Psychiatry Flashcards
(54 cards)
1
Q
What is acute stress disorder?
A
acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event
2
Q
What are the features of acute stress disorder?
A
- intrusive thoughts e.g. flashbacks, nightmares
- dissociation e.g. ‘being in a daze’, time slowing
- negative mood
- avoidance
- arousal e.g. hypervigilance, sleep disturbance
3
Q
What is the management for acute stress disorder?
A
- trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
- benzodiazepines
sometimes used for acute symptoms e.g. agitation, sleep disturbance
should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation
4
Q
What is the pathophysiology of alcohol withdrawal?
A
- chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
- alcohol withdrawal is thought to lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
5
Q
What are the features of alcohol withdrawal?
A
- symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
- peak incidence of seizures at 36 hours
- peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
6
Q
What is the management for alcohol withdrawals?
A
- long-acting benzodiazepines e.g. chlordiazepoxide or diazepam.
- Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
- carbamazepine also effective
7
Q
What are the features of anorexia nervosa?
A
- reduced body mass index
- bradycardia
- hypotension
- enlarged salivary glands
8
Q
What are the physiological findings in anorexia nervosa?
A
- hypokalaemia
- low FSH, LH, oestrogens and testosterone
- raised cortisol and growth hormone
- impaired glucose tolerance
- hypercholesterolaemia
- hypercarotinaemia
- low T3
9
Q
What is the diagnostic criteria for body dysmorphic syndrome?
A
- Preoccupation with an imagine defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive
- The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)
10
Q
What is bulimia nervosa?
A
eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours
11
Q
What are the features of bulimia nervosa?
A
- recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
- a sense of lack of control over eating during the episode
- recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
- occur, on average, at least once a week for three months.
- self-evaluation is unduly influenced by body shape and weight.
- the disturbance does not occur exclusively during episodes of anorexia nervosa.
12
Q
What is the management of bulimia nervosa?
A
- referral for specialist care is appropriate in all cases
- focused guided self-help for adults
- If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, NICE recommend that we consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- children should be offered bulimia-nervosa-focused family therapy (FT-BN)
- pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking
13
Q
What is Charles Bonnet syndrome?
A
- persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness.
- generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis).
- Insight is usually preserved.
- must occur in the absence of any other significant neuropsychiatric disturbance.
14
Q
What are the risk factors for Charles Bonnet syndrome?
A
- Advanced age
- Peripheral visual impairment
- Social isolation
- Sensory deprivation
- Early cognitive impairment
15
Q
What ophthalmologic conditions are associated Charles Bonnet syndrome?
A
age-related macular degeneration glaucoma
cataract.
16
Q
What is Cotard syndrome?
A
rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent.
17
Q
What is De Clerambault’s syndrome?
A
- also known as erotomania
- form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her
18
Q
What is delusional parasitosis?
A
relatively rare condition where a patient has a fixed, false belief (delusion) that they are infested by ‘bugs’ e.g. worms, parasites, mites, bacteria, fungus
19
Q
What factors suggest depression rather than dementia?
A
- short history, rapid onset
- biological symptoms e.g. weight loss, sleep disturbance
- patient worried about poor memory
reluctant to take tests, disappointed with results - mini-mental test score: variable
- global memory loss (dementia characteristically causes recent memory loss)
20
Q
What are the side effects of ECT?
A
Short-term side-effects
- headache
- nausea
- short term memory impairment
- memory loss of events prior to ECT
- cardiac arrhythmia
Long-term side-effects
- some patients report impaired memory
21
Q
What is the only absolute contraindication to ECT?
A
raised intracranial pressure
22
Q
Which medications can trigger anxiety?
A
salbutamol
theophylline
corticosteroids
antidepressants
caffeine
23
Q
What is the management of generalised anxiety disorder?
A
step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment.
step 4: highly specialist input e.g. Multi agency teams
Drug treatment:
- Sertraline 1st line
- If ineffective offer alternative SSRI or SNRI (duloxetine/venlafaxine)
- Pregabalin if cannot tolerate SSRI/SNRI.
24
Q
What is the management of panic disorder?
A
step 1: recognition and diagnosis
step 2: treatment in primary care -
step 3: review and consideration of alternative treatments
step 4: review and referral to specialist mental health services
step 5: care in specialist mental health services
Treatment in primary care:
NICE recommend either cognitive behavioural therapy or drug treatment
- SSRIs are first-line. If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
25
What are the key features of mania?
- Lasts for at least 7 days
- Causes severe functional impairment in social and work setting
- May require hospitalization due to risk of harm to self or others
- May present with psychotic symptoms
26
What are the features of hypomania?
- A lesser version of mania
Lasts for < 7 days, typically 3-4 days.
- Can be high functioning and does not impair functional capacity in social or work setting
- Unlikely to require hospitalization
- Does not exhibit any psychotic symptoms
27
What is Korsakoff's syndrome?
- marked memory disorder often seen in alcoholics
- thiamine deficiency causes damage and haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus
- often follows on from untreated Wernicke's encephalopathy
28
What are the features of Korsakoff's syndrome?
- anterograde amnesia: inability to acquire new memories
- retrograde amnesia
- confabulation
29
What are the adverse effects of Lithium?
- nausea/vomiting, diarrhoea
- fine tremor
- nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
- thyroid enlargement, may lead to hypothyroidism
- ECG: T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
- leucocytosis
- hyperparathyroidism and resultant hypercalcaemia
30
What is obsessive compulsive disorder (OCD)?
- presence of either obsessions or compulsions, but commonly both. The symptoms can cause significant functional impairment and/ or distress.
- obsession is defined as an unwanted intrusive thought, image or urge that repeatedly enters the person's mind
- compulsions are repetitive behaviours or mental acts that the person feels driven to perform.
31
What are the risk factors for OCD?
- family history
- age: peak onset is between 10-20 years
- pregnancy/postnatal period
- history of abuse, bullying, neglect
32
What is the management of OCD?
- Y-BOCS scale to classify into mild/moderate/severe
- Mild:
* low-intensity psychological treatments: cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)
* If insufficient or can't engage in psychological therapy, then offer a choice of either a course of an SSRI or more intensive CBT (including ERP)
- Moderate:
* offer a choice of either a course of an SSRI (any SSRI for OCD but fluoxetine specifically for body dysmorphic disorder) or more intensive CBT (including ERP)
* consider clomipramine (as an alternative first-line drug treatment to an SSRI) if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
- Severe:
* refer to the secondary care mental health team for assessment
* whilst awaiting assessment - offer combined treatment with an SSRI and CBT (including ERP) or consider clomipramine as an alternative as above
33
What is Othello's syndrome?
pathological jealousy where a person is convinced their partner is cheating on them without any real proof. accompanied by socially unacceptable behaviour linked to these claims.
34
What are the key features of personality disorder as per ICD-11?
- Persistent Pattern: The individual's patterns of cognition, emotional experience, behaviour, and interpersonal functioning deviate from cultural expectations. These patterns are stable over time and span across various personal and social situations.
- Impairment: results in significant problems or dysfunctions in the person’s life, especially in relationships, work, or social functioning.
- Duration: These characteristics are stable over time, beginning in adolescence or early adulthood, and are not transient.
- Distress or Dysfunction: The impairment may result in distress to the individual or others. These patterns are not explained by another mental disorder, a medical condition, or substance misuse
35
What are the features of post traumatic stress disorder?
- re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
- avoidance: avoiding people, situations or circumstances resembling or associated with the event
- hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
- emotional numbing - lack of ability to experience feelings, feeling detached
36
What is the management of PTSD?
- watchful waiting may be used for mild symptoms lasting less than 4 weeks
- trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
- drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried
- In severe cases, NICE recommends that risperidone may be used
37
What may be used to screen for depression in the post natal period?
Edinburgh Postnatal Depression Scale
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a 'depressive illness of varying severity'
sensitivity and specificity > 90%
includes a question about self-harm
38
What are the features of 'Baby Blues'?
Seen in around 60-70% of women
Typically seen 3-7 days following birth and is more common in primips
Mothers are characteristically anxious, tearful and irritable
Reassurance and support, the health visitor has a key role
39
What are the features of Postnatal depression?
Affects around 10% of women
Most cases start within a month and typically peaks at 3 months
Features are similar to depression seen in other circumstances
reassurance and support
Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine may be used if symptoms are severe ( can continue to breastfeed)
40
What are the features of puerperal psychosis?
Affects approximately 0.2% of women
Onset usually within the first 2-3 weeks following birth
Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)
Admission to hospital is usually required, ideally in a Mother & Baby Unit
There is around a 25-50% risk of recurrence following future pregnancies
41
What are the risk factors for developing schizophrenia?
- Family hx is strongest risk factor
- Black Caribbean ethnicity - RR 5.4
- Migration - RR 2.9
- Urban environment- RR 2.4
- Cannabis use - RR 1.4
42
What are the features of schizophrenia?
Schneider's 1st rank sx:
- Auditory hallucinations
- Thought disorder
- Passivity phenomena
- Delusional perceptions
Other sx:
- Impaired insight
- Negative sx
- Neologisms
- Catatonia
43
What is the management for Schizophrenia?
1st line = oral atypical antipsychotics
CBT offered to all patients
Reduce cardiovascular risk factors
44
What indicates a poor prognosis in Schizophrenia?
- Strong family hx
- gradual onset
- low IQ
- prodromal phase of social withdrawal
- lack of obvious precipitant
45
What is sleep paralysis?
- transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep
- thought to be related to the paralysis that occurs as a natural part of REM (rapid eye movement) sleep
46
What are the features of sleep paralysis?
- paralysis - this occurs after waking up or shortly before falling asleep
- hallucinations - images or speaking that appear during the paralysis
47
What is the management for sleep paralysis?
clonazepam if troublesome
48
What factors are associated with an increased risk of suicide?
- male sex (hazard ratio (HR) approximately 2.0)
- history of deliberate self-harm (HR 1.7)
- alcohol or drug misuse (HR 1.6)
- history of mental illness
- history of chronic disease
- advancing age
- unemployment or social isolation/living alone
- being unmarried, divorced or widowed
49
What is somatisation disorder?
- multiple physical SYMPTOMS present for at least 2 years
- patient refuses to accept reassurance or negative test results
50
What is hypochondriasis (illness anxiety disorder)?
- persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
- patient again refuses to accept reassurance or negative test results
51
What is Functional neurological disorder?
- Typically involves loss of motor or sensory function
- the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
- patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
52
What is dissociative disorder?
- dissociation is a process of 'separating off' certain memories from normal consciousness
- in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
- dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
53
What is Factitious disorder?
- also known as Munchausen's syndrome
- the intentional production of physical or psychological symptoms
54
