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Phase 3A DJF > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

What are the aspects of the MSE?

A 
Appearance
Behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
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2
Q

What three aspects form the risk assessment?

A

Risk to self intentionally/unintentionally
Risk to others
Risk to society

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3
Q

What is the difference between neuroses and psychoses?

A

Neuroses are conditions where symptoms vary from normality only in severity (eg Depression)
Psychoses are conditions where symptoms are notably different from normal experiences (eg Schizophrenia)

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4
Q

What 3 aspects form psychiatric aetiology?

A

Predisposing factors
Precipitating factors
Perpetuating factors

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5
Q

How do SSRIs work?

A

SSRIs inhibit serotonin (5HT) uptake in synapses, thus increasing the level of synaptic serotonin and increasing neuronal firing.

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6
Q

What are the possible side effects of SSRIs?

A

Nausea, Vomiting, Headache, Diarrhoea, Dry mouth, Bleeding, Serotonin syndrome

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7
Q

What is serotonin syndrome?

A

A toxic, hyperserotonergic state causing agitation, confusion, tremor, diarrhoea, tachycardia, hyperthermia and hypertension

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8
Q

What can happen if SSRIs are withdrawn suddenly?

A

Discontinuation syndrome:

Shivering, anxiety, Dizziness, Headache, Nausea, ‘electric shocks’

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9
Q

How do tricyclic antidepressants work?

A

Inhibit monoamines and reuptake of serotonin and noradrenaline.

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10
Q

How do SNRIs work?

A

Inhibit reuptake of serotonin and noradrenaline in synapses

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11
Q

How does Mirtazapine work?

A

5HT2 and 5HT3 antagonist and alpha2-adrenergic blocker. These combine to increase noradrenaline and selected (2+3) serotonin transmission.
Causes sedation

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12
Q

What is the difference between mania and hypomania?

A

Hypomania describes symptoms of elevated mood that are within the boundaries of that individual’s personality - they may be doing same activities but with more rigour
Mania describes symptoms of elevated mood that are beyond the individual’s normal personality - new tasks or activities or psychotic features

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13
Q

Name the stages of normal grief

A 
Shock/disbelief
Anger
Guilt
Sadness
Acceptance/Resolution
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14
Q

What word describes a hallucination upon waking up?

A

Hypnopompic

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15
Q

What word describes a hallucination upon falling asleep?

A

Hypnogognic

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16
Q

Define a delusional perception

A

A delusion that forms as a result of a real perception (eg a bird landed in that tree, therefore I shall die today)

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17
Q

Define concrete thinking

A

Taking things absolutely literally

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18
Q

Describe circumstantiality

A

Taking a long, convoluted trip before eventually answering your question

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19
Q

What word describes a patient filling in holes in their memory with made up stories?

A

Confabulation

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20
Q

Define stupor

A

Non-response to environmental stimuli

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21
Q

What phrase describes jumping from topic to topic within the same sentence?

A

Flight of ideas

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22
Q

How do you describe high speed, high volume, one way conversation?

A

Pressure of speech

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23
Q

Define anhedonia

A

Loss of enjoyment of hobbies

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24
Q

How do you describe ‘poker face’

A

Blunting of affect

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25
Define incongruity of affect
Mis-match between expressions and feelings
26
Define depersonalisation
Detachment from body (but still inside mind)
27
Define dissociation
Detachment from body and mind - out of body experience
28
Define derealisation
Feeling the world (except themselves) is fake
29
Describe akathesia
Restlessness caused as an extrapyramidal side effect of drugs
30
Describe section 2 of the MHA
Assessment section, but patients can be treated Lasts 28 days (unrenewable) Requires 2 doctors and 1 AMHP with evidence of mental disorder and risk of harm
31
Describe section 3 of the MHA
Treatment section Lasts 6 months (renewable for 6 more months then annually after that) Requires 2 doctors and 1 AMHP with a mental health diagnosis, reason for hospital based treatment which is in patient's best interests and risk of harm
32
Describe section 4 of MHA
Emergency section - used until section 2 or 3 can be implemented Lasts 72 hours Requires 1 doctor or AMHP, evidence of mental health disorder and risk, and not enough time/people for different section to be used
33
Describe section 5(2) of the MHA
Doctor's inpatient holding power (A&E not inpatients, use section 4) Lasts 72 hours Requires one doctor Does NOT permit treatment against will
34
Describe section 5(4) of the MHA
Nurse's holding power Lasts 6 hours Requires one nurse Does NOT permit treatment against will
35
Describe section 135 of the MHA
Police section for access to private property in order to bring psychiatric patients into safe place for assessment
36
Describe section 136 of the MHA
Police section to bring psychiatric patients from a public place into safe place for assessment
37
Describe schozophrenia
A form of functional psychosis which affcts the brain's function but not structure. It can involve positive and negative symptoms and may occur in later life
38
Describe the epidemiology of schozophrenia
Equal M=F, but males frequently more severe Life time risk 1% Typical onset in 20-30s
39
What are the risk factors for schozophrenia?
Young age Family history Childhood trauma (especially sexual abuse) Cannabis use
40
What are the first rank symptoms of schizophrenia? | What are the other symptoms of schizophrenia?
- Thought alienation (Insertion, Broadcast, Withdrawal) - Passivity phenomena (Being controlled) - 3rd Person auditory hallucinations - Delusional perceptions ``` Other hallucinations or delusions Mood disturbance Blunting of affect Poverty of speech/thought Self neglect ```
41
What investigations would be appropriate for ?schizophrenia?
FBC, U+E, LFT, Glucose, Ca, TFT, PTH, cortisol CT/MRI head Urine drug screen and MC+S
42
What is the management of schizophrenia?
Antipsychotics (eg. Olanzapine) - Do ECG prior to starting therapy as drugs can prolong Q-T interval Rehabilitation to normal lifestyle Treat comorbidities with psychotherapy or other medications
43
What antispychotic is good for treatment resistant schizophrenia?
Clozapine
44
What is the prognosis for schizophrenia?
Generally good with medication compliance | Better prognosis if acute onset with positive symptoms than chronic onset with negative symptoms
45
How do antipsychotic medications work?
Combined D1 receptor agonists and D2 receptor antagonists. Underactive D1 receptors in mesocortical pathway cause negative symptoms, but overactive D2 receptors in the mesolimbic pathway cause positive symptoms. Blocking dopamine in nigra-stridal pathway causes extrapyramidal symptoms
46
What are the potential side effects of antipsychotics?
``` Extrapyramidal side effects Neuroleptic Malignant Syndrome Weight gain Urinary incontinence Hypotension Blurred vision Hyperprolactinaemia Sedation Dry mouth ```
47
What is the epidemiology of depression?
Women twice as likely as men Prevalence 10% Leading cause of death in 20-24 year olds (suicide)
48
What are the risk factors for depression?
``` Genetics Traumatic childhood Anxious, impulsive or obsessional personality Divorce or Bereavement Unemployment Chronic illness ```
49
What are the symptoms of depression?
``` Depressed mood (all day with little variation) Anhedonia Anergia/Apathy Worthlessness/Hopelessness Suicidal thoughts or attempts ``` All above continuing over 2 weeks with no organic cause and having an impact on person's functioning Also weight loss, appetite change, disturbed sleep, loss of libido, psychotic symptoms if severe
50
How is depression staged for severity?
``` Mild = 2 core symptoms + 2 other symptoms Mod = 2 core symptoms + 3+ other symptoms Severe = all core symptoms + other symptoms ```
51
What investigations are appropriate for depression?
FBC, U+E, LFT, TFT, glucose, Ca, ESR, B12/Folate If indicated, Toxicology, Syphilis, Dexamethasone suppression test (Cushing's) or Cosyntropin stimulation test (Addison's)
52
How is depression treated?
``` Mild = Self help/CBT Mod = Antidepressant + CBT/IAPT Severe = add Crisis team, ECT, Antipsychotic ```
53
What is the prognosis for depression?
50% relapse | 50% asymptomatic after 12 months
54
Name 5 types of antidepressant, give examples of each
``` SSRI (Sertraline, fluoxetine) SNRI (Venlaflaxine, Duloxetine) Tricyclic (Amytriptyline, Trimipramine) MOAIs (Phenelzine) NaSSA (Mirtazapine) ```
55
Describe dysthymia
Low grade chronic depression where the patient can remember feeling well. Often treatment resistant. Rarely diagnosed.
56
Describe bipolar affective disorder
A combination of depressive episodes and (hypo)manic episodes, with normal periods in-between. Can be rapid cycling. Americans describe Type 1 (manic) or 2 (hypomanic).
57
Describe the epidemiology of bipolar
Prevalence 1% | M=F
58
What are the risk factors for bipolar?
Family history Previous depression Disturbed childhood
59
How does bipolar present?
Periods of normality followed by weeks of elevated mood and periods of clinical depression. Elevated mood presents with energy, enthusiasm, high self esteem, distractability, over-familiararity and reduced sleep. Can be manic or hypomanic.
60
What is cyclothymia?
A milder form of bipolar where the depressive and manic episodes are milder
61
How do you treat an acute manic episode of bipolar?
Lorazepam or diazepam ECT if life threatening Stop antidepressants Add mood stabiliser (Lithium or Valporate)
62
How should a bipolar patient be treated prophylacticly?
``` Mood stabiliser (Lithium or Valporate) Add 2nd gen antipsychotic if required Psychoeducation of patient and family CBT support groups ```
63
What are the problems with Lithium and what are the potential side effects?
Narrow therapeutic index Requires monitoring (serum level) 7 days after any dose change Teratogenicity Toxicity SE: Polyuria, weight gain, tremor, GI upset, sedation, cognitive problems
64
In what way is lithium tetarogenic?
Ebstein's abnormality (tricuspid malformation)
65
How does lithium toxicity present?
``` Anorexia Tremor Myoclonic jerks Diarrhoea Dehydration Restlessness Hypertonia ```
66
What is the prevalence of generalised anxiety disorder?
5.7% | More common in females
67
What can be the cause of anxiety disorders?
Genetics Insecure attachments/loss of parents Overprotective or under-nurturing parents Childhood trauma
68
What are the symptoms of generalised anxiety disorder?
``` Restlessness Fatigueability Difficulty concentrating Irritability Palpitations Sweating Nausea Hot and cold flushes Easily startled ```
69
How is generalised anxiety disorder managed?
Benzodiazepine for somatic symptoms SSRI for depressive symptoms Beta blocker for CVR and autonomic symptoms CBT Buspirone for psychotic symptoms if present
70
What is the prognosis of generalised anxiety disorder?
Chronic and disabling condition, can be well controlled with treatment
71
Describe panic disorder
Recurrent panic attacks not secondary to an organic cause (drugs) Can be spontaneous or triggered, sometimes nocturnal
72
Describe the epidemiology of panic disorders
3% lifetime risk More common in women Age of onset bimodal: 15-24 then 45-54
73
What are the risk factors for panic disorders?
``` Marital separation or bereavement Urban living Lower educational achievement Early parental loss Abuse ```
74
What are the symptoms of panic disorders?
Attacks consisting of palpitations, hyperventilation, sweating, GI upset, fear of death, suicidal thoughts Associated with fear of next attack and behaviour changes to avoid attacks
75
What investigations are appropriate in ?Panic disorder?
FBC, U+E, LFT, glucose, TFT, Ca, UMA/pHVA | ECG
76
What is the management of generalised panic disorder?
SSRI for 18 months Short term benzodiazepine until SSRI takes effect Add antipsychotic if severe and treatment resistant CBT
77
What is the prognosis for attack disorders?
Good response to treatment but relapses frequent
78
Describe OCD
Obsessions and compulsions regarding one topic that interfere with the patient's functioning. Insight often present at time of presentation Associated with anxiety and depression and Tourette's
79
What is the epidemiology of OCD?
Prevelance 2% M=F Age usually before 25
80
What can cause OCD?
Dysregulation of serotonin system Genetics Previous anxiety provoking event/trauma
81
What is the management of OCD?
CBT, focused on exposure and response prevention Group/Family therapy SSRI ECT if serious or suicidal
82
What is the prognosis of OCD?
Frequently improvement with treatment but relapse rate high
83
Describe an acute stress reaction
A transcient disorder lasting hours or days immediately following an emotional stressor that has a severe threat to the individual's or a loved one's life or security
84
Describe the epidemiology of acute stress reactions
15-20% following exceptional stress
85
What are the symptoms of an acute stress reaction?
``` Dazed and disorientated Depression, anxiety, anger or despair Social withdrawal Aggression Hopelessness Excessive grief ```
86
How are acute stress reactions managed?
Reassurance but now medical intervention required unless becomes acute stress disorder
87
What is the prognosis for acute stress reactions?
Self resolves within a few hours | Can develop into acute stress disorder (Like PTSD but less than 4 weeks, PTSD if over 4 weeks)
88
Describe PTSD
Severe psychological disturbance following a traumatic event, associated with anxiety, depression, substance misuse and somatization syndrome
89
What is the epidemiology of PTSD?
Risk following event: Male 10% Female 25%
90
What are the symptoms of PTSD?
``` 1 month history of symptoms impairing function within 6 months of stressful event: Difficulty sleeping Flashbacks Hypervigilance Easily startled Concentration difficulties Partial amnesia of stressful event Avoidance of connections to stressful event ```
91
How is PTSD managed?
CBT + trauma counselling Eye movement desensitisation and reprocessing (EMDR) Relaxation or hypnotherapy 2nd line: SSRI/Mirtazapine/Mood stabiliser
92
What is the prognosis for PTSD?
50% recover fully | 30% become chronic
93
Describe a phobia
A recurring, excessive and unreasonable psychological or autonomic symptoms of anxiety in the anticipated or real presence of a specific feared object or situation
94
What are the 5 topics/catagories of phobias?
``` Animals Nature Blood and injuries Situational Other ```
95
What is the lifetime prevalence of a phobia? | Gender bias?
12.5% | M=F, though F more likely to have animal phobias
96
What is the age of onset of phobias?
``` Animals = 7 Blood/Injury = 8 Situational = 20 ```
97
What are the symptoms of a phobia?
``` In response to anticipated or presence of trigger: Sweating Tremor Palpitations Intense fear Nausea Lightheadedness and fainting Hyperventillation ```
98
What is the management of phobias?
Progressive exposure and desensitisation CBT Coping strategies Initially BDZ or Beta blocker for symptom control
99
What is the prognosis of a phobia?
If untreated can be a lifelong condition. Usually resolved slowly by treatment
100
What is agoraphobia?
Fear of embarrassing situations
101
What is somatisation disorder?
Repeated presentations of medically unexplained symptoms affecting multiple organs. Associated with significant psychological distress and causes functional impairment. Risk of harm from resulting medical treatment aka functional symptoms
102
Splitting phenomena is commonly seen with somatisation disorder. What is this?
Where the patient decides they like certain things/people and dislike others with no obvious reason, making it tricky for certain staff to work with the patient as the patient has a strong dislike for them
103
How is somatisation disorder managed?
Education of patient and family that these symptoms are real and disabling and have a psychological stressor cause. Regular review by the same doctor CBT
104
Describe personality disorder
An enduring and pervasive disorder of inner experience and behaviour causing distress or social impairment to functioning. Often affect cognition, affect and behaviour
105
What is the epidemiology of personality disorders?
Prevalence 10% | Antisocial, Histrionic and borderline (EUPD) most common
106
What are the risk factors for personality disorders?
Genetics ADHD Poor parenting (harsh or inconsistent) Childhood trauma (especially sexual abuse)
107
Describe the features of Borderline personality disorder
Intense and unstable relationships Impulsivity Self harm Unpredictable/mismatched affect and behaviour
108
Describe the features of Paranoid personality disorder
Suspicious Self referential Preoccupied with conspiracies Distrust of others
109
Describe the features of Schizoid personality disorder
Emotionally cold Detached Lack of interest in others
110
Describe the features of Schizotypal personality disorder
Peculiar ideas, perceptions or behaviours | Interpersonal discomfort
111
Describe the features of Antisocial personality disorder
Lack of concern for others Irresponsibility Irritable and aggressive Unstable relationships
112
Describe the features of Histrionic personality disorder
``` Dramatic Shallow affect Egocentric Manipulative Craves attention ```
113
Describe the features of Narcissistic personality disorder
Grandiose Need for admiration Lacks empathy
114
Describe the features of Anxious or Avoidant personality disorder
Self consciousness Insecurity Fear of negative judgement from others Timid
115
Describe the features of Dependent personality disorder
Clinging Submissive Desperation to be cared for Helplessness when not receiving care
116
What are the clusters of personality disorders and which ones fall into each cluster?
Cluster A - Odd and eccentric - Paranoid - Schizoid - Schizotypal Cluster B - Emotional and dramatic - Borderline - Antisocial - Histrionic - Narcissistic Cluster C - Anxious and fearful - Avoidant and Anxious - Dependent
117
How are personality disorders managed?
Dialectical behaviour therapy (DBT) CBT Therapeutic community (day units designed as PD treatment centres to help people adjust to normal life) 2nd line - Antipsychotic or antidepressant
118
What is the prognosis for personality disorders?
High suicide rates or accidental death rates | Worsened prognoses for any other mental health condition
119
Describe the features of dependence syndrome
Primacy of drug seeking behaviour (the drug is the most important thing to patient, over food or shelter) Narrowing of repertoire (drug, RoA, location) Tolerance (can be lost suddenly in advanced dependence syndrome) Loss of control (if they have one they will have many) Continued use despite significant loss (job, loved one) Withdrawal symptoms if abstinence attempted Drug taking to avoid withdrawal symptoms
120
How is alcohol dependence managed?
Motivational interviewing Change to safe drinking or tee-total Detoxification
121
What are the symptoms of alcohol withdrawal? (Not including DTs)
4-12 hours post drink; Tremor, sweating, insomnia, tachycardia, N+V, anxiety. Craving for alcohol. Lasts up to 5 days Seizures - grand mal, 6-48 hours post drink, high risk if previous epilepsy or head trauma
122
What are the symptoms of Delirium Tremens?
1-7 days post drink (high risk if infection, high dependence or liver damage) Acute confusion Amnesia Hallucinatios Severity fluctuates hour by hour, worst at night Risk of death from sudden CVR collapse (10%)
123
Describe an alcohol detoxification?
Inpatient or community based - Reducing BDZ regime - Psychological counselling, motivational interviewing - Nutritional support: Thymine, MultiVits incl Mg and Vit B
124
What medication can be given following an alcohol detoxification to aid abstinence?
Disulfiram - intensifies hangover Acamprosate (or 2nd line = Naltrexone) reduce cravings Most issues following detoxification are with abstinence
125
What is the indication for an alcohol detoxification?
Consumption over 10 units per day for the previous 10+ days running
126
Describe Wernicke-Korsakoff syndrome
Wernicke encephalopathy and Korsakoff psychosis are the acute and chronic phases of a single disease process of neuronal degeneration secondary to thiamine deficiency which is mostly seen in heavy drinking. (also starvation, anorexia nervosa and gastric resection)
127
What are the symptoms of Wernicke encephalopathy?
Acute onset confusional state Nystagmus or Ophthmaloplegia Ataxic gait Peripheral neuropathy, resting tachycardia, nutrient defficiency
128
What causes the symptoms of Wernicke encephalopathy?
Thiamine deficience causes haemorrhages and secondary gliosis in periventricular and periaqueductal gray matter.
129
How is Wernicke encephalopathy managed?
IV pabrinex (vit B1 replacement, 2 ampoules infused in 30mins BD)
130
What is the prognosis for Wernicke encephalopathy?
If treated all resolves except ataxia, nystagmus and neuropathy which may be permenant
131
What are the symptoms of Korsakoff psychosis?
Short term memory loss and variable length amnesia with confabulation filling amnesia episodes. Working, procedural and emotional memory all unimpaired
132
What is the management of Korsakoff psychosis?
Oral thiamine and multivitamin replacement for 2 years | OT assessment
133
What is the prognosis following Korsakoff psychosis?
50% return to independent living
134
Name three opiates
Heroin Codeine Methadone
135
Name two depressants
Alcohol | Benzodiazepines
136
Name three stimulants
MDMA Cocaine Amfetamines
137
Name three hallucinogenics
LSD Mushrooms Ketamine
138
Describe illegal highs
Synthetic alternatives to natural drugs which are often dangerously mixed together
139
What is the management of substance abuse?
Harm reduction advice (don't do it alone, avoid combining drugs, avoid IV injections) Safer injecting advice (sterile needles, rotate site, go with blood flow) Detoxification Counselling and support sercives Conversion to prescribed drug (if abstinence impossible)
140
What is the management of acute drug overdose?
``` ABCDE + resuscitation Substance ID - pupils, breath smell, IV needlemarks, oral burns, hyperventillation Gastric lavage Activated charcoal Dialysis Psychological assessment ```
141
Describe serotonin syndrome
A rare but potentially fatal syndrome caused by excessive serotonin, usually as a result of drug combinations or overdose
142
What are the symptoms of serotonin syndrome?
``` Confusion or coma Agitation Tremor Rigidity Hyperreflexia Myoclonus Ataxia Diarrhoea Hyperthermia ```
143
What investigations are appropriate in serotonin syndrome?
FBC, U+E, LFT, Glucose, pH, Ca, Mg, Phosphate, CK, Tox screen CXR ECG
144
What is the management of serotonin syndrome?
IV fluids Cooling of patient BDZ Serotonin receptor antagonist (Chlorpromazine, Propranolol) Consider cause - activated charcoal and gastric lavage if overdose
145
What is the prognosis following serotonin syndrome?
Mostly resolved within 36 hours
146
Name the four stages of extrapyramidal side effects
Acute dystonia Induced Parkinsonism Akathisia Tardive Dyskinesia
147
What are the risk factors of acute dystonia?
``` Family history Under 45 Male Liver failure high dose antipsychotic medication Hypocalcaemia ```
148
What are the symptoms of acute dystonia?
Symptoms occur within 7 days: Painful muscle spasms occurring in episodes lasting minutes to hours Mostly head and neck affected - head turning and jaw opening More generalised in children (almost seizure like)
149
What is the management of acute dystonia?
IM anticholinergic agent (Procyclidine), IV if life threatening. Continue for 7 days then titrate down Change or lower antipsychotc Check Ca for alternative cause (hypocalcaemia)
150
How do antipsychotics cause drug induced Parkinsonism?
Blocking of D2 receptors in the nigrostriatal pathway causes Parkinsonism, as reduced dopamine in body.
151
What are the symptoms of drug induced Parkinsonism?
Onset within 4 weeks: | Bilateral and often absent at night tremor, rigidity and bradykinesia
152
What is the treatment of drug induced Parkinsonism?
``` Drug change or dose reduction Anticholinergic agent (Procyclidine) ```
153
Describe akathisia
Feeling of inner restlessness accompanied by physical restlessness mostly of the legs Onset variable but always due to drugs
154
What are the risk factors for akathisia?
``` High dose antipsychotics Chronic antipsychotics Rapid change in antipsychotic regime Organic brain disease Lithium SSRIs ```
155
What is the management of akathisia?
Rule out organic cause (full bloods and drug screen) Change antipsychotic regime Propranolol Anticholinergic agent (Procyclidine)
156
What is the prognosis of akathisia?
Can last 3 months
157
Describe tardive dyskinesia
Repetitive involuntary, purposeless muscular movements mostly of face or neck. Considered the biggest tell for Schizophrenics who have concealed their mental illness with medication
158
What is the prevalence of tardive dyskinesia ?
30% of chronic treated patients
159
What are the risk factors for tardive dyskinesia?
``` Chronic antipsychotics Change in antipsychotic regime Anticholinergic treatment Female Organic brain disease DM Lithium ```
160
What are the symptoms of tardive dyskinesia?
Repeititve, involuntary, purposeless movements of face or neck Becomes worse with distraction but suppressed by focused concentration Absent when sleeping
161
What is the management of tardive dyskinesia?
Reduce antipsychotic treatment Reduce or stop anticholinergic treatment If treatment resistant swap to Clozapine and try adjuvant BDZ
162
What is the prognosis for tardive dyskinesia?
Tends to improve though symptoms wax and wane
163
Describe Neuroleptic Malignant Syndrome
A rare, life threatening reaction to antipsychotic medication, antidepressants, Carbamazapine, Lithium, reducing antiparkinsonism medications or to the OCP
164
Describe the incidence and mortality of Neuroleptic Malignant syndrome
Incidence 0.1% | Mortality under 20%
165
What are the risk factors for Neuroleptic Malignant syndrome?
``` Dehydration Agitation Catatonia Rapid or large change in antipsychotic medications High dose antipsychotic medications Organic brain disease Previous Neuroleptic Malignant Syndrome ```
166
What are the symptoms of Neuroleptic Malignant Syndrome?
``` Hyperthermia Muscular rigidity New confusion or agitation Tachycardia Tachypnoea Hypertension or hypotension Diaphoresis Tremor Urinary or bowel incontinence/retention/obstruction Metabolic acidosis ```
167
What is the diagnosis? A 32 year old whose antipsychotic medication you have recently increased returns feeling hot, agitated and breathing quickly. They report stiff joints and occasionally have a shake they can't control. On examination you find tachycardia, hypertension and tachypnoea.
Neuroleptic Malignant syndrome
168
What investigations are appropriate in Neuroleptic Malignant syndrome?
``` FBC, LFT, U+E, Ca, Phos, CK, Cultures, tox screen, Coagulation studdies Urine myoglobin ABG CXR ECG CT head LP ```
169
What is the management of Neurolepitc Malignant syndrome?
Benzodiazepine (for behavioural disturbance) Stop causative drug (or restart antiparkinsonism drug) Oxygen Fluids Cooling if hyperthermic IV Sodium bicarbonate if rhabdomyelysis suspected (high CK)
170
What is the prognosis of an uncomplicated Neuroleptic Malignant syndrome?
Good
171
What can cause catatonia?
``` Schizophrenia Mania Depression Delirium Neurological disorders ```
172
Name the two forms of catatonia | Name three other types of catatonia (conditions)
Stuporous/Retarded Excited/Delirious Neuroleptic Malignant syndrome Serotonin syndrome Malignant catatonia
173
Describe the symptoms of catatonia
Mutism Posturing (holding a posture or position like a statue) Negativism (lack of verbal response) Staring Rigidity or Waxy flexibility (body holds position in which it is placed by another person) Echopraxia (repeating actions someone else does) Echolalia (repeating words someone else says) Stereotypy (frequent repetitive movements for no reason) Agitation
174
What investigations are appropriate in catatonia?
Vital signs FbC, U+E, LFT, Glucose, TFT, Cortisol, Prolactin CT head
175
What is the management of catatonia?
Benzodiazepine if agitated and excited ECT Treat the underlying cause
176
Describe schizoaffective disorder
A mental health condition with features of schizophrenia and mood affective disorder
177
What is the lifetime prevalence of schizoaffective disorder?
0.7%
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What are the symptoms of schozoaffective disorder?
``` Simultaneous symptoms of schizophrenia and bipolar: Delusions Hallucinations Thought interference Passivity Mania/Hypomania Depression ```
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What is the management of schizoaffective disorder?
Antipsychotic Mood stabiliser Benzodiazepine if currently manic and risk of harm
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What is the prognosis of schizoaffective disorder?
Moderate | Better than schizophrenia, worse than bipolar
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Describe schizotypal disorder
Schizophrenia without delusions or hallucinations. | Tends to run a stable course
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What are the symptoms of schizotypal disorder?
``` Ideas of reference (everything relates to themselves) Excessive social anxiety Odd beliefs Illusions Eccentric behaviour and appearance Inappropriate or constricted affect Paranoia ```
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What is the treatment of schizotypal disorder?
Antipsychotics | CBT
184
Describe delusional disorder
An uncommon disorder where patients experience non-bizarre delusions in the absence of hallucinations, thought disorders, mood disorders or flattening of affect.
185
Name the subtypes of delusional disorder (7)
Erotomanic (celebrity is in love with patient) Grandiose (Patient is superhero/god) Jealous (aka Othello syndrome - belief partner has been unfaithful) Persecutory (Belief others wish to harm patient) Somatic (Beliefs regarding body eg. infestation, dysmorphia) Mixed (multiple themes) Unspecified
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What are the symptoms of delusional disorder?
Delusion present for over 1 month in the absence of hallucinations, thought disorder or mood disorder. Unimpaired cognition or consciousness Speech, mood and behaviour affected by emotional tone of delusion (congruent) No insight
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What are the risk factors for delusional disorder?
``` Old age Isolation Low socioeconomic status Sensory impairment Family history Head trauma ```
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What is the management of delusional disorder?
``` Admission if high risk Separate patient from source of delusion Antipsychotic SSRI Benzodiazepine if anxiety symptoms Psychological therapy ```
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Describe counselling
A short term intervention that aims to help patients talk through their problems to find solutions
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Describe CBT
Cognitive behavioural therapy, structured sessions talking through situations describing the thoughts, resultant feelings and resultant behaviours that occur, and how these might be managed or changed for the better
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Describe cognitive analytical therapy
CBT + psychoanalysis
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Describe dialectic behavioural therapy
A process of learning to manage emotions through acceptance (used for EUPD)
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Describe family therapy
Assessment of family dynamics, often done with one therapist involved in the family situation and another watching from afar
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Describe interpersonal therapy
Like counselling but for relationship problems of grief counselling. Uses counsellor's own experiences to open up the patient
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Describe trauma based counselling
Counselling aimed at working through the painful experience a patient endured that is causing them PTSD, and resolving the issues there
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Describe exposure
Graded and progressive exposure of a patient to the object that causes them fear or obsessions. Used in phobias, OCD and PTSD
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Describe psychodynamic or psychoanalytic therapy
A discussion between patient and therapist where the therapist interprets the patient's symptoms or emotions as in relation to past events to find the source of the disturbance.
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What are the potential consequences of self harm?
``` Suicide (deliberate or accidental) Shame or social anxiety Distress for friends and family Physical damage causing a chronic condition (which might cause additional psychological strain) Economic impact ```
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Define delusion
A firmly held belief despite contrasting evidence. The content is frequently impossible but the belief is unshakeable.
200
Define hallucination
An interpretation of an absent stimulus. | Can be visual, olfactory, auditory, tactile, gustatory or somatic.
201
What three aspects to a psychiatric presentation and management plan do you need to consider?
Bio Psycho Social
202
Describe anorexia nervosa
An eating disorder where patients have a phobia of fat, and see themselves as being ugly and overweight despite being clinically underweight. It is most common in female teenagers
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Describe bulimia nervosa
An eating disorder where patients go through periods of binge eating but compensate for this by purging - vomiting, excessive exercise or taking laxatives. It is most common in female teenagers
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What are the symptoms of anorexia nervosa?
``` Reduced oral intake Low BMI Feeling of being overweight despite low BMI Taking appetite suppressant medication Amenorrhoea Dry skin Lightheadedness Fatigue Mood disturbance ```
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What are the symptoms of bulimia nervosa?
Binge eating (no control) Purging behaviours Fear of putting on weight Mood disturbance
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What investigations are appropriate in eating disorders?
FBC, U+E, LFT, TFT, glucose, B12, Folate, ECG BP Vital signs
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What is the management of eating disorders?
``` Urgent referral for CBT or Cognitive Analytic therapy Family therapy Dietary counselling Avoidance of purging behaviours Vitamin and mineral supplements ```
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What are the risks associated with treating eating disorders?
Refeeding syndrome Wernicke's encephalopathy Neuroleptic Malignant Syndrome
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What is refeeding syndrome?
When starvation is followed by acutely increased oral intake it can cause low K, low Mg and low Phophate
210
Describe attachment theory in relation to personality disorders
Attachment theory suggests that the connections formed between a baby and it's parents, especially mother, in the first 5 years of life impact personality. If these are insecure or cut short by bereavement or departure this can lead to unstable personalities.
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What is the difference between learning disabilities and learning difficuties?
Learning disabilities are those that cause reduced intellectual ability. Learning difficulties are those that do NOT affect intellectual ability.
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How are learning disabilities catagorised?
Mild Moderate Severe PMLD (Profound and Multiple Learning Disabilities) These are based on IQ and clinical judgement
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Describe dyslexia
Dyslexia is a learning difficulty with regard to spelling and words, where patients mix words up or spell things phonetically
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Describe dyspraxia
Dyspraxia is a learning difficulty with regard to fine and/or gross motor movements and coordinating them, giving rise to difficulties with sports and handwriting
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Describe dyscalculia
Dyscalculia is a learning difficulty with regard to numbers and time, making maths very complex or these people
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Describe ADHD
ADHD is a learning difficulty with regard to attention and hyperactivity. These people struggle to focus

Phase 3A DJF (3 decks)

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