Psych Conditions Flashcards
(143 cards)
1
Q
Dementia with Lewy Bodies core features
A
Fluctuating cognition
Parkinsonism
Visual hallucinations
Also: delusions, depression, falls LOC, syncope
2
Q
Management Dementia with Lewy Bodies
A
Acetyl cholinesterase inhibitors e.g Rivastigmine
N.B. Do not give APs as worsen parkinsonian Sx
3
Q
Frontotemporal Dementia - core diagnostic features
A
- Insidious onset with gradual decline in social function.
- Unable to regulate personal conduct
- emotional blunting
- early loss of insight
- language impairment
4
Q
3 subtypes of FTD
A
Behavioural - frontal lobe
Progressive non-fluent aphasia - temporal
Semantic - loss of the knowledge of things and concepts
5
Q
Treatment FTD
A
SSRI, supportive and carers
6
Q
5 A’s of Alzheimers
A
Amnesia Aphasia Agnosia Apraxia Associated behaviors - BPSD
7
Q
What are examples of the behavioral and psychological symptoms of Dementia
A
Delusions, hallucinations, depression, sleepiness, aggression, crying, screaming, pacing, hoarding etc
8
Q
How long do you need to be Sx of Dementia for a diagnosis
A
6 months
9
Q
ICD- 10 mild dementia
A
- Memory loss sufficient to interfere with everyday activities
- Compatible with independent living
- Difficulty registering, storing and recalling elements in daily living
10
Q
ICD-10 moderate dementia
A
- Memory loss represents serious handicap to independent living
- Only highly learned or very familiar material is retained
- Unable to function w/o assistance of another
11
Q
ICD-10 severe dementia
A
- Complete inability to retain new information
- Mind can no longer tell the body what to do
12
Q
Pharmocological management Dementia
A
o Acetylcholinesterase Inhibitors: Donepezil, rivastigmine, galantamine
- Mild to moderate
o Memantine
- Moderate to severe
o Antipsychotics not recommended for BPSD
13
Q
What are the four dopamine pathways?
A
Mesolimbic - positive Sx
Mesocortical -Negative Sx
Nigrostriatal - EPSE
Tuberoinfundibular - Prolactin secretion
14
Q
Criteria for Anorexia Nervosa
A
Anorexia Nervosa
BMI <17.5
Core psychopathology
Amenorrhoea
15
Q
Criteria for Bulimia
A
BMI >17.5
Binge – purge cycle >2x/week
Core psychopathology
16
Q
How common is Bulimia
A
F: 1 in 50
M: 1 in 500
17
Q
How common is AN
A
F: 1 in 250
M: 1 in 2000
18
Q
Core psychopathology of eating disorders
A
o Fear of fatness o Pursuit of thinness o Body dissatisfaction o Body image distortion: overvalued idea o Self-evaluation based on perceived weight and shape
19
Q
SCOFF Questionnaire
A
S Do you ever make yourself SICK because you feel uncomfortably full?
C Do you ever worry you’ve lost CONTROL over how much you eat
O Have you recently lost more than ONE stone in a 3month period?
F Do you believe yourself to be FAT when others say you’re too thin?
F Would you say that FOOD dominates your life?
20
Q
Stages of the cycle of change
A
o Precontemplation o Contemplation o Preparation o Action o Maintenance o Relapse
21
Q
Clinical risk assessment in eating disorders
A
o Clinical Hx o Physical Ex - Irregular pulse - Bradycardia - Hypotension (may be postural) - Hypothermia - Proximal myopathy o BMI (kg/m2) - <17.5 = AN - <15 = moderate risk - <13 = high risk o ECG -Most deaths due to cardiac arrest - T wave changes hypokalaemia - Bradycardia <40bpm - Prolonged QT >450s o Blood investigations - FBC, U+E, LFTs, Glucose, TFT, CK, Phos, Mg, Ca
22
Q
Management AN
A
o Ideally done as outpatients
- Nutritional rehabilitation
- Psychological intervention
- CBT
- Cognitive Analytic Therapy
- Interpersonal Therapy (IPT)
- Family Interventions - decrease high expressed emotion
23
Q
Management BN
A
- Guided self Help
- CBT
- IPT
- Fluoxentine
24
Q
Classic sign in BN
A
Russell’s sign: calluses on dorsum of hand from purging
25
Delusion
o Fixed belief that is held with unshakeable conviction despite overwhelming evidence to the contrary and cannot be explained by the subjects culture or religious background
26
Delusions of control
o Belief that ones thoughts, feelings or actions are being replaced by an external agency
o Thought Insertion
o Thought withdrawal
o Thought broadcast
o Passivity of affect, volition or actions
o Somatic passivity
27
Persecutory delusion
o Belief that they are being persecuted e.g. being spied upon by secret service
28
Overvalued idea
o Belief which in itself is acceptable and comprehensible but dominates thinking and behaviour e.g. desire for thinness in eating disorders
29
Ideas of reference
o Belief that objects, events or other people have special significance pertaining to them. E.g. watching the TV and it has a special message just for them
o If it becomes a fixed belief it is a delusion of reference
30
Delusions of misidentification
o Capgras: belief that a familiar individual has been replaced by an identical imposter
o Fregoli Syndrome: familiar individual is disguising as multiple people
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Grandiose delusion
o Delusion of being of special status of significance of having special powers or attributes or a special mission or purpose
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Nihilistic delusion
o Delusion of extreme negativity, they no longer exist or are about to die
o Cotards Syndrome: belief that they are dead
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Delusion of infestation/parasistosis
o Belief that the skin is infested by parasites
| o Ekbom’s syndrome
34
Delusions of Jealousy
o Delusion of infidelity of partner
| o Othello’s Syndrome
35
Delusions of love
o Delusion of being loved by someone who is inaccessible or with whom they have little contact
o Erotomania/De clerambault’s: someone of higher status is in love with them
36
Pressure of thought
o Thoughts arise in unusual variety and abudnace and pass through the mind quickly
o Experienced as pressure of speech
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Flight of ideas
o Thoughts move quickly from one idea to the next and are loosely connected
38
Thought blocking
o Sudden loss of thoughts often mid-sentence
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Loosening of associations
o Thoughts move quickly from one idea to another but seem not to be connected at all
o Experienced as muddled or illogical speech
40
Concrete thinking
o Inability to understand abstract concepts and metaphorical ideas – take literal understanding of things (autism)
41
Three types of illusion
o Affect Illusion: arise during periods of heightened emotion
o Completion illusion: arise during periods of inattention
o Paraidolic illusion: arise from poorly defined stimuli e.g. seeing shapes in the clouds
42
Illusion
False perception of a real stimulus
43
Hallucination
o Perception which occurs in the absence of an object, arises from the 5 senses and not from the mind and is indistinguishable from reality
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Hypnogogic hallucination
As going to sleep
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Hyponpompic hallucination
As waking up
46
Derealisation
o Alteration in the perception of the environment that it is strange or unreal
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Depersonalisation
o Altered perception of self, feel as if they are unreal and acting a part
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Sx of alcohol withdrawal
```
o Agitation/restless
o Tremor
o Sweating
o Nausea
o Palpitations
o Anxiety
o Anorexia
o Tachycardia
o Insomnia
```
49
Symptoms and timing of delerium tremens
```
o Usually 48-72hours after stopping
o Sx of Withdrawal AND
- Hallucinations
- Delusions
- Severe agitation
- HTN
- Pyrexia
- Altered mental state
```
50
Sx of alcohol dependance
Tolerance – drink large amounts to have same effect
continue despite knowing harm
Anhedonia in anything unrelated to alcohol
Withdrawal Sx
Explosive – unable to control amount Desire/compulsion to drink
51
Recommendations for alcohol consumption in the UK
o Males and Females: 14 units/week
o 2 alcohol free days a week
o No more than ½ total units should be consumed in 1 sitting
o Pregnancy: avoid alcohol in first 3 months, no more than 2 units once or twice a week after this
52
Triad of wernickes encephalopathy and cause
```
o Thiamine B1 deficiency
o Triad
- Confusion
- Ataxia
- Opthalmoplegia
```
53
CAGE
o Have you ever felt that you should cut down the amount of alcohol you drink
o Have you ever felt annoyed by comments someone has made about the amount you drink
o Have you ever felt guilty about the amount of alcohol you drink
o Have you ever needed a drink first thing on a morning
54
Management alcohol withdrawal
ABCDE
o Chlordiazepoxide
- over 5-7 days with reducing dose
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Management wernickes
Pabrinex
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Medicines to help stop drinking alcohol
o Acamprosate - Decrease cravings
- Enhances GABA transmission so mimics the CNS depressant effects of alcohol
o Disulfiram
- Alcohol sensitising deterrent
- Sx of flushing, palpitations, headache, and nausea
57
Refeeding Syndrome
Decrease in phosphate, Magnesium, Calcium, Potassium
| Caution when giving people nutrition who have been starving themselves
58
Learning Disability definition
1) IQ under 70
2) Loss of adaptive social functioning
3) onset before age 18
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Mild learning difficulty
IQ 50-69 language fair, fairly independant
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Moderate learning disability
IQ 35-49 better receptive than expressive
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Severe learning disability
IQ 20-34 severe motor and sensory deficits. 50% epilepsy
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Profound learning disability
IQ <20 development approx 12m
| very vulnerable
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Causes of learning disability
Prenatal - Downs, Fragile X, Fetal alcohol
Peri natal - O2 deprivation, prem baby, birth complications
Post-natal - Illness, injury or environment
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Symptoms of autism
```
sensory and perceptual distortion
organisation and planning difficulties
inflexibility of thought and actions, transitions difficult
social interactions challenging
concrete thinking
```
65
Latency in PTSD
1-6months
66
Formulation components
Presenting, precipitating, perpetuating, predisposing and protective
67
GAD
6 months of varying concerns/worries
| persistent free floating anxiety not related to external stimulus
68
Managment GAD
self help, applied relaxation, sleep hygiene
CBT
SSRI
Beta blocker for tachy/palps
Benzos short term e.g. flight/funeral, max 2-4w
69
Phobia anxiety disorder
1) restricted to specific phobia
2) fear out of proportion with stimulua
3) cannot be reasoned or explained away
4) Anticipatory anxiety
5) avoidance behaviour
70
Phobia management
Psychoeducation
| exposure - systematic desensitisation
71
Sx Panic attack
Need 4 Sx
Autonomic arousal - tachy, sweating, shaking, dry mouth
Chest/Abdo - SOB, chest pain, claustrophobia, nausea
Mental state - dizzy, faint, derealisation, fear
General - hot flush, numbness, tingling
72
Panic attack
- Rapid onset of severe anxiety lasting for about 20 – 30 minutes
- Occur recurrently and unexpectedly
73
Panic attack disorder
Need 4 attacks in 4 weeks.
| N.B. can't be primary diagnosis if also have depression
74
Obsession
o Recurrent idea, image or impulse
o Recognised as being a product of one’s own mind
o Usually perceived as being senseless
o Unsuccessful if resisted
o Results in marked anxiety and distress/impairment of functioning
75
Compulsion
o Recurrent stereotyped behaviour
o Reduces anxiety but isn’t useful or enjoyable
o Usually perceived as being senseless but unsuccessful if resisted
o Results in marked anxiety and distress/impairment of functioning
76
Management OCD
o CBT
- Exposure and response prevention
o High dose SSRIs
- Can use adjuncts if necessary e.g. gabapentin, lamotrigine, olanzapine, risperidone
o Combo of CBT and SSRIs is most effective
77
Predisposing factors PTSD
Personality traits e.g. compulsive, asthenic
Past psych Hx
Genetic
78
Sx PTSD
Reexperiencing catastrophic event
Hypersrousal/ Startle reaction
Emotional blunting
Depression and Suicide
79
Treatment PTSD
Trauma focussed CBT
Eye movement desensitisation and reprocessing
Antidepressant - paroxetine or mirtazipine
80
Paranoid personality disorder
Cluster A (MAD) - patient has excessive sence of own importance, and blames others for mistakes and problems. Big on conspiracy theories, and mistrusts others.
81
Schizoid personality disorder
Cluster A (MAD) - Emotionally cold, finding little pleasure in any activities. Solitary and introspective, and indifferent to expectations of others within society.
82
Disocial personality disorder
Cluster B (BAD) - Disregard for people’s feeling and social norms, with a failure to feel guilt. Easily frustrated, with low threshold for anger/violence.
83
Histrionic personality disorder
Cluster B (BAD) - Exaggerated emotions, and craves attention. Shallow personality, easily influences by others/circumstances.
84
Emotionally unstable personality disorder: borderline type
Cluster B (BAD) - uncertain about personal and sexual identity. Feeling of emptiness. Forms intense unstable relationships, with big rejection issues. Recurrent suicidal/self harm threats. Violent and threatening behaviour.
85
Emotionally unstable personality disorder: impulsive type
Cluster B (BAD) - impulsive and lack self control, with sudden outbursts of anger.
86
Anankastic personality disorder
Cluster C (SAD) - rigid, stubborn, excessively organised. Perfectionist. Insist people do things their way or not at all.
87
Anxious (avoidant) personality disorder
Cluster C (SAD) - persistent tension and apprehension. Low self esteem. Avoid situations where they may feel criticised, rejected or disapproved.
88
Dependant personality disorder
Cluster C (SAD) - Feel unable to cope and make decisions on own, fear being left alone, and put the needs of those they are dependent on ahead of their own.
89
Schneiders first rank symptoms
11 in total
Auditory hallucinations - 3rd person discussion or running commentary
Broadcast, echo, withdrawal, insertion
Control - passicity of acts, impulses and affect
Delusional perception
90
Causes Schizophrenia
Genetic - MZ twins 50%
Environmental - winter birth, urban home, viral infection, TL epilepsy, encephalitis
Life events - social exclusion, economic adversity, childhood trauma, migrant, HEE
Substance misuse - canabis, amphetamines
Peri- natal trauma - hypoxia, maternal stress
91
Diagnostic hierachy
1) organic disorders - delerium, demnetia
2) functional psychosis - BPAD, SZP
3) Non- psychotic disorders - depression, anxiety
4) Personality disorders
92
To detain under the MHA
- mental disorder
- risk to self/others/neglect or exploitation
- unwilling to go voluntarily with capacity
93
Requirements to section someone under MHA
2 doctors - one of which section 12 approved, can't be on same team
provided tot he applicant - AMHP
detained to the mangaers of the hospital
94
Voluntary admission to mental health ward
only if have capacity to make decision
95
Section 2 MHA
For assessment, 28 days.
| Pt has right to appeal in the first 14 days
96
Section 3 MHA
Detained for treatment of their mental health condition - already need diagnosis
Up to 6 months
97
Section 5(2)
- Doctors holding power for 72hrs
- need to be detained to a bed (not A and E)
- Allows process of section 2/3 to go through
98
Section 136
Police detention from a public place to a place of safety for assessment
99
Section 135
Allows police to enter persons property to take hem to hospital them for their own safety
100
Core Sx of Depression
o Persistent sadness or low mood
o Loss of interests or loss of pleasure or enjoyment (anhedonia)
o Increased fatigue or low energy
For two weeks or more - not secondary to drugs or alcohol
101
Grading of depression
o Mild - 2 core + 2 other
o Moderate - 2 core + 3 other
o Severe - 3 core + 4 other
102
Biological Sx of Depression
- Poor sleep or hypersomnia with initial early morning wakening
- Diurnal variation of mood
- Reduced libido
- Reduced attention and concentration
- Psychomotor retardation or agitation
103
ECT
o 70-80% response - Severe life threatening or treatment resistant depression, catatonia or severe mania
o Need maintenance AD or high rate of relapse
o 2x/week - Preoxygenated, short GA and muscle relaxant by anaesthetist, not painful, (30-40s)
o Bilateral electrodes placed on head then shock
o S/E: nausea, headache, muscle pain, memory loss
104
Biopsychosocial Mx of depression
Bio - excercise, diet, meds, ECT
Psycho - IAPT, self help, CBT, IPT, Behavioural activation
Social - Manage debts, food banks, socialisation, charity support, carer support, employment
105
Low intensity psychological therapy
Sleep hygiene and regular excercise
CBT based self help - 6-8w
structured group activity programme
106
CBT
16-20 sessions over 3-4 months
based on Beck's cognitive theory to remove cognitive bias.
Talking therapy with homework
Maps out problem, makes goals and deals with problems and thought processes
107
IPT
16-20 session
| foccusses on relationships, grief, conflicts, over reliance, life changes etc
108
Behavioural activation
Simple goals. act according to plan rather than how feel. small steps for sense of achievement
109
First line Mx Depression based on severity
Mild - IAPT referral, self help. Advice sleep hygiene and reg excercise, cut down alcohol.
Moderate to severe - SSRI and CBT/IPT. all the lifestyle stuff
110
Paranoid SZP
- Commonest type
| - Paranoid delusions often accompanied by auditory hallucinations and perceptual disturbances
111
Hebephrenic SZP
- More common in young people
- Affective changes are prominent
- Delusions and hallucinations fleeting and fragmentary
- Behaviour irresponsible and unpredictable
- Mood is shallow and inappropriate
- Disorganised thought and incoherent speech
- Social isolation and rapid development of –ve Sx: flattening of affect and loss of volition
112
Catatonic SZP
- Presents with psychomotor Sx and can alternate b/w extremes
- Episodes of violent excitement may be a striking feature
113
Diagnosing SZP
Sx for 1 month at least.
Cannot make diagnosis of schizophrenia in the presence of - Overt brain disease
- During drug intoxication, use of psychoactive substances/withdrawal
- Extensive depressive or manic Sx unless clearly predates current Sx
114
Positive Symptoms of SZP
Hallucinations
Delusions
Thought disorder
115
Negative Symptoms SZP
- Taken away from the normal mental state e.g. reduced speech
- More debilitating and less responsive to Rx
- Avolition: loss of motivation
- Anhydonia: unable to experience pleasure
- Alogia: poverty of speech
- Asociality: lack of desire of relationships
- Affect blunt: part of a continuum of normal traits, often late feature
116
Prevalence SZP
1% population
117
Prognosis SZP
Rule of thirds -
one-third of all people will recover completely
one-third will have some relapses but generally well managed
one-third will have have resistant szp
118
Where do you refer the first presentation of psychotic Sx to?
local community based mental health service e.g. CMHT, HTT, EIS
Need full assessment by psychiatrist and care plan
119
Psychosocial management of SZP
o Offer CBT to all people with Schiz
o Family Intervention
- Educate and support those who live with or are in close contact
- Reduces relapses
- Especially with high expressed emotion families
o Art therapy for negative Sx
o Distraction techniques
o Avatar therapy
o If acute phase aim to start ASAP to improve outcome
120
What factors increase your chance of relapse in SZP
```
o Presence of persistant Sx
o Poor adherence to Rx
o Lack of insight
o Substance use
o Stopping AP abruptly
```
121
Baseline investigations before starting an AP med
o Bloods - FBC, U+E. LFT, HbA1c, prolactin, lipids and cholesterol
o Physical - Weight, BP, pulse
o ECG - Risk of prolonged QT and arrhythmias
122
Components of a mental capacity assessment
o Weigh up the information
o Retain
o Understand
o Communicate
123
Deprivation of liberty safeguard (DoLS)
Apply to an incapacitous person who needs to be deprived of their liberty in their best interests
Urgent (up to 7days) or standard application (up to 1year)
124
Best interests decision
- Consider persons past/present/future wishes
- Beliefs and values
- Views of anyone named by person
- Anyone engaged in caring for the person
- Lasting power of attorney
- Deputy appointed by the court
- IMCA
125
Mania Sx
Mania Acronym - DIG FAST
Disorganised
Insomnia, ↓ need for sleep
Grandiose/expansive ideas
Fast thoughts
Activity ↑
Speech: Pressured, need to talk
Taking risks: money, sex,substance misuse, driving…
126
Psychosocial Mx BPAD
Psycho education about BAD
- Mood monitoring
- CBT for depressive episodes
- Education about Sx and identifying early signs of relapse
- Importance of drug compliance
- Lifestyle advice: avoid stressful situations or learning how to cope better
- Involve family
- Balance between work/leisure and relaxation
- Reduced caffeine
127
Hypomania
Mood is elevated, expansive or irritable but no psychotic features
No marked impairment of social or occupational functioning
128
How long do you need Sx for mania diagnosis
1 week
129
How long to manic and depressive episodes typically last in BAD
Mania tends to start abruptly and last 3-6months
| Depression tends to last 6-12months
130
BAD I and BAD II definitions
Bipolar I - Episodes of major depression and mania
| Bipolar II- Episodes of major depression and hypomania
131
Risk factors for BAD
Genetic: first degree relative
| Life events and environmental factors (severe stress, disruption todaily routine) can trigger episodes
132
Risk factors for DSH/suicide
- Hx of DSH is very strong RF
- Mental health disorder especially affective disorders, schizophrenia and personality disorders
- Physical illness
- FHX of DSH or suicide
- single, male, unemployed, life stresses, poor social support
133
Abnormal grief reaction
- Unusually intense
- Unusually prolonged
- Meets criteria for depressive disorder
- Lasts >6months
- Delayed, inhibited or distorted
134
Dissociative/Conversion Disorders
Traumatic event results in a disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment
135
Dissociative Amnesia
Loss of memory commonly for a traumatic or stressful event
136
Dissociative Fugue
Memory loss or confusion about personal identity or assumption of another identity
May last several months
When it ends the memory of the fugue is lost
137
Dissociative Stupor
Motionless and mute, no response to stimulation
138
Hypochondria Disorder
Fear or belief of having a serious physical disorder despite medical reassurance to the contrary
Includes body dysmorphic disorder
RF: male, medical students
139
Somatisation Disorder
Long history of multiple and severe physical symptoms that cannot be accounted for by a physical or psychiatric disorder
F > M
Briquet’s syndrome, St louis hysteria
140
Malingering
Sx which are manufactured or exaggerated for a purpose other than assuming the sick role e.g. to evade to police, get compensation
141
Class A drugs
Heroin (diamorphine), cocaine (including crack), methadone, ecstasy (MDMA), LSD, and magic mushrooms.
142
Class B drugs
amphetamines, barbiturates, codeine, cannabis, cathinones (including mephedrone) and synthetic cannabinoids.
143
Class C drugs
benzodiazepines (tranquilisers), GHB/GBL, ketamine, anabolic steroids and benzylpiperazines (BZP).
