Psychiatry Flashcards

Question

What is the treatment of wernickes korsakoff's?

Answer 1

Thiamine administration

Answer 2

Other causes include other reasons of gross malnourishment: Anorexia nervosa, stomach cancer and gastrectomy.

Answer 3

Withdrawal Symptoms Agitation Seizures (peak incidence is at 36 hours) Delirium tremens (this appears 2-5 days after the last drink and is a life-threatening condition, consists of psychosis, confusion and autonomic hyperactivity, fever, tachycardia, visual hallucinations) Tactile hallucinations - involves the sensation of bugs crawling on the skin Tremor Sweating Tachycardia

Answer 4

CAGE: –Have you tried to Cut down? –Have you felt Annoyed by people criticising your drinking? –Have you felt Guilty about drinking? –Have you felt the need to have an Eye-opener? AUDIT (alcohol use disorders identification test) FAST (4 questions) PAT (paddington alcohol test)

Answer 5

Pattern of use causing damage to physical or mental health. Use over 1 months or repeatedly over 12 months

Answer 6

3 or more of the following for \> 1 month or repeatedly over 12 months: Cravings / compulsions to take Difficulty controlling use Primacy (it is most important) Increasing tolerance Physiological withdrawal on reduction / cessation Persistence despite harmful consequences \*think of pouring a bowl of **krave**, you are having difficulty **controlling** the amount of krave you are pouring. You are a **primary** school student and you are getting measured because you are getting taller (**tolerance**) you are getting **withdrawn** from school but you keep trying to get back in (**persistence**)

Answer 7

Support **CBT**, **group therapy** **Social work** inputs (benefits, housing, child protection) Skills training Community support Inpatient or residential treatment

Answer 8

Medication Benzodiazepines (e.g chlordiazepoxide - typically given as a reducing dose protocol) Carbemazepine is also an effective treatment of alcohol withdrawal (perhaps this will help with seizures and autonomic instability?) Aversion / deterrant medication = disulfiram (antabuse) Anti-craving medication (acamprosate, baclofen, naltrexone and nalmefene)

Answer 9

Decreased inhibitory GABA Increased NMDA glutamate transmission

Answer 10

Intrauterine growth restriction Pre-term labour

Answer 11

Blocks the uptake of noradrenaline, serotonin and dopamine

Answer 12

Damage to nose and airways Cardiac arrhythmias and MI Paranoid psychosis

Answer 13

Drowsiness Euphoria Respiratory depression Bradycardia and hypotension Pupillary constriction

Answer 14

Side effects: First time = nausea / vomiting and headache Medium term: phlebitis Anorexia Constipation Longer term: Tolerance Withdrawal Social and health problems

Answer 15

Dilated pupils Insomina Increased salivary, nasal and lacrimal secretions Piloerection

Answer 16

Muscle hypertrophy Acne, stretch marks, baldness Gynaecomastia Hypertension Depression

Answer 17

Hallucinations: Full force and clarity of true perception Located in external space No external stimulus Not willed or controlled 5 special senses: Auditory or visual Tactile Olfactory and gustatory Disordered thinking Delusions: (grandiosity, paranoid, hypochondrical, self referential)

Answer 18

2nd generation anti-psychotics: monitoring cardiovascular risk factors 1st generation anti-psychotics - monitoring ECG for QTC prolongation

Answer 19

•“ a delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction.”

Answer 20

Examples * grandiose (characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful) * paranoid (correctly persecutory) * hypochondriacal * self referential - this is the saem as ideas of reference (thinking a billboard sign is meant specifically for you)

Answer 21

Other factors implicated in schizophrenia: Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse

Answer 22

Psychosis may be involved in the following conditions: Schizophrenia Delirium A severe affective disorder such as a depressive episode with psychotic symptoms, manic episode with psychotic symptoms

Answer 23

Thinking Emotion Behaviour

Answer 24

Hallucinations Delusions Disordered thinking

Answer 25

Apathy Lack of interest Lack of emotions

Answer 26

For more than a month in the absence of organic or affective disorder: At least one of the following: * a) Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting. * b) Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception. * c) Hallucinatory voices giving a running commentary on the patient's behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body. * d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather). And OR at least two of the following: e) Persistent hallucinations in any modality, when occurring every day for at least one month. f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech. g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor. h) "Negative" symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses. There are subtypes including paranoid, catatonic,

Answer 27

Pharmacological treatment: Atypical antipsychotic (olanzapine, quetiapine - 6-8 week trial) Treatment resistant schizophrenia = clozapine Depot antipsychotic (intramuscular injection every 2-4 weeks if patient prefers/non-compliant. (clopixol)

Answer 28

Psycho-education and support for the family and carers Cognitive behavioural therapy Family interventions Art therapy

Answer 29

Being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms

Answer 30

Pathogenesis = Neurotransmitters (e.g dopamine hypothesis including hyperactivity of dopaminergic transmission at D2 receptor)

Answer 31

After first episode 20 % never have recurrence, 50% have relapsing and remitting illness. 30% have ongoing symptoms. Suicide in 10% especially soon after diagnosis

Answer 32

Good prognostic indicator: Absence of family history Good premorbid function - stable personality, stable relationships Clear precipitant Acute onset Mood disturbance Prompt treatment Maintenance of initiative, motivation.

Answer 33

Poor prognostic indicators: - Slow, insidious onset and prominent negative symptoms (apathy, lack of interest and lack of emotions are associated with a worse outcomes)

Answer 34

Preference for solitary activities Lack of interest in companionship/sexual interactions

Answer 35

Odd speech Eccentric behaviour Paranoid ideation and suspiciousness Lack of close friends (although they want friends unlike schizoid who would prefer to be alone) Odd beleifs and magical thinking

Answer 36

Questioning of loyalty of friends Reluctance to confide in others Unwaranted tendancy to perceive attacks on their character Psychological projection

Answer 37

Little empathy Disregard for social and societal norms Impulsive Willing to hurt others if it helps them Aggressive and unlawful bnehaviour Osmosis says that you have to be atleast 18 years old to be diagnosed with anti-social personality disorder

Answer 38

Grandiose self image Entitled Fragile self-esteem that's vulnerable to criticism Lack empathy Only get involved in situations that will benefit personal agenda

Answer 39

Unstable self-image Recurrent suicidal activity Difficulty controlling temper Unstable mood Defence mechanism of splitting - (when an individual classes something as either completely good or completely bad)

Answer 40

Cluster B personality disorders have a genetic link with mood disorders such as depression and bipolar disorder. They also have a genetic link with substance abuse disorders.

Answer 41

Attention seeking Superficial relationships Excessive emotionality - manipulative to draw attention (inappropriately flirtatious, over dramatising stories)

Answer 42

Avoid social risk - but they would want close relationships Shy Timid Low self-esteem Hypersensitive to rejection and negative feedback

Answer 43

Obsessed with orderliness, perfectionism, complete control, rules, details, schedules Person is inflexible, easily stressed and has very rigid moral beleifs = they are perceived as being stubborn

Answer 44

Overly indecisive Excessive fear of separation / rejection Overly dependant on others

Answer 45

Symptoms evident in more than one environment (e.g home, school and in clinic), before age 6 leading to moderate to severe psychological, social and/or educational or occupational impairment Impaired attention Overactivity Associated features: **recklessness** in potentially dangerous situations impulsive **flouting** of social rules - difficulty waiting their turn, interrupting activities. Co-morbidity is common (e.g conduct disorder, depressive disorder, autism)

Answer 46

Parenting - training/education programme. Schools to implement training programme Group treatment (cognitive behavioural therapy/social skills training for child) Pharmacological interventions such as methylphenidate or atomoxetine , guanfacine (Meth, Finn, hydrate) (ALT-J, mexican, Tigne) (guacamole, face, shine) Stimulant medication acts on DA and NAd systems. Atomoxetine is a non-stimulant and also acts on NAd systems, it is second line. Treat co-morbidities. Psychotherapy

Answer 47

Reciprocity Language Obsession

Answer 48

Impairment in reciprocal social interaction Impairment in communication Restricted repetitive and stereotyped patterns of behaviour, interests and activities. Associated features include a lack of cognitive flexibility, altered seonsory sensitivity, sensory processing difficultes, emotional dysregulation Emotional dysfunction

Answer 49

Psychoeducation Specialist education and behavioural programmes in mainstream or specialist school. Treatment of co-morbidities. Life-long condition. Many adults with autism require lifelong care. Decrease the demands, reduce the stress, improve the coping

Answer 50

Male to female ratio is 4:1

Answer 51

Neurofibromatosis Tuberous sclerosis ALso linked to down syndrome, fragile X Maternal infection of rubella

Answer 52

Repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age appropriate societal norms

Answer 53

Outcomes: Early death Social exclusion Poor school achievement Long-term unemployment Criminal activity Adult mental health problems Poor interpersonal relationships including those with their own children

Answer 54

Management: Parent training programme (12 or younger) e.g. The Incredible Years Modification of school environment eg behavioural support Functional family therapy Multi-systemic therapy Child interventions: social skills, problem-solving, anger management, confidence building Treat comorbidity Address child protection concerns

Answer 55

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The person finds it difficult to control the worry C. The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). * Restlessness or feeling keyed up or on edge * Being easily fatigued * Difficulty concentrating or mind going blank * Irritability * Muscle tension * Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Other symptoms include: Autonomic arousal - swallowing difficulties, dyspepsia, nausea, wind, tight chest, palpitations, dizziness, sweating Hyperventilation - breathlessness, hypocapnia

Answer 56

Depression Substance misuse

Answer 57

Low intensity = * Individual faciliitated self-help * Indivdual guided self-help * Psychoeducational groups High intensity = * CBT - one to one sessions * Applied relaxation

Answer 58

Drug therapy for generalised anxiety disorder at step 3: Offer SSRI first line eg sertraline (off label but most cost effective) / fluoxetine If ineffective then swap to a different SSRI or an SNRI (venlaxafine / duloxetine) If ineffective then consider using pregabalin Do not use benzodiazepines except for short-term measures during a crisis Do not offer antipsychotics for anxiety disorder in primary care Review patients regularly Continue therapy for at least 12 m after initiation to reduce the risk of relapse If patient fails to respond to adequate drug treatment or to high-intensity psychological therapies, offer the alternative treatment.

Answer 59

Severe anxiety disorder with marked functional impairment and: - risk of self-harm or suicide Significant comorbidity (substance misuse, personality disorder, complex physical health problems) Self-neglect Failure to respond to step 3 interventions Step 4 will develop comprehensive care plan, may offer combined drug and psychological intervetnsions, augmentation of antidepressaants or combinations of antidepressants

Answer 60

60% is improved at 5 years High co-morbidity with alcohol 10% severe impairment

Answer 61

The following may affect the development, course and severity of anxiety state: Other anxiety disorder Depression Substance misuse Physical health problems (complex physical health problems is listed as a reason to refer to specialist care) History of mental health problems Past experience and response to treatments.

Answer 62

Differential diagnosis: Psychiatric Conditions * Depression * Schizophrenia * Dementia * Substance Misuse Physical Conditions * Thyrotoxicosis * Phaeochromoctoma * Hypoglycaemia * Asthma and or Arrhythmias

Answer 63

Same core features as GAD, only in specific circumstances, person behaves to avoid these circumstances. Anticipatory anxiety - thinking of the actual thing they are afraid of

Answer 64

Do you find yourself avoiding social situations or activities? Are you fearful or embarassed in social situations?

Answer 65

Agoraphobia Social phobia (inappropriate anxiety where a person feels observed or could be criticised - restaurants, queues, public speaking) - symptoms are the same as GAD however blushing and tremor predominate. He or she believe that they will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating. The person realises that the fear is unreasonable and excessive. The fear or avoidance is not due to direct physiological effects of a substance (e.g drugs, medications) or a general medical condition not better accounted for by another mental disorder. Specific phobias

Answer 66

For social anxiety disorder 1st line = CBT 2nd line = medication (sertraline or escitalopram). Continue for 6 months of treatment once treatment has become effective

Answer 67

Combination of obsession and compulsions Obsessions: repetitive thoughts, images or impulses, unsuccessfully resisted, recognised as the patient’s own. These are unwilled and occur repeatedly. They are unpleasant and distressing. Anxiety symptoms arise Compulsions: non-enjoyable repeated rituals or stereotyped behaviours that the patient believes may prevent harm to self or others. Patient recognizes as pointless or ineffective and tries to resist. Compulsions can include things like locking doors and washing hands.

Answer 68

Obsessions and/or compulsions must be present on most days for at least two successive weeks, causing distress or interference with daily activities Differentials include: depressive disorder, obsessive compulsive personality disorder, part of tourettes syndrome or schizophrenia. MSE to exclude treatable depressive illness.

Answer 69

1st line therapy = CBT including exposure and response prevention (asking people to resist their urges / compulsions) 2nd Line: Medication; SSRIs (sertraline/citalopram/fluoxetine/paroxetine) - often required at higher doses for longer duration - up to 12 weeks to see a response 3rd line: Medication; clomipramine (most SSRI like of tricyclics)

Answer 70

Three key elements to reaction Hyperarousal Re-experiencing phenomena Avoidance of reminders Hyper-arousal = persistent anxiety, irritability, insomnia, poor concentration Re-experiencing phenomena = intense intrusive images, flashbacks when awake, nightmares during sleep Avoidance = emotional numbness, cue avoidance, recall difficulties, diminishes interests, anhedonia?

Answer 71

Onset is within 6 months of the event

Answer 72

Psychological interventions: Survivors of disasters are screened after one month. trauma focused CBT has the best evidence base EMDR (eye movement desensitisation and reprocessing) Pharmacological interventions: paroxetine (SSRI) or mirtazapine

Answer 73

Combat Rape Natural or human disaster Assult torture Witnessing any of the above

Answer 74

Mood disorders Previous trauma especially as a child Lack of social support Female

Answer 75

Higher eduactional group Social group Good parental relationship

Answer 76

Depression Suicidality Self-harm Substance misuse

Answer 77

6 months or more decline in memory and thinking including impairment of activities of daily living There must be a clear conscious (i.e not delirium)

Answer 78

Alzheimer's Early stages - memory impairment, executive dysfunction (impaired reasoning, concentratino, impaired visuospatial skills, anosognosia, slee disturbance) Intermediate stages - behaviour and psychological symptoms (apathy, social disengagement, wandering), dyspraxia, word finding difficulties Advanced - complete bilitatinon, dependance on others, urinary/fecal incontinence

Answer 79

Diffuse cortical atrophy (especially on the hippocampus) Gyri narrowing Sulci wideneing Ventricle enlargement

Answer 80

Neurofibriallry tangles - happen as a result of tua proteins Beta amyloid plaques - happen as a result of amyloid precursor protein

Answer 81

e4 allele of apolipoprotein E

Answer 82

mutations in PSEN1 (chromosome 14) and PSEN2 (chromosome 1) genes (these code for presenilin 1 and presenilin 2 (these code for subunits of gamma secretase that is needed to chop up amyloid precursor protein)

Answer 83

Gene responsible for producing APP is found on chromosome 21 - extra expression of APP and therefore there is a potential for more amyloid plaque build up

Answer 84

NICE recommend offering 'a range of activities to promote wellbeing that are tailored to the person's preference' NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia other options to consider include group reminiscence therapy and cognitive rehabilitation (So basically give them activities to do, give them cognitive stimulation therapy, group remniscience therapy and cognitive rehabilitation)

Answer 85

Antichilinesterase inhibitors: rivastigmine, galantamine, donepezil Memantine

Answer 86

NMDA receptor antagonist

Answer 87

→ moderate Alzheimer's who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors → as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer's → monotherapy in severe Alzheimer's

Answer 88

antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress

Answer 89

7-10 years

Answer 90

Cholinesterase inhibitors = improve cognitive function, slow decline, improve non-cognitive symptoms (ADL, longer at home, reduce carer stress)

Answer 91

Nausea, vomiting, diarrhoea Fatigue Insomnia Muscle cramps Headaches, dizziness Syncope Breathing problems

Answer 92

Pneumonia UTI

Answer 93

Step wise progression

Answer 94

History of stroke or transient ischaemic attack (TIA) Atrial fibrillation Hypertension Diabetes mellitus Hyperlipidaemia Smoking Obesity Coronary heart disease A family history of stroke or cardiovascular

Answer 95

Cerebral artery atherosclerosis Carotid artery/heat embolisation Chronic hypertension - cerebral arterioles sclerosis Vasculitis

Answer 96

Depends on the cortical area affected: - Frontal = executive dysfunction - Left parietal = aphasia, agnosia, apraxia - Right parietal = hemineglect, confusion, agitation, visuospatial - Temporal = anterograde amnesia - Subcortical infarcts = Focal motor signs, gait disturbance, personality / mood change

Answer 97

MRI/CT scan - would show cortical/subcortical infarcts After the infarcts are identified you would want to do further testing to assess the etiology: - Carotid doppler - reveal carotid plaques - Echocardiogram - reveal cardiogenic emboli

Answer 98

There is no specific pharmacological treatment approved for cognitive symptoms Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies³.

Answer 99

Amnesia not present PARKINSONISM AND VISUAL HALLUCINATIONS Two = probable, One = possible fluctuation - marked, important feature Visual hallucinations parkinsonism Deficits of attention, frontal executive, visuospatial Supported by falls, syncope, loss of consciousness, other psychiatric problems, autonomic dysfunction, scans, sleep disturbance and sleep walking

Answer 100

Abnormal DAT scan Normal patient will show normal reuptake of the dopamine transporter in the caudate nucleus and putamen in the shape of a comma, whereas in DLB, re-uptake in the putamen is reduced, leading to the full-stop sign.

Answer 101

Alpha synuclein protein aggregation in the neurones (particularly in the neurones and the substantia nigra) forming lewy bodies

Answer 102

Acetylecholinesterase inhibitors Dopamine anologues (for motor symptoms) Atypical neuroleptic agents (persistent disabling hallucinations, psychotic features, used very cautiosuly)

Answer 103

Behaviour change (loss of social inhibition, aggression, apathy and ritualized behaviours, imuplsive behaviours) Early emotional blunting Speech disorder - altered output, stereotypy, echolalia, persevation, mutism Preservation of memory and visuospatial function

Answer 104

If patient scores two or more then an eating disorder is likely Questions include: Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone of weight 6.35 kg in a three month period? Do you believe yourself to be fat when others say that you are too thin? Would you say that food dominates your life?

Answer 105

Weight loss: self-induced by dieting/vomiting/purging, excessive exercise, use of appetite suppressants / diuretics, insulin Overactivity - obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads Cooling - inadequate dress, open windows etc Body image distortions: fear of fatness as over-valued idea. Endocrine disorder: for females this includes amenorrhoea, for males it includes reduced libido/potency If onset is pubertal then puberty is delayed or arrested. Cold intolerance Blue hands and feet Constipation Bloating Delayed puberty Primary or secondary amenorrhea Dry skin Fainting Hypotension Lanugo hair Scalp hair loss Early satiety Weakness, fatigue Short stature Osteopenia & osteoporosis

Answer 106

Body weight at least 15 percent below of that expected, or BMI index 17.5 or below because of fear of eating

Answer 107

Differentials include depressive disorder, obsessive compulsive disorder, personality disorder. Somatic causes of weight loss include chronic debilitating diseases, neoplasia, intestinal diseases such as crohn’s disease or a malabsorption syndrome

Answer 108

Psychological interventions: cognitive analytical therapy, CBT, interpersonal psychotherapy and family interventions - focussed specifically on eating disorders. Little evidence for pharmacological interventions. Hospitalisation: minority of patients will require hospital admission with a structured symptom focused weight-restoration programme, with careful monitoring during re-feeding, combined with psychosocial interventions.

Answer 109

OCD Anxiety disorders Perfectionism Trauma

Answer 110

Mental implication: depression, anxiety, loss of concentration Starvation: reduced immunity, subfertility, anaemia, bone loss, heart damage (arrhythmias, seizures)

Answer 111

Recovery is only in one third Anorexia nervosa is associated with a mortality of 5-20 percent Sufferers withdraw from friendships and lose interest in sexual relationships

Answer 112

Persistent preoccupation with eating. Irresistable cravings leading to binges Attempts to counteract fattening foods by self-induced vomiting, purgative abuse, alternating periods of starvation, use of appetite suppressants, thyroid preparations, or diuretics, neglect of insulin treatment in diabetics. Morbid dread of fatness, sets self sharply defined weight threshold, well below optimal and pre-morbid weight. Mouth sores Pharyngeal trauma Dental caries (tooth decay or cavities) Heartburn, chest pain Esophageal rupture Impulsivity: * Stealing * Alcohol abuse * Drugs/tobacco Muscle cramps Weakness Bloody diarrhoea Irregular periods Fainting Swollen parotid glands hypotension Russell's sign

Answer 113

Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months

Answer 114

Differential diagnosis = Upper GI disorder, depressive disorder, personality disorder (where the eating disorder may coexist with alcohol dependance and petty offences such as shoplifting)

Answer 115

Evidence based self-help programme Cognitive behavioural therapy for bulimia nervosa Anti-depressants (SSRI’s specifically fluoxetine) Involve family members in treatment - psycho eduction/behavioural management/communication.

Answer 116

Risk factors for bulimia: Obesity Mood disorder Sexual or physical abuse Parental obesity Substance misuse Low self-esteem

Answer 117

Similar to binge eating disorder but without the purging behaviour

Answer 118

ACUTE ONSET FLUCTUATING ·Impaired attention/**concentration** **·Anterograde memory impairment** ·Disorientation in time, place or person ·Fluctuating levels of **consciousness** (often nocturnal exacerbations) **·Disordered sleep/wake cycle** ·Increased/decreased **psychomotor** activity ·**Disorganised thinking** as indicated by rambling, irrelevant or incoherent speech ·Perceptual distortions, leading to misidentification, illusions, and **hallucinations** ·Changes in mood such as anxiety, depression and lability

Answer 119

Infection (but not always a UTI!) Dehydration Biochemical disturbance Pain Drugs Constipation/Urinary retention Hypoxia Alcohol/drug withdrawal Sleep disturbance Brain injury Stroke/tumour/bleed etc Changes in environment

Answer 120

Preserved global intellectual abilities Anterograde amnesia Retrograde amnesia (temporal gradient) Preserved registration/working memory (digit span) Preserved procedural (implicit memory)

Answer 121

Causes of Amnesic Syndrome: Hippocampal damage: **·Herpes simplex virus encephalitis** ·**Anoxia** ·Surgical removal of temporal lobes ·Bilateral posterior cerebral artery occlusion ·Closed head injury ·Early Alzheimer’s disease Diencephalc Damage: ·**Korsakoff’s** syndrome (alcoholic and non-alcoholic) ·3rd ventricle tumours and cysts **·Bilateral thalamic infarction** ·Post subarachnoid haemorrhage, especially from anterior communicating artery aneurysms

Answer 122

Epilepsy – increased incidence and complexity with severity of learning disability (10-50%) Sensory impairments – hearing (40 %) and vision (20%), earwax Obesity – predisposes to other health problems Gastrointestinal – swallowing problems, reflux oesophagitis, Helicobacter pylorii, constipation Respiratory problems – chest infections, aspiration pneumonia Cerebral palsy – especially with severe learning disability Orthopaedic problems – joint contractures, osteoporosis Dermatological and Dental problems- 33% unhealthy gums, for Down’s Syndrome, 80% Psychiatric disorders as well.

Answer 123

Schizophrenia Psychosis Mood disorders OCD Autism Overactivity syndromes

Answer 124

Head banging Rocking

Answer 125

Aetiliogy Assocaited biomechanical conditions Severity of LD Psychiatric disorders, their cause and consequences (so what caused them, how basd they are, anything else going on?)

Answer 126

‘A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’ SO basically this is an underdeveloped brain, a deficit in skills which contribute to their level of intelligence

Answer 127

Criteria: 1. Intellectual impairment (IQ \< 70) (Wechsler) 2. Social or adaptive dysfunction (Vineland Scale) Deficits/Impairments in 2 or more of following adaptive skills: communication, self-care, home living, social skills, community use, self direction, health and safety, functional academics, leisure & work 3.Onset in the developmental period (age 18)

Answer 128

Classification: IQ is used to classify Mild learning disability 50 to 69 Moderate learning disability 35 to 49 Severe learning disability 20 to 34 Profound learning disability \<20

Answer 129

Take time and have patience. Value what is being communicated. Recognise non-verbal cues. Find out about the person's alternative communication strategies if verbal communication is difficult (e.g. their typical non-verbal cues, use symbols, sign language). Explain things clearly in an appropriate way (verbally & with pictures etc). Simple, short, jargon free language Be prepared to meet the person several times to build up rapport & trust. Use the knowledge and support of people's carers Books beyond words - this helps communication with people with learning difficulties

Answer 130

Aetiology ●Genetic: e.g. Single gene: Fragile X, PKU, Retts Syndrome Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome Chromosomal abnormality: Down Syndrome ●Infective : ante-natal e.g. rubella; post-natal e.g. meningitis, encephalitis ●Toxic: e.g. foetal alcohol syndrome ●Trauma: e.g. birth asphyxia, head injury ●Unknown: for most individuals, the cause of their LD is unknown

Answer 131

Beware of ‘diagnostic overshadowing’ Presenting symptoms are put down to their learning disability, rather than seeking another potentially treatable cause: Social cause - change in carers, lack of support, lack of social activities Psychological issues - bereavement, abuse Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing. Psychiatric cause - depression, anxiety, psychosis, dementia

Answer 132

Panic attacks are described as intense fear or physical discomfort reaching its peak within a few minutes. 4 of the following symptoms are present: * Palpitations, pounding heart, tachycardia * Sweating * Muscle trembling, shaking * Shortness of breath, sensations of smothering * Choking sensations * Chest pain or discomfort * Nausea, abdominal distress * Dizzy, lightheaded, instability, feeling faint * Derealization, depersonalization * Fears of losing control or going crazy * Fear of dying * Numbness, tingling sensations * Chills, hot flushes.

Answer 133

‘Recurring unforeseen panic attacks, followed by at least a month of persistent worry about having another attack and concern about its consequences OR a significant change in behaviour related to the panic attacks.’ So you have persistnat panic attacks You are worried about having another You are concerned about the consequences of a panic attack or a significant change in behaviour related to the panic attack.

Answer 134

Mild-moderate = Self help Moderate - severe = Psychological therapy Drug treatment Self-help = offer bibliotherapy based on CBT principles, offer information on support groups, discuss the benefits of exercise as part of good health. Review progress appropriately based on individual circumstances (often every 4-8 weeks) Psychological interventions: CBT Drug treatment: SSRI for panic disorder (citalopram, sertraline, paroxetine, escitalopram but NOT fluoxetine If there is no response in 12 weeks / unable to use the SSRI then consider imipramine or clomipramine - both of these are dangerous in overdose. Avoid benzodiazepines / sedating antihistamines / antipsychotics If one therapy (CBT, drugs, self-help) fails to give adequate response, try an alternative from the list; if no response, refer for specialist input (CMHT)

Answer 135

* Feelings of disbelief and difficulty comprehending the reality of the loss. * Bitterness/anger/guilt/blame. * Impaired functioning: within the family, socially, ability to work/go to school. * Intense yearning and sadness, and emotional and physical pain. There may be physical symptoms of anxiety. * Mental fogginess, difficulty concentrating, forgetfulness. * Loss of sense of self or sense of purpose in life. * Feeling disconnected from other people and ongoing life. * Difficulty engaging in activities or making plans for the future.

Answer 136

Differentiating grief from depression * Grief includes longing/yearning for the loved one * positive emotions can still be experienced * symptoms worst when thinking about the deceased person. * people often want to be with others, whereas people with depression tend to want to be alone.

Answer 137

Presence of distress and disability for more than 6 months after bereavement

Answer 138

Treatment options: Counselling eg Cruse Antidepressants for co-morbid depression Behavioural /cognitive/exposure therapies Refer if significant impairment in functioning

Answer 139

* Avoid stimulating activities before bed * Avoiding alcohol/caffeine/smoking before bed * Avoid heavy meals or strenuous exercise before bed * Regular day time exercise * Same bedtime each day * Ensure bedroom environment promotes sleep * Relaxation

Answer 140

CBT - 1 Medications not routinely advised Melatonin licensed if over 55 years for short term insomnia \<13 weeks use Hypnotics: Z drugs (zolipidem/zopiclone) / temazepam - only in severe disabling insomnia causing marked distress Addictive potential, may interfere with next day tasks, avoid driving / operating machinery 8 hrs after use Reduces time to fall asleep by 22 minutes

Answer 141

Anxiety / depression Physical health problems (pain, dyspnoea) Obstructive sleep apnoea (risk increased if BMI is 30 or over or neck circumference is 40 cm or greater) Excess alcohol or illicit drugs Parasomnias (restless legs, sleep walking/talking/sleep terrors/teeth grinding (bruxism etc) Circadian rhythm disorder (especially shift workers)

Answer 142

Antihistaminic (sedation and weight gain) Antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction) Anticholinergic (**dry mouth, dry eyes, constipation, memory deficits and potentially delirium**) Lethal in overdose Can cause QT lengthening Side effects of secondary TCAs are the same as tertiary TCAs but are generally less severe

Answer 143

Phenelezine

Answer 144

Anti-adrinergic and anti-muscarinic? Orthostatic hypotension Sexual dysfunction Sedation Dry mouth Sleep disturbance Hypertensive crisis can develop when MAOI’s are taken with tyramine rich foods or sympathomimetics (cheese reaction)

Answer 145

Serotonin syndrome can happen as a result of taking MAOIs as well as meds that increase the levels of serotonin as well as drugs with sympathomimetic actions.

Answer 146

Serotonin Sy: Abdominal pain Diarrhoea Sweats Tachycardia Myoclonus HTN Can lead to hyper-pyrexia, cardiovascular shock and death

Answer 147

TO AVOID SEROTONIN SYNDROME - wait two weeks before switching from an SSRI to an MAOI. Fluoxetine = 5 weeks because of the long half-life.

Answer 148

Paroxetine - short half-life, sedating - bad discontinuation syndrome - can be given during pregnancy? Sertaline - short half-life, less sedating, requires full stomach for max absorption Fluoxetine - long-half life (this means there is less incidence of discontinuation syndrome, good if issues with compliance). More likely to induce mania than some other SSRI’s. Citalopram - low inhibition of P450 enzymes so fewer drug-drug interactions. Increases QT interval. GI side effects.

Answer 149

GI upset Sexual dysfunction Anxiety Restlessness Nervousness Insomnia Fatigue Sedation Dizziness

Answer 150

agitation, nausea, disequilibrium and dysphoria

Answer 151

Mirtazapine is an antidepressant preferred in patients with anorexia nervosa as it also elevates the appetite and produces weight gain.

Answer 152

Venlaxafine Duloxetine

Answer 153

Inhibit both serotinin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects

Answer 154

Mirtazapine (5HT2 and 5HT3 receptor antagonist) Buproprion - this is contraindicated in bulimia

Answer 155

Bipolar diosrder Cyclothymia Schizoaffective disorder

Answer 156

GI - nausea, vomiting, diarrhoea Fine tremor Noprhotoxicity - polyuria secondary to nephrogenic diabetes insipidus Thyroid enlargement - may lead to hypothyroidism ECG - t wave flattening/inversion Weight gain IIH

Answer 157

Lithium toxicity: Mild = **vomiting**, **diarrhoea**, ataxia, dizziness, **slurred speech**, nystagmus Moderate = nausea, vomiting, blurred vision, **clonic limb** movements, **convulsions**, **delirium**, syncope Severe = generalised convulsions, **oliguria** and **renal failure**

Answer 158

Baseline U and E and TSH Check for pregnancy (avoiding ebsteins anomaly)

Answer 159

mild-moderate toxicity may respond to volume resuscitation with normal saline haemodialysis may be needed in severe toxicity sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

Answer 160

Thrombocytopenia and platelet dysfunction **Nausea, vomiting, weight gain, sedation** Increased risk of neural tube defects in general population secondary to reduction in folic acid

Answer 161

Carbamzepine

Answer 162

Rash is the most common SE seen Nausea, vomiting, sedation Aplastic anaemia and agranulocytosis Hyponatraemia - SiADH

Answer 163

TENS Stevens Johnson's syndrome Blood dyscrasias

Answer 164

Fluphenazine Haloperidol Pimozide

Answer 165

Extrapyramidal side effects: - Parkinsonism Acute dystonia (torticollois and oculogyric crisis) Antipsychotics = stroke and VTE risk Antimuscarinic (dry mouth, blurred vision, urinary retention, constipation) Sedation Weight gain Raised prolactin (reduced inhibition from dopamine) Neuroleptic malignant syndrome Reduced seizure threshold Prolonged QT (especially haloperidol)

Answer 166

olanzapine risperidone Quetiapine CLozapine

Answer 167

Agranulocytosis - requires weekly blood draws for 6 months, then every two weeks for 6 months Clozapine is used for treatment resistant schizophreia becuase of the side effect profile

Answer 168

Solomnence Cognitive deficits Amnesia Disinhibition Tolerance Dependance

Answer 169

Panic disorders GAD substance related disorders and their withdrawal Insomnias Parasomnias

Answer 170

Mental Health (and care) act 2003

Answer 171

Emergency detention certificate = 72 hours Short-term detention certificate = 28 days Compulsory treatment order = 6 months Nurses holding power = 3 hours

Answer 172

Emergency detention certifiicate = Before granting the certificate, the doctor must consult a mental health officer and get his/her agreement, unless it is not possible for this consultation to take place. Short term detention certificate = Before granting the certificate, the doctor must consult a mental health officer (MHO) and get his/her agreement. Before deciding whether to agree to the certificate, the MHO should see you and discuss matters with you, unless there is a good reason why they cannot do this. Compulsory treatment order = Mental health officer sends an application to mental health tribunal, also recquires reports from GP and approved medical practitioner or 2 approved medical practitioners

Answer 173

Must consider it likely that: - Patient has a mental disorder - Becasue of their mental disorder their decision making ability is impaired Must also be satisfied that: - Detaiment is needed in order to decide medical treatment - Risk to themselves or the others if not detained - Granting short-term detention certificate would involve undesirable delay

Answer 174

Must consider it likely that: - Patient has a mental disorder - Becasue of their mental disorder their decision making ability is impaired Must also be satisfied that: - Detaiment is needed in order to decide medical treatment (CTO - medical treatment is available and would likely prevent deterioration or allevaite symptoms) - Risk to themselves or the others if not detained - It is necessary

Answer 175

Powers (these are the people who make decisions for the person) Intervention order (one off power is required and there is an application to the court, so I think this means that thye court makes a decision for the patient) Guardianship order. Somone else is appointed to make decisions on behalf of the adult (financial or welfare or both)

Answer 176

Mentally disordered offenders provisions - Criminal procedures act 1995

Answer 177

Criminal Responsibility - part of criminal justice and licensing act Says a person can be acquitted from a criminal act if they were unable to appreciate the wrongful nature of an act as a resul tof a mental disorder. This does not include aggressive and irresponsible disorders of personality.

Answer 178

Criminal justice and licensing act (scotland 2010)

Answer 179

Diminished responsibility: A person with abnormality of the mind at the time of the offence can be charged of culpable homocide instead of murder. Abnormality of mind includes mental disorder. Being on drugs or alcohol doesn't constitute abnormality of mind.

Answer 180

Compulsion order Restriction order Assessment order Treeatment order

Psychiatry Flashcards

(207 cards)