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Cross reference - year 5 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is an illusion?

A

altered perception of a real object

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2
Q

what is a pareidolic illusion?

A

perceived meaningful images from vague stimulus

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3
Q

what is a delusion?

A

fixed false belief held despite evidence to the contrary

not explained by patient’s background

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4
Q

what is the most common delusion?

A

persecutory/paranoid (i.e. being hunted by FBI)

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5
Q

Ekbom’s vs formication

A

Ekbom’s: belief that one if infected with parasites

Formification: tactile hallucinations

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6
Q

what is capgras syndrome?

A

believing close acquaintance has been replaced by an imposter

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7
Q

what is Folie a deux?

A

shared delusions/ hallucinations between people

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8
Q

What is neurosis?

A

inappropriate emotional/behavioural response to perceived stressor (e.g. phobia, GAD, OCD)
neurotic person never loses touch with reality, has normal mental functioning

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9
Q

what does the MCA cover?

A

capacity rather than mental health

covers physical health

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10
Q

what is section 4 of the MHA?

A

emergency admission
72 hour duration
1 doctor, 1 AMHP

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11
Q

what are the discharge applications for section 2?

A
  • NR to MHRT within 14 days

- by responsible clinician

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12
Q

what are the discharge applications for a section 3?

A
  • by patient to MHRT at any time
  • by NR to hospital (can be barred by responsible clinician)
  • under S17 (leave)
  • By RC
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13
Q

what is section 35?

A
  • assessment of a patient accused of committing a crime
  • 28 days
  • cannot appeal
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14
Q

what is section 37?

A
  • treatment of convicted criminal
  • applied for by court if evidence from 2 doctors
  • 6 months
  • can appeal (within 21 days to court, after 6 months to MHRT)
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15
Q

what is the role of the independent mental health advocates?

A
  • help people find out their rights

- can’t have with sections 4, 5, 135, 136

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16
Q

what is the MOA of atypicals?

A

blocks D2 and 5-HT2 receptors

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17
Q

what is the MOA of clozapine?

A

blocks D1 and D4

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18
Q

what do you need to be careful with all antipsychotics?

A

lower seizure threshold

cause QTc prolongation

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19
Q

what is the most common side effect of clozapine?

A

constipation

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20
Q

what can increase the concentration of clozapine?

A

caffeine

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21
Q

what is the monitoring that you need with clozapine?

A
  • weekly FBC for first 18 weeks
  • then every 2 weekly until 1 year
  • then monthly
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22
Q

what are the side effects of risperidone?

A
  • hyperprolactinaemia (makes pregnancy harder)

- dyslipademia

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23
Q

what are the features of aripiprazole?

A
  • low SE profile
  • takes 2 weeks to work orally
  • can be given as depot
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24
Q

what is dystonia?

A

involuntary painful sustained muscle spasm

e.g. oculogyric crisis and torticolis

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25
Q

what is tardive dyskinesia?

A

rhythmic involuntary movements of mouth/face/limbs/trunk

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26
Q

what is the treatment of dystonia?

A

anticholinergic e.g. procyclidine

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27
Q

what is the treatment of akathisia?

A

switch/lower dose
propanolol
BDZ

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28
Q

what is the treatment of the parkinsonism?

A

increase dose

anticholinergic

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29
Q

what is the treatment of tardive dyskinesia?

A

switch meds

tetrabenazine

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30
Q

how long does EIS do follow up?

A

3 years

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31
Q

SSRI SEs?

A

5 S’s, hyponatraemia, blurred vision

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32
Q

what should SSRIs not be taken with?

A
  • triptans (ask about migraines)

- NSAIDs/aspirin (if need = PPI)

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33
Q

what is important to remember about fluoxetine?

A

increased half life

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34
Q

what are the side effects of SNRIs?

A
  • increased BP
  • headache
  • avoid in arrhythmia
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35
Q

what is the MOA of MAOIs?

A

increase MAO levels
don’t give with SSRIs = serotonin syndrome
e.g. Phenelzine, Selegiline

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36
Q

give an example of a RIMA

A

moclobemide

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37
Q

what BDZ should you use in hepatic impairment?

A

oxazepam

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38
Q

describe the withdrawal process from zopiclone/BDZs?

A

1/8th daily dose reduction every 2 weeks

e. g. diazepam 40mg/day
- dec dose by 5mg every 2 weeks until 20mg/day
- dec dose by 2mg every 2 weeks until 10mg/day
- dec dose by 1mg every 2 weeks until 5mg/day
- dec dose by 0.5mg every 2 weeks until stoped

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39
Q

what are the disadvantages of benzo/Z drugs?

A
  • sedation, confusion, anterograde amnesia, ataxia
  • potentiates other CNS depressants (i.e. alcohol)
  • tolerance and dependence
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40
Q

what increases the free plasma concentration of benzo/ z drugs?

A

when given with aspirin or heparin

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41
Q

what is the disadvantage of zopiclone in pregnancy?

A

cleft lip

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42
Q

what are the MOAs of stimulants?

A
  • potentiate effects of MOA neurotransmitters = increase energy, alertness, euphoria
  • increases monoamine pathway activity = increase concentration and learning maturation
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43
Q

give 2 examples of stimulants

A

methylphenidate

dexamphetamine

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44
Q

what levels cause lithium OD vs toxicity?

A

OD > 1.2 mmol/L

toxicity > 1.5mmol/L

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45
Q

what are the triggers for lithium OD?

A
  • dehydration

- drugs (NSAIDs, ACEi, ARBs, diuretics, SSRIs)

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46
Q

what is the only anti-epileptic that can be used for acute mania?

A

sodium valproate

other ones are prophylaxis

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47
Q

what is an important interaction of carbamazepine?

A

CYP450 inducer

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48
Q

what is a bad side effect of lamotrigine?

A

SJS

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49
Q

what is the treatment of acute mania relapse in known bipolar patient?

A
  1. inc dose of mood stabiliser
  2. antipsychotic augmentation
  3. ECT
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50
Q

what are the first line psychotropics in perinatal period?

A
  • sertraline: expressed in breast milk but considered safe
  • olanzapine: 1st line, present in breast milk so stop
  • avoid mood stabilisers and benzo’s
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51
Q

describe the rigidity in NMS

A

lead pipe

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52
Q

difference in muscle tone in NMS vs SS

A

NMS: more rigidity
SS: more hyperreflexia, myoclonus

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53
Q

what is the efficacy rate of ECT?

A

80%

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54
Q

what do you need to do prior to ECT?

A

reduce antidepressant dose prior to procedure

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55
Q

how can you describe CBT to a patient?

A

a way of thinking about your thinking

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56
Q

what is the process of CBT?

A
  • targets thoughts that lead to emotions and behaviours
  • especially negative automatic thoughts (NATs)
  • thoughts –> emotions –> behaviours
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57
Q

describe the longitudinal method

A
  • detailed Hx including early life
  • identify NATs and cognitive distortions
  • challenge distortions
  • explore core beliefs
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58
Q

what is the psychodynamic psychotherapy?

A
  • problems shaped by childhood experiences and family environment
  • causes conflict between conscious and unconscious mind
  • therapy helps reveal unconscious mind
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59
Q

what is the aim of psychodynamic psychotherapy?

A

deep seated change in personality and emotional development

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60
Q

what is the difference between psychoanalytic vs psychodynamics?

A 
psychoanalytics = internal conflicts
psychodynamic = inter-personal conflicts
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61
Q

describe delirium

A
  • mental status change
  • quick onset
  • disorientated
  • inattention
  • change from baseline
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62
Q

why do anticholinergics worsen delirium?

A

cholinergic neurones impacted by delirium and are underactive so anticholinergics worsen it

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63
Q

what is important to exclude in derilium?

A

undiagnosed dementia

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64
Q

treatment of delirium

A

PO antipsychotics

1st line = Haloperidol

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65
Q

what is important to remember for rapid tranquilisation?

A
  • follow local protocol

- do not give haloperidol to patients with cardiac disease/DLB/Parkinsons

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66
Q

depression SIGECAPS mnemonic

A 
Sleep changes
Interest Loss
Guilt (worthlessness)
Energy loss (fatigue)
Cognition/concentration difficulties
Appetite Loss +/- weight loss
Psychomotor (agitation)
Suicidal ideation
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67
Q

what is subthreshold depression?

A

<2 core symptoms

no functional impairment

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68
Q

what is mild depression?

A

2 and 2 other symptoms

still can continue with most activities

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69
Q

what is moderate depression?

A

2 core symptoms + 3 others

considerable functional impairment

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70
Q

what is severe depression?

A
  • 3 core symptoms and 4 others

- major impact

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71
Q

what are some organic causes of depression?

A

anaemia
thyroid
diabetes
hypercalcaemia

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72
Q

management of children depression

A
  • self help “youngminds.org”
  • mild = IAPT 6-8 sessions, psychoeducation
  • 2nd line: CBT
  • needs not met = referral to CAMHS
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73
Q

what are the different low intensity psychosocial interventions for depression?

A
  • group CBT
  • computerised CBT
  • guided self help
  • structured group physical activity programme
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74
Q

over how long is sertraline increased?

A

over 6 weeks

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75
Q

what is the catch up phenomena?

A

if someone recovers from depression and then medication is suddenly stopped, if they experience depression again, then they will be in a worse state

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76
Q

what are the complications of paroxetine in pregnancy?

A

1st: congenital heart defects
3rd: persistent pulmonary HTN

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77
Q

what are the characteristics of hypomania?

A

> 3 characteristics lasting 4+ days

no functional impact

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78
Q

what is the treatment of rapid cycling BPAD?

A

sodium valproate

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79
Q

what if there is depression co-existent with mania?

A

can’t use anti-depressants alone

give with mood stabiliser or anti-psychotic

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80
Q

what is the use of CBT in BPAD?

A
  • sense of perspective
  • identify release indications
  • relapse prevention strategies
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81
Q

what are the types of schizophrenia?

A
  1. paranoid
  2. hebephrenic (incoherent/irrelevant speech)
  3. catatonic (psychomotor disturbance)
  4. simple (negative symptoms, apathy, social withdrawal)
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82
Q

how long do the symptoms of schizophrenia need to last for?

A

present most of the time for more than 1 month

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83
Q

what ratings/assessments need to be done in Schizophrenia?

A

Brief Psychiatric Rating Scale

ADL assessment and Housing and Finance

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84
Q

Schizophrenia Bio-Psycho-Social management

A

Bio: aripiprazole (low dose)/olanzapine + education/support
trial for 6 weeks before change
Psych: CBT - reality testing, family therapy
Social: social skills training, education, benefits, housing

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85
Q

what could you use in non compliance?

A

zuclopenthixol depot

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86
Q

what is the DSM-V definition of schizoaffective disorder?

A
  1. Psychotic state (>2 weeks) without concurrent affective symptoms
  2. 2 episodes of psychosis: 1 episode lasting >2w without mood disorder symptoms, 1 episode requires overlap of mood/psychosis sx
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87
Q

how do you treat schizoaffective disorder?

A

treat as per schizophrenia

add mood stabiliser if affective component not being controlled

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88
Q

what is delusional disorder?

A

persistent life long delusions with few/no hallucinations
<3 months = temporary
>3 months = persistent

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89
Q

if you have delusional disorder, what cannot you have?

A
  • auditory hallucinations
  • schizophrenic symptoms
  • evidence of organic disease
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90
Q

what are the RFs for delusional disorder?

A
  • old age
  • substance abuse
  • social isolation
  • premorbid personality disorder
  • head injury
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91
Q

what are examples of delusional disorders?

A
  • erotomania
  • othello syndrome
  • fregoli syndrome
  • factitious disorder
  • folie a deux
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92
Q

what is the treatment of delusional disorder?

A
  • limited evidence for drugs
  • BDZ for anxiety
  • Psych: CBT, psychoeducation
  • Social: social skills training
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93
Q

what neurotransmitters are underactive in anxiety disorders?

A

serotonin
NA
GABA

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94
Q

what should you ask about in anxiety? (SEDATED)

A 
Symptoms of anxiety
Episodic or continuous
Drink and drugs
Avoidance and escape
Timings and triggers
Effect on life
Depression
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95
Q

what are the different anxiety rating scales?

A
  • Beck Anxiety Inventory
  • HADS
  • GAD-7
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96
Q

what do the different scores in GAD mean?

A
  • mild = 5
  • moderate = 10
  • severe = 15
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97
Q

what are the criteria for a GAD diagnosis?

A

3+ symptoms for more than 6 months

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98
Q

what drug should not given in anxiety?

A

BDZ

99
Q

when should you follow up in anxiety?

A

weekly F/U after starting medication in anxiety

100
Q

what are the properties of obsessions in OCD?

A
  • self recognized as product of own mind
  • thoughts of carrying out are not pleasurable
  • commonly themed
  • egodystonic
  • unpleasantly repetitive
101
Q

what are compulsions?

A

irrational belief they will prevent a dreaded event

102
Q

what drug for OCD? how long should it be continued for?

A

Fluoxetine

12m after remission

103
Q

what are the 4 phases of cognitive therapy for OCD?

A
  1. Relabel (hands are not dirty)
  2. Reattribute (OCD telling me to feel this, my hands are not dirty)
  3. Refocus (divert attention when thoughts come up)
  4. Revalue (don’t give importance to OCD thoughts)
104
Q

how long do ASD symptoms need to persist for?

A

3+ days

105
Q

what is acute stress disorder?

A
  • transient disorder
  • individual without any other apparent mental disorder
  • response to exceptional physical and mental stress
  • subsides within hours/days
106
Q

what is an adjustment disorder?

A
  • onset within weeks
  • lasts <6 months
  • symptoms of anxiety and depression without biological symptoms
  • arise in period of adaption to significant life change/event
107
Q

how long can a grief reaction last for?

A

up to 2 years

108
Q

what are the features of an abnormal grief reaction?

A
  • delayed onset
  • greater intensity
  • prolongation of reaction
  • preoccupation with negative thoughts
  • suicidal ideations
  • hallucinatory experience
109
Q

what is PTSD?

A

delayed/ protracted response to stressful event of exceptionally threatening or catastrophic nature

110
Q

what are the signs and symptoms?

A
  • re-experiencing (flashbacks, nightmares)
  • avoidance of triggers
  • hyperarousal (hypervigilance, insomnia, irritability)
  • other: MH problems, self-destructive behaviour
111
Q

management of PTSD

A

trauma focused CBT

EMDR if >3m after non-combat related event

112
Q

what are the features of dependency?

A

(3+ in last month)

  • tolerance
  • craving
  • withdrawal
  • problems controlling use
  • continued use despite harm
  • salience/primacy
  • reinstatment
  • narrowing repertoire
113
Q

how do you calculate a unit?

A

volume x (% alcohol/1000)

114
Q

what are the symptoms of alcohol withdrawal after 4-12 hours?

A
  • course tremor
  • sweating
  • insomnia
  • tachycardia
  • N+V
  • psychomotor agitiation
  • anxiety
  • hallucinations
115
Q

what are the symptoms of alcohol withdrawal after 36 hours?

A
  • alcohol withdrawal syndrome with seizures

- grand mal seizures

116
Q

what are the symptoms after 48-72 hours?

A

delirium tremens

117
Q

what are some measures of 1 unit of ETOH?

A
  • 10mL/8g pure ethanol
  • 25mL 40% proof alcohol
  • half a pint, small glass of wine (125mL)
118
Q

what are the different rating scales for alcohol dependence?

A
  • AUDIT (>20 possible dependence)
  • SADQ
  • FAST (in A&E)
  • CIWA-Ar (for severity of withdrawal)
119
Q

which people need admission for a detox regimen?

A
  • acute alcohol withdrawal

- Wernicke’s encephalopathy

120
Q

what happens if there are less serious signs of dependence?

A

alcohol addiction service

if less serious signs of dependence

121
Q

how do you manage patients expectations in acute alcohol withdrawal?

A

detox will be worse in first 48 hours

don’t stop abruptly

122
Q

what are the criteria and follow up of community based assisted withdrawal?

A

criteria: >15U/day or >20 on AUDIT

2-4 meetings/week (up to 3 weeks)

123
Q

what are the criteria and follow up of inpatient admission

withdrawal?

A

criteria: >30U/day, >30 on SADQ, PMHX of epilepsy, withdrawal related seizure)
admitted to hosptial

124
Q

what is the acute treatment of alcohol withdrawal? for how long?

A

up to 7 days
Outpt: oral chlordiazepoxide + IV/IM thiamine
Inpt: oral lorazepam + IV/IM thiamine

125
Q

what is the chronic treatment and when do you start it?

A

after 7 days, start only after successful withdrawal

  1. acamprosate/naltrexone
  2. disulfuram
126
Q

why should you not give IV dextrose to heavy drinkers before IV Pabrinex?

A

as glucose can precipiate Wernicke’s

127
Q

what is the bio-psycho-social for chronic management of alcohol withdrawal?

A

Bio: acamprosate, naltrexone, then disulfuram
Psychosocial: AA, SMART recovery, drink diary
1. Motivational interviewing 2. CBT

128
Q

what is the MoA of acamprosate?

A

increase GABA

decrease craving

129
Q

Psychosocial management for chronic treatment

A

AA
SMART recovery
Drink diary

  1. Motivational interviewing
  2. CBT
130
Q

when does heroin withdrawal start, peak and last?

A
  • starts 6 hours after
  • peak at 36-48 hours
  • last 5-7 days
131
Q

S/S of heroin withdrawal

A
  • flu like symptoms
  • D+V
  • lacrimation
  • rhinorrhoea
  • Goose-flesh (pilomotor unit erection)
  • mydriasis (dilation)
132
Q

for how long is heroin in the urine?

A

2 days

133
Q

what is the opiate withdrawal scale?

A

COWS (Clinical Opiate Withdrawal Scale)

134
Q

steps to management of heroin withdrawal?

A
  1. appoint a key worker
  2. harm reduction (needle exchange, vaccination for BBV, naloxone in case of OD)
  3. health education (sleep hygiene, support e.g. SMART recovery, narcotics anonymous)
135
Q

what are the 2 ways of opioid substitution therapy?

A
  1. Maintenance: stabilise lifestyle and reduce harm (methadone, buprenorphine)
  2. Detoxification detox and abstinence (12 weeks outpt)
136
Q

what are the different options for detox?

A
  1. Methadone or buprenorphine

2. Lofexidine (alpha 2 agonist): rapid detox, mild dependence, preference

137
Q

follow up for heroin withdrawal

A

drugs and alcohol service for at least 6 months

CBT to reduce change of relapse

138
Q

what is the active ingredient in cannabis

A

delta-9-tetrahydrocannabinol

139
Q

for how long is cannabis in the urine?

A

up tp 4 weeks

140
Q

what are the acute complications of cannabis?

A

paranoia
panic attacks
psychosis/ schizophrenia

141
Q

what are the chronic complications of cannabis use?

A

dysthmia
anxiety/depressive illness
amotivational syndrome

142
Q

complications of spice use

A 
psychosis
confusion
aggressive behaviour
collapse
vomiting
143
Q

side effects of phencyclidine use

A

violent outburst

ongoing psychosis

144
Q

effects of ketamine in small and large doses

A 
small = dissociation
large = hallucinations, synaesthesia
145
Q

stimulant drugs (e.g. cocaine, amphetamine, ectasy) SEs

A
  • anxiety disorders
  • panic disorders
  • drug induced psychosis
146
Q

side effects of chronic cocaine use

A
  • nasal septum necrosis
  • foetal damage
  • panic and anxiety
  • delusions
  • psychosis
  • Cocaine-induced delusional disorder
147
Q

side effects of amphetamine use?

A
  • post-use depression

- quasi-psychotic state with visual/auditory/tactile hallucinations

148
Q

what is ectasy death associated with?

A

dehydration and hyperthermia

149
Q

what are the 2 stages to cocaine withdrawal?

A
  1. crash phase (from 3 hours): depression, exhaustion, agitation, irritability
  2. withdrawal: cravings, irritability, anergia, poor concentration, insomnia, slowed movements
150
Q

when does a BDZ withdrawal begin?

A

few days to 3 weeks depending on half life

151
Q

symptoms of BDZ withdrawal

A
  • insomnia
  • tachypnoea
  • tremor
  • ANXIETY
  • palpitations
  • risk of seizures and psychosis
  • delusions
  • depression
  • irritability
152
Q

what are the symptoms of a sudden withdrawal from BDZ?

A

delirium tremens like picture

153
Q

what is the management of BDZ dependence?

A
  1. address underlying need for BDZ
  2. address long term complications
  3. check willingness to withdraw (can it be done in primary care?)
  4. assess driving risk
  5. advice may take 3m to 1 year
154
Q

what is the management of stopping smoking?

A
  1. verbal and written into on risks/benefits (first 3-4 days are the hardest)
  2. medications: NRT, Varenicline, Buproprion
155
Q

what is important to remember Varenicline and Buproprion?

A
  • Varenicline (partial nicotine receptor agonist, start 7-14 day before stopping)
  • Buproprion (selective DA+NA reuptake inhibitor, start 7-14 days before stopping)
156
Q

3 types of weird personality

A

paranoid
schizoid
schizotypa;

157
Q

4 types of wild personality

A

dissocial
EUPD
histrionic
narcissistic

158
Q

3 types of worried personality

A

anakastic
anxious-avoidant
dependent

159
Q

ICD-10 personality disorder criteria

A

REPORT
Relationships affected
Enduring
Pervasive (occurs in all/most areas of life)
Onset in childhood/adolescence
Results in distress
Trouble in occupational/social performance

160
Q

paranoid PD

A
  • sensitive
  • unforgiving
  • suspicious
  • possessive
  • conspiracy theories
  • excessive self importance
161
Q

histrionic PD

A
  • attention seeking
  • concerned with appearance
  • theatrical
  • shallow affect
  • racy and seductive
162
Q

EUPD

A
  • affective instability
  • explosive behaviour
  • impulsive
  • outbursts of anger
  • unable to plan
163
Q

dissocial PD

A
  • forms but cannot maintain relationship
  • irresponsible
  • guiltless
  • heartless
  • temper easily lost
  • someone else’s fault
164
Q

anxious PD

A

worried about fear/rejection

165
Q

dependent PD

A
  • subordinate
  • undemanding
  • fears abandonment
  • feels helpless when alone
  • reassurance needed
  • encourages others to make decisions
166
Q

what is reaction formation?

A

immature ego defence where one suppresses unacceptable emotions and replaces them with the exact opposite

167
Q

what is identification

A

someone models the behaviour of someone else

168
Q

what is PDQ-4?

A

personality diagnostic questionnaire

169
Q

what psych management do you use in anti-social PD?

A

CBT

focus on interaction between thoughts, feelings, behaviours

170
Q

what is CAT (Cognitive Analytical Therapy)?

A

focus on specific issues to describe, understand their origin
develop methods to change ideas surrounding specific problem

171
Q

what is the most common ED?

A

binge eating disorder

172
Q

what levels are high in anorexia?

A

“Gs and Cs”

  • cortisol
  • cholesterol
  • carotenaemia
  • glands (salivary)
  • LFTs
173
Q

what tests in AN?

A
  • squat test
  • ECG (long-QT in BN)
  • DEXA
174
Q

when do you admit in AN?

A

BMI <13
WL > 1kg/week
HR < 40bpm + long QT
suicide risk

175
Q

ICD-10 AN definition

A
  • BMI <17.5
  • deliberate weight loss
  • fear of the fat
176
Q

when do you refer in AN?

A

no watchful waiting

refer immediately

177
Q

what AN guidelines are used in A&E?

A

MARSIPAN

178
Q

what is the psych management for AN?

A
  • CBT-ED (1-2-1, 40 weekly sessions)
  • MANTRA (20 sessions, focus on cause of anorexia)
  • SSCM (explore problems and future)
  • Family therapy if child
179
Q

what can a low phosphate cause?

A

hypophosphatemic HF

180
Q

what screening questionnaire can be used in AN and BN?

A

SCOFF

181
Q

when do you need to make an urgent referral to CEDS in BN?

A
  • daily purging
  • significant electrolyte imbalance
  • comorbidity
182
Q

what is the management of BN?

A
  1. guided self help programme (BN-focused)

2. CBT-ED (if 1st line ineffective for 4 weeks)

183
Q

what is dissociative disorder?

A

disorders of physical functions under voluntary control and loss of sensation

184
Q

what is somatisation disorder?

A

disorders involving pain and autonomically controlled sensations

185
Q

management of dissociative (conversion) disorder?

A

supportive therapy

  • encourage return to normal activity
  • avoid reinforcing behavior
  • address physical stressors
186
Q

what is somatisation?

A

multiple recurrent and frequently changing physical symptoms

>2 years duration

187
Q

subtypes of somatisation

A
  1. undifferentiated
  2. hypochondrial disorder
  3. somatoform autonomic dysfunction
  4. persistent somatoform pain disorder
188
Q

what is somatoform autonomic dysfunction?

A

symptoms presented as if due to physical disorder under control of ANS (cardio/resp/GI)
e.g. palpitations/ tremor, fleeting aches/pains, bloating

189
Q

management of somatisation

A

explain and reassure
1. broaden clinical agenda from physical to physical AND psychological
2. be clear about NEGATIVE clinical findings and link symptoms to psych cause
3. explain no further investigations
4. emotional support and coping strategies
5. encourage normal function
then CBT

190
Q

what is BPSD?

A

Behaviour and Psychological Symptoms of Dementia

  1. mood changes
  2. abnormal behaviour
  3. hallucinations/delusions
191
Q

what are the different cognitive assessments?

A
  • screening: AMTS, GPCOG

- detailed: Addenbrooke’s (ACE-R), MMSE, MoCA

192
Q

what is included in the dementia/delirium screen?

A
  • TFTs (hypothyroid = cognitive decline)
  • LFTs (Korsakoff’s)
  • U+Es, dipstick (infection, diabetes)
  • HbA1c
  • Vit B12 and folate
  • Calcium
193
Q

what scan is important in Lewy Body Dementia?

A

DaT Scan

194
Q

what questions in the AMTS assess orientation in TIME?

A
  1. what is the time to the nearest hour?
  2. what year are we in?
  3. How old are you?
    (state address)
195
Q

what question in AMTS test orientation in SPACE?

A
  1. Where are you now?
196
Q

what question in AMTS assess orientation in PERSON?

A

name 2 people here

197
Q

what questions in AMTS assess long-term MEMORY?

A
  1. What is your DoB?
  2. When did WW2 end?
  3. Who is our current prime minister?
198
Q

what are the last 2 questions in AMTS that assess short term memory?

A
  1. Count backwards from 20-1

10. Recall the address I told you

199
Q

what does the PrP immunostain detect?

A

CJD (Creutzfeldt-Jakob Disease)

200
Q

management suggestions for depression in the eldery

A
  • problem-solving, increasing socialisation, day-time activities
  • psychological therapies (e.g. CBT, group therapy, family therapy, couple therapy)
  • Age UK
201
Q

what are the 3 Alzheimer’s pathophysiology theories?

A
  • amyloid
  • tau
  • inflammation
202
Q

what is the amyloid theory?

A
  1. APP cleaved by beta-secretase
  2. sAPPbeta released, C99 fragment remains
  3. C99 digested by gamma-secretase, releases beta-amyloid protein
  4. alpha-beta protein forms toxic aggregates
203
Q

what is the tau theory?

A
  1. hyperphosphorylated tau is insoluble = self aggregates
  2. self aggregates form neurofibrillary tangles
  3. tangles = mictotubule instability and neurotoxic damage to neurones
204
Q

what is the inflammation theory?

A
  1. increase inflammatory mediators and cytotoxic proteins
  2. increase phagocytosis
  3. decreased levels of neuroprotective proteins
205
Q

what are the genetics for familial/early onset AD?

A
  • presenilin 1 gene (Chr 14)

- preseniln 2 gene (Chr 1)

206
Q

with what syndrome is dementia caused by beta-amyloid precursor protein (APP) gene on Chr 21 associated with?

A

Down Syndrome

207
Q

the signs and symptoms of Alzheimer’s are due to which 4 key elements of the pathophysiology?

A
  1. Plaque formation (beta amyloid, triggers inflammation, damage to blood vessels)
  2. Neurofibrillary tangle formation (severity of AD most closely associated with number of NFTs in neocortex)
  3. Cortical atrophy follows from neuronal loss
  4. Cholinergic loss
208
Q

what are the 4 A’s of Alzheimers?

A

Amnesia
Aphasia (speech muddled)
Agnosia (visual)
Apraxia (dressing)

209
Q

how can you explain AD to a patient

A

AD causes dementia which describes a set of symptoms including memory loss and difficulties with thinking, problem-solving or language
AD is a physical disease that affects the brain

210
Q

what are the absolute contraindications to anticholinesterases?

A
  • anticholinergics
  • beta blockers
  • NSAIDs
  • muscle relaxants
211
Q

medical treatment to help in vascular dementia

A

aspirin

212
Q

Psych treatment in dementia

A
  • structural group cognitive stimulation sessions
  • reminiscence therapy
  • multisensory therapy
213
Q

what are lewy bodies?

A

abnormal eosinophilic, intracytoplasmic neuronal structures composed of alpha-synuclein with ubiquitin

214
Q

differences between PD and DLB

A

PD: Lewy bodies in brainstem, parkinsonian symptoms first
DLB: Lewy bodies in brainstem, angulate gyrus, neocortex, dementia symptoms first

215
Q

symptoms of LBD, what medication to not offer?

A
  • fluctuating confusion
  • vivid visual hallucinations
  • Parkinsonism
  • do not offer antipsychotics
216
Q

3 clinical presentations of FTD

A
  1. Frontotemporal dementia: frontal lobe syndrome
  2. Semantic depression: progressive loss of understanding of verbal and visual meaning
  3. Progressive non-fluent aphasia (1st naming difficulties, 2nd mutism)
217
Q

what are the 2 pathologies in FTD

A
  1. Tau +ve: Pick’s bodies (hyperphosphorylated Tau)

2. Tau -ve: no tau = FTLD with ubiquinated inclusions

218
Q

what is the psych treatment in FTD?

A

same as AD

OT, SALT, physio

219
Q

what are the Huntington’s disease S/S?

A
  • movement: chorea, speech/swallowing, stumbling/clumsiness
  • cognitive: organizing tasks, flexibility, impulse control, difficulty concentrating
  • psych: depression, irritability, mood swings, personality change
220
Q

what is chorea?

A

involuntary jerking or fidgety movements that tend to follow from one area to another

221
Q

what gene is implicated in Huntington’s?

A

HTT gene

222
Q

what should you do when managing a conduct disorder?

A

pay attention to “protective” or “resilience” factors

e.g. time spent together as family, regular exercise, regular sleep

223
Q

features of ADHD

A

impaired attention
overactivity
impulsivity

224
Q

rating scale in ADHD

A

Conner’s Comprehensive Behaviour Rating Scale

225
Q

management of ADHD

A
  1. watch and wait for 10 weeks
  2. group based ADHD focused parent training programme
  3. refer to speciality
226
Q

monitoring in ADHD

A
  • height, weight, BP, HR
  • response with symptom rating scale
  • assess if development of tics from stimulant meds
227
Q

ASD associations

A
  • Fragile X syndrome
  • Tuberous Sclerosis
  • Neurofibromatosis
  • Di George
228
Q

ASD trio of symptoms

A

impairment in:

  1. verbal and non-verbal communication
  2. reciprocal social interaction
  3. restrictive and repetitive behaviors
229
Q

ways to assess ASD

A

ADI-R
ADOS
Childhood Autism Rating Scale (CARS)

230
Q

management of ASD

A

MDT

  1. psychosocial play based intervention
  2. applied behavioural analysis (focus on improving speech behaviours)
  3. reduce impairment in communication (consider visual aids)
  4. reduce reinforcement of behaviour
231
Q

when are pharmacological treatments indicated in ASD?

A

used if behaviours making psychosocial training ineffective

e.g. anti-psychotics

232
Q

what is it called when there are symptoms of conduct disorder are present before age of 10?

A

oppositional defiant disorder

233
Q

management of conduct disorder

A
  1. parent management training programme

2. child interventions (problem solving, anger management)

234
Q

Learning difficulty definition

A
  • IQ < 70
  • impaired social/ adaptive functioning
  • onset in childhood
235
Q

what is an important physical sign of LD?

A

have a poor sleep wake cycle

Tx: melatonin

236
Q

what is a mild IQ?

A

50-70

237
Q

at is a moderate IQ?

A

35-50

238
Q

what is a severe IQ?

A

20-35

239
Q

what is a profound IQ score?

A

<20

240
Q

what is a way to remember these?

A

20,15,15,20

241
Q

investigations in LD

A 
WAIS III or IQ
ABAS II (assess adaptive and social functioning)
242
Q

what is the management of LD?

A

Biopyschosocial

  • general helo: communication aid, scheduling board, health promotion
  • meds: tx comorbid problems, melatonin
  • Pysch: CBT, family therapy, art therapy
  • Social: support groups, alternative communication strategies
243
Q

what can be used in severe cases of post-partum psychosis?

A

ECT

244
Q

what is the post-partum depression aetiology?

A

falling levels of oestrogen, progesterone and cortisol post natally

Cross reference - year 5 (22 decks)

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