PSYCH EXTRA CONDITIONS Flashcards
(45 cards)
1
Q
ACUTE STRESS REACTION
What is acute stress reaction?
A
- Transient disorder that can occur as an immediate response to exceptional stressor with threat to security or physical integrity (rape, natural catastrophe) but typically resolves once stressor removed/after few days
1
Q
ACUTE STRESS REACTION
How does acute stress reaction present?
A
- Anger, depression/anxiety, excessive grief, social withdrawal, narrow attention
- Basically presents as PTSD but <1m so not called PTSD (only if no resolution >1m)
2
Q
GRIEF REACTION
What is the normal grief reaction?
How does it present?
A
- Normal reaction after a sad event e.g. sad after death of loved one
- Usually occurs <6m from event (delayed grief = >2w until grieving, prolonged grief = hard to define but >12m)
3
Q
GRIEF REACTION
What are the stages of a normal grief reaction?
A
- Denial incl. numbness, pseudohallucinations of deceased (auditory, visual), may focus on physical objects that remind them
- Anger usually to family or HCPs
- Bargaining, depression + acceptance (may not go through all 5 stages)
4
Q
TIC DISORDERS
What is the epidemiology of tics?
A
- Transient simple tics affect 10% of children
- May be associated with OCD, ADHD + ASD
- M>F, usually present around or after 5y
5
Q
TIC DISORDERS
What are the two types of tics?
How may they manifest?
A
- Simple
- Complex
- May be invisible to observer (abdo tensing, toe crunching)
6
Q
TIC DISORDERS
Give some examples of simple tics
A
- Throat-clearing
- Blinking
- Sniffing
- Head jerking
- Eye rolling
7
Q
TIC DISORDERS
Give some examples of complex tics
A
- Physical movements (twirling on spot, touching objects)
- Copropraxia (obscene gestures)
- Coprolalia (obscene words)
- Echolalia
8
Q
TIC DISORDERS
What improves or worsens tics?
What sensations are felt before tics?
A
- Stress + stimulant meds worsen, distraction improves
- Premonitory = pts feel urge to perform tic, often several times to get relief from that urge (can be suppressed but internal tension builds)
9
Q
TIC DISORDERS
What is the management of mild tics?
A
- Watch + wait (usually improve over time
- Education + reassurance
- Avoid caffeine + stress
10
Q
TIC DISORDERS
What is the management of severe tics?
A
- Habit reversal training
- ERP
- Antipsychotics considered in VERY severe cases
11
Q
CONDUCT DISORDER
What is conduct disorder?
What are the 2 types?
A
- Persistently, marked antisocial behaviours
- Socialised = child has peer group, often share antisocial behaviour
- Unsocialised = rejected by others so more isolated + hostile
12
Q
CONDUCT DISORDER
What is the epidemiology of conduct disorder?
What are some risk factors?
A
- M>F, more common in adolescents
- Urban upbringing, deprivation, parental criminality, harsh or inconsistent parenting (behaviours often learned from parents)
13
Q
CONDUCT DISORDER
What is the clinical presentation of conduct disorder?
A
- Aggression/violence towards people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
14
Q
CONDUCT DISORDER
How is conduct disorder managed?
A
- 3–11y = group parent training programme (focus on parenting skills to improve child’s behaviour)
- 9–14y = child-focused programmes (focus on child’s behaviours)
- Older = multimodal interventions with many services
15
Q
CONDUCT DISORDER
What can be used as a last resort in conduct disorder?
A
- Antipsychotic like risperidone to reduce aggressive tendencies
16
Q
ODD
What is oppositional defiant disorder (ODD)?
What may be linked to ODD?
A
- Negative, hostile + defiant behaviour particularly directed towards authority figures like parents + teachers
- Common in children with ADHD, may be linked to parenting styles
17
Q
ODD
How can ODD and conduct disorder be differentiated?
A
- Less severe + more common
- Children are NOT aggressive and do NOT destroy property or steal etc.
18
Q
ODD
What is the clinical presentation of ODD?
A
- Loses temper + argumentative
- Actively defies or refuses to comply with adult’s requests or rules
- Blames others for their mistakes or misbehaviour
19
Q
ODD
What is the management of ODD?
A
- Child-focussed programmes + group parent training programmes
20
Q
CONVERSION DISORDERS
What is a conversion disorder?
A
- Actual loss or disturbance of normal motor/sensory function which initially appears to have neuro or physical cause but is later credited to psychological
21
Q
CONVERSION DISORDERS
What is the most severe form of dissociative/conversion disorders?
A
- Dissociative identity disorder (multiple personality disorder) = inability to recall personal information, may have loss of identity.
22
Q
CONVERSION DISORDERS
What are the features of conversion disorders?
A
- Paralysis (any pattern)
- Aphonia (complete loss or whispered speech)
- Sensory loss (area may cover patient’s beliefs about anatomy)
- Seizure (NEAD)
- Amnesia (short-term memory loss usually too severe for forgetfulness)
23
Q
CONVERSION DISORDERS
When would you suspect conversion disorder?
A
- Clinically inconsistent nature (or absence) of signs
- Excluded underlying organic disease
- Convincing psychological explanation for deficit (can be induced by stressful event)
24
CONVERSION DISORDERS
What is the management of conversion disorder?
- Present Dx of positive (emphasise likelihood of recovery)
- May need physio
- CBT, interpersonal therapy, supportive psychotherapy or family therapy may help
25
HYPOCHONDRIASIS
What is hypochondriacal disorder?
- Preoccupation with fear of having a serious disease (C = condition) which persists despite -ve Ix + appropriate reassurance
26
HYPOCHONDRIASIS
What is the clinical presentation of hypochondriasis?
- Over-valued idea of having serious medical condition, often fatal
- Ruminates on possibility, misinterprets insignificant bodily abnormalities as signs of serious disease needing investigation
- Unable to be reassured by negative investigations
27
HYPOCHONDRIASIS
What is the management of hypochondriasis?
- Clarify Sx real but emphasise absence of organic cause
- SSRIs may help
- ERP to illness cues, CBT to identify + challenge misinterpretations + substitute realistic interpretations
28
SOMATOFORM PAIN
What is somatoform pain disorder?
- Complaint of persistent + distressing pain which is not adequately explained by organic pathology
29
SOMATOFORM PAIN
What is the management of somatoform pain disorder?
- Atheoretical "see what works" approach
- Pain clinics (anaesthetics led, antidepressants, transcutaneous electrical nerve stimulation/TENS, local + regional nerve blocks)
- Relaxation training, CBT, hypnotherapy
30
MUNCHAUSEN'S
What is Munchausen's (factitious disorder)?
- Pt intentionally falsifies their Sx, past Hx + fabricate signs of physical or mental disorder with primary aim of obtaining medical attention + Tx
- May flee when story questioned
31
MUNCHAUSEN'S
What are the 3 subtypes of Munchausen's?
- Wandering
- Non-wandering
- By proxy
32
MUNCHAUSEN'S
What is wandering Munchausen's?
- M>F
- Move hospital-hospital, job-job, place-place, makes elaborate stories, changes name
33
MUNCHAUSEN'S
What is non-wandering Munchausen's?
- F>M
- More stable lifestyles, less dramatic presentations
- Often paramedical professionals
- Associated with EUPD
34
MUNCHAUSEN'S
What is Munchausen's by proxy?
- F>M
- Mothers, carers, paramedic staff who simulate or prolong illness in their dependents
- Clinical focus to prevent further harm on the dependent
35
MUNCHAUSEN'S
What is the management of Munchausen's?
- Reduce iatrogenic harm from inappropriate tests + treatment
- Challenge pt in non-punitive manner
- Healthcare systems change to prevent harm (blacklisting)
36
MALINGERING
What is malingering?
Give some examples
- Fraudulent simulation or exaggeration of Sx for personal gain
- Drug-seeking behaviours, avoid army service, compensation
37
SLEEP DISORDERS
What is insomnia?
- Issues with – falling to, maintaining or poor quality of sleep (≥3d/week for 1m)
38
SLEEP DISORDERS
What are the 2 types of insomnia?
- Primary = intrinsic + Extrinsic factors (fear of falling asleep, poor sleep hygiene, change of environment)
- Secondary = to illness or substance misuse (sleep apneoa, circadian rhythm disorder, shift work)
39
SLEEP DISORDERS
What is the management of insomnia?
- Rx with zopiclone if good sleep hygiene unsuccessful
- Mirtazapine
40
SLEEP DISORDERS
What is narcolepsy?
What is cataplexy?
- Hypersomnolence, sleep paralysis, hypnogogic + hypnopompic hallucinations
- Cataplexy = sudden loss of muscle tone often triggered by emotion
41
SLEEP DISORDERS
What is the management of narcolepsy?
- Multiple sleep latency EEG, early onset REM sleep
- Rx with daytime stimulants (modafinil) + night-time sodium oxybate
42
SLEEP DISORDERS
What is circadian rhythm disorder?
- Mismatch between sleep-wake cycle + circadian rhythms (jet lag, shift work)
43
SLEEP DISORDERS
What is parasomnia?
- Restless leg syndrome
- Nightmares + night tremors
- Sleep walking + talking
44
SLEEP DISORDERS
What are some sleep hygiene advice?
- Limit caffeine, alcohol + cigarettes
- Reduce noise, lights + phone use, wind down before bed
- Reduce sleep during day + try establish regular pattern
