Psychiatry Flashcards
(384 cards)
1
Q
psychiatric history components
A
Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP
2
Q
Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP
A
categories for a psychaitric history
3
Q
psychiatric history: information
A
PT details, under section vs informal visit, PT vs collateral history
4
Q
PT details, under section vs informal visit, PT vs collateral history
A
points to cover in the information section of a psych history
5
Q
psych history: introductions
A
who’s who, roles, purpose of interview, consent, permission to take notes
6
Q
who’s who, roles, purpose of interview, consent, permission to take notes
A
points to cover in the intriductions section of a psych history
7
Q
psych history: PC
A
ideally get PT’s own words
8
Q
ideally get PT’s own words
A
for psych PC in hisory
9
Q
psych history: HPC
A
can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before
10
Q
psych history: HPC depression
A
SOCRATES, is mood always low, when worst, anything to lift mood, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work, thoughts abouth themselves, the world, the future
11
Q
SOCRATES, when worst, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work
A
HPC things to ask about if depressive PC
12
Q
can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before
A
for HPC psych
13
Q
psych history: HPC psychosis
A
strange thoughts, others commented on strange things, plots against you/out to get you, interference with thoughts (insertion, withdrawal, broadcasting), see/hear things that others can’t, get messages from things you see/hear, insight, controlled by others, how longs has this been going on, has it changed over time
14
Q
strange thoughts, others commented on strange things, plots against you, interference with thoughts, see/hear things that others can’t, insight, how longs has this been going on, has it changed over time
A
questions to ask in HPC for psychosis
15
Q
psych history: HPC generalised anxiety
A
general feeling, on edge, worry, irritable, unable to relax, fears, increased vigilance, insomnia (initial/middle/fatigue on waking), tremor, tachycardia
16
Q
general feeling, on edge, worry, irritable, unable to relax
A
psych history HPC to ask for generalised anxiety
17
Q
psych history: HPC panic attacks
A
hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers, fear, impending doom
18
Q
hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers
A
HPC questions to ask in panic attacks PC
19
Q
psych history: HPC phobias
A
fears that you/others may consider irrational, obsessive thoughts
20
Q
fears that you/others may consider irrational, obsessive thoughts
A
things to ask in HPC for someone presenting with phobias
21
Q
psych history: SH
A
lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems
22
Q
lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems
A
psych history: SH
23
Q
psych history: PPH
A
contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers
24
Q
contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers
A
psych history: PPH
25
psych history: DH
current medication, allergies, previous regimes, recreational drugs, alcohol (CAGE), side effects, compliance/feelings towards their medications
26
current medication, allergies, previous regimes, recreational drugs, alcohol, side effects, compliance/feelings towards their medications
psych history: DH
27
psych history: FH
who is in their family, who close to, occupations, an MH disease in family/suicides
28
who is in their family, who close to, occupations, an MH disease in family/suicides
FH psych history to ask
29
psych history: PH
childhood: where born, parents together, schooling (attendance, grades, friends), moved a lot, siblings, enjoyed childhood, abuse
occupational: jobs held, reason for leaving, free time
psychosexual: first sexual encounter, orientation, relationships/marital status, reasons for ending, children
forensic: any problems with the police
30
childhood, occupational, psychosexual, forensic
ask about in PH
31
psych history: PP
(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests
32
(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests
psych hisotry: PP
33
CAGE questionnaire
have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?
34
have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?
CAGE questionnaire
35
psych assessment includes
psych history + MSE
36
psych history + MSE =
full psych assessment
37
MSE components
appearance, behaviour, speech, mood, thoughts, perception, cognition, insight
38
appearance, behaviour, speech, mood, thoughts, perception, cognition, insight
MSE components
39
appearance + behaviour
self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements
40
self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements
appearance + behaviour
41
speech
form: rate + flow, incoherent
content: appropriateness, congruency
42
tardive dyskinesia
involuntary movements fo face + neck, may follow use of antipsychotics
43
involuntary movements fo face + neck, may follow use of antipsychotics
tardive dyskinesia
44
waxy flexibility
PT stays in the same position that they've been put in e.g. schizophrenia/structural brain disorder
45
PT stays in the same position that they've been put in e.g. schizophrenia/structural brain disorder
waxy flexibility
46
forced grasping
takes examiner's hand whenever offered, e.g. dementia/chronic schizophrenia
47
takes examiner's hand whenever offered, e.g. dementia/chronic schizophrenia
forced grasping
48
stereotypies uniform
repetitive non-goal directed actions e.g. schizophrenia
49
repetitive non-goal directed actions e.g. schizophrenia
stereotypies uniform
50
form: rate + flow, incoherent
content: appropriateness, congruency
speech
51
presure of speech
goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)
52
goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)
pressure of speech
53
mutism
severe depression/schizophrenia
54
perseveration
repeating the same words/phrases e.g. dementia/frontal lobe trauma
55
repeating the same words/phrases e.g. dementia/frontal lobe trauma
perseveration
56
neologisms
creating new words e.g. schizophrenia
57
creating new words e.g. schizophrenia
neologism
58
echolalia
repeating the same words/phrases as examiner e.g. schizophrenia
59
repeating the same words/phrases as examiner e.g. schizophrenia
echolalia
60
mood
subjective vs objective, depression, anxiety, mania, congruency, lability
61
subjective vs objective, depression, anxiety, mania, congruency, lability
mood
62
thoughts
delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals
63
delusions in schizophrenia
primary delusions, thought alienation, presecutory delusions
64
primary delusions, thought alienation, presecutory delusions
delusions in schizophrenia
65
delusions in depression
nililistic, hypochondrial, worthless, guilt, hopelessness
66
nililistic, hypochondrial, worthless, guilt, hopelessness
delusions in depression
67
delusions in mania
grandiose
68
grandiose
delusions in mania
69
thought alienation
insertion, withdrawal, broadcast, plots to harm you
70
insertion, withdrawal, broadcast, plots to harm you
thought alienation
71
depersonalisation
feeling unreal/any part of the body is unreal e.g. in anxiety disorders
72
feeling unreal/any part of the body is unreal
depersonalisation
73
derealisation
feeling that things around them are unreal e.g. in anxiety disorders
74
feeling that things around them are unreal
derealisation
75
delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals
thoughts
76
perception
aka hallucinations, illusions
77
aka hallucinations, illusions
perception
78
cognition
orientation to person, place + time, MMSE, AMTS, ACE-R
79
MMSE, AMTS used to assess
cognition
80
insight
recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment
81
recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment
insight
82
auditory illusion
auditory sound misinterpreted by listener
83
auditory sound misinterpreted by listener
auditory illusion
84
illusions
can occur in any sensory modality and aren't usually an indicator of a mental illness/psychiatric problem
85
can occur in any sensory modality and aren't usually an indicator of a mental illness/psychiatric problem
illusions
86
affect illusion
associated with specific mood state e.g. someone may see a loved one who has recently died
87
associated with specific mood state e.g. someone may see a loved one who has recently died
affect illusion
88
completion illusion
inattention when reading e.g. misreading words, completing faded letters
89
inattention when reading e.g. misreading words, completing faded letters
completion illusion
90
pareidolia
perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds
91
perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds
pareidolia
92
most common side efffect of clozapine
urinary incontinence
93
side effect of clozapine that we're most worried about
agranulocytosis
94
agranulocytosis
side effect of clozapine that we're most worried about
95
urinary incontinence is the most common side effect of
clozapine
96
methylphenidate
CNS stimulant used to treat ADHD, also used as an apetite surpressor + in the treatment of sleep disorders e.g. narcolepsy
97
CNS stimulant used to treat ADHD
methylphenidate
98
methyylphenidate SE
insomnia, agitation, HTN, weight loss
99
insomnia, agitation, HTN, weight loss
methylphenidate SE
100
psychiatric drugs which cause weight gain
olanzapine (SGA), mirtazapine (NaSSA)
101
olanzapine + mirtazapine can cause
weight gain
102
Schneider's 1st rank symptoms of schizophrenia
```
auditory hallucinations (thoughts spoken aloud/voices referring to themselves in the 3rd person/commentary)
thought withdrawal/insertion/interruption/broadcasting
delusional perceptions
feelings/actions controlled by external agents (passisivity)
```
103
auditory hallucinations, thought disordered, delusional perceptions, feelings/actions controlled by external agents
schneider's 1st rank symptoms
104
schizophrenia diagnosis
6/12 duration, at least 2 symptons (1 must be positive)
105
6/12 duration, at least 2 symptons (1 must be positive)
schizophrenia
106
negative symptons schizophrenia
avolition, asocial, apathetic, affect blunting, alogia, attention deficit, paucity of speech, poor memory
107
avolition, asocial, apathetic, affect blunting, alogia, attention deficit
negative symptons schizophrenia
108
brief psychotic disorder
symptoms <1/12
109
psychotic symptoms <1/12
brief psychotic disorder
110
schitzoaffective disorder
mix of psychotic and affective symptoms, alternating not simultaneously
111
mix of psychotic and affective symptoms, alternating not simultaneously
schizoaffective disorder
112
ICD-10 diagnostic criteria for depression
1. persistent low mood/sadness
plus at least 1 of the following most days/most of the time for at least 2/52: 2. loss of interest/pleasure 3. fatigue/low energy
associated symptoms: 4. disturbed sleep 5. poor concentration/indecisiveness 6. low self-confidence 7. poor/increased appetite 8. suicidal thoughts/acts 9. agitation/slowing of movement 10. guilt/self-blame
113
of the ICD-10 10 symptoms of depression 0-3/10
not depressed (don't forget to also assess functional impact)
114
of the ICD-10 10 symptoms of depression 4/10
mild depression (don't forget to also assess functional impact)
115
of the ICD-10 10 symptoms of depression 5-6/10
moderate depression (don't forget to also assess functional impact)
116
of the ICD-10 10 symptoms of depression 7-10/10
severe depression +/- psychosis, symptoms >1/12, every symptom should be present for most of every day
117
not depressed score according to ICD-10
0-3/10 (don't forget to also assess functional impact)
118
mild depression score according to ICD-10
4/10 (don't forget to also assess functional impact)
119
moderate depression score according to ICD-10
5-6/10 (don't forget to also assess functional impact)
120
severe depression score according to ICD-10
7/10 every symptom should be present for most of every day, symptoms for >1/12
121
first line medical management of depression
SSRI
122
second line medical management of depression
switch to a different SSRI
123
DSM-IV criteria for subthreshold depression
<5/10 symptoms
124
DSM-IV criteria for mild depression
few if any symptoms > the 5/10 to make the diagnosis, minor functional impairment
125
DSM-IV criteria for moderate depression
symptoms/functional impairment -/- mild + severe
126
DSM-IV criteria for severe depression
most of the /10 symptoms, marked interference with functioning, +/- psychotic symptoms
127
DSM-IV <5/10 symptoms
subthreshold depression
128
DSM-IV 5/10 symptoms
mild depression
129
DSM-IV most of the /10 symptoms
severe depression
130
all severities depression management
treat comorbid physical ailments, treat substance misuse problems
131
mild depression management
self help groups, structured physical activity groups, guided self help, computerised CBT, behavioural couples therapy
132
moderate depression management (+ unresponsive mild)
add antidepressant, individual CBT, interpersonal therapy
133
severe depression management
ECT (poor PO intake), admission, crisis team, antipsychotic (if psychotic)
134
third line medical management of depression
SNRI
135
flight of ideas
mania
136
thought block
sudden interruption in train of thought e.g. schizophrenia, depression
137
circumstantiality
thinking proceeds slowly via convoluted path, final point is eventually reached e.g. particular personality traits, mania
138
psychomotor retardation
slowing of thoughts/speech e.g. depression
139
tangentiality
deflected path of speech, never reaching point/answering question e.g. psychosis, dementia, delerium
140
sudden interruption in train of thought
thought block e.g. schizophrenia, depression
141
thinking proceeds slowly via convoluted path, final point is eventually reached
circumstantiality e.g. particula personality traits, mania
142
slowing of thoughts/speech
psychomotor retardation e.g. depression
143
deflected path of speech, never reaching point/answering question
tangentiality e.g. psychosis, dementia, delerium
144
delusional mood
feels something going on around them, can't describe it, becomes > clear /specific when the delusional idea/perception occurs
145
feels something going on around them, can't describe it, becomes > clear /specific when the delusional idea/perception occurs
delusional mood
146
delusion of love
2' delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met
147
2' delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met
deluson of love
148
de Cleraumbault's syndrome
delusion of love involving a celebrity
149
delusion of love involving a celebrity
de Cleraumbault's S
150
delusional perception
delusion forms in response to an ordinary object e.g. traffic light changing sending a message
151
delusion forms in response to an ordinary object e.g. traffic light changing sending a message
delusional perception
152
autochthonous delusion
delusional ideas that arise out of nowhere, appear fully formed in the PT's mind
153
delusional ideas that arise out of nowhere, appear fully formed in the PT's mind
autochthonous delusions
154
delusions of jealousy
2' delusions, e.g smell of perfume on partner's coat means they're having an affaire
155
2' delusions, e.g smell of perfume on partner's coat means they're having an affaire
delusions of jealousy
156
other side effects of clozapine
neurtropaenia, myocarditis, sedation, seizures, hypersalivation, postural hypotension
157
neurtropaenia, myocarditis, sedation, seizures, hypersalivation, postural hypotension
side effects of clozapine
158
obsessional thoughts
recurrent, intrusive, unpleasant/disturbing thoughts/ideas/images, that are one's own, but unwanted, recognises them as absurd
159
compulsions
repettitive, purposeful, obsessional motor/mental actions, PT recognises as unnecessary but can't resist performing them w/o anxiety
160
obsessional motor actions, PT recognises as unnecessary but can't resist performing them w/o anxiety
compulsions
161
unpleasant/disturbiing thoughts/ideas/images, that are one's own, but unwanted
obsessional thoughts
162
histrionuc PD
self-dramatisation, theatrical, exaggerated emotions, suggestible/easiy led, shallow + labile affect, seeking to be centre of attention, inappropriate disinhibition/flirtiness, over concern with physical attractiveness
163
EUPB/boarderline PD
self-image disturbances, short term v intense relationships, emotional crisis when relationships end, self harm, feeling of chronic emptiness
164
anakastic PD/obsessive-compulsive PD
preoccupied with detail/rules/organisation/schedules, perfectionism hinders completion of tasks, pedantic + preoccupied, reduced enjoyment, loss of relationships
165
schizoid PD
emotionally detached, asocial, little interest in others, preoccupied by fantasy
166
paranoid PD
high/inappropriate suspicion of people + their intentions, feel victim of 'ganging up'/plots, difficult to convince otherwise
167
self-dramatisation, theatrical, exaggerated emotions, suggestible/easiy led, shallow + labile affect, seeking to be centre of attention, inappropriate disinhibition/flirtiness, over concern with physical attractiveness
histrionic PD
168
self-image disturbances, short term v intense relationships, emotional crisis when relationships end, self harm, feeling of chronic emptiness
EUPD/borderline PD
169
preoccupied with detail/rules/organisation/schedules, perfectionism hinders completion of tasks, pedantic + preoccupied, reduced enjoyment, loss of relationships
anakasticPD/obsessive-compulsive PD
170
emotionally detached, asocial, little interest in others, preoccupied by fantasy
schizoid PD
171
high/inappropriate suspicion of people + their intentions, feel victim of 'ganging up'/plots, difficult to convince otherwise
paranoid PD
172
trailing illusion
associated with hallucinogenics, moving object perceived as a series of images
173
associated with hallucinogenics, moving object perceived as a series of images
trailing illusion
174
LBD
deteriorating cognition, visual hallucinations, Parkinsonianisms
175
deteriorating cognition, visual hallucinations, Parkinsonianisms
LBD
176
Charles Bonnet S
psychophysical visual disturbances, complex visual hallucinations, in partial/severe blindness, PT is aware that hallucinations aren't real
177
psychophysical visual disturbances, complex visual hallucinations, in partial/severe blindness, PT is aware that hallucinations aren't real
Charles Bonnet S
178
Li toxicity
anorexia, diarrhoea, vomiting, drowsiness, restlessness, dysarthria, dizziness, ataxia, incoordination, m twitches, coarse tremor, hyperreflexia, convulsions, AKI, collapse, coma, death
179
anorexia, diarrhoea, vomiting, drowsiness, restlessness, dysarthria, dizziness, ataxia, incoordination, m twitches, coarse tremor, hyperreflexia, convulsions, AKI, collapse, coma, death
Li toxicity
180
drugs associated with Li toxicity
thiazides
181
hypnogogic hallucinations
going off to sleep, auditory>other modalities
182
going off to sleep hallucinations, auditory>other modalities
hypngogic
183
hypnopompic hallucinations
waking up
184
waking up hallucinations
hypopompic
185
reflex hallucination
true sensory stimulus causes a hallucination in a different sensory modality
186
true sensory stimulus causes a hallucination in a different sensory modality
reflex hallucination
187
autoscopy
experience of seeing oneself + knowing that it is oneself
188
experience of seeing oneself + knowing that it is oneself
autoscopy
189
autoscopy aka
phantom mirror image
190
phantom mirror image aka
autoscopy
191
lilipitian hallucination
visual hallucination associated with micropsia e.g delerium
192
visual hallucination associated with micropsia
liliputian hallucination e.g. delerium
193
elementary hallucination
flashes of light
194
flashes of light hallucination
elementary
195
extracampine hallucination
hallucination outside of limits of sensory field e.g. seeing someone behind them when they're looking forward
196
hallucination outside of limits of sensory field e.g. seeing someone behind them when they're looking forward
extracampine
197
SNRI stands for
selective noradrenaline-seratonin reuptake inhibitors
198
duloxetine
SNRI
199
asessing memory
repeat something back after 5 mins
200
assessing orientation in time, place + person
day, date, time, identity/job, names
201
assessing attention + concentration
counting backwards
202
assesing dyspraxia
drawing intersecting pentagons
203
assessing receptive dysphasia
following a command
204
assessing expressive dysphasia
naming objects
205
assessing the components of executive (frontal lobe) functioning test
approximation (guessing distances), abstract reasoning (1, a, 2, b, next in sequence), verbal fluency (words beginning with a, 1 min), proverb interpretation
206
repeat something back after 5 mins tests
memory
207
day, date, time, identity/job, names tests
orientation to person, place, time
208
counting backwards tests
attention + concentration
209
drawing intersecting pentagons tests
dyspraxia
210
following a command tests
receptive dysphasia
211
naming objects tests
expressive dysphasia
212
risk assessment is the balance between
PT risks factors vs PT rights
213
risk assessment components
risk to self (suicide, DSH, self neglect, accidental harm), risk to others, risk from others, safeguarding children/vulnerable adults
214
tools to help assess risk
Hx, MSE, past behaviour, collateral, previous notes
215
risk of self harm determine
suicidality: thoughts, plans, intentions, things that prevent them acting, DSH: previous episides, circumstance, method, management, predisposing factors: FH suicide, social isolation, substance misuse, disengagement from/unwillingness to engage with support services, hopelessness, worthlessness
216
risk of harm to others determine
(to whom, f, severity, methods) acts/threats of violence, arson, sexual inappropriateness, containment, compliance with previous/current psychaitric intervention, increased risk: discontinuation of medicaton, change in recreational drug use, EtOH/drug misuse, impulsive/unpredictable behaviour, recent stressful life event, persecutory delusions, delusions of control/passivity phenomenon, command hallucinations)
217
passivity phenomenon
the belieft that one is no longer in control of one's own body, thoughts or feelings, controlled by some external agent
218
risks of self neglect/accidental self harm can manifest as
malnutrition, failure to access health care, living in squalid conditions, falls (fraility, intoxication), failure to safeguard against fire/explosion, wandering (getting lost, unsafe t to be out), poor road safety, accidental OD/under dose, vulnerability to crime (front door open, inviting in strangers)
219
risks to vulnerable adults mneumonic
how safe
220
how safe mneumonic means
HOme safety (leaving gas on), Wandering, Self neglect, Abuse, crime vulnerability, Falls, Eating (malnutrition)
221
the belieft that one is no longer in control of one's own body, thoughts or feelings, controlled by some external agent
passivity phenomenon
222
how safe mneumonic to remember
risk to vulnerable adults
223
psychiatric investigations
FBC, ESR, U+E, glucose, TFT, LFT, Ca, folate, B12, syphilis, MSU, CXR, CT head/MRI, EEG
224
classes of medications used in psychiatry
antipsychotics, antidepressants, antimanic drugs/mood stabilisers, hypnotics/anxiolytics, stimulants, antidementia
225
DoLS applies to
people in hospitals/care homes who lack capacity, are deprived of their liberty (i.e. not able to come + go as they please), not under a section of the MHA
226
DoLs authorisatoinis granted by
2 assessors
227
DoLS must conform to the following
>18 y.o., no LPA/advinced decision/court of protection conflicts, lacks capacity, MH disorder, not under MHA, not to enable MH treatment, best interest
228
DoLS must be renewed
annually
229
MHA section 2
28/7, authorised by 2 Drs, for assessment purposes
230
MHA section 3
6/12, 2 Drs, treatment purposes
231
MHA section 4
72h, 1 Dr, urgent assessment from community, no t to arrange section 2
232
MHA section 5(2)
72h, 1 Dr, urgent detention of inPT
233
MHA section 5(4)
6h, registered MH nurse, urgent detention of psych inPT in the absence of a Dr
234
MHA section 135
72h, police officer, removal from home to place of safety
235
MHA section 136
72h, police officer, premouval from public space to place of safety
236
28/7, authorised by 2 Drs, for assessment purposes
MHA section 2
237
6/12, 2 Drs, treatment purposes
MHA secion 3
238
72h, 1 Dr, urgent assessment from community, no t to arrange section 2
MHA section 4
239
72h, 1 Dr, urgent detention of inPT
MHA section 5(2)
240
6h, registered MH nurse, urgent detention of psych inPT in the absence of a Dr
MHA section 5(4)
241
72h, police officer, removal from home to place of safety
MHA section 135
242
72h, police officer, premouval from public space to place of safety
MHA section 136
243
in order to warrent sectioning
PT deemed to have MH disorder sufficient to warrent detention due to risk, unwilling to attend voluntarity
244
who can apply for a MHA section
AMHP - approved MH professional: social worker, nurse, psychologist, OT (not a Dr)
245
at least one of the Drs completing the MHA section has to be
section 12 approved
246
depression DD
normal sadness (berevement, physical illness), psychotic depression, schizophrena, EtOH/drug withdrawal
247
biological mechanism behind depression
reduction in seratonin/noradrenaline availiability in the brain
248
duration of antidepressant therapy
at least 6/12, taper off dose, can continue for prophylaxis
249
depression prognosis - single episodes
duration 3-8/12, 50% recurrence
250
depression prognosos - severe depression
80% recurence, suicide risk
251
reduction in seratonin/noradrenaline availiability in the brain is the hypothersises mechanism behind
depression
252
biological mechanism behind anxiety
low GABA levels, frontal cortex remodelling in stress, heightened amygdala activation
253
anxiety is associated with
childhood abuse, separations, demand for high achievement, excessive conformity, life stresses, physical health probelms
254
panic attack definition
unpredictable recurrent episodic panic attacks, not restricted to a particular situation, associated with persistent worry RE another attack/maladaptive behavioural changes
255
panic attack vicious cycle
catastrophic misinterpretation of ambiguous physical sensation e.g. SOB increase arousal, creating a +ve feedback loop
256
generalised anxiety discorder
generalised, persistent, excessive anxiety/worry RE a number of events that the individual finds difficult to control, >6/12 duration
257
generalised anxiety disorder DD
withdrawal from drugs/EtOH, excessive caffeine, depression, psychotic disorder, thyrotoxicosis, parathyroid DZ, hypoglycaemia, phaeochromocytoma, carcinoid S
258
management of generalised anxiety disorder
individual guided self help (CBT principles), psychoeducational groups, face to face CBT, aplpied relaxation, SSRI, SNRI, pregabalin, BZD (not regularly, just for crises)
259
CBT for generalised anxiety disorder aims to
identify morbid anticipatory thoughts, replace with > realistic cognition, learn + use distractions, breathing + relaxation exercises
260
agoraphobia
fear + avoidance of places/situations from which escape may be difficult/help unavailable in the event of a panic attack
261
agoaphobia diagnosis required anxiety to be restricted to these
crowds, public places, travelling away from home, travelling alone
262
management of agoraphobia
CBT, graded exposure to situations, SSRI
263
social phobia
persistent fear of social situations involving unfamiliar people/possible scrutiny by others, fear of humiliation/embarrasement
264
management of social phobia
CBT, self help material, graded exposure to situations, social skills training, SSRI
265
specific phobias
fear of specific people/objects/situations
266
management of specific phobias
graded exposure to situation, response prevention, short term BZD
267
low GABA levels, frontal cortex remodelling in stress, heightened amygdala activation might underly
anxiety disorders
268
unpredictable recurrent, not restricted to a particular situation, associated with persistent worry RE another attack/maladaptive behavioural changes
panic attack
269
catastrophic misinterpretation of ambiguous physical sensation e.g. SOB increase arousal, creating a +ve feedback loop
panic attack vicious cycle
270
generalised, persistent, excessive anxiety/worry RE a number of events that the individual finds difficult to control, >6/12 duration
GAD
271
fear + avoidance of places/situations from which escape may be difficult/help unavailable in the event of a panic attack
agoraphobia
272
persistent fear of social situations involving unfamiliar people/possible scrutiny by others, fear of humiliation/embarrasement
social phobia
273
fear of specific people/objects/situations
specific phobia
274
risk factors for generalised anxiety disorder
35-54 y.o., divorced, separated, living alone, lone parent
275
persecutory delusions e.g.
having enemies, feeling that someone is out to get you
276
delusions of reference e.g.
getting specific messages for you from the TV
277
Schneider's 2nd rank symptoms
persecutory delusions, delusions of reference, hallucinations, neologisms/disorganised speech
278
psychotic disorders include
schizophrenia, delusional disorder, schizoaffective disorder, psychotic depression, bipolar affective disorder
279
DSM-V criteria for schizophrenia
6/12 duration, 2/5 of: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, negative symptoms
280
subtypes of schizophrenia
paranoid, catatonic, hebephrenic, residual, simple
281
paranoid schizophrenia
delusions + auditory hallucinations are evident
282
catatonic schizophrenia
psychomotor disturbances are prominent (motor immobility to excessive activity), rigidity, posturing (waxt flexibility), echolalia, echopraxia
283
echopraxia
copying behaviours
284
hebephrenic schizophrenia
early onset, poor prognosis, unpredictable + irresponsible behaviour, innapropriate mood, incongruous affect, giggling, mannerisms, pranks, thought incoherance, fleeting delusions, hallucinations
285
residual schizophrenia
Hx of paranoid/catatonic/hebephrenic schizophrenia, but in current illness negative/cognitive symptoms predominate
286
simple schizophrenia
uncommon, negative symptoms w/o preceeding overt psychotic symptoms
287
psychosis prodrome
anxiety, depression, ideas of reference, distress, declune in social functioning
288
risk factors for developing psychosis
FH, advanced paternal age, winter birth, obstetric complications, developmental delay, smoking week in adolescence, childhood abuse
289
other forms pfo psychosis
schizoaffective disorder, delusional disorder, brief psychotic episodes
290
schizoaffective disorder
affective + schizophrenic symptoms occur together + with equal prominence
291
delusional disorder
fixed delusion/delusional system with other areas of thinking/functioning preserved
292
brief psychotic episodes
<6/12 duration
293
management of acute psychotic episode (schizophrenia)
antipsychotics (lowest effective dose, PO, monitor SE, adherence), psychological therapy (self help, CBT, family therapy, art therapy), social support (engagement, hope, reduce stigma, supported employment, accommodation)
294
two types of antipsychotic
typical/first generation, atypical/second generation
295
antipsychotics are not so good at treating
the negative symptoms
296
duration of treatment with antipsychotic before determining its effectiveness
4-6/52
297
medication used in treatment R schizophrenia
clozapine
298
schizophrenia good prognostic factors mneumonic
finding plans
299
finding plans mneumonic meaning
Female, In relationship, good social support, No -ve symptoms, aDherence, Intelligence (> educated), No stress, Good premorbid personality, Paranoid subtype, Late onset, Acute onset, No substance misuse, Scan (CT/MRI) N
300
suicide risk in schizophrenia is higher among
young men, 1st few y of illness, persistent hallucinations/delusions, illicit drug Hx, previous suicide attempts
301
persecutory delusions, delusions of reference, hallucinations, neologisms/disorganised speech describe
Schnieder's 2nd rank symptoms
302
delusions + auditory hallucinations are evident describes
paranoid schizophrenia
303
psychomotor disturbances are prominent (motor immobility to excessive activity), rigidity, posturing (waxt flexibility), echolalia, echopraxia
catatonic schizophrenia
304
early onset, poor prognosis, unpredictable + irresponsible behaviour, innapropriate mood, incongruous affect, giggling, mannerisms, pranks, thought incoherance, fleeting delusions, hallucinations
hebephrenic schizophrenia
305
Hx of paranoid/catatonic/hebephrenic schizophrenia, but in current illness negative/cognitive symptoms predominate
residual schizophrenia
306
uncommon, negative symptoms w/o preceeding overt psychotic symptoms
simple schizophrenia
307
fixed delusion/delusional system with other areas of thinking/functioning preserved
delusional disorder
308
finding plans is a mneumonic for
good prognositic factors in schizophrenia
309
young men, 1st few y of illness, persistent hallucinations/delusions, illicit drug Hx are at higher risk of
suicide attempts in schizophrenia
310
self harm demographics
women, <35 y.o., lower socioeconomic classes, single, divorced
311
self harm is associated with
depression, personality disorders
312
self harm assessment
motivaiton (interrupt a sequence of events, attention, communication, wish to die), current psychiatric illness, suicide note, will, continued determination to die, hopelessness, method, discovery, employment
313
self harm management
reduce risk, initiate/continue treatment, address ongoing social difficulties, what seems feasible to the PT, crisis team, SSRI, psychological therapy
314
PTSD onset w/i
6/12 (ICD-10), 1/12 (DSM-5) of stressor
315
dissociative symptoms of an acute stress reaction predict and increased risk of
PTSD
316
dissociative symptoms of an acute stress include
wandering aimlessly, reduced sleep, nightmares
317
symptons of PTSD
>1/12 duration, persistent intrusive thoughts, reexperiences (memories, nightmares, flashbacks), avoidance of reminders, numbing, detachment, estrangement from others, sense of foreshortened future, increased arousal (hypervigilance, sleep disturbances, irritability, poor concentration, exaggerated startle response)
318
treatment for PTSD
trauma-focused CBT, EMDR (eye movement desensitisation + reprocessing therapy), antidepressants (paroxetine, mirtazapine)
319
PTSD definition
follows severe stressful experiencs of exceptionally threatening/catastrophic nature: assult, accident, disaster, act ro terrorism, war
320
PTSD comorbidities
EtOH/drug abuse, depression
321
PTSD risk factors
proportional to stressor, man-made>natural disaster, continuation of stress, lack of social support, other adversities, premorbid personality
322
>1/12 duration, persistent intrusive thoughts, reexperiences (memories, nightmares, flashbacks), avoidance of reminders, numbing, detachment, estrangement from others, sense of foreshortened future, increased arousal (hypervigilance, sleep disturbances, irritability, poor concentration, exaggerated startle response) may indicate
PTSD
323
ex of obsessions
thoughts (blasphemy, sex, violence, contamination, numbesr), images (vivid, morbid, violent scenes), impulses (fear of jumping infront of a train), ruminations (continuous pondering), doubts
324
ex of compulsions
had washing, cleaning, counting, checking, touching _ rearranging objects to achieve symmetry, checking _ repeating thoughts, hoarding, counting, desire to utter a forbidden word, asking endless Q's to seek answers to commonplace facts, inappropriate + excessive tidiness
325
OCD is characterised as
time consuming >1h/d, obsession +/- compulsion, most days for >2/52, distressing + interfere with activities
326
other features of OCD
avoidance of trigger stimuli/activities, onset during adolescence
327
OCD can be divided into 4 categories
obsessions + compulsions - hand washing concerned with contamination
checking compulsions in response to obsessional thoughts about potential harm - leaving gas on
obsessions w/o any covers compulsive acts
hoarding
328
complications of OCD
depression, anxiolytic/EtOH abuse
329
FH in OCD ask about
OCD, tics, Tourette's S, parental overprotection
330
a FH of tics, Tourette's S, parental overprotection is associated with
OCD
331
diagnostic features of anorexia nervosa
morbid fear of fatness, distorted body image, deliberate weight loss, amonorhoea, BMI <17.5, loss of libido
332
anorexia nervosa DD
psychosis, DM, depression, substance/EtOH abuse, Addison's, malabsorption, malignancy
333
anorexia nervosa management
family therapy, motivational counselling, CBT, IPT (interpesonal psychotherapy), focused psychodynamic therapy, hospitalisation (sig physical abnormalities, suicide risk, BMI >13.5)
334
anorexia nervosa FH ask about
eating disorders, OCD, depression
335
anorexia nervosa personal Hx
abuse, overprotective/overcontrolling environment, overvaluation of food/eating/weight/body shape, troubled family relationships, bullied because of size
336
anorexia nervosa subtypes
restrictive vs bulimic
337
other features of anorexia nervosa
preoccupation with food, self-consciousness RE eating in public, socially isolating behaviour, vigorous exercise, constipation, cold intollerance, depressive/OCD symptoms
338
physical signs of anorexia nervosa
emaciation, dry/yellow skin, lanugo hair on face/trunk, bradycardia, hypotension, anaemia, leucopenia, consequences of repeated V (hypokalaemia, alkalosis, pitted teeth, parotid swelling, Russell's sign)
339
bulimia nervosa diagnostic features
morbid fear of fatness, distorted body image, craving for food, uncontrolled binge eating, purging/V/laxative abuse, fluctuating weight, preoccupation with body weight/shape
340
bulimia nervosa managemetn
CBT, IPT (interpersonal therapy), SSRIs (fluoxetine)
341
bulimai nervosa associations
N/excessive body weight (fluctuant), loss of control/trance-like binges, self-loathing, depression, EtOH/drug abuse, DSH, stealing/sexual disinhibition, poor impulse control
342
physical signs in bulimia nervosa
amenorrhoea, hypokalaemia, oesophageal tears
343
opiates of abuse
heroin, morphine, methadone
344
stimulants of abuse
cocaine, amphetamines
345
hallucinogens of abuse
MDMA, GHB, GBL, LSD, mushrooms
346
signs of opiate dependence
miosis, tremor, malaise, apathy, constipation, weakness, impotence, neglect, malnutrition
347
opiate OD
miosis, resp depression, death
348
cannabis negative effects
conjunctival irritation, reduced spermatogenesis, L DZ, flashbacks, transient psychosis, schizophrenia, depression, apathy
349
opiate detox medications
methadone/buprenorphine
350
mneumonic to assess dependence
CAN'T STOP
351
cant stop mneumonic stands for
Compulsion to take substance, Aware of harms but persists, Neglect of other activities, Tolerance, Stopping causes withdrawal, Time preoccupied with substance, Out of control use, Persistant/futile wish to cut down
352
psychoactive substance ICD-10 classification classes
acute intoxification, harmful use, dependence, withdrawal state, psychotic disorder, amnesic disorder, residual + late onset psychotic disorder
353
acute intoxification (psychoactive substance)
transient disturbances of consciousness, cognition, perception, affect or behaviour following administration of psychoactive substance
354
harmful use (psychoactive substance)
damage to individual's health + adverse effects on family + society
355
dependence (psychoactive substance)
signs of dependence (mneumonic), associated neglect of important social, occupationsal or recreational activities
356
withdrawal state (psychoactive substance)
physical + psychological symptoms occuring on absolute/relative withdrawal of the substance, after repeated, usually prolonged +/- high dose use
357
psychotic disorder (psychoactive substance)
psychosis during/immediately after use, vivid hallucinations, abnormal affet, psychomotor disturbances, delusions of persecution + reference
358
amnesic disorder (psychoactive substance)
memory or other cognitive impairments caused by substance use
359
residual + late onset psychotic disorders (psychoactive substance)
effects on behaviour, affect, personality or cognition that last beyond the period during which a direct psychological substance's effect might be expected e.g. flashbacks
360
management of substance misuse
rehab, hospital, community, CBT, motivational interviewing, self-help groups
361
early opiate withdrawal signs
24-48h, craving, flu like symptoms, sweating, yawning
362
late opiate withdrawal signs
7-10 days, mydriasis, abdo cramps, diarrhoea, agitation, restlessness, piloerection, tachycardia
363
stigmata of alcohol abuse O/E
jaundice, spider naevi, palmar erythema, gynaecomastia, peripheral neuropathy
364
complications of alcohol abuse
Wernike's encephalopathy, peripheral neuropathy, ED, ejaculatory impotence, cerebellar degeneration, dementia, other physical + social complications, psychiatric complciations (depression, suicidal ideations, suicide attempts, severe anxiety, insomnia), foetal alcohol S (reduced m tone, poor coordination, developmental delay, heart defects, facial abnormalities)
365
alcohol abuse management
abstinence, detoxificaion (in hospital if risk of delirium tremens), chlordiazepoxide, motivational interviewing, psychological therapies, self-help groups, disulfiram (flushing, headache, N, anxiety if EtOH ingested)
366
treatment of delirium tremens
lorazepam, haloperidol or olanzapine
367
miosis, tremor, malaise, apathy, constipation, weakness, impotence, neglect, malnutrition are signs of
opiate dependence
368
conjunctival irritation, reduced spermatogenesis, L DZ, flashbacks, transient psychosis, schizophrenia, depression, apathy are negative effects of
canabis
369
can't stop is a mneumonic to remember factors suggestive of
dependence
370
transient disturbances of consciousness, cognition, perception, affect or behaviour following administration of psychoactive substance
acute intoxification
371
damage to individual's health + adverse effects on family + society
harmful use
372
signs of dependence (mneumonic), associated neglect of important social, occupationsal or recreational activities
dependence
373
physical + psychological symptoms occuring on absolute/relative withdrawal of the substance, after repeated, usually prolonged +/- high dose use
withdrawal state
374
psychosis during/immediately after use, vivid hallucinations, abnormal affet, psychomotor disturbances, delusions of persecution + reference
psychotic disorder
375
memory or other cognitive impairments caused by substance use
amnesic disorder
376
effects on behaviour, affect, personality or cognition that last beyond the period during which a direct psychological substance's effect might be expected e.g. flashbacks
residual + late onset psychotic disorder
377
craving, flu like symptoms, sweating, yawning
early opiate withdrawal signs 24-48h
378
mydriasis, abdo cramps, diarrhoea, agitation, restlessness, piloerection, tachycardia
late opiate withdrawal signs 7-10 days
379
bipolar affective disorder definition
recurent episodes of altered mood, activity + energy: depressive, manic, hypomanic, mixed
380
mania characteristics
increased psychomotor activity, exaggerated optimism, inflated self esteem, decreased social inhibitions (sexual overactivity, reckless spending, dangerous driving, inappropriate business/religious/political initiatives), heightened sensory awareness, rapid thinking and speech, uninterruptible/pressured speech, flight of ideas, lack of insight
381
bipolar affective disorder DD
substance abuse, endocrine disturbance, epilepsy, schizophrenia, schizoaffective disorder, personality disorder, ADHD, transient psychoses
382
management of acute mania
haloperidol, olanzapine, quetiapine. risperidone
383
mood stabilsers
Li, Na valproate
384
bipolar affective dosirder management
indicidual/family/group therapy, Li (most effecive long tern treatment for BPAD, required blood monitoring)
