PSYCHIATRY 2 Flashcards
(245 cards)
1
Q
What is anxiety?
A
An unpleasant emotional state involving subjective fear, bodily discomfort and physical symptoms, often a feeling of impending threat or doom
2
Q
What is the Yerkes-Dodson curve?
A
Anxiety can be beneficial to a certain point of optimal function, then performance declines with further anxiety
3
Q
What groups of people is anxiety more common in?
A
Young adults
Middle age
Women
4
Q
Causes of anxiety? (5)
A
Low levels of GABA neurotransmitter Stress in early life - separation, conformity Alcohol/benzodiazepines Genetics - 1st degree relatives Life stress/physical illness
5
Q
How does stress in early life cause anxiety?
A
Stress/separation leads to remodelling of the frontal cortex and amygdala, altering behavioural response as adults
6
Q
What is generalised anxiety disorder?
A
Generalised, persistent, excessive anxiety or worry about a number of events that the person finds difficult to control lasting over 3 weeks
7
Q
Symptoms of generalised anxiety disorder? (5)
A
Apprehension and fear Increased vigilance and restlessness Sleeping difficulty, fatigue on waking Motor tension, tremor Autonomic hyperactivity - tachycardia
8
Q
Treatment of generalised anxiety disorder? (5)
A
CBT, group therapy, applied relaxation SSRIs or SNRIs 2nd line pregabalin Short term benzodiazepines Beta blockers propanolol for tachycardia
9
Q
What is a phobia?
A
Extreme irrational fear or aversion to something
10
Q
What is agoraphobia?
A
Fear and avoidance of places or situations from which escape may be difficult, or help may not be available, often with panic disorder
11
Q
Give 3 examples of places agorophobes would avoid
A
Crowds
Public places
Travelling alone or away from home
12
Q
Treatment of agorophobia? (2)
A
CBT with graded exposure to situations
SSRIs
13
Q
What is social phobia? (2)
A
Persistent fear of social situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others
Fear they will be humiliated or embarrassed
14
Q
Treatment of social phobia? (3)
A
CBT
Self help, graded self exposure, social skills training
SSRIs 2nd line
15
Q
What are specific phobias?
A
Fear of specific people, objects or situations
16
Q
Treatment of specific phobias? (2)
A
Graded exposure and response prevention
Short term benzodiazepines i.e. for flying
17
Q
What is panic disorder?
A
Recurrent episodic severe panic attacks which occur unpredictably and are not restricted to any particular situation
18
Q
What is a panic attack?
A
Discrete periods of intense feat, impending doom or discomfort accompanied by symptoms
19
Q
Symptoms of a panic attack? (9)
A
Palpitations/tachycardia Sweating, trembling, breathlessness Feeling of choking Chest pain or discomfort Nausea/abdominal discomfort Dizziness, paraesthesia Chills and hot flushed Derealisation or depersonalisation Fear of losing control, dying
20
Q
How long do panic attacks last?
A
A few minutes but anticipatory fear may develop and maladaptive behavioural changes - i.e. refusal to leave the house or be alone
21
Q
What is the cognitive model of panic attacks?
A
Panic attacks occur when catastrophic misinterpretations of ambiguous physical sensations creates a positive feedback loop leading to panic
22
Q
Treatment of panic disorder? (3)
A
CBT and SSRIs
2nd line tricyclic antidepressants
23
Q
What is PTSD?
A
Post traumatic stress disorder - prolonged abnormal response to a severely stressful experience of an exceptionally threatening or catastrophic nature, usually within 6 month of event
24
Q
Types of severe psychological stress? (5)
A
Threat - war, terrorism Disasters Assault Accidents Loss
25
Normal reaction to psychological stress?
Fear, sadness, fatigue, denial, avoidance
26
What is abnormal stress reaction?
Exaggerated or maladaptive responses
27
Symptoms of PTSD? (9)
```
Persistent intrusive thinking or re-experiencing of trauma - memories, nightmares, flashbacks
Avoidance of reminders of the event
Numbing and detachment from others
Loss of interest in activities
Sense of shortened future
Increased arousal
Hypervigilance, easy to startle
Poor concentration
Sleep disturbance
```
28
Common comorbid conditions with PTSD? (2)
Depression, substance misuse
29
What increases risk of PTSD? (3)
Magnitude of stress
Lack of support
Other life events occurring
30
Treatment of PTSD? (3)
Trauma focussed CBT
Eye movement desensitisation and reprocessing therapy (EMDR)
2nd line antidepressants
31
What are obsessions?
Unwelcome, persistent, intrusive senseless thought that the patient recognises are from their own mind and tried to suppress them
32
Types of obsessions? (5)
```
Thoughts - numbers, contamination
Images
Impulses
Ruminations - constant pondering
Doubts
```
33
What are compulsions?
Repetitive, purposeful physical or mental behaviours performed with reluctance in response to an obsession, carried out by certain rules to try and neutralise discomfort - but often excessive and not realistically related to obsession
34
Examples of compulsions? (5)
```
Hand washing
Counting, checking
Rearranging objects
Hoarding
Folie du pourquoi - seeking explanations for everything
```
35
What is OCD?
Obsessive compulsive disorder - characterised by time consuming (>1 hr a day) obsessions and/or compulsions most days for 2 weeks interfering with activities e.g. avoidance of triggers
36
Subtypes of OCD? (4)
Obsessions and compulsions related to contamination
Checking compulsions
Obsessions without overt compulsions
Hoarding
37
Causes of OCD? (4)
Genetics - OCD, tics, Tourette's
Parental overprotection
Serotonin abnormalities
Abnormalities of cortico-striatothalamic circuit mediating social behaviour
38
What does brain MRI show in OCD?
Functional abnormalities of the frontal cortex and basal ganglia
39
How is compulsive behaviour maintained?
Anxiety reduction after performing the compulsion
40
Treatment of OCD? (4)
Psychoeducation, CBT involving exposure and response prevention
SSRIs
Tricyclic antidepressants
Possible psychosurgery - deep brain stimulation
41
What is adjustment disorder?
Abnormal psychological responses to life adversity e.g. job loss, moving, divorce which usually occurs within weeks of the event but does not last more than 6 months if the stressor does not persist
42
Presentation of adjustment disorder? (2)
Anxiety - autonomic symptoms, insomnia, irritable
| Depression - sad, teary, worried
43
How is adjustment disorder diagnosed?
Insufficient symptoms of specific anxiety or depressive disorder
Identified stressor
44
Treatment of adjustment disorder?
Usually resolves after cause passes
| CBT and problem solving strategies, therapy
45
What are the 5 stages of grief?
Denial, anger, bargaining, sadness, acceptance
46
What is somatisation disorder?
At least 2 years of multiple physical symptoms with no physical explanation, and patient refusal to accept conclusion that there is nothing wrong
Affects social and relationship functioning
47
Most common complaints in somatisation disorder?
Skin, GI
48
Most common group of people in somatisation disorder?
Women under 30
49
Cause of somatisation disorder?
Healthy anxiety causing misinterpretation of normal body sensations or mild discomfort as illness
50
Treatment of somatisation disorder?
Patient wants a diagnosis - rule out any illness
| CBT
51
What is hypochondriacal disorder?
Non-delusional preoccupation with possibility of a serious illness (cancer, HIV) despite medical reassurance
52
Most common 2 groups of people in hypochondriacal disorder?
Men
| Health workers
53
Treatment of hypochondriacal disorder?
Patient wants the all clear or fears confirmed to access treatment - rule out illness
CBT
54
What is conversion (dissociative) disorder?
Physical (mostly neurological) symptoms/signs occurring in the absence of pathology and with a clear relationship with a stressor
55
Types of dissociative disorder? (4)
Dissociative motor/sensory deficits - limb weakness, blind
Dissociative convulsions - nonepileptic seizures
Dissociative amnesia
Dissociative fugue - amnesia, planned journey away
56
Theory of dissociative disorder?
Painful thoughts or feelings are cut off from the conscious self and converted into more bearable physical symptoms
57
Treatment of dissociative disorder?
Rule out organic cause, treat any mood disorder
| Therapy - identify secondary gain i.e. wanting sympathy
58
Difference between somatisation and dissociative disorders?
Dissociative disorders often present with actual physical signs rather than vague symptoms
59
What is persistent somatoform pain disorder?
Somatoform disorder where pain is the predominant symptom, cannot be attributed to a physical cause and created significant distress or impairment
60
Cause of somatoform pain disorder? (3)
Stress i.e. abuse
Learned theory - children ay imitate family for gain
Unconscious conflicts converted to pain to help cope
61
Treatment of somatoform pain disorder? (4)
Rule out organic cause
CBT
Possible pain medication
Treat concurrent anxiety or depression
62
What are personality disorders?
Deeply ingrained and enduring patterns of behaviour that are abnormal in a particular culture, leading to subjective stress and potentially distress of others
63
When do personality disorders usually start?
Childhood or adolescence
64
What causes personality disorders?
Genetics
Adverse intrauterine/perinatal factors causing abnormal cerebral maturation
Childhood sexual abuse
Poor parenting/adverse childhood environment
65
What is the cognitive theory of PDs?
People with PDs developed ways of coping with early life adversity that manifest as maladaptive traits later in life
66
What is the psychodynamic theory of PDs?
PDs result from insecure attachment in childhood and thus in adult relationships
67
General treatment of PDs? (5)
```
Need boundaries and consistency
Housing and social help
Treat other psych illness and substance misuse
Short term sedatives in crisis
Mood stabilisers if impulsive
```
68
What are cluster A personality disorders?
Odd/eccentric
| Paranoid, schizoid, schizotypal
69
What are cluster B personality disorders?
Flamboyant/dramatic
| Emotionally unstable, histrionic, antisocial
70
What are cluster C personality disorders?
Fearful/anxious
| Anxious/avoidant, dependent, anankastic
71
Symptoms of paranoid personality disorder? (5)
Cold affect
Distrust and suspicion
Preoccupied by mistrust of friends/family
Hypersensitive to negativity and rejection
Grandiose sense of personal rights
May progress to psychosis
72
Symptoms of schizoid personality disorder? (6)
```
Social withdrawal
Restricted range of emotional expression
Restricted pleasure
Lacking trusted friends, isolated
Indifferent to praise or criticism
Aloof and insensitive to cultural norms
No increased risk of schizophrenia
```
73
Symptoms of schizotypal personality disorder? (6)
Pervasive social and interpersonal deficits
Ideas of reference
Magical thinking
Unusual perception - bodily illusions
Vague, circumstantial, tangential thinking
Inappropriate affect
May progress to psychosis
74
Symptoms of antisocial personality disorder? (6)
```
Disregard of rights or safety for others
Gross irresponsibility
Low threshold for frustration and aggression
Incapacity for feeling guilt
Deceitful and scapegoating
Impulsive
```
75
How is antisocial personality disorder prevented and treated?
Prevention - target children with conduct disorder and educate parents
Group CBT
76
Symptoms of emotionally unstable personality disorder? (6)
Unstable and intense interpersonal relationships
Self damaging impulsivity - spending, sex, driving
Identity confusion, low self esteem
Chronic anhedonia
Recurrent self harm, suicidal behaviour
Effort to avoid real or imagined abandonment
77
Types of emotionally unstable personality disorder?
Impulsive
| Borderline
78
Symptoms of impulsive emotionally unstable personality disorder? (5)
```
Act unexpectedly without consequence
Conflict seeking
Angry outbursts
Unstable mood
Difficulty maintaining actions without immediate reward
```
79
Symptoms of borderline emotionally unstable personality disorder? (5)
```
Uncertainty of self image or aims
Unstable relationships leading to crises
Effort to avoid abandonment
Self harm
Feeling empty
Strongly linked to childhood sexual abuse
```
80
Treatment of emotionally unstable personality disorder? (3)
Dialectical behaviour therapy, CBT
Continuity of care
Treat depression or anxiety
Can predispose to bipolar
81
Symptoms of histrionic personality disorder? (5)
Excessive shallow emotions, shallow/labile affect
Attention seeking and suggestibility
Inappropriate sexual seductiveness with immaturity
Narcissistic, grandiose
Exploitative actions
82
Symptoms of anxious/avoidant personality disorder? (4)
Feelings of tension and inadequacy
Social inhibitions
Unwilling to be involved with people unless certain of being liked
Restricted lifestyle to maintain physical security
83
Symptoms of dependent personality disorder? (6)
Need to be taken care of, submissive
Fear of separation, needs close relationships
Low self esteem, compliant with others
Needs excessive guidance to make decisions
Needs others to assume responsibility
Unwilling to make demands or express disagreement
84
Symptoms of anankastic personality disorder? (6)
Excessive doubt, caution, rigidity
Preoccupied with details, lists, order
Perfectionism interfering with task completion
Excessive conscientiousness
Productivity excludes pleasure and relationships
Pedantic, adheres to social norms
85
Difference between anankastic personality disorder and OCD?
Can progress to OCD (or depression)
In anankastic personality disorder, obsessional thoughts or impulses are not resisted - they don't realise it's a problem as with OCD who know the thoughts are a product of their own mind
86
What is anorexia nervosa?
Morbid fear of fatness with a distorted body image, and deliberate weight loss (BMI <17.5)
Restricted eating, compulsive over exercising
87
When does anorexia nervosa commonly start?
Between 13-20, women
88
Cause of anorexia nervosa? (7)
```
Genetics - first degree relatives
Anxious, obsessive personality
Altered serotonin function
Childhood abuse
Overcontrolling environment
Media overvaluing body image
Troubled relationships
```
89
How does altered serotonin function predispose to anorexia?
Dysregulation of appetite and mood
90
Psychological symptoms of anorexia nervosa? (5)
```
Constricted affect
Reduced emotional responsiveness
Preoccupied by food
Self conscious about eating in public
Isolated
```
91
Physical symptoms of anorexia nervosa? (4)
Amenorrhoea
Loss of sexual potency in men
Constipation
Cold intolerance
92
Physical signs of anorexia nervosa? (8)
```
Emaciation
Dry/yellow skin
Lanugo hair
Bradycardia
Hypotension
Russell's sign - scarring back of hand from vomiting
Pitted teeth
Parotid swelling
```
93
Signs from blood tests in anorexia nervosa? (4)
Anaemia
Leucopaenia
Hypokalaemia
Alkalosis
94
Treatment of anorexia nervosa? (3)
Family intervention 1st if teenager
If adult CBT, IPT, family therapy
NG feeding under MHA
95
When do you have to admit anorexics to hospital? (4)
BMI <12.5
Arrhythmia
Hypoglycaemia
Suicide risk
96
Complications of anorexia nervosa? (3)
Refuse treatment as they value being thin
Osteoporosis
Suicide
97
Prognosis of anorexia nervosa?
75% recover or improve, 20% chronic disorder, 5% die
98
What is bulimia nervosa?
Morbid fear of fatness, craving for food and binge eating, recurrent behaviour to prevent weight gain i.e. vomiting or laxatives
99
Symptoms of bulimia nervosa? (4)
Normal or excessive weight often fluctuating
Loss of control during binging
Self loathing, depression
Other impulses - self harm
100
Signs of bulimia nervosa? (3)
Amenorrhoea despite normal weight
Hypokalaemia
Signs of vomiting - Russell's, pitted teeth
101
Management of bulimia nervosa? (3)
CBT or IPT
Fluoxetine if depression
Medically stabilise if hypokalaemia is severe
102
What are psychosexual disorders?
Sexual difficulties with psychological origins rather than physical origins
103
Types of psychosexual dysfunction in males? (2)
Erectile failure
| Ejaculatory failure
104
Types of psychosexual dysfunction in females? (4)
Low sexual interest or pleasure
Vaginismus
Dyspareunia
Orgasmic dysfunction
105
Causes of psychosexual dysfunction? (8)
```
Stress
Past sexual abuse
Poor relationship with partner
Physical conditions - MS, diabetes, hypothyroid
Poor adjustment i.e. after mastectomy
Depression or anxiety
Substance misuse
Medications - beta blockers, diuretics, antipsychotics, antidepressants, benzodiazepines
```
106
Management of psychosexual dysfunction? (7)
```
Treat underlying cause
Sildenafil for erectile dysfunction
Low dose antidepressants for premature ejactulation
Mechanical penile pumps
CBT
Sex education
Couples therapy
```
107
How are disorders of sexual preference classified?
Variations in the sexual object or of the sexual act
108
Examples of variations of the sexual object? (3)
Paedophilia
Fetishism - inanimate object
Transvetism
109
Examples of variations of the sexual act? (2)
Exhibitionism
| Voyeurism
110
Management of variations of the sexual object?
Behaviour therapy
| Antiandrogens for men
111
What is exhibitionism? What are the types?
Indecent exposure
Genital exposure accompanied by excitement and arousal
Either those of aggressive temperament where act involves masturbation or inhibited temperament where penis is flaccid
112
Treatment of variations of the sexual act? (3)
Psychodynamic therapy
Behavioural therapy
Hormonal treatment i.e. antiandrogens
113
What is disorder of sexual identity?
Belief that sex assigned inappropriately, strong wish to be of other sex - more common in men
114
Features of disorders of sexual identity?
Commonly disappears as get older
| Do not regard themselves as homosexual
115
Treatment of disorders of sexual identity? (2)
Gender reassignment surgery and hormones - after 2 years living as other gender
Psychotherapy
116
What is Munchausen's syndrome?
Factitious disorder - deliberately feigned symptoms, usually physical but sometimes psychiatric, results in multiple presentations and sometimes surgery
117
Features of Munchausen's syndrome? (2)
Patients often use different aliases and have no fixed home
| Characteristically occurs in severe PDs
118
Treatment of Munchausen's syndrome? (2)
Confrontation without rejection
| CBT
119
What is Munchausen's by proxy?
When the parent or guardian fakes illnesses in the child or dependent - form of abuse
120
Possible reasons for Munchausen's and Munchausen's by proxy? (2)
Gain attention, sympathy, reassurance
| Financial benefits
121
Name 5 sleep-wake disorders
```
Insomnia
Hypersomnolence
Narcolepsy
Restless legs
Substance use
```
122
How common is night time wakefulness in children?
20%
123
What causes sleep disorders?
Misalignment of the circadian rhythm system and external environment
Social/behavioural factors can perpetuate
124
What is primary insomnia?
Sleeplessness not attributable to medical, psychiatric or environmental cause
125
How is primary insomnia diagnosed? (4)
Difficulty initiating or maintaining sleep or suffering from non restorative sleep
Clinically significant distress or impairment in daily functioning
Does not occur exclusively during other illness
Not due to other conditions, or drugs
126
Treatment of insomnia? (6)
```
Possibly antihistamines
Melatonin
Benzodiazepines
Sedating low dose antidepressant - trazodone, mirtazepine, amitriptyline
CBT
Relaxation therapy
```
127
What is the difference between learning disability and learning difficulty?
Learning disability - globally reduced intellect (IQ below 70) and difficulty performing everyday tasks
Learning difficulty - specific problems processing certain forms of information e.g. dyslexia, no global reduction in intellect
128
Types of learning disability and their IQ?
Mild 50-70
Moderate 35-49
Severe 20-34
Profound <20
129
What causes learning disability?
Mild - limited social/learning opportunities, genetically low IQ
Moderate/severe/profound - specific biological cause e.g. Down's syndrome
130
Differences in symptoms between severity of learning disability?
Mild may live independently and have a job but not be able to cope with stress and complex social functioning
ranging to
Profound has very limited skills and language, deficits in movement and continence
Epilepsy more common the more severe the disability
131
Define learning disability?
Low intellectual performance, from birth or early childhood, leading to reduced life skills
132
Give a chromosomal, X linked, autosomal dominant and autosomal recessive cause of learning disability
Chromosomal - Down's, Turner's
X linked- Fragile X
AD - Neurofibromatosis
AR - metabolic disorders
133
Give 2 antenatal causes of learning disability?
Infection - rubella, CMV
| Hypoxia
134
Perinatal causes of learning disability? (3)
Prematurity
Hypoxia
Intracerebral bleed
135
Postnatal causes of learning disability? (5)
```
Infection
Injury
Malnutrition
Hormonal
Epileptic
```
136
Name 5 psychiatric conditions increased in people with learning disability?
```
Depression
Anxiety
Behavioural disturbance
Mania
Schizophrenia
```
137
What is Down's syndrome?
Most specific cause of learning disability, trisomy of chromosome 21
Most have moderate-severe LD
138
Complications of Down's syndrome? (5)
```
Alzheimer's
Hypothyroidism
Cardiac septal defects (AVSD)
Duodenal atresia
Leukaemia
```
139
Physical features of Down syndrome child? (6)
```
Broad hands with single palmar crease
Flat occiput
Epicanthal folds
Flat nasal bridge
Small mouth
High arched palate
```
140
Treatment of Down's?
Social and family support
| Capacity legislation for best interests
141
What is fragile x syndrome?
Most common cause of inherited learning disability, mutation of FMR1 gene on X chromosome, affects boys more severely
142
How is fragile x inherited?
X linked dominant
143
How is fragile x related to autism?
Fragile X is the most common identified cause of autism - 1/3 of fragile x have autism
144
Features of fragile x syndrome? (5)
```
Large head and ears
Poor eye contact
Abnormal speech
Hyperesensitivity to touch, auditory, visual stimuli
Head flapping, hand biting
```
145
What is autism spectrum disorder?
Developmental disorders characterised by difficulties in social interaction and communication and by restricted/repetitive thought patterns
146
Symptoms of autism spectrum disorder? (7)
```
Failure to make relationships - aloof, poor empathy
Language and communication difficulties
Resistance to change, ritualistic
Restricted range of interests
Stereotyped behaviour
Hypo/hyperrreactivity
Some have isolated higher skills
```
147
Treatment of autism spectrum disorder? (3)
Intensive behavioural treatments
Reward positive behaviour
Family support
148
What are Aspergers and autism classified as?
Pervasive developmental disorders
149
Features of Asperger's? (4)
Less severe than autism
Later onset
Normal intelligence and language
Schizoid personality - pedantic, preoccupation with obscure facts
150
What is enuresis?
Non organic, involuntary bladder emptying after 5 years of age, during day or night
Primary or secondary (period of previous continence)
151
Causes of enuresis? (4)
Family history
Developmental delay
Unsettling events
Behavioural problems
152
Management of enuresis? (5)
```
Exclude physical cause e.g. UTI
Address fluid intake and toilet patterns
Reward systems
Enuresis alarms activated by moisture
Desmopressin
```
153
What is Tourette's syndrome?
Involuntary facial or vocal tics, mostly males, can be transient or chronic
154
Causes of Tourette's?
Family history of tics/OCD
Learning disability, autism, ADHD
Smoking/alcohol/cannabis during pregnancy
Possible imbalance of neurotransmitters
155
Name 6 types of tic
```
Coprolalia - swearing
Copropraxia - rude signs
Echolalia/echopraxia
Palilalia - repeating self
Self injury
Non obscene socially inappropriate behaviours
```
156
Treatment of Tourette's? (3)
Psychoeducation
Behavioural therapy - habit reversal, comprehensive behavioural intervention for tics (CBIT)
Possible antipsychotics
157
How is attention-deficit hyperactivity disorder diagnosed? (4)
>6 months of short attention span
Distractibility
Overactivity
Impulsivity
158
What causes ADHD? (5)
```
Genetics
Social adversity
Parental alcohol abuse
Diet - lead
Tranquilliser exposure
```
159
What does ADHD commonly exist with? (5)
```
Conduct disorder
Anxiety/depression
Learning difficulty
Antisocial behaviour
Substance misuse
```
160
Treatment of ADHD? (3)
Parent education
Classroom behavioural interventions
Methylphenidate - ritalin
161
What is conduct disorder?
Persistent disruptive, deceptive, aggressive behaviours
162
5 examples of behavioural problems in conduct disorder
```
Disobedience
Truancy
Lying
Arson
Stealing
```
163
Causes of conduct disorder? (6)
```
Low socioeconomic class
Learning difficulty/ADHD
Familial problems such as harsh parenting
Parents with alcohol dependence
Depression
Antisocial PD
```
164
What is socialised and unsocialised conduct disorder?
Socialised - behaviour viewed as normal among peers
| Unsocialised - solitary behaviour, peer rejection
165
Management of conduct disorder? (3)
Parental education
Behavioural management
CBT, social skills therapy
166
What is separation anxiety disorder?
Anxiety disorder in which an individual expresses excessive anxiety regarding separation from home or from people to whom the individual has strong emotional attachment
167
When is separation anxiety most common?
6 months - 3 years
168
Causes of separation anxiety disorder? (4)
Parental psychiatric illness
Early/traumatic separation
Life events - parental divorce/new school/bereavement
Predisposing temperament
169
Management of separation anxiety disorder? (5)
```
Counselling
CBT
Family therapy
Behavioural therapy
SSRIs for anxiety
```
170
What are the top 4 most common illicit drugs used?
Cannabis
Cocaine
Ecstasy
Amphetamines
171
The 7 types of substance use disorders?
```
Acute intoxication
Harmful use
Dependence
Withdrawal state
Psychosis
Amnesia
Residual/late onset
```
172
Signs of dependence? (8)
```
Compulsion to take substance
Aware of harm but persists
Neglect of other activities
Tolerance
Withdrawal on stopping
Increasing time taken up by substance
Out of control use
Persistent futile wish to stop
```
173
Causes of substance misuse? (5)
```
Availability
Peer pressure - young men
Desire for pleasurable effects
Prescription drug use
Psychiatric illness - impulsivity, anxiety, PD
```
174
Why do drugs give a pleasurable effect?
Activate the dopamine system in the mesolimbic reward pathway
175
General management of substance misuse? (6)
```
In community - hospital or rehab if severe
Rewards e.g. for sticking to methadone
CBT
Motivational interviewing
Self help groups
Harm reduction e.g. needle exchange
```
176
Name 3 opioids
Heroin, methadone, morphine
177
How are opioids taken? (5)
Snorted, smoked, oral, IV, SC
178
Effects of opioids? (3)
Intensely pleasurable rush
Peace and detachment
CNS depression
179
Signs of opioid dependence? (8)
```
Mioisis (constricted pupils)
Tremor
Malaise
Apathy
Constipation
Weakness
Impotence
Neglect/malnutrition
```
180
Risks of opioid use? (4)
HIV
Hepatitis B/C
Respiratory depression
Death (2-3% annually)
181
Why are opioids so addictive?
Tolerance and withdrawal develop quickly
| Short half life of heroin so need more quickly
182
Management of opioid misuse? (4)
Methodone or buprenorphine for detox or maintenance
Harm reduction - needle exchange
Psychosocial support
Overdose - give naloxone
183
Withdrawal symptoms from opioids? (4)
Cravings
Flu like symptoms
Sweating, tachycardia
Abdo cramps, diarrhoea
184
Why is methadone used for opioid addiction?
Less euphoriant
Longer half life
Prevents withdrawal as prescribed at high dose
185
What is the active compound in cannabis?
Tetrahydrocannabinol
186
How is cannabis taken?
Orally, smoked
187
Effects of cannabis? (4)
Euphoria
Relaxation
Increased appetite
Decreased body temperature
188
Adverse effects of cannabis? (5)
```
Conjunctival irritation
Decreased spermatogenesis
Schizophrenia/transient psychosis
Lung disease
Depression, apathy
```
189
Treatment of cannabis?
Community therapy
190
Name 2 stimulants
Cocaine
| Amphetamines
191
How are stimulants taken?
IV, snorted, smoked (crack cocaine)
192
Effects of stimulants? (5)
```
Brief high and euphoria
Increased energy and concentration
Depression and tiredness after use
Possible psychosis
Cocaine - hallucinations of insects, paranoia
```
193
Treatment of stimulants?
Community therapy
194
Name 3 hallucinogens
Ecstasy, LSD, magic mushrooms
195
How are hallucinogens taken?
Orally
196
Effects of hallucinogens?
Stimulant
| Hallucogenic
197
Adverse effects of hallucinogens?
Ecstasy - severe dehydration or hyponatraemia from excessive water
LSD - psychosis, seizures
198
Effects of benzodiazepines? (3)
Dependence common
Seizures when withdrawing
Euphoria, less anxiety, relaxation
199
How do benzodiazepines work?
Increase GABA-inhibitory neurotransmitter
200
How are solvents taken and what effect does this cause?
Sniffed, red rash around mouth and nose
201
Effects of solvents? (4)
Initial euphoria then drowsiness
Weight loss, nausea, vomiting
Cognitive impairment and polyneuropathy
Toxic fatal effects - bronchospasm, arrhythmias
202
What is alcohol misuse?
Regular or binge consumption of alcohol sufficient to cause physical, neuropsychiatric or social damage
203
How to work out alcohol units?
Volume of drink (ml) x ABV%
| /1000
204
Recommendations for alcohol per week?
14 units men and woman, 2 drink free days and no binges (4/5 drinks in 2 hours)
205
Signs of alcohol intoxication? (5)
```
Slurred speech
Impaired coordination and judgment
Labile affect
Hypoglycaemia
Coma
```
206
Signs of alcohol withdrawal? (6)
```
Malaise
Nausea
Autonomic hyperactivity
Tremor
Insomnia
Hallucinations/seizures
```
207
What is delirium tremens? 4 signs
Severe life threatening alcohol withdrawal - rapid confusion, tremor, seizures, arrhythmia
208
Treatment of delirium tremens/acute alcohol withdrawal? (3)
Give benzodiazepines! 1st
Antipsychotics
Rehydrate, correct electrolytes, give thiamine
209
2 screening tests for alcohol
CAGE - tried to cut down, annoyed when asked about alcohol, guilty, eye opener
FAST - frequency of: can't remember night before, failed to function normally, someone else being concerned
210
Physical signs of alcohol misuse? (3)
Jaundice
Spider naevi
Peripheral neuropathy
211
Causes of alcohol misuse? (7)
```
Genetics e.g. different metabolism
Depression or other chronic illness
Occupation - soldiers, doctors
Culture
Availability and cost
Social reinforcement
Environment - learning by copying
```
212
What is classical and operant conditioning?
Classical - drinking associated with pleasure, activates mesolimbic dopaminergic reward pathway
Operant - avoiding withdrawal effects
213
Complications of alcohol misuse? (8)
```
Peripheral neuropathy
Erectile/ejaculatory impotence
Cerebellar degeneration
Dementia
Liver failure
Social complications - jobs, relationships
Wernicke's/Korsakoff's
Depression and suicide
```
214
Symptoms of alcohol related dementia?
Caused by long term use
| Characterised by impaired executive function - planning, thinking, judgment
215
Treatment of alcohol related dementia?
Stop drinking
Replace vitamins (thiamine)
May be permanent
216
How to do acute detoxification of alcohol? (3)
In hospital if risk of seizures/delirium tremens
High dose of benzodiazepines then tapered
Rehydrate, give electrolytes, thiamine
217
Psychological treatment of alcohol dependence? (3)
Motivational interviewing
Self help groups
Individual psychotherapy
218
3 medications to maintain alcohol abstinence and how they work
Disulfiram - blocks alcohol metabolism causing headache, nausea if drink
Acamprosate - acts on GABA to reduce relapse and desire for alcohol
Naltrexone - opioid receptor antagonist and reduces desire for alcohol
219
Prevention of alcohol misuse? (3)
Increase alcohol tax
Restrict advertisement and sale
Educate in schools
220
Symptoms of Wernicke's encephalopathy? (4)
Ataxia
Nystagmus
Opthalmoplegia
Acute confusion
221
What causes Wernicke's encephalopathy?
Thiamine deficiency - inadequate intake, decreased absorption from GI tract, poor utilisation all due to alcohol
Thiamine deficiency causes mamillary body damage
222
Treatment of Wernicke's encephalopathy?
Thiamine
223
What is Korsakoff's psychosis?
Confabulation and profound short term memory loss due to long term drinking - thiamine deficiency
224
Treatment of Korsakoff's psychosis?
Thiamine but unlikely to recover as damage done
225
3 conditions lithium is used in
Bipolar
Mania
Schizoaffective disorder
226
Why is lithium toxicity dangerous?
Lithium interacts with all body systems where sodium, potassium, calcium or magnesium are involved
Probably affects neurotransmitters
227
What is the therapeutic range of lithium?
Narrow - 0.4-1mmol/L
228
What monitoring needs to be done with lithium? (2)
Thyroid and renal (excreted by kidneys)
| Serum lithium levels
229
Side effects of lithium? (6)
```
Nausea
Fine tremor
Weight gain
Oedema
Polydipsia and polyuria
Hypothyroid
```
230
Signs of lithium toxicity? (7)
```
Vomiting and diarrhoea
Coarse tremor
Slurred speech
Ataxia
Drowsy/confused
Seizure
Coma
```
231
Treatment of lithium toxicity? (2)
Stop lithium
| Iv fluids
232
Causes of lithium toxicity? (2)
Dehydration, diuretics
233
What causes serotonin syndrome?
Drugs that increase serotonin availability e.g. SSRIs, more likely 2 in combination
234
Symptoms of serotonin syndrome? (7)
```
Confusion
Delirium
Shivering
Sweating
Hypertension
Seizures
High temperature
```
235
Treatment of serotonin syndrome?
Discontinue medications
Benzodiazepines
Body cooling
Serotonin antagonist - cyproheptadine
236
What is neuroleptic malignant syndrome?
Potentially fatal complication of antipsychotics (usually typical) due to blockage of dopamine receptors
237
Symptoms of neuroleptic malignant syndrome? (5)
```
Hyperpyrexia
Autonomic instability
Confusion
Hypertonia
Raised creatinine phosphatse
```
238
Treatment of NMS? (5)
```
Stop antipsychotic
Body cooling - dontrolene
Hydrate
Benzodiazepines
Bromocriptine - dopamine agonist
```
239
What is acute dystonic reaction?
Side effects of antipsychotics (usually typical) - is a movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting movements, fixed postures
240
Name 4 acute dystonic reactions
Torticollis
Oculogyric crisis
Increased muscle tone
Tardive dyskinesia
241
What is torticollis?
Head rotates to one side, back, to chest
242
What is an oculogyric crisis?
Extreme sustained upward deviation of eyes, often with backward neck flexion and jaw clenching
243
What is tardive dyskinesia?
Grimacing, sticking out tongue, smacking lips
244
Treatment of acute dystonic reactions? (4)
Rehabilitation
Anticholinergics
Anti Parkinsons meds - ropinirole, bromocriptine
Diazepam
245
What is paraphilia?
Paraphilic disorders are recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of oneself or the partner with the potential to cause harm
