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Flashcards in Psychiatry Deck (25):
1

What is generally the disease course of schizophrenia?

Prodromal phase of emotional and behaviour symptoms with transient or subclinical psychotic symptoms
Acute phase with frank positive symptoms
Either recovery or chronic phase, predominated by negative symptoms

2

Name 3 features that are associated with poor prognosis in schizophrenia

Male sex
Long duration or untreated
Low intelligence
Low socioeconomic status
Social isolation
Negative symptoms
Family history
Significant psychiatric history
COntinuing substance misuse

3

Name 3 causes of premature death in schizophrenia

T2DM
Cancer
Suicide
Cardiovascular disease
COPD
Infections eg HIV and TB

4

How is schizophrenia diagnosed?

Need at least 1 of the following for a month:
Auditory or somatic hallucinations
Passivity perception
Delusions
Thought disorder

OR
At least 2 of the following for a month:
Persistent hallucinations
Neologisms
Catatonia
Blunting or incongruity of affact
Mannerisms
Reduced speech
Negative symptoms

5

What are the negative symptoms of schizophrenia?

Blunted affect
Poverty of speech
Withdrawal
Avolition
Anhedonia

6

Give three differential diagnoses for generalised anxiety disorder

Phaeochromocytoma
Hyperthyroidism
Anaemia
Panic disorder
Social anxiety disorder
Adjustment disorder
Substance misuse
Coexistant with depression

7

Give three causes of generalised anxiety disorder

Environmental factors eg unemployment or domestic violence
Genetics
Substance dependence
COgnitive styles of negative thinking
CHronic illness
Neurophysiological responses

8

WHo should be screened for generalised anxiety disorder?

People with chronic pain or chronic disease
People presenting multiple times with symptoms that don't respond to treatment
People with history of substance misuse
People with family history

9

How is generalised anxiety disorder diagnosed?

Excessive, widespread worry present more often than not for at least 6 months or
Difficulty controlling worry/anxiety plus at least three of the following for 6 months:
Tension/restlessness
Irritability
Tendency to become easily fatigued
Reduced concentration or mind going blank
Significant muscle tension
Difficulty sleeping

10

How should generalised anxiety disorder be managed?

Depends on severity, patient preference and impact on functional impairment
Low to high intensity psychological therapy
+/- medical therapy or combination ie SSRI or venlafaxine or pregabalin
If complex or marked impairment or risk of harm then specialist treatment or crisis team involvement

11

How should phobias be managed?

Behavioural therapy with graded exposure
+/- antidepressants and anxiolytics

12

What are the features of panic attacks?

Severe, paroxysmal anxiety
Somatic symptoms
Depersonalisation
Derealisation

13

What is panic disorder?

Recurrent panic attacks over 1 month and associated fear of further attacks

14

Give 3 questions that should be asked of someone with suspected anxiety disorder

What situation, thought or image causes anxiety
What physical symptoms occur
What goes through your mind
What do you do (behaviour)

15

How should an acute stress reaction be managed/

DOn't debrief early
Remove the stressor
Reassure
Support
Consider short course of benzodiazepine

16

What is the typical time frame of an adjustment disorder?

Between 1 and 6 months of the stressful event

17

Give 3 features of an adjustment disorder

Depression
Anxiety
Reduced concentration
Irritability
Preoccupation with the event
Anger

18

What form of psychological therapy may be helpful in adjustment disorder?

Problem-solving therapy

19

Give three features of PTSD

Hypervigilance
Avoidance
Flashbacks
Hyperarousal
Anger
Exaggerated startle response
Numbness and detachment
Poor concentration
May be alcohol misuse and depression

20

How is PTSD managed?

Eye movement desensitisation and reprocessing

21

What is the diagnostic criteria for OCD?

Obsessions and compulsions must be present on most days for at least 2 weeks.
They originate within the patient and are not imposed by other people or outside influences
Repetitive and unpleasant, excessive and unreasonable
Subject tries to resist the o/c
The compulsion is not pleasurable to carry out
THe o/c causes distress or interferes with function

22

How should OCD be managed?

CBT and/or medication
SSRI (not citalopram) or clomipramine
Review regularly

23

What is physical substance dependence?

Adaptive state produced by repeated drug administration with intense physical disruption on cessation

24

What is psychological substance dependence?

Intense drive or craving for a substance. User feels it is necessary for their wellbeing

25

Give 3 risk factors for substance misuse

Birth trauma
Childhood abuse
Parental or sibling death
Impulsive or novelty seeking personality
Parental abandonment
Break up of family
Genetics