paranoid PD (Mistrust, cold, hypersenstive, poor
relationships)
- Schizotypal PD (delusions, ideas of reference, magical
thinking)

B: Dramatic
- Borderline PD (unstable/intense relationships,
impulsive, transiently suicidal)
- Histrionic PD (immature, shallow, suggestible)
- Narcissistic PD
- Antisocial PD

C: Anxious
- Avoidant/ Anxious PD (persistent feelings of
inadequacy, reluctancy to engage due to fear)
- Obsessive compulsive PD (excessive doubt, stubborn,
rigidity, perfectionist)
- Dependent PD

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24
Q

What is the management for BPD/EUPD?

A

DBT!! Dialectical Behavioural Therapy (CBT + acceptance)

Group therapies

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25
Q

What is the management for cluster C (anxious) personality disorders?

  • Anxious PD
  • OCPD
  • Dependant PD
A

CBT + Psychodynamic

Group therapies

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26
Q

What are the principles of CBT?

A

Links between:

  • Thoughts
  • Feelings
  • Behaviour

Challenge thinking patterns to overcome associations

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27
Q

What is required to deem that someone has capacity?

A
  1. Understanding information
  2. Retain information
  3. weigh and use this information to make a decision
  4. Communicate that decision
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28
Q

Which law governs issues on mental capacity?

A

The Mental Capacity Act (2006)

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29
Q

What is a lasting power of attorney?

A

Someone with capacity gives someone else (usually friend or relative) the right to make decisions on their behalf should they lose capacity

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30
Q

What is an advance decision?

A

Making decisions for the future in advance in case they are unable to do so in the future

Can be regarding;

  • healthcare
  • DNACPR
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31
Q

What is a DoLS?

A

Deprivation of Liberty Safeguards

  • Deprived of liberty (ability to come and go as they please)
  • In a carehome or hospital

Must:

  • be over 18
  • Have a mental disorder
  • Lack capacity
  • be in the patient’s best interest
  • Not sectioned under Mental Health Act
  • DoL must not contradict any advanced decisions or LPA
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32
Q

What is the difference between a DoL and sectioning?

A

DoL: not being treated for mental health disorder

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33
Q

What is sectioning?

A

Compulsory admission due to a mental disorder severe enough that the person is at risk to themselves or others

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34
Q

What is Section 2?

  • Who can do it
  • What for
  • How long for
A

2 doctors (1 who is section 12 approved)
+ 1 AMHP
For assessment
28 days

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35
Q

What is Section 3?

  • Who can do it
  • What for
  • How long for
A

2 doctors (1 who is section 12 approved)
+ 1 AMHP
For treatment
6 months

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36
Q

What is Section 4?

  • Who can do it
  • What for
  • How long for
A

1 doctor
When situation is too urgent to arrange a section 2
72 hours

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37
Q

What is Section 5(2)?

  • Who can do it
  • What for
  • How long for
A

1 doctor
Urgent detention of an inpatient (anywhere except A+E)
72 hours

38
Q

What is Section 5(4)?

  • Who can do it
  • What for
  • How long for
A

1 Mental health nurse
Urgent detention of a psychiatric inpatient in the absence of a doctor
6 hours

39
Q

What is Section 135?

  • Who can do it
  • What for
  • How long for
A

Police Officer
Removal from home to a safe place
72 hours

40
Q

What is Section 136?

  • Who can do it
  • What for
  • How long for
A

Police Officer
Removal from public to a safe place
72 hours

41
Q

What are the risk factors for suicide?

A 
Male
Age 35-49
Mental illness 
Physical disability 
Chronic illness or pain 
Drug and alcohol abuse 
Loss of job 
Social isolation 
Relationship breakdown 
Debt 
Bereavement 
Imprisonment
42
Q

What are indicators of an upcoming successful suicide attempt?

A
  • Plans
  • Written notes
  • Final acts (arranging finances, wills etc.)
  • Efforts to avoid discovery
  • Previously violent attempts
43
Q

What is conversion disorder?

A

Patients experience loss of physical function without a cause

44
Q

What is Munchausen’s syndrome?

A

Patients cause their own disability to seek attention or care

45
Q

What is somatisation?

A

Patients simply complain of symptoms

46
Q

What is malingering?

A

Faking disability or disease for personal gain (e.g. financial or drug)

47
Q

What is the SSRI of choice in adolescents?

A

Fluoxetine

48
Q

What is Othello syndrome?

A

Patient believes partner is being unfaithful

Delusional jealousy

49
Q

What is ECT licensed for?

A

Rapid and short term management of:

Severe and treatment-resistant depression
Catatonia
Prolonged episode of mania

50
Q

What are the signs of dependence?

A 
Compulsions to engage with addicted substance/action
Aware of harms but persist
**Neglect of other activities**
Tolerance 
Stopping causes withdrawal
Time is preoccupied with substance/action
Out of control use
Persistent
51
Q

What pathway causes substance abuse?

A

Mesolimbic dopaminergic reward pathway

52
Q

What is the management for substance abuse?

A

Residential rehabilitation
CBT
Group therapy
Contingency management programmes (e.g. rewards given for negative drug tests)
Management of any infections (e.g. HIV or Hepatitis with IVDU)

53
Q

What is the aetiology of substance abuse?

A

Peer pressure
Addiction to prescribed opioids
Desire for pleasurable effect
Psychiatric illness: depression, impulsivity/anxiety, BPD, Antisocial PD,

54
Q

What is delerium tremens?

+ presentation

A

Severe alcohol withdrawal:

  • tremors
  • seizures
  • auditory and visual hallucinations
  • headache
  • vomiting/ nausea
  • agitation
  • sweating
  • palpitations
  • depression
  • craving
  • insomnia
55
Q

In delerium tremens, when do symptoms start?

A

6-12 hours: sweating, agitation, craving, anxiety, tremor

36 hours: seizures

48-72 hours: COARSE tremors, hallucinations, confusions, delusions, tachycardia

56
Q

What is the management of delerium tremens?

A

Reducing doses of chlordiazepoxide

CBT, community support groups

contingency management programmes

57
Q

What is the management for schizophrenia?

A

Antipsychotics: Atypical: Olanzapine or Risperidone

Typical: Haloperidol

58
Q

What are the side effects of ECT?

+ who is at risk?

A

Immediate:

  • Status epilepticus
  • Involuntary muscle spasm
  • SE of GA
  • arrhythmias
  • Headache

Long term:
- Retrograde and anterograde amnesia

At increased risk:

  • Elderly
  • Pregnant
59
Q

What is mania?

A 
Period >7 days 
Euphoria/ elevated mood 
Irritability 
Inappropriate elation
Increased energy
Increased pressure and speed of speech 
Increased speed of thoughts- flight of ideas
±grandiose delusions
Loss of inhibition 
Poor attention
Insomnia
Increased appetite

Symtoms cause functional impairment
May require hospitalisation due to risk to self/ others

60
Q

What is hypomania?

A 
Period <7 days 
Increased mood and energy
Increased pressure/ speed of speech
Flight of ideas
Poor attention
Insomnia
Increased appetite

NO psychotic symptoms

61
Q

What is bipolar disorder?

A

Condition with 2 or more episodes of significant mood disturbance inc. at least one episode of mania/hypomania/ mixed

62
Q

What is the Type 1 and Type 2 Bipolar Disorder?

A 
Type 1 (most common): Mania+ Depression 
Type 2: Hypomania + Depression
63
Q

What is the management for bipolar disorder?

A

Acute:

  • Depression: SSRI or lithium or atypical antipsychotic
  • Mania: Lithium or atypical antipsychotic

Long term (prophylaxis):

  • Lithium
  • Sodium Valproate
  • Lamotrigine
  • Carbamazepine
64
Q

What are the risks of Lithium?

A 
Thyrotoxic 
Teratogenic 
Nephrotoxic 
Can cause arrhythmias 
- hypercalcaemia
65
Q

What is depression?

A

> 2 weeks of low mood

66
Q

What are the symptoms of depression?

A 
Low mood 
Anhedonia 
Feelings of guilt 
Feelings of worthlessness 
Change in appetite/ libido/ weight
Disturbed sleep 
Psychomotor agitation or retardation 
Fatigue  
Deliberate self harm 
Thoughts of suicide/ death

Psychotic symptoms:

  • delusions or poverty, guilt, inadequacy, nihilism
  • hallucinations (auditory, visual, olfactory)
  • Catatonia
67
Q

What investigations would you want to do in ?depression?

A

Bloods: FBC, blood glucose, TFTs, LFTs, U+Es, calcium levels

Imaging: Head CT/MRI if atypical presentation

68
Q

What is the management for depression?

A

CBT, CAT, Individual guided self help, structured group activity

SSRIs- Fluoxetine, Citalopram, Escitalopram, Sertraline
SNRIs- Venlafaxine, Duloxetine
TCA
Other: mirtazapine

ECT

69
Q

What are the side effects of SSRIs?

A

Nausea, vomiting, diarrhoea
Insomnia, irritability
Erectile dysfunction

Increased suicidal ideology

70
Q

What are the side effects of SNRIs?

A

Raised BP and HR

Nausea, vomiting, diarrhoea
Insomnia, irritability
Erectile dysfunction

Increased suicidal ideology

71
Q

What is the management of generalised anxiety disorder?

A

First and second line: individual guided self help, then CBT

Drugs: propanolol, SSRIs or venlafaxine

Acute: Benzodiazepines, zopiclone

72
Q

What is OCD?

A

Marked anxiety associated with compulsions and obsessions
Cause distress
Has good insight

73
Q

What is the management of OCD?

A

CBT (exposure and response therapy)
Behavioural therapy
Family psychotherapy

SSRIs; escitalopram, fluoxetine, sertraline
Antipsychotics (risperidone, olanzapine)

ECT

74
Q

How do you detox and maintain detoxification from heroin?

A

Buprenorphine
and
Methadone

75
Q

What is the presentation of PTSD?

A
  1. Re-experiencing;
    flashbacks, nightmares, visions, distress
  2. Avoidance or rumination;
    avoiding stimuli or obsessing over it
  3. Hyper-arousal or Emotional numbing;
    hyper-vigilance, easily startled, irritable,
    social withdrawal, difficulty
    concentrating, sleep disturbances,
    feelings of detachment, amnesia
76
Q

What is the management for PTSD?

A

Therapy: Eye movement desensitisation and reprocessing (EMDR) or Trauma-Focussed CBT (TF-CBT)

Drugs: Paroxetine, mirtazipine, zopiclone short-term

77
Q

What is the presentation of OCD?

A

Carrying out a compulsion is not a pleasurable act
Obsessions/thoughts are distressing
Must have at least one compulsion that is unsuccessfully resisted
Obsessions are known to be the individuals own thoughts
Symptoms for >2 weeks

Commonly; cleaning, checking, counting

78
Q

What is the presentation of panic disorder?

A

> 4 panic attacks a week for >4 weeks

Unanticipated and not affected by surroundings

79
Q

What is the management of panic disorders?

A

CBT and SSRIs

80
Q

What is agoraphobia?

A

Fear of unfamiliar spaces with no way to escape or hide

81
Q

What is a phobia?

A

Anxiety disorder with a strong, irrational fear towards something that poses no actual threat

82
Q

What is the management of phobias?

A

CBT and SSRIs

83
Q

What is anorexia nervosa?

Inc DSM criteria

A

An eating disorder based on food restriction

DSM Criteria:

  1. Persistent restriction of energy intake
  2. Irrational fear of gaining weight or getting fat
  3. Undue influence of body weight and image on self-evaluation, or lack of recognition of seriousness of condition, or disturbance in perception of body weight or image
84
Q

What investigations would you want to do in ?anorexia?

A

ESR + TFTs- weight loss
U+Es to check for electrolyte balance in malnutrition and?vomiting
DEXA
ECG

85
Q

What is a healthy BMI?

A

18.5-24.9

86
Q

What is the management for anorexia nervosa?

A

CBT-ED
MANTRA

Multivitamin and mineral supplementation
Oral supplementation of nutrition

87
Q

What is bulimia nervosa?

+ DSM criteria

A

Repeated episodes of uncontrolled eating followed by compensatory weight loss behaviours

DSM:

  1. recurrent episodes of binge eating (eating a lot without control)
  2. Recurrent compensatory weight loss behaviours e.g. vomiting, laxatives, excessive exercise etc.
  3. At least once a week for 3 months
  4. Body image/ weight unduly effects self-esteem and valuation
  5. Does not occur in anorexia nervosa
88
Q

What are the investigations and management of bulimia nervosa?

A

Investigations: U+Es (hypokalaemia with vomiting)

Management: Bulimia focused guided self help
CBT-ED

89
Q

What is the management for gambling addiction?

A

Group therapies; 12 step recovery: Gamblers Anonymous

CBT

90
Q

What mental health teams are available for community?

A

Early intervention team- for first episode psychosis
Community mental health team
Crisis team
Assertive outreach team- long term illness

Phase 3a (9 decks)

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