Flashcards in Psychiatry Deck (25):
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
Name 3 features that are associated with poor prognosis in schizophrenia
Long duration or untreated
Low socioeconomic status
Significant psychiatric history
COntinuing substance misuse
Name 3 causes of premature death in schizophrenia
Infections eg HIV and TB
How is schizophrenia diagnosed?
Need at least 1 of the following for a month:
Auditory or somatic hallucinations
At least 2 of the following for a month:
Blunting or incongruity of affact
What are the negative symptoms of schizophrenia?
Poverty of speech
Give three differential diagnoses for generalised anxiety disorder
Social anxiety disorder
Coexistant with depression
Give three causes of generalised anxiety disorder
Environmental factors eg unemployment or domestic violence
COgnitive styles of negative thinking
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
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:
Tendency to become easily fatigued
Reduced concentration or mind going blank
Significant muscle tension
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
How should phobias be managed?
Behavioural therapy with graded exposure
+/- antidepressants and anxiolytics
What are the features of panic attacks?
Severe, paroxysmal anxiety
What is panic disorder?
Recurrent panic attacks over 1 month and associated fear of further attacks
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)
How should an acute stress reaction be managed/
DOn't debrief early
Remove the stressor
Consider short course of benzodiazepine
What is the typical time frame of an adjustment disorder?
Between 1 and 6 months of the stressful event
Give 3 features of an adjustment disorder
Preoccupation with the event
What form of psychological therapy may be helpful in adjustment disorder?
Give three features of PTSD
Exaggerated startle response
Numbness and detachment
May be alcohol misuse and depression
How is PTSD managed?
Eye movement desensitisation and reprocessing
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
How should OCD be managed?
CBT and/or medication
SSRI (not citalopram) or clomipramine
What is physical substance dependence?
Adaptive state produced by repeated drug administration with intense physical disruption on cessation
What is psychological substance dependence?
Intense drive or craving for a substance. User feels it is necessary for their wellbeing